RBC, WBC, and Anemia Flashcards
sensitivity rules __ disease
out
specificity rules __ disease
in
hb equation
hb = rbc x 3
hematocrit equation
hct = hb x 3
or
hct = rbc x 9
rbcs are indirect measure of what
hemoglobin
hematocrit is indirect measure of what
rbcs in volume of blood
what tells you average size of rbc
MCV
what tells you quantity of hemoglobin in rbc
MCH
what tells you concentration or color of rbc
MCHC
increase in RDW suggests what
what conditions
increase in different types of cell sizes
factor deficiency, homozygous globinpathy
normal RDW suggests what conditions
thalassemia minor
heterozygous globinpathy
chronic disease anemia
what is a spherocyte
type of microcyte
round and lacks center clear area
what are polychromatophile RBCs
reticulocytes
immature RBCs
what is rouleaux
rbcs partially adhering to each other like stack of coins
what is anemia defined as
decrease in hemoglobin concentration
may result from loss of RBCs which contain hb
what are the causes of pseudoanemia
overhydration fluid retention pregnancy athletics hypoalbuminemia lab error posture
what are causes of anemia
hemorrhage bone marrow failure renal disease dietary deficit hemolytic disease
anemia is classified by what
cell morphology
- macrocytic, micro, normo
- hypochromic, normo
pathogenesis
- factor deficiency
- production deficit
- depletion
what are the steps to determine if patient is anemic
ask question - are they anemia
morphology classification
pathogenesis
factor deficiency results from what
lack of raw materials necessary for hematopoesis
what are factors necessary for hb synthesis
iron
b12
folic acid
pyridioxine
microcytosis results from hb molecule lacking __ or __
iron - IDA
pyridoxine - sideroblastic anemia
most common cause of microcytosis
IDA
MCV and MCHC decrease
IDA
microcytosis is a process that evolves over time
what happens to serum ferritin? si? and tibc?
ferritin decreases
si decerases
tibc increases
IDA morphology and pathogenesis
microcytosis
hypochromic
what is necessary for the development of heme
pyridoxine
what is pyridoxine decreased by
alcohol stress diet
in pyridoxine deficiency, the si is __ and tibc is __
si increases
tibc decreases
macrocytosis results from what
b12 or folic acid deficit
b12 and folic acid cause macrocytosis how
affect DNA synthesis of precursor cells in marrow
what is found in foods of animal origin
cyanocobalamin
deficiency of b12 and folic acid result from what
absorption issues - intrinsic factor autoimmune antibodies on parietal and chief cells lack of gastric acid terminal ileum malabsorption distal bowel surgery
b12 dietary deficiency is __
found in who
rare
vegetarians
MCV is increased over __ in b12 deficiency
MCHC is ___
100
normal
MCV increase and MCHC normal
b12 deficiency
macrocytosis and normochromic
b12 deficiency anemia morphology and pathogenesis
macrocytosis and normochromic
what is schillings test used for
b12 anemia
pernicious anemia
malabsorption
what is used to determine if clinically borderline levels of b12 deficit is present
does this increase or decrease
MMA assay increases
what is the most common cause of folic acid deficiency
common in who
diet
alcoholics
what will confirm folic acid anemia
serum foliate
and
rbc foliate
production defect anemia results from what
inadequate erythropoiesis
(hypoplastic bone marrow/aplastic anemia/systemic disease in bone marrow)
with or without factor deficiency
production defect anemia results in what cell morphology and pathogenesis
normocytic and normochromic
sometimes hypochromic
production defect anemia is due to what
hypoplastic bone marrow
aplastic anemia
systemic disease on bone marrow
what directly replaces or depressed the cellular elements of bone barrow –> hypoplastic marrow
fibrosis causing myelofibrosis
mets causing myelophthisic anemia
what is a peripheral pancytopenia and platelets due to deficiency of bone marrow cell precursors without cell abnormality or replacement of tumor or fibrosis
aplastic anemia
hypoplastic marrow and aplastic anemia are caused by what
damage to bone marrow
meds
autoimmune condition
systemic and chronic disease do what to si and tibc
why
decrease si and tibc
renal disease (damage and decrease epo), azotemia, neoplasia, infection, RA, liver disease, hypothyroid
all associated with decrease RBC life span, not enough progenitor cells, decrease epo, or impaired iron metabolism
what are two main types of depletion anemia
abnormal loss of rbc - hemorrhage
abnormal destruction of rbc - hemolytic anemia
hemolytic anemias are classified as what
intracorpuscular and extracorpuscular defects
what results in free hemoglobin in circulation
hemolysis
free hb will damage what
renal tissue
what binds with hb to eliminate it
once it is saturated it binds with ___ to form ___
if free hb is still found in serum it will result in
haptoglobulin + albumin = methemalbumin
hemoglobulinuria
what are extrinsic agents that cause depletion anemia
imha - immune mediated hemolytic anemia
maha - microangiopathic hemolytic anemia
tranfusion reaction
fetal rh incompatibility
lead, bacteria, benzene, parasites - malaria
what are the intrinsic agents that cause depletion anemia
hb structural abnormalities - sickle cell
normal hb is 98% what
the other 2% is what
hb A
hbF
newborns have __% of hb _ bit it is normally replaced by what time period
> 50%
hbF
6 months of age
hbA is comprised of what
95-98% hbA1
1-2% of hbA2
sickle cell disease mostly occurs in what population
african americans
sickle cell disease
what percent of people have the trait
what percent of people have the disease
trait - 8%
disease - 1%
what is the hemoglobin and the percent in sickle cell disease
what is the hemoglobin and percent in sickle cell trait
disease – hbS - 80%
trait – hbS 20-40% and hbA 60-80%
sickle cell prep screens pick up small amounts of hbS so it is only reliable at what age
after 6 months of age
what is the definitive screen for sickle cell disease
hb electrophoresis
what does sickle cell trait cause
no anemia!
except under certain conditions
what is a structural abnormality of hemoglobin
what is a abnormality of hemoglobin synthesis
structural - sickle cell
synthesis - thalassemia
no thalassemia hb, so what causes thalassemia to occur
genetic abnormality of globin chain synthesis
globin portion of hb contains what
2 pairs of chains
alpha and beta
in thalassemia disease, what are the hemoglobin present
which contains the most
hbF 60%
hbA1 20%
hbA2 3%
in thalassemia trait, what are the hemoglobin present
which contains the most
hbA1 50%
hbA2 4-6%
hbF 3%
what is thalassemia disease called
what is thalassemia trait called
disease - thalassemia major
trait - thalassemia minor
thalassemia major presents as anemia with ___ and ___
what cells are present in thalassemia disease/major
microcytosis and hypochromic
target cells
what thalassemia is from a history of mediterranean origin
thalassemia major - disease
what thalassemia looks like IDA
thalassemia major
how does thalassemia minor differ from IDA
normal RDW
anemia is unlikely - RBC > 5x10 to the 6th power
in thalassemia minor, what is going on with TIBC and ferrtin
what is going on in IDA
thalassemia minor - TIBC decreased and normal ferritin
IDA - TIBC increased and ferritin decreased
what is the only rbc enzyme deficiency
how is it genetic
affects what gender more
brought on by what factors
glucose 6 phosphate dehydrogenase
x sex linked
men more than women
drugs - asa, phenacetin, sulfas, nitrofurntoin
what are the rbc membrane abnormalities
due to what
what happens to MCHC
symptoms
hereditary spherocytosis and eliptocytosis
lack of protein spectrin - part of cytoskeleton
mchc increased
hemolysis, juandice, splenomegaly
is it anemia
what values do you check
what is the ratio? explain
rbc, hb, hct
3:1
1 is low - ehh
2 is low - suspicious
3 is low - yes its anemia
slow or chronic bleeds usually result in what
factor deficiency anemia
under 45 years old
males cause of factor deficiency
female cause of factor deficiency
over 45 years old
under 45
males - peptic disease
females - menstrual disorder
over 45
both - occult cancer
hypersegmented neutrophils are seen in what condition
b12 deficiency
sideroblasts are seen in what condition
pyrdoxine deficiency
production deficit produces normocytic normochromic cells that is caused by what
chronic disease
depletion anemia produces normocytic normochromic cells that is caused by what
acute bleeds or hemolytic disease
if the patient is anemic and you rule out microcytic and macrocytic, what do you look for
elevated reticulocyte count - indicates bone marrow activity or production of new rbcs
elevated reticulocyte count is seen in what situations
acute blood loss
hemolysis
treatment of anemia
what are the percentages of WBC found in a adult
never let my engine blow
neutrophils - 60 lymphocytes - 30 monocytes - 8 eosinophils - 3 basophils - 0
WBCs are used to diagnose or evaluate what
inflammation
infection
neoplasia
immunosuprresion
lymphocytes predominate in what years of life
age 4-5
what is the predominate WBC if the patient is less than 5 years old
lymphocytes
what is the predominate WBC if the patient is greater than 5 years old
neutrophils
neutrophils predominate in what years of life
> 5 years old
what is -osis or -philia mean
increase in WBC
what is -penia mean
decrease in WBC
what does a shift to the left represent in WBCs
increase in number of immature forms of cells
leukocytosis indicates what
inflammation or bacterial infection
leukopenia indicates what
marrow suppression
overwheming infection
autoimmune
viral syndromes
neutrophilia indicates what
bacterial infection
inflammation
relative lymphocytosis indicates what
true lymphocytosis indicates what
RELATIVE LYMPHOCYTOSIS - viral infection
(absolute lymph count normal, WBC count shows leukopenia because of decrease granulocytes)
TRUE LYMPHOCYTOSIS - pertussis, infectious lymphocytosis, lymphocytic leukemia
(absolute lymph count and WBC count elevate)
monocytosis is indicates what
SBE TB lymphoma leukemia typhoid
eosinophilia indicates what
acute allergic reaction
skin conditions - pemphagus and psoriasis
scarlet fever
brucelliosis
basophilia indicates what
CML
myoproliferative diseases
leukemoid reaction indicates what
non leukemic WBC count >50,000
OR
differential count of >5% metamyelocytes
leukemia can develop at what stage of cell maturation
any stage of maturation and is named accordingly
in leukemia, the more immature the predominant cell means what
worse the prognosis
blast cells (acute) = worse prognosis
mature cells (chronic) = better prognosis
“leukemia” means what
total count of WBCs are ?
malignancy of white blood cells
elevated
acute leukemia has __% of __ forms
where are these forms present
chronic leukemia has __ forms
> 25%
blast forms
peripheral blood
mature forms
ALL occurs when
before the age of 10
AML occurs when
over the age of 50
what do you see in acute leukemia types
1/2 WBCs counts elevated
1/2 WBCs normal
anemia is moderate to severe in 80% of people
what type of leukemia makes up 30% of all leukemias
CLL
CLL makes up what % of all leukemias
30%
CLL occurs when
over the age of 50
CML occurs when
ages 20-50
CML makes up what % of all leukemias
20%
what type of leukemia makes up 20% of all leukemias
CML
what cell types are present in CML
myelocytes and metamyelocytes
what leukemia is associated with philadelphia chromosome
CML
what is an increase in the blood cell mass called
polycythemia
what are the 3 types of polycythemia
vera - all cells increasd (WBC, RBC, platelets)
relative - dehydration
secondary - hypoxia
