Labs for Heme onc Flashcards
What is a left shift and when do you see it
Increase in number of immature WBC types (an example is in bandemia, which is an increase in band neutrophils)
Common in infection and inflammatory disorders
What is the normal vs clinically significant value for a left shift
Normal: <1%
Significant: >10%
What is bandemia
an excess or increased levels of band cells (immature white blood cells) released by the bone marrow into the blood.
Type of left shift
What are the 3 measures looked at to examine the class of RBCs as a whole most commonly
RBC count, hemoglobin, hematocrit
Which value do we use to assess anemia
Hemoglobin almost exclusively
What measures examine RBCs individually (morphology)
MCV (how big or small the RBC is)
MCHC (hemoglobin within each RBC concentration)
MCH (Hemoglobin per RBC)
RDW (RBC uniformity. If higher value, you have more variability between size and shape of RBCs)
If someone is microcytic, what measure of RBC morphology is being examined, and what does this indicate
They are looking at MCV ( average volume) and they have low size / volume
If someone is hypochromic, what is this measuring and what is wrong
Measures Average hemoglobin content in RBC
Hypochromic= low levels of Hgb
What is anisocytosis
elevated RDW (size dysregulation of RBCs)
If someone has normocytic, normochromic anemia, what do their labs look like and what causes this
Normal MCV and MCHC,
Acute blood loss, Aplastic anemia, leukemia, bone marrow problem.
If someone has microcytic, hypochromic anemia, what do their labs look like and what causes this
MCV decreased, MCHC decreased
Iron deficiency, thalassemia, lead poisioning, anemia
If someone has microcytic, normochromic anemia, what do their labs look like and what causes this
MCV decreased
MCHC normal
Examples: Iron deficiency, thalassemia
If someone has macrocytic, normochromic anemia, what do their labs look like and what causes this
MCV increased
MCHC normal
Folate deficiency, Vitamin B12 deficiency, pernicious anemia
Hgb and Hct vs RBC indices
Whole blood vs individual RBCs morphology
What does EPO do
stimulate bone marrow to make RBCs and Reticulocytes
People who have chronic anemia might have which factor deficiency
EPO deficiency
Poikilocytosis is what
a term that indicates the presence of abnormally shaped red cells like dacryocytes (teardrop shaped red cells), schistocytes (fragmented red cells) and elliptocytes
When do you see Dacryocytes
mylofibrosis
What is a Spherocyte characteristic of
Spherocytosis, immune hemoytic anemia
What is an Echinocyte characteristic of
Renal failure, malnutrition
What are acanthocytes characteristic of
Spur cell anemia, abetalipoprotenimia
Renal toxicity can lead to what type of RBCs
Echinocytes (renal failure is characteristic of these)
Target cells are assocaited with which disease
thalassemia and iron deficiency
What does alcoholism cause
Macrocytosis from B12 folate deficiency
Where is a bone marrow biopsy done most commonly in adults
PSIS
What does flow cytometry identify
cells via surface proteins
What does cytoenics identify
metaphase cells and chromosomal analysis(helps to identify protective factors of cancer vs leukemias or other cancers)
What does FISH identify
Chromosomal deletions, duplications, translocation
What does NGS identify
genome or gene panel
Sequence genetic profile of abnormal cells, look for genes associated with leukemias/lymphomas
Which iron test is the most sensitive to order
ferritin–> iron storage protein, levels indicative of body’s iron stores
Low vs high ferritin measures what
Low ferritin- very sesnitive for iron deficiency
high ferritin- iron overload, measures end organ damage (BUT, it is also an acute phase reactant, so can be elevated in patients who have liver disease).
If someone has a high Total iron binding capacity, what is occurring?
Still many binding sites available for iron on transferrin, which indicates an iron deficiency. Transferrin has a higher capacity for binding because they can still be filled by iron.
If someone is iron deficient, what do you expect their ferritin and TIBC to look like
Low Ferritin (low iron stores)
High TIBC (high affinity because many of the binding sites are empty since there is a lack of iron)
Which pathways is PT evaluating
Extrensic and common coagulation pathways
2, 7, 9, 10
What pathways is PTT evaluating
intrensic and common coagulation pathways
12, 11, 9, 8
What does the presence of D-dimers indicate
Fibrin degredation product
D-dimers indicate that a fibrin clot was formed, and then subsequently degraded
Elevated when the coagulation system has been activated, followed by fibrinolysis
If you suspect that a patient has auto antibodies to RBCs, which test do you order
Coombs/DAT
When do you order a Coombs/DAT test
When you want to detect if the patient has auto antibodies to RBCs
Which Ig’s activate B cells
IgM and IgD
Which antibodies cross the placenta into the fetus
IgG
Which antibodies are attached to the surface of a B cell or secreted in an early immune response
IgM
Which Ig blocks transport of microbes across mucosal surfaces
IgA
Which immunoglobulin makes up the majority of serum Ig’s
IgG
