Quiz 2 Flashcards
1
Q
iron-deficiency anemia
A
can be caused by blood loss, pregnancy, poor diet, gastric bypass
2
Q
vitamin-deficiency anemia
A
low B12 or folate from poor diet
3
Q
aplastic anemia
A
results when body stops erythropoiesis; from chemicals, drugs, autoimmune causes
4
Q
hemolytic anemia
A
destruction of RBCs; multiple causes, inherited, infection
5
Q
anemia of chronic disease
A
results from decreased RBC production by bone marrow, chronic inflammatory and neoplastic states that impair RBC production
6
Q
sideroblastic anemia
A
multiple causes, bone marrow produces abnormal RBCs which prevent iron from being incorporating in hemoglobin
7
Q
anemia r/t thalassemia
A
body produces abnormal alpha or beta chain of hemoglobin; genetic
8
Q
types of WBCs
A
monocyte, eosinophil, basophil, lymphocyte, neutrophil
9
Q
granulocytes
A
neutrophils, basophils, and eosinophils
10
Q
fluctuations in WBC count can be due to:
A
time of day, exercise, pain, pregnancy, strong emotional reactions
11
Q
leukocytosis
A
infections (MOSTLY BACTERIAL), certain medications (corticosteroids), inflammatory processes, bone marrow disorder or malignancy, physical exertion, stress, anesthesia, smoking, increased in newborns
12
Q
leukopenia
A
infections (VIRAL, parasitic, some bacterial), decreased production (bone marrow malignancy or defect, chemo, nutritional deficiency (B12, folate)), radiation tx for CA, benign ethnic leukopenia, alcohol abuse, poor nutrition, gastric bypass (leading to impaired folic acid absorption leading to decreased WBC production)
13
Q
neutrophils come in 2 forms:
A
bands (“stabs” or “sticks”) (less mature nucleus) and segmented (segs, polys, PMNs) neutrophils (mature nucleus)
14
Q
left shift
A
higher predominance of immature neutrophils present; generally occurs in infection or inflammatory response
15
Q
3 types of lymphocytes
A
T cells, B cells, natural killer cells
16
Q
lymphocytosis
A
infection (predominately VIRAL: mononucleosis, cytomegalovirus (CMV), primary HIV infection, viral PNA, MMR, varicella, influenza, hepatitis, pertussis, bartonella); higher in infants/young children; drug reactions (esp. anticonvulsants), emergencies/stress/trauma, sz, splenectomy, acute or chronic lymphocytic leukemia, smoking, alcohol use/abuse
17
Q
lymphocytopenia
A
bacterial or fungal sepsis, post-op state, chemo/radiation, malignancy, glucocorticosteroids, immunosuppressants
18
Q
causes of increased monocytes
A
infection (bacterial, viral, or parasitic), hematologic or myeloproliferate disorder, hemolytic anemia, autoimmune disorders
19
Q
eosinophilia
A
PARASITES, ALLERGIC DISORDERS, some drug reactions, occasionally autoimmune disorders
20
Q
eosinopenia
A
most acute or bacterial infections
21
Q
basophilia
A
parasitic infections, allergy related illnesses
22
Q
reactive thrombocytosis (cytokine-driven)
A
infection, post-op, malignancy, post-splenectomy, acute blood loss or iron deficiency
23
Q
autonomous thrombocytosis (overproduction)
A
malignancy
24
Q
thrombocytopenia
A
lab error (platelet clumping by EDTA or error in automated cell counter), drug induced, infection (HIV, hep C, epstein-barr virus, sepsis, parasites), alcohol, pregnancy, nutritional deficiencies, malignancies
25
anemia results from:
blood loss, drop in production of RBCs, increase in destruction of RBCs, or lack of iron, B12, or folic acid (co-factors in RBC production)
26
increased RBC count
cigarette smoking (d/t increased presence of carboxyhemoglobin), dehydration, increase in production of erythropoietin (EPO), bone marrow malignancy or disease (myeloproliferative disease), polycythemia (abnormally high RBC count and corresponding high Hgb count)
27
decreased RBC count
anemia, bleeding (GI/GYN primarily), drug-induced (Abx, NSAIDs), hematopoetic failure *(radiation, toxins, or tumors), poor nutrition (B6, B12, folate, iron), pregnancy, overhydration
28
increased Hgb
tobacco use, advanced COPD, alcohol abuse, living at high altitude, dehydration (false elevation), EPO abuse, myeloproliferative disease, polycythemia
29
decreased Hgb
acute blood loss anemia, malnutrition (B12, iron, folate), myeloproliferative disorders or CA, chemo, renal failure (EPO produced in kidneys), disorders of Hgb structure (thalassemia, sickle cell)
30
hematocrit
percentage of whole blood that is made up of RBCs; AKA packed cell volume (PCV)
31
RDW
RBC distribution width; refers to variation of RBC volume (as a percentage); higher = larger variation in RBC volume
32
calculate RDW
(Standard deviation of MCV ÷ mean MCV) × 100
33
RDW significance
earliest manifestation of iron deficiency anemia; frequently increased in nutritional-linked anemias
34
anisocytosis
cells of varying size
35
MCV
mean corpuscular volume; measures the average volume of the RBC by dividing the Hct/Hgb; categorizes the size of RBCs and divides them into 3 categories
36
microcytic
decreased MCV
37
normocytic
normal MCV
38
macrocytic
increased MCV
39
MCH
mean corpuscular hemoglobin; measures the avg WEIGHT of Hgb within the RBC by dividing Hgb/RBC; rises or falls w/ rise and fall of MCV
40
MCHC
mean corpuscular hemoglobin concentration; measures the proportion of each RBC that is taken up by hemoglobin (increased Hgb = increased iron = increased red color of RBC)
41
hypochomic RBCs
decreased concentration of Hgb (decreased MCH or MCHC)
42
normochromic RBCs
normal concentration of Hgb (normal MCH/MCHC)
43
hyperchromic RBCs
increased concentration of Hgb (increased MCH or MCHC)
44
most frequently encountered anemias
normocytic anemias; decreased RBC production or increased RBC destruction (Hgb/Hct decreased but MCV nl)
45
causes of normocytic anemias
acute blood loss, hypersplenism (increased sequestering and RBC destruction), anemia of chronic disease, hemolytic anemia
46
causes of microcytic anemias
iron deficiency anemia (most common), alpha-thalassemia, beta-thalassemia, anemia of chronic disease (25% is microcytic), lead poisoning
47
causes of macrocytic anemia
alcoholism, B12/folate deficiency, hypothyroidism, multiple myeloma, acute leukemia, aplastic anemia, liver disease, myeloproliferative disease, drugs
48
reticulocytes
immature red blood cells that are visible d/t presence of ribosomal RNA that turns blue when stained; used to investigate bone marrow disorders
49
increased reticulocyte count
hemolysis or hemolytic anemia, acute blood loss, infiltrative marrow disorders
50
decreased reticulocyte count
represents decrease in RBC production; vitamin deficiency anemia, iron deficiency anemia, bone marrow failure, decreased EPO production (renal disease/failure)
51
Hgb A
2 alpha and 2 beta chains
52
Hgb A2
2 alpha and 2 delta chains
53
Hgb F (fetal)
2 alpha and 2 gamma chains (higher O2 affinity in utero)
54
alpha thalassemia
impaired production of alpha chains
55
beta thalassemia
impaired or very reduced beta Hgb chains, common in Mediterranean, Asian, African descent
56
Hgb S
sickle cell trait or disease
57
Hgb C
mild anemia
58
Hgb E
mild anemia, common in Asian descent
59
medications that can alter iron level
antibiotics, birth control pills, estrogen, hypertension medication, cholesterol medications, Deferoxamine (removes excess iron from the body), gout medication, testosterone
60
causes of increased iron level
beta-thalassemia, alcoholic cirrhosis, high iron intake, hereditary hemochromatosis
61
causes of decreased iron level
iron deficiency anemia, anemia of chronic disease, chronic renal failure, inadequate absorption (antacid use, competition w/ other metals such as copper or lead, bowel resection, celiac disease, inflammatory bowel disease), increased loss (from GI tract, epistaxis, menstruation, CA, trauma, phlebotomy), increased demand (pregnancy)
62
function of ferritin in the body
storage unit for iron (15-20% of the body's iron), releases iron when needed by body; is an acute phase reactant
63
"gold standard" in diagnosis of iron deficient anemia
serum ferritin
64
serum ferritin value in anemia of chronic disease
ferritin >10 ng/mL
65
acute phase reactant
concentration increases in response to inflammation
66
causes of increased ferritin
hereditary hemochromatosis, excess iron intake/poisoning, chronic hepatitis, other chronic disease states (CA, alcoholism)
67
causes of decreased ferritin
iron deficiency anemia
68
transferrins
glycoproteins that are responsible for the transport of iron to almost all tissues of the body; can bind 2 iron molecules
69
total iron binding capacity
maximum amount of iron that serum proteins (mainly transferrin) can bind to; reflects the potential for iron binding if ALL of the binding sites on transferrin were filled
70
TIBC in iron deficient states
increased. less iron in body = more sites available for iron to bind to
71
TIBC in iron overload states
decreased. too much iron in body = fewer sites for iron to bind to
72
increased TIBC
iron deficiency anemia, pregnancy, oral contraceptives, viral hepatitis
73
decreased TIBC
anemia of chronic disease, hemochromatosis, sideroblastic anemia
74
transferrin saturation
measurement of percentage of transferrin binding sites that are actually bound by iron; increase represents increase in iron absorption (serum iron/TIBC)
75
increased transferrin saturation
megaloblastic anemia, sideroblastic anemia, iron overload states, hemochromatosis
76
decreased transferrin saturation
iron deficiency anemia, chronic infection, malignancy, pregnancy, anemia of chronic disease
77
plasma components
55% of blood. contains: blood proteins (7%), nutrients (2%), hormones, electrolytes (1%); water (91%)
78
major plasma proteins
albumin (50-60%), fibrinogen (?%), globulins (36%)
79
albumin
most abundant blood plasma protein. synthesized in liver. involved in maintenance of oncotic pressure, transportation of fatty acids, hormones, drugs, and other substances
80
increase in serum albumin
dehydration (false)
81
decrease in serum albumin
liver disease, malabsorption/malnutrition, abnormal loss (renal disease, GI loss, skin loss, severe burns), dilution by IVF, genetic variants
82
prealbumin
synthesized mainly in liver, functions as a transport protein for thyroxine and vitamin A
83
prealbumin test
much better assessment of pt's nutritional status than albumin b/c has a shorter half-life and is more sensitive to rapid changes in nutrition (may not be accurate in pts with inflammation, infection, or trauma)
84
increased prealbumin
pregnancy, hodgkin's lymphoma
85
decreased prealbumin
renal/liver disease, malabsorption/malnutrition, Crohn's disease, low protein diet, severe illness/inflammation/infection
86
alpha-1-antitrypsin
an alpha-1 globulin; inhibits the action of many key enzymes that are released during inflammatory rxns in the lungs; deficiency can lead to early-onset COPD. abscence causes damage to lung parenchyma. can also caused liver disease
87
decreased/deficient alpha-1-antitrypsin manifestations
early-onset COPD, prolonged jaundice or hepatitis in infants, liver dysfxn in children, portal HTN, chronic hepatitis, cirrhosis, hepatocellular carcinoma
88
ceruloplasmin
alpha-2 globulin that is made in liver; transports 6-7 copper atoms; is an acute phase reactant
89
Wilson's disease results from:
low ceruloplasmin; impaired transport of copper can lead to liver disease (excess copper in the liver)
90
increased ceruloplasmin
oral contraceptives, 1st trimester pregnancy, infections
91
decreased ceruloplasmin
wilson's disease, hereditary low ceruloplasmin, liver failure or hepatitis
92
haptoglobin
plasma protein; produced in liver, function is to bind to free Hgb when RBCs are destroyed, then trasport Hgb to liver where heme is converted to bilirubin. acute phase reactant. useful when looking for signs of hemolytic anemia
93
increased haptoglobin
infection, inflammation, neoplastic disease, pregnancy, trauma, acute MI
94
decreased haptoglobin
hemolytic anemia, transfusion rxn, artificial heart valves
95
complement proteins
supplement the action of antibodies to destroy and eliminate pathogens from the body via opsonization; 9 different proteins (C1-C9) in plasma. typically synthesized in liver. C3 and C4 are acute phase reactants.
96
complement pathway
C1 recognizes antibody-antigen complex or bacteria/virus. C3 is cleaved causing inflammation and opsonization. pathway goal is to produce membrane attack complex (MAC) and insert into membrane of pathogen causing lysis
97
CH50 total complement activity
test used to measure immune processes or detect complement deficiency. measures ability of human serum to lyse RBCs that have been coated w/ antibody (measures amount of hemolysis); all 9 C proteins must be present
98
decreased CH50
decreased complement activity
99
CH50 = 0
one of the complement pathyway components is absent
100
C3 and C4 test
often used to investigate the undetectable CH50 level or monitor some diseases (ex. lupus)
101
decreased C3, C4
systemic lupus erythematosus, bacterial infections, cirrhosis, hepatitis, malnutrition
102
increased C3, C4
cancer, ulcerative colitis
103
immunoglobulins
AKA antibodies. developed to target specific foreign invaders (bacteria, viruses, toxins); produced by B lymphocytes and develop to become very specific
104
IgA
usually found in and defends secretions and along mucosal epithelium; allows for clearance of pathogens by cilia or of toxins in GI tract; present in saliva, tears, colostrum, and mucus (think: SECRETIONS)
105
IgA deficiency
can by asymptomatic, or can cause frequent resp infections, inflammation of GI tract, unexplained asthma sx
106
IgD
fxn/clinical significance unknown. only 0.25% of immunoglobulins. ound to activate basophils and mast cells. increases w/ chronic infections; highest in leprosy, TB, malaria, AIDS, hepatitis, staph infections
107
IgE
involved in allergic rxns and parasitic infections; binds to mast cells to initiate a chain of immune responses; increase most likely r/t allergies
108
IgG
major antibody when antigen is encountered. most prevalent and longest half life. responsible for immunity to bacteria and other microorganisms. crosses the placenta so that the fetus can be protected
109
IgM
INITIAL antibody secreted. usually indicate recent infection. deficiency is rare
110
IgG and IgM testing
useful when trying to determine if someone has an active infection currently or has already had the infection in the past. commonly used in: epstein-barr virus, cytomegalovirus, herpes I/II, varicella, MMR
111
protein electrophoresis indications
detecting some forms of CA or pre-CA, immune abnormalities, kidney or liver dysfxn, multiple myeloma
112
multiple myeloma
incurable. neoplastic disorder when causes proliferation of a monoclonal immunoglobulin (usually IgG and IgA); clones of a single structurally-identical antibody multiplies rapidly and becomes "M protein" (monoclonal protein)
113
protein electrophoresis in multiple myeloma
spike in gamma portion (M protein); can also occur in alpha-2 or beta range. M protein a/w plasma cell disorder. poss. signifies neoplastic process
114
conditions a/w M protein on protein electrophoresis
multiple myeloma, smouldering muyeloma, monoglonal gammopathy of undetermined significance, solitary plasmacytoma, AL amyloidosis, heavy chain deposition disease, light chain deposition disease, chronic lymphocytic leukemia, any B- or T-cell lymphomsa, breast CA, colon CA, cirrhosis, sarcoidosis, autoimmune disorders
115
polyclonal gammopathy
infectious, inflammatory and reactive processes may be a/w a broader based peak in the gamma region. ex. liver disease (cirrhosis, hepatitis), autoimmune disease (SLE/lupus, RA), infection (HIV, hepatitis, osteomyelitis, endocarditis), hematologic disorders/malignancies (non-hodgkins, sickle cell, thalassemia), non-hematologic malignancies
116
complete metabolic panel
proteins, electrolytes, renal and liver function, monitoring DM and HTN
117
monitoring electrolyte fxn and abnormalities on CMP
Na, K, Cl, CO2, anion gap, Ca
118
monitoring renal fxn on CMP
BUN/Cr
119
monitoring liver fxn on CMP
bilirubin, alk phos, AST, ALT
120
monitoring proteins on CMP
albumin, total protein
121
monitoring diabetes on CMP
glucose
122
sodium
predominant cation in the extracellular space; major determinant of ECF osmolality (tonicity)
123
sodium regulation via:
hormones such as aldosterone, naturietic hormone, primarily antidiuretic hormone (ADH) AKA vasopressin; functions to increase renal free water reabsorption
124
hypernatremia
typically occurs in unreplaced water loss; elderly pts who have impaired mental faculties w/ diminished thirst stimulation, or pts w/o free access to water (hypertonic saline solutions)
125
hyponatremia
dietary/nutritional intake, thiazide diuretics, renal insuffiency
126
potassium
major intracellular cation; affects potential across cell membrane (involved in muscle/nerve excitability). secreted via kidneys. changes can affect muscle contractility (esp. cardiac muscle)
127
causes of hyperkalemia
increased dietary or IV intake, crush injuries or infection (cellular injury releases K), acidotic states
128
causes of hypokalemia
deficient dietary or IV intake, fluid and electrolyte loss, alkalotic states, DIURETICS
129
glucose
levels are controlled by glucagon and insulin. increases after eating, insulin is then released to decrease levels. can be affected by several hormones.
130
hyperglycemia
diabetes, acute stress response, pancreatitis, certain diuretics, corticosteroid therapy
131
hypoglycemia
insulinoma (insulin secreting tumor), insulin OD, starvation, hypothyroidism
132
glomerulus
main filtering structure of the kidney
133
glomerular filtration rate (GFR)
of mL of body fluid cleared by the kidneys per unit of time (mL/min)
134
blood urea nitrogen (BUN)
urea formation in liver as a result of carabolism of protein into amino acids; free amonia is formed in the process. ammonia molecules combine to form urea; BUN reflects the metabolic functioning of the liver and excretory fxn of kidneys
135
increased BUN
high protein diets, GI bleed (via deceased kidney perfusion), dehydration, certain meds, sepsis
136
decreased BUN
primary liver disease/failure, low protein diets, overhydration
137
creatinine
byproduct of catabolism of creatinine phosphate; filtered by glomerulus of kidney; secreted by kidneys at a constant rate; marker for renal fxn, NOT AFFECTED BY LIVER FXN; production dependent on muscle mass
138
increased creatinine
disorders of renal fxn, urinary tract obstruction, diabetic neuropathy, rhabdomyolysis, gigantism/acromegaly
139
decreased creatinine
debilitation, decreased muscle mass
140
calcium
more abundant in ECF than ICF; involved in muscle contraction, cardiac fxn, neural transmission, clotting cascade
141
calcium exists in the body in 3 forms:
protein-bound (mostly albumin, but also alpha, beta 1 & 2, gamma globin); complexed (w/ phosphate, citrate, bicarb, sulfate); ionized ("free" calcium in its active form)
142
calcium is regulated by
parathyroid hormone (PTH); as Ca decreases, PTH is released and Ca is reabsorbed by kidneys, released from bone and absorption from GI tract is increased
143
calcitonin function
released by thyroid gland in response to rising Ca levels in blood; leads to increased excretion of calcium by kidneys and calcium deposition in bone.
144
parathyroid hormone (PTH) function in calcium
released by parathyroid glands in response to decreased calcium levels in blood. leads to increased reabsorption of calcium by kidneys, calcium release from bone, increased calcitriol production (causing Ca2+ absorption from digestive system)
145
hypercalcemia
hyperparathyroidism, vit. D intoxication, MALIGNANCY, acromegaly
146
hypocalcemia
hypoparathyroidism, vit. D deficiency, hypoalbuminemia, malabsorption
147
bilirubin
formed from breakdown of RBCs; is a component of bile
148
unconjugated (indirect) bilirubin
RBC is broken down to form heme + globin molecules. heme is catabolized and formed biliverdin which then becomes unconjugated bilirubin
149
conjugated (direct) bilirubin
unconjugated bilirubin becomes conjugated with glycuronide when in the liver
150
total bilirubin =
direct + indirect
151
causes of indirect hyperbilirubinemia
hepatocellular disfunction (hepatitis, cirrhosis, neonatal hyperbilirubinemia), any disease process that increases RBC destruction (transfusion rxn, sickle cell anemia, hemolytic anemia), many medications
152
causes of direct hyperbilirubinemia
OBSTRUCTION of extrahepatic ducts! via gallstones, tumor
153
serum protein
reflects synthesis and maintenance of total amount of protein in circulation
154
low serum protein
can be d/t renal disease; glomerulus becomes less able to filter proteins --> less reabsorbed, so excreted in urine
155
hyperproteinemia
dehydration (less water leads to increased concentration of proteins), malignancy (overproduction of immunoglobulins), infection (overproduction of immunoglobulins)
156
hypoproteinemia
hepatic failure/disease, malnutrition, malabsorption, renal failure/disease
157
hyperalbuminemia
dehydration d/t concentration of albumin
158
hypoalbuminemia
malnutrition, pregnancy, hepatic disease or failure, protein-losing nephropathies
159
liver enzyme tests/LFTs
alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT)
160
alk phos
functions in growth and development of bones, teeth, and other tissues (essential for bone mineralization)
161
increased alk phos
cirrhosis of liver, obstruction of biliary tract, liver tumors, drugs that are toxic to liver; cancers that metastasize to bone, primary CA of bone, post-fx, hyperparathyroidism, growing children
162
decreased alk phos
malnutrition
163
aspartate aminotransferase (AST)
found in highly metabolic tissue w/in the body (heart, liver, skeletal muscle); damage to tissue or cell inflammation/injury/death releases AST in circulation
164
elevated AST
liver disease, liver tumors, infectious mononucleosis, skeletal muscle disease or trauma (burns, myositis, muscular dystrophy)
165
alanine aminotransferase (ALT)
found primarily in liver!!!! but can be found in smaller amount in other tissue. released when liver damage occurs. in jaundiced pt, elevated ALT = liver as source (not RBC hemolysis). elevated ALT = liver abnormality!
166
increased ALT
hepatitis, cirrhosis, hepatotoxic drugs, MI, myositis
167
AST:ALT ratio >1
alcoholic cirrhosis (frequently >2!!!!!!!); metastatic tumor of liver
168
AST:ALT ratio less than 1
acute/viral hepatitis, mononucleosis
169
azotemia
refers to increase in nitrogen containing compounds in the blood
170
pre-renal azotemia
results from abnormalities in systemic circulation that decrease blood flow to kidney
171
intra-renal azotemia
results from abnormalities w/in the kidneys themselves
172
post-renal azotemia
results from obstruction of collecting system of kidneys
173
BUN/Cr ratio >/= 20:1 pre-perfusion
volume depletion, sepsis, hypotension, CHF
174
BUN/Cr ratio less than/= 10:1 intra-renal
nephrosclerosis, glomerulonephritis
175
early: BUN/Cr ratio >/= 20:1 or late: BUN/Cr ratio less than/= 10:1 post-renal
urinary tract obstruction, nephrolithiasis, prostatic hyperplasia, metastatic disease
176
normal BUN/Cr ratio
10:1 to 20:1
177
serum ferritin in iron deficient anemia
less than 10 ng/mL
