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Heme/Onc Exam 2 > RBC Disorders - Diagnostic studies > Flashcards

RBC Disorders - Diagnostic studies Flashcards

1
Q

Contains EDTA as anticoagulant

A

“Purple top” or “Lavender top”
vacutainer tubes are used for CBC

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2
Q

A CBC with diff includes
_____, in addition to normal CBC
information:

A

WBC differentiation

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3
Q

When is CBC with diff indicated?

A

Generally costs a little more and is really only indicated when infectious processes are in question or in the case of leukemia/lymphoma

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4
Q

On a CBC, “Hgb” gives us the ____

A

total hemoglobin concentration

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5
Q

Hemoglobin & hematocrit are increased in

A

hemoconcentration (vomiting,
dehydration, burns), polycythemia, etc.

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6
Q

Hemoglobin & hematocrit are decreased in

A

hemodilution and macrocytic,
normocytic, and microcytic anemias

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7
Q

Critical low for hemoglobin

A

Critical low: Less than 7 g/dL

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8
Q

How is HgB measured?

A

It is measured by spectrophotometry on automated instruments after lysis of RBCs as part of the process

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9
Q

Hct

A

The percentage of whole blood
volume composed of erythrocytes.

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10
Q

How is Hct measured?

A

Nowadays, measured by automated
instruments with calculation of RBC
count X the MCV.
○ Normal for males: About 39-49%
○ Normal for females: About 35-45%

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11
Q

Anemia diagnosis with CBC

A

“Anemia” can be diagnosed based on
the H & H, but then further evaluation of the CBC (and possibly other tests) is needed to determine the type and cause of the anemia

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12
Q

Red Blood Cell Count

A

The actual number of red blood cells in a microliter of blood

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13
Q

RBC’s counting process and range

A

RBCs are counted by automated instruments using electrical impedance or light scattering.
○ Normal for males: About 4.3-6.0 x 10 6 /mcL
○ Normal for females: About 3.5-5.5 x 10 6 /mcL

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14
Q

RBCs increased in

A

Polycythemia vera, secondary
polycythemia, hemoconcentration (such as dehydration), etc.

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15
Q

RBCs are decreased in

A

most macrocytic, normocytic,
and microcytic anemias.

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16
Q

White Blood Cell Count measurement

A

Typically measured by an automated lab hematology analyzer in today’s day in age. Manual differentiation can be done.
○ Normal: About 4.5-11.0 x 10 3 /mcL. Critical: Less than 1.5

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17
Q

WBC count is increased in

A

acute infections, inflammatory disorders, leukemias, myeloproliferative
disorders, steroid use, allergies,
hypersensitivity reactions, stress, etc

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18
Q

WBC count is decreased in

A

infections, myeloid hypoplasia,
myelosuppression, hypersplenism, alcoholism, etc

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19
Q

Absolute counts of WBCs can be calculated from a combination of the
_____

A

WBC count and the percentage of each WBC type

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20
Q

Platelet count measurement

A

It is typically obtained by an automated CBC analyzer.
○ Normal: About 150-450,000 per mcL
○ Many labs are now reporting 100-500,000 as normal

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21
Q

Critical low platelets

A

Less than 25,000 per mcL

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22
Q

Critical low WBCs

A

Less than 1.5

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23
Q

WBC normal ranges

A

○ Neutrophils: 50-70%
○ Lymphocytes: 20-40%
○ Monocytes: 2-6%
○ Eosinophils: 1-4%
○ Basophils: 0-1%

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24
Q

Platelets can be increased in

A

some myeloproliferative conditions, some myelodysplastic disorders, acute blood loss, postsplenectomy,
reactive thrombocytosis, infection, some malignancies, etc

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25
Q

Platelets can be decreased in

A

bone marrow suppression, chemotherapy, HIV, hypersplenism, disseminated intravascular coagulopathy, TTP, ITP, some drugs, etc

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26
Q

RBC Indices

A

Red Blood Cell indices are a group of blood tests
included in the CBC that provide information about the
hemoglobin content and size of red blood cells

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27
Q

What is included in the RBC indices

A

○ Mean Corpuscular Volume (MCV)
○ Mean Corpuscular Hemoglobin (MCH)
○ Mean Corpuscular Hemoglobin Concentration (MCHC)
○ Red Cell Distribution Width (RDW)

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28
Q

Abnormal values in RBC indices areas can indicate the presence of
_____

A

certain types of anemia

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29
Q

The _____ is the average volume of the
red blood cells.

A

Mean Corpuscular Volume

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30
Q

Helps us determine if an anemia is categorized as a
macrocytic, normocytic, or microcytic anemia

A

MCV

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31
Q

Normal MCV

A

80-100 fl

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32
Q

Common microcytic anemias based on MCV

A

● Iron Deficiency
○ Chronic blood loss
○ Dietary
● Thalassemias
● Anemia of Chronic Disease (some)
● Lead toxicity

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33
Q

Common normocytic anemias based on MCV

A

● Anemia of Chronic Renal Disease
● Anemia of Chronic Disease (some)
● Aplastic Anemia
● Acute Blood Loss
● Hemolytic Anemia

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34
Q

Common macrocytic anemias based on MCV

A

● Vitamin B12 Deficiency
● Folate Deficiency
● Myelodysplasia
● Alcoholism related
● Aplastic Anemia (sometimes)

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35
Q

The Mean Corpuscular Hemoglobin indicates the amount of
hemoglobin per RBC in absolute units

A

Mean corpuscular hemoglobin

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36
Q

MCH increased in

A

macrocytosis and hemochromatosis

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37
Q

Normal MCH =

A

26-34 pg

38
Q

MCH decreased in

A

iron deficiency, thalassemia, lead poisoning, and anemia of chronic disease

39
Q

The ____ represents the average hemoglobin concentration in RBCs

A

Mean Corpuscular Hemoglobin Concentration - MCHC

40
Q

Normal MCHC

A

31-36 g/dL

41
Q

MCHC increased in

A

autoimmune hemolytic anemia, as well as other forms of hemolytic anemia

42
Q

MCHC decreased in

A

iron deficiency anemia, thalassemia, lead poisoning, anemia of chronic disease, etc.

43
Q

The ____ is a measurement of the variability of RBC size

A

RDW - Red Cell Distribution Width

44
Q

_____ means variability in the size of RBCs

A

Anisocytosis

45
Q

Normal rance RDW

A

11.5-14.5

46
Q

The higher it is, the more variation in size describes what

A

RDW

47
Q

Normal RDW And elevated MCV =

A

Aplastic anemia

48
Q

Normal RDW And normal MCV:

A

Normal (obviously), or it could be anemia of chronic disease, acute blood loss, hemolysis, thalassemia, etc

49
Q

Elevated RDW and elevated MCV:

A

Vitamin B12 deficiency, folate deficiency,
autoimmune hemolytic anemia, liver disease, etc

50
Q

Elevated RDW and normal MCV:

A

EARLY iron deficiency anemia, folate
deficiency anemia, or vitamin B12 deficiency anemia

51
Q

elevated RDW and decreased MCV:

A

Iron deficiency anemia, certain forms of
Thalassemia (uncommon).

52
Q

Serum Vitamin B12 Level is increased in

A

Leukemia, marked leukocytosis, and
polycythemia vera (not diagnostically useful, however).

53
Q

Serum Vitamin B12 Level is decreased in

A

Pernicious anemia, gastrectomy, gastric
carcinoma, malabsorptive conditions (such as Celiac Disease), pregnancy, dietary deficiency, and some drugs
(such as omeprazole, metformin, carbamazepine).

54
Q

Folate can either be measured as a _____ or _____

A

plasma level or from the
red blood cells (both automated processes)

55
Q

Folic acid is decreased in

A

folic acid deficiency (inadequate intake,
malabsorption), alcoholism, some drugs, vitamin B12 deficiency (50-60%, since cellular uptake of folate depends on Vitamin B12).

56
Q

_____ is very important for maintaining several functions in the body, especially the production of functional hemoglobin

A

Iron

57
Q

Serum iron is increased in

A

excessive iron states, hemolytic anemia, pernicious anemia, thalassemia, hemochromatosis, etc.

58
Q

Serum iron is decreased in

A

iron deficiency anemia,
nephrotic syndrome, chronic renal failure,
and active hematopoietic states

59
Q

_____ is a measurement of the
maximum amount of iron the blood is able to bind/carry

A

Total Iron Binding Capacity - TIBC

60
Q

an indirect measure of available Transferrin

A

TIBC

61
Q

Each Transferrin is able to bind ____ Iron molecules

A

two

62
Q

Normal TIBC

A

About 250-460 mcg/dL

63
Q

TIBC is increased in

A

iron deficiency anemia, infancy, acute hepatitis, late pregnancy, and some oral contraceptives

64
Q

Decreased in _____

A

hypoproteinemic states (malnutrition,
nephrotic syndrome), hemochromatosis, thalassemia, etc.

65
Q

Normal ferritin level

A

○ Normal for males: About 16-300 ng/mL
○ Normal for females: About 4-161 ng/mL

66
Q

In the absence of liver disease and infection/inflammation,
_____ is a more sensitive test for iron deficiency than TIBC
and serum iron levels

A

Ferritin

67
Q

Ferritin is decreased in

A

iron deficiency

68
Q

Ferritin is increased in

A

Hemochromatosis, acute or chronic liver disease, alcoholism, inflammatory conditions, some malignancies, etc.

69
Q

Similar to and based off the TIBC, the _____ is an estimate of the percentage of Transferrin that
is saturated with iron

A

percent of iron saturation

70
Q

Percent iron saturation is increased in ____

A

hemochromatosis, excessive iron intake,
hemolytic anemia, recent transfusion, thalassemia, etc.

71
Q

Percent iron saturation is decreased in ____

A

hypochromic anemias, such as iron deficiency anemia (usually saturation less than 16%).

72
Q

Peripheral Blood Smear

A

Also sometimes called a Blood Film or Manual Differential, this test
involves examining a whole blood sample under a microscope

73
Q

The peripheral blood smear should be
examined when the CBC _____

A

reveals abnormal
blood counts.

74
Q

T/F No evaluation of anemia is complete without
inspection of the blood smear

A

T

75
Q

Poikilocytosis

A

Variability in RBC shape

76
Q

Spherocytes

A

Small, spherical RBCs

77
Q

_____, a familial hemolytic disorder caused by hemolytic destruction of abnormally shaped RBCs (a form of
hemolytic anemia)

A

Hereditary spherocytosis

78
Q

Target Cells are

A

RBCs with small amounts of Hgb
Seen sometimes with Hemoglobinopathies, such as Thalassemia, sickle cell disease, etc

79
Q

_____: Fragmented RBCs, appearing in various “jagged” shapes

A

Schistocytes

80
Q

____: Inclusions within RBCs composed of denatured Hgb

A

Heinz Bodies

81
Q

____: Damaged RBCs, with chunks taken out.

A

Bite Cells (Degmacyte)
○ Fairly characteristic of hemolytic anemia secondary to G6PD deficiency

82
Q

_____: Nuclear remnants (clusters of DNA) in RBCs

A

Howell-Jolly Body

83
Q

_____: Stacks or linear aggregates of RBCs

A

Rouleaux Formation

84
Q

Characteristic of Multiple Myeloma (or preparation artifact)

A

Rouleaux Formation:

85
Q

_____: Small peripheral dots in the RBCs (ribosomes)

A

Basophilic Stippling

86
Q

Several potential causes of basophilic stippling

A

Hemolytic anemia, lead poisoning, heavy metal poisoning, alcohol abuse, Myelodysplastic syndrome, etc

87
Q

A reticulocyte count measures ____

A

how rapidly these are produced
by the bone marrow and released into circulation
○ Reflects the erythropoietic activity of the bone marrow

88
Q

Reticulocyte count is increased in

A

hemolytic anemia, acute blood loss, and response to therapy from iron, vitamin B12, or folate

89
Q

Reticulocyte is decreased in

A

iron deficiency anemia, aplastic anemia,
anemia of chronic disease, megaloblastic anemia, bone marrow suppression or infiltration, myelodysplastic syndrome, etc

90
Q

Normal reticulocyte count

A

33-137K / mcL

91
Q

Hemoglobin Electrophoresis

A

A blood test that can detect different forms of Hemoglobin found within a patient’s blood sample

92
Q

Coomb’s Test two types:

A

Also known as Antiglobulin Test (AGT)
○ Direct Coomb’s Test (DCT) / Direct Antiglobulin Test (DAT)
○ Indirect Coomb’s Test (ICT) / Indirect Antiglobulin Test (IAT)
● The Direct Coomb’s Test is more sensitive and specific for diagnosing Autoimmune Hemolytic Anemia.

Heme/Onc Exam 2 (7 decks)

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