1
Q
Components of a CBC
A
- WBC
- Hgb
- HCt
- PLT
2
Q
How do we check Hemoglobin?
A
- Red cells broken down to get hemoglobin in solution
- Free hemoglobin exposed to cyanide to form cyanmethemoglobin
- By shining light (540 nm) through the soln the concentration of hemoglobin can be determined.
3
Q
Normal Hemoglobin Range for Men
A
14-18 mg/dL
4
Q
Normal Hemoglobin Range for Women
A
12-16 mg/dL
5
Q
What is the “Hematocrit”?
A
Relative volume of blood occupied by erythrocytes.
6
Q
Normal Hematocrit Levels
A
41-52%
7
Q
What is the normal Hemoglobin/Hematocrit Ratio?
A
1:3
8
Q
How much should a hematocrit rise after one unit of blood is transfused?
A
3 points
9
Q
DDx for Anemia
A
- IDA
- Bleeding
- B12 Deficiency
- Folate Deficiency
- Chronic Disease
- Leukemia
- Sickle Cell Disease
- Genetics?
- Myelodysplastic Syndrome
10
Q
How do you evaluate a patient with suspected anemia?
A
- Determine Acuity
- Look at patient FIRST, not labs
- Past records will show old baselines.
11
Q
If someone has been chronically anemic and is of Mediterranean descent and has an MCV of 60, what disease process should you be thinking of?
A
Thalassemia
12
Q
Three potential CAUSES of anemia
A
- Decreased Production
- Increased Destruction
- Blood Loss
13
Q
What can be a Decreased Production cause of Anemia?
A
- Nutritional Deficiency
- Bone Marrow Failure
- Hormone Deficiency
- Epo failure (Kidney failure where epo is made)
Examples:
- B12 Deficiency
- Folate Deficiency
- Aplastic Anemia
- Leukemia
- Myelodysplastic Syndrome
14
Q
What can be a Increased Destruction cause of Anemia?
A
- Inherited Hemolytic Anemia
2. Acquired Hemolytic Anemia
15
Q
Examples of Acquired Hemolytic Anemia
A
- Autoimmune Hemolytic Anemia
- Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome
- Malaria
- Mechanical Valve Replacement
16
Q
Examples of Inherited Hemolytic Anemia
A
- Hereditary Spherocytosis
- Sick Cell Disease
- Thalassemia Major
17
Q
This is a condition where RBS are like little spheres instead of biconcave discs and therefore do not go through the vessels well that can cause rupture.
A
Hereditary Spherocytosis
18
Q
What can cause Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP/HUS)?
A
Antibiotics and some Viral Illnesses
19
Q
Most common cause of Anemia?
A
Blood Loss
20
Q
What can be a Blood Loss cause of Anemia?
A
- Traumatic or Apparent Bleeding
- Occult Bleeding
- Iatrogenic
21
Q
Examples of Traumatic or Apparent Bleeding
A
- Melena
- Hematemesis
- Menometrorrhagia
22
Q
Examples of Occult Bleeding
A
- Colonic Polyp
- Carcinoma
23
Q
Examples of Iatrogenic Cause of Bleeding
A
- Blood Draws (esp. in infants)
- Dialysis
- Surgery
24
Q
What is MCV?
A
Mean Corpuscular Volume
An indicator of how big the RBC is (macrocytic vs. normocytic vs. microcytic)
25
Normal Value of MCV?
80-98
26
This is the term for an MCV >98.
Macrocytic Anemia
27
Causes of Macrocytic Anemia
- B12 Deficiency
- Folate Deficiency
- Drugs
- Release of Immature Cells (from Bone Marrow)
- Cirrhosis
- Hypothyroidism
- EtOH
- Multiple Myeloma
28
RBCs should be the same size as a __________.
Neutrophil
29
This is the term for an MCV < 80.
Microcytic Anemia
30
What is the #1 cause of Microcytic Anemia
Iron Deficiency
31
Causes of Microcytic Anemia
- Thalassemias
- Sideroblastic Anemia
- Chronic Blood Loss?
- Anemia of Chronic Dz (rarely!!! Normally causes normocytic anemia)
32
This is the term for a blood smear showing differently sized blood cells.
Aniscocytosis
33
This is the term for a blood smear showing differently shaped blood cells (usually more than 10%)
Poikilocytosis
34
Causes of Normocytic Anemia
- Acute Blood Loss
- Early Fe Deficiency
- Anemia of Chronic Disease (ACD)
- Renal Failure (low Epo)
35
This is the term for a Hematocrit > 52.
Polycythemia
36
This type of Polycythemia is caused by a mutation leading to an abnormality in erythroid progenitor cells, it can be due to polycythemia vera or other familiar variants.
Primary Polycythemia
37
This type of Polycythemia is caused by a circulating plasma factor stimulting erythropoiesis, usually erythropoietin (EPO).
Secondary Polycythemia
38
Causes of Secondary Polycythemia
- Hypoxia
- EPO-Secreting Tumor
- Living at High Altitudes
- COPD
- Blood Doping
39
What causes Nucleated RBC or Erythroblasts to be present in the blood?
Early release from marrow due to hypoxia (stress).
40
What causes Reticulocytes to be present in the blood?
Change to RBC in 24 hours.
* Normal in Peripheral Blood
* Increased in Anemia with Rapid Blood Loss
41
What causes Spherocyte Formation?
Defect in Cell Membrane or Loss of Membrane
Caused by:
- Drugs
- Hereditary Hemolytic Anemia
- Autoimmune Hemolytic Anemia
42
Are Spherocytes in the blood normal?
No, they need further evaluation.
43
What causes Schistocyte Formation ("bite cells")?
Trauma!
Caused by:
- Prosthetic Heart Valves
- Disseminated Intravascular Coagulation (DIC)
44
What causes Sickled Cells Formation?
- Hemoglobin S Polymers
45
What is Cold Agglutinin Disease?
Caused by IgM Abs leading to RBC clumping.
*Underlying Problem with Reynaud's.
46
What is Rouleaux?
"Coin stacking" of RBCs
47
How would Rouleaux show up on blood analysis?
Machine may say it's macrocytic anemia due to these artifact clumpings.
48
These come from megakaryocytes (flakes). They have no nucleus and are responsible for hemostasis. They help repair injury to vascular endothelium.
Platelets
49
Normal Range of Platelet Counts
150-400
*Remember these are in thousands*
50
Four major Platelet Functions
1. Platelet Adherence
2. Platelet Activation and Secretion
3. Platelet Aggregation
4. Interaction with Coagulation Factors
51
Where do Megakaryocytes live?
Bone Marrow
52
This is the term for any disorder in which there is an abnormally low amount of platelets.
Thrombocytopenia
53
What can be a Decreased Production cause of Thrombocytopenia?
- Post Viral Syndrome (MMR, HIV, EBV, Hep)
- Aplastic Anemia
- EtOH Toxicity
- B12, Folate Deficiency
54
What can be a Increased Destruction cause of Thrombocytopenia?
- Idiopathic thrombocytopenic purpura
- DIC
- TTP
- HELLP syndrome (hemolytic anemia, elevated liver function tests, and low platelet count) in pregnant women
- Drugs, most notably heparin, quinine, and valproic acid.
55
This is the term for a condition where the platelet count is FALSELY low.
Pseudothrombocytopenia
56
Causes of Pseudothrombocytopenia
1. Not enough anticoagulant in blood draw tube
| 2. EDTA (preservative) dependent clumping
57
How do correct for pseudothrombocytopenia?
Redraw CBC in EDTA free tube
| Bypasses both causes of Pseudothrombocytopenia
58
If you have a platelet count of 600,000+, what should you think?
Reactive Thrombocytosis
59
Causes of Reactive Thrombocytosis
1. Infection (31%)
2. Infection + Post-Surg Status (27%)
3. Post-Surg Status (16%)
4. Malignancy (9%)
5. Post-Splenectomy State (9%)
6. Acute Blood Loss or Iron Deficiency (8%)
60
This is the term for the body causing an increase in thrombocytes on its own.
Autonomous Thrombocytosis
61
Cause of Autonomous Thrombocytosis
Chronic Myeloproliferative Disorders
Such as:
- Essential Thrombocythemia (ET)
- Polycythemia Vera (PV)
- Myeloid Metaplasia
- Chronic Myelogenous Leukemia (CML)
62
Elevated WBC would indicate...
- Infection
- Stress
- Cancer
63
What is the Absolute Neutrophil Count (ANC)?
(Neutrophils + Bands) x WBC
64
What do neutrophils and bands do?
Fight Bacteria
65
What is a band?
Immature Neutrophils
66
ANC < 500 would indicate what?
Antibiotics!
67
This type of lymphocyte comes from bone marrow and provides humoral immunity. It recognizes free antigen and mature into plasma cells.
B-Lymphocytes
68
This type of lymphocyte comes from the thymus. It orchestrates immune system's response to infected or malignant cells.
T-Lymphocytes
69
Causes of Lymphocytosis
- Mainly Viral Illness
- CMV
- EBV
- Mumps
- Flu
- Hep
- Early HIV
- TB
- Toxoplasmosis
- Lymphomas
- ALL
- CLL
70
Causes of Lymphopenia
- Bone Marrow Suppression
| - HIV
71
This is the term for phagocytic white blood cell that has a single well-defined nucleus and fine granulation in the cytoplasm.
Monocytes
72
When are Monocytes Elevated?
- Preggo
- Asplenic State
- Certain Infections
- Inflammatory Conditions
- AML
73
This is a WBC that is granular and stains red.
Eosinophil
74
When are Eosinophils elevated?
- Allergies
- Parasitic Infection
- CA
- Cushing's
75
In an Iron Panel, what would you see if there is an iron deficiency?
- Iron and Iron Saturation will be LOW
- TIBC will be HIGH
*Think back to school bus carrying around the iron. There aren’t many people on the bus in this case, lots of empty seats on the bus so TIBC is high.
76
In an Iron Panel, what would you see if there is an Anemia of Chronic Disease (ACD)?
- Iron and Iron Saturation will be Normal to Low
- TIBC will be LOW
*Problem with Hepcidin, iron isn’t transporting properly. Driver won’t let anyone on the bus.
77
When do you perform Hemoccult Testing?
Evaluating Anemic Patient
78
How do you perform Hemoccult Testing?
- Smear feces on on side of the card.
- Flip the card and drop develope on it (in control and test spots)
Blue = Occult Blood = GI Bleed
79
Look at Case Studies
K Thanks Bye
Lab Medicine
flashcards
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