Module 2 - Hematology Flashcards
Life span:
RBC
120 days
Life span:
Platelets
10 days
Life span:
Macrophages
months-years
Life span:
Granulocytes (neutrophils, eosinophils, basophils)
3-4 days
Life span:
Lymphocytes
100-300 days
Cells involved in innate immunity?
complement, NK cells, neutrophils and macrophages
Innate immunity has ___ response
fast
____ immunity contains and limits spread of infection (SWAT team)
Innate
Cells involved in acquired immunity?
lymphocytes (B and T cells)
Acquired immunity has ______ response
slower
______ immunity seeks out foreign invaders and destroys them (Spies)
Acquired
What causes inflammation?
neutrophils and macrophages eat or engulf foreign invaders and recruit more to injured site
What are interferons?
triggers production of virus-blocking enzymes
What are NK (natural killer) cells?
non-specifically destroy virus and cancer cells
What does the complement system do?
punches holes in the plasma membrane of non-self cells
What are the 2 branches of acquired immunity?
1) humoral
2) cell-mediated
B cells are part of ______ immunity
humoral
T cells are part of ________ immunity
cell-mediated
What is the RBC count?
the amount of red blood cells per litre of blood
Why do women have less RBC than men after puberty?
- menstrual blood loss
- lower androgen levels than men (androgens are erythropoietic)
- erythropoesis is the process of making red blood cells
Reasons for RBC being high?
- steroid use/blood doping
- high altitude
- renal carcinoma, renal transplant
- polycythemia vera, leukemias
Are reticulocytes part of a CBC?
NO WAY MAN
*must order separately
Reticulocytes also known as ______
retics
What are reticulocytes?
immature red blood cells
Describe reticulocytes
are larger than red blood cells; become mature in about 1 day after release into the blood
What are reticulocytes an indication of?
new RBC production
Reticulocytes are increased in?
- acute blood loss
- hemolysis
- treated anemias
Reticulocytes are decreased in?
-untreated iron, folate and vitamin B12 deficiency
What is hemoglobin?
The amount of metalloporphyrin-protein contained in one litre of blood
What does hemoglobin tell us about?
the oxygen-transport capacity of the blood
What could cause hemoglobin to be low?
- anemia
- blood loss
- drugs
- nutritional deficiency
- bone marrow disease
What could cause hemoglobin to be high?
- blood doping (erythropoietin use)
- high altitude
- dehydration
- polycythemia
- bone marrow disease
What is hematocrit?
-The percentage amount of blood that is composed of erythrocytes; also known as packed cell volume
Why might HCT (hematocrit) be altered?
if the size or shape of RBCs is not normal
What is the formula for Hct?
Hct = (length of packed RBCs)/(Length of whole blood)
What is the MCV (mean corpuscular volume)
The average volume of the RBCs
What is the MCV used to determine?
size of the RBCs
Normal Hct = ?
normocytic cells
Low Hct = ?
microcytic cells (small) - iron deficiency
High Hct = ?
microcytic cells (large) - folate/ vit B12 deficiency
What can falsely elevate MCV?
- reticulocytosis (larger than mature RBCs) can increase MCV
- hyperglycemia (diluent is hypotonic = cells swell) can increase MCV
What is MCH (mean corpuscular hemoglobin)?
the average weight of hemoglobin per RBC
What is the formula for MCH
MCH = Hgb/RBC
low MCH = ?
iron deficiency anemia
Why is MCH used alone not that clinically significant?
alone cannot distinguish between microcytosis and hypochromia
What can falsely elevate MCH?
hyperlipidemia
What is MCHC (mean corpuscular hemoglobin concentration) ??
The average hemoglobin concentration in the RBCs
What is MCHC used to determine?
color of RBCs
What does Low MCHC indicate?
hypo chromic (pale) cells AND iron deficiency anemia
Formula for MCHC?
MCHC = Hgb/Hct
What can falsely elevate MCHC?
hyperlipidemia (sample turbid which looks like higher hemoglobin)
Can MCHC distinguish between microcytosis (normal MCHC) and hypochromia (low MCHC) ?
yes
What does RDW (red cell distribution width) measure?
measures the variability in size of the RBCs
What is anisocytosis?
high RDW value = RBCs are of unequal size
What does anisocytosis with microcytosis (small) indicate?
- iron deficiency anemia
- sickle cell anemia
What does anisocytosis with macrocytosis (large) indicate?
- folate/B12 deficiency
- chronic liver disease
- hemolytic anemia
- chemotherapy
Thrombocytosis = ?
high platelet count
Thrombocytopenia = ?
low platelet count
What could cause thrombocytosis (high platelet count)?
- trauma/acute blood loss
- splenectomy
What could cause thrombocytopenia (low platelet count)?
Drugs such as:
- amphotericin B
- penicillins, cephalosporins
- heparin
- antineoplastics
What is the mean platelet volume?
- reflects the average size of platelets
- inverse relationship with platelet count
Low Mean Platelet Volume = ?
impaired platelet production
High Mean Platelet Volume = ?
increased destruction of platelets
When are WBC elevated?
during an infection or inflammatory process
See the assessing anemia chart
otay
Not enough iron causes _______ anemia
microcytic (small cells)
Who is at risk of iron deficiency anemia?
- blood loss
- heavy menstruation
- altered absorption
- pregnancy/lactation
- vegetarians or vegans
- more on slide 25
What does serum iron measure?
the amount of iron bound to transferrin
Serum iron will be ____ in iron deficiency anemia
LOW
Why is serum iron not very useful on its own?
because it can fluctuate during the day
What is TIBC (total iron binding concentration)
TIBC measures the iron binding capacity of transferrin protein (how much total iron can bind?)
In iron deficiency anemia, TIBC is _______
increased
- synthesis of transferrin goes up
- low iron = more binding capacity
What does ferritin reflect?
-reflects total body iron stores (storage iron)
What is ferritin?
an iron-protein complex (ionized iron can cause oxidative damage)
About _________ mg or iron is stored as ferritin
500-1500mg
What is low ferritin an indicator of?
iron deficiency anemia
Ferrous gluconate 300mg tab has ____ elemental iron
35mg (11.6%)
Ferrous sulfate 300mg tab has ____ elemental iron
60mg (20%)
Ferrous fumarate 300mg tab has ____ elemental iron
99mg (33%)
What is the dose of iron for iron deficiency anemia treatment?
2-3mg/kg/day elemental iron
________ will increase by day 3-4, peak at day 7-10 then normalize by 2 weeks of iron therapy
Reticulocytes
Monitor ____ in 2-3 weeks, increase by 10g/L
hemoglobin
Monitor ______ in 2-3 weeks, increase by 6%
hematocrit
Monitor ______ in 1-2 months
ferritin
All labs related to anemia should normalize by ______ months of therapy
1-2
Patients should be treated for ___ months to build up iron stores
3-6
List a few drugs that can cause macrocytic anemia
- H2 blockers
- Proton Pump Inhibitors
- ASA
- oral contraceptives
- metformin
- slide 33
What is vitamin B12 important for?
proper formation of red blood cells and the maintenance of the central nervous system (myelination)
Symptoms of vitamin B12 deficiency anemia
parenthesis, poor concentration, irritability, painful tongue, loss of appetite, diarrrhea/constipation, microcytic anemia
Who is at risk of vit B12 deficiency anemia?
- elderly
- vegans
- patients with defective intrinsic factor
What labs need to be monitored for vitamin B12 deficiency anemia?
- Vit B12 levels
- RBC folate ?
- CBC
- K+ (rapid production of reticulocytes use up potassium)
Decreased white blood cell count is called ________
leukopenia
Increased white blood cell count is called ________
leukocytosis
What can cause leukopenia (decreased WBC)?
- severe infection (sepsis)
- chemotherapy or other drug causes
What can cause leukocytosis (increased WBC)?
- acute infection
- inflammatory processes
- leukemia
Neutrophils are also called ???
“polys”
“segs”
“PMNs”
What do neutrophils do?
most abundant, act as phagocytes to digest foreign bacteria and fungi
________ = increased neutrophils
demargination
Low neutrophil count = ________
neutropenia
High neutrophil count = ___________
neutrophilia
What can cause a high neutrophil count (neutrophilia)?
- bacterial infection
- chronic inflammation
What kind of drugs can cause a low neutrophil count (neutropenia)?
- clozapine
- cancer chemotherapy - direct toxic effects on bone marrow
Clozapine requires regular blood work to monitor for ________
agranulocytosis
What else requires close monitoring of white blood cells?
cancer chemotherapies
What is the formula for ANC?
ANC = [(WBC x 1000) x (%PMN + % bands)] / 100
What does a left band shift indicate?
an infection is occurring
Where are eosinophils found?
In large numbers in the intestinal mucosa and lungs
What can eosinophils do?
phagocytize, kill and digest bacteria and yeast
What can elevate eosinophils?
- allergic reactions (IgG, IgE surface receptors)
- asthma/eczema
- parasitic infections
- malignancies
Describe basophils
similar to mast cells and can release heparin, histamine, prostaglandins and leukotrienes
What can elevate basophils?
1) Allergies
- Anaphylactic reactions (immediate hypersensitivity)
- Delayed hypersensitivity reactions
2) Leukemia
Monocytes/Macrophages leave the circulation in _____ hours then mature into macrophages in the tissues
16-36
Monocytes/Macrophages are known as ??
garbage collectors - they destroy old RBCs, denatured proteins, and plasma lipids
What are a few reasons for elevated monocytes (monocytosis)
- recovery from bacterial infection
- endocarditis
- tuberculosis
- rickettsial or protozoa infection
- leukemia
_________ = T-cells, B-cells, and NK cells
Lymphocytes
Lymphocytes are important for proper functioning of the _________ immune response
adaptive
What do lymphocytes attack?
Mostly intracellular invaders:
- Viruses (including mononucleosis)
- Bacteria (tuberculosis, syphilis, pertussis (toxin)
What will cause increased lymphocytes (lymphocytosis) ?
- viral infection
- some bacterial infections
- lymphoma
What will cause decreased lymphocytes (lymphophenia)?
- HIV type 1
- radiation
- glucocorticoids
- lymphoma
When should a WBC start to decline after initiating antibiotic therapy?
should start to decline in 24-48 hours
What is aPTT test?
Activated Partial Thromboplastin Time:
-used to screen for deficiencies and inhibitors of factors within the intrinsic pathway (8, 9, 11, 12) and for the final common pathway (2, 5, 10)
What is added to the patient’s blood to do a aPTT test?
A reagent and calcium are added to the patient’s blood to see how fast it clots
What does a lower aPTT indicate?
risk of clotting
What does a higher aPTT indicate?
risk of bleeding
What is PT and INR?
PT = prothrombin time INR = International Normalized Ratio
What is PT and INR used to screen?
used to screen for deficiencies in the extrinsic and common pathways (factors 2, 5, 7, and 10)
What is the difference between PT and INR?
PT is in seconds
INR is unit-less
Higher INR = ?
greater risk of BLEEDING
Lower INR = ?
greater risk of CLOTTING
What is the formula for INR?
INR = patient PT/mean normal PT
What does heparin do?
Potentiates the action of Antithrombin 3 (inactivates thrombin), prevents the conversion of fibrinogen to fibrin and deactivates Factors 9, 10, 11, and 12
What do LMWH inhibit?
Factors Xa and IIa
What does warfarin inhibit?
inhibits the synthesis of Factors 2, 7, 9 and 10
Which factor (2, 7, 9, or 10) has the shortest half life? **need to know this for Clinical as well
factor 7
When starting warfarin therapy, wait at least _____ before measuring INR
3 days
What is the antidote for warfarin?
vitamin K
What is the target INR for most patients on warfarin?
2.0 - 3.0
