CBC

Question 1

Reticulocyte

Answer 1

immature RBCs

elevated in hemolytic anemia

measures the effectiveness of erythropoiesis

reticular network of ribosomal RNA visible when stained with methylene blue on microscopy

**not part of the CBC

Question 2

differential CBC vs CBC

Answer 2

Regular CBC does not break down the #’s and Types of WBCs

Question 3

Leukocytosis

Answer 3

elevated leukocytes

leukocytes >11

• indication for a differential
• causes of elevation:
  
  • INFECTION →should always look at previous CBCw and trends
  • steroids (mild elevation)
  • cancers
  • catastrophic events (trauma, MI surgery)

Question 4

Leukopenia

Answer 4

decreased leukocytes

Question 5

agranular leukocytes

Answer 5

lymphocytes and monocytes

Question 6

granular leukocytes

Answer 6

basophil, neutrophil, eosinophil

Question 7

Neutrophils

Answer 7

Polymorphonuclear neutrophils (PNMs) “Polys”

• fight bacteria and fungus
• attracted by chemokines
• de-granulate antimicrobial proteins
• Two forms:
  
  • bands and segs
    
    • segmented: senior/mature cell
    • bands: baby/immature cell
• Left shift! → recruits the immature band form
• Absolute #: 1.8-7.7K

Question 8

Segmented Neutrophil

Answer 8

Senior/mature cell

normal = 50-62% of WBCs

Question 9

Banded Neutrophil

Answer 9

Baby/immature cell

normally only 3-5% of WBCs

Question 10

WBC count

Answer 10

4.5-11K

Question 11

RBC

Answer 11

4.5-5.9M

Question 12

Hgb

Answer 12

14-18g/dL

Question 13

Hematocrit

Answer 13

40-52

• percentage of packed RBC to total volume of blood
• HCT is approx HGB x 3
• calculated RBC x MCV

Question 14

MCV

Answer 14

Mean Cell Volume ( SIZE )

80-100 fL

microcytic <80fL

macrocytic >100fL

Question 15

MCH

Answer 15

Mean Corpuscular Hgb (average hgb/RBC)

27-33pg

Question 16

MCHC

Answer 16

Mean Corpuscular Hgb Concentration (REDNESS)

32-36%

normochromic= normal redness

hypochromic = less red

hyperchromic = more red

Question 17

Platelet count

Answer 17

1.30-4.00K/MM³

Question 18

RDW

Answer 18

Ratio of Distribution Wide

how variable is the size of the RBCs

0.0-14.7%

Question 19

MPV

Answer 19

mean platelet volume

6.8-10.0fL

Question 20

ANC

Answer 20

Absolute Neutrophil Count

1.8-7.7K/MM

• mild neutropenia 1000-1500 cells/MM
  
  • increased risk of infection
• ANC < 500 cells/MM severe neutropenia
  
  • pt will fail to control local flora/common pathogens
    
    • lots of infections!
• includes both bands and segs!

Question 21

What can trigger demargination of neutrophils aside from infection?

Answer 21

• steroids
• major trauma
• both will cause a small increase in ANC (absolute neutrophil count)

Question 22

Lymphocytes

Answer 22

• 1.0-4.8K/MM³ (16-45%)
• fight viral infections
• important in antibody formation
• types of Lymphocytes:
  
  • B cells
  • helper T cells
  • cytotoxic T cell
  • regulatory T cell
  • natural killer cell

Question 23

Monocytes

Answer 23

0.1-0.8K/MM³

• 3-10% of WBCs
• attracted by chemokines and differentiate into macrophages and dendritic cells
• fight both viral and bacterial infections
• in TB:
  
  • form wall around the MTB= create a granuloma

Question 24

Eosinophils

Answer 24

0.0-0.5K/MM³

• Normal range: 0-7%
• present in tissues and mucous membranes
• fight parasites and helminths
• elevated in allergic response
• release toxic granules that can cause extreme reaction

Question 25

Basophils

Answer 25

**0.0-0.2K/MM³** * 0-2% * contain **heparin** and **histamine** * large dark granules * **allergy** and **stress** response * can be elevated in **leukemia**

Question 26

how to remember the WBCs

Answer 26

Never Let Monkeys Eat Bananas * Neutrophils: 1.8-7.7K * Lymphocytes: 1.0-4.8K * Monocytes: 0.1-0.8K * Eosinophils: 0.0-0.5K * Basophils: 0.0-0.2K

Question 27

Thrombocytopenia

Answer 27

low plateletes increased bleeding risk caused by decreased production, increased destruction or sequestration

Question 28

Thrombocytosis

Answer 28

high platelets increased clotting risk * _reactive_: overproduction after infection, traumatic event, splenectomy * _essential_: myeloproliferation (blood cancer)

Question 29

Echinocytes

Answer 29

Burr Cells small blunt projections, **uniformly** spaced over the red cells ccells maintain the central pallor liver disease uremia

Question 30

Acanthocytes

Answer 30

Spur Cells irregular projections associated with cirrhosis

Question 31

Sickle Cell Anemia

Answer 31

* inherited HbS gene from both parents * abnormally shaped cells that cause stacking or sticking * chronic low level anemia due to hemolysis hbg 8-10 * impaired splenic function * small infarcs in the spleen * Howell-Jolly Bodies on smear * fragment of nucleus left over in RBC (usually cleaned out by the spleen)

Question 32

Rouleaux Formation

Answer 32

stacked RBCs in linear distrubtion appearance of stacked coins indication of multiple myeloma

Question 33

WBCs during acute bacterial infx vs later bacterial infx

Answer 33

acute bacterial: PMNs, bands later stages: lymphocytes increase overall: WBC = high

Question 34

WBCs during acute viral infx

Answer 34

lymphocytes are predominant * overall WBC may be normal or decreased * can also be slightly elevated but not as high as bacterial

Question 35

CRP

Answer 35

not part of CBC, **c-reactive protein** **direct measurement** * higher CRP = more inflammation in your body * isn't unique to one disease * can help monitor disease progress and flares * Shows up before ESR * produced by the **liver** when it is exposed to i**mmune complexes** * peaks at 36-50 hours * half life of 5-7 hours

Question 36

ESR

Answer 36

erythrocyte sedimentation rate (not part of CBC) increased ESR = sinking faster **indirect measurement:** indicator of inflammatory process * high ESR signals high levels of inflammation in the body * can help to evaluate how well tx is working * pts with autoimmune disease will have a high ESR * associated with **fibrinogen** * peaks at 7-10 days * half-life measured in weeks

Question 37

Procalcitonin

Answer 37

produced by cells in the body often in response to bacterial infx or tissue injury can be used to identify systemic bacterial infections and sepsis * \<0.5micrograms/L = systemic infection unlikely