Heme Tests

Question 1

Hematopoiesis

Answer 1

production of blood cells

occurs in bone marrow (RBC, WBC, Thrombocytes (platelets), come from stem cells)

> 10 billion/day and need to keep this level of production

Question 2

Function of Blood

Answer 2

• Transportation of O2, nutrients, hormones, waste products
• Regulation: fluid, acid-base balance, electrolytes
• Protection: clotting and fighting infections

Question 3

Leukocytes (Granulocytes)

Answer 3

neutrophils: segmented neutrophil (segs) which are
- Bands: young or immature neutrophils that are pushed out into periphery (blood system) to help out

Eosinophil: allergy and parasitic infections

Basophil: allergy and inflammation

Phagocytosis: phagocytes ingest small cells, cell fragments, microorganisms.

Question 4

Leukocytes (Agranulocytes)

Answer 4

lymphocytes: cellular and humoral immunity (B & T lymphocytes)

Monocytes: potent phagocytes, live in blood

Macrophages: monocytes that have left blood and moved to tissue

Resident macrophages: live and start out in tissues, they never enter blood system

Natural Killer Cells

Question 5

WBC Ranges

Answer 5

Normal range: 5,000-10,000

greater than 10,000 = indicates infection

less than 5,000 = leukopenia (you have decreased response to infection)

Question 6

RBC’s

Answer 6

erythrocyte:

• hemoglobin carries O2
• lifespan = 120 days
• reticulocyte = immature RBC (sometimes can get pushed into peripheral circulation but we don’t want this to happen b/c if they are immature they aren’t functioning to full capacity)

Question 7

Erythropoiesis

Answer 7

RBC production

• stimulated by hypoxia
• controlled by erythropoietin (hormone secreted by kidneys to increase production of RBC)
• production is dependent on availability of nutrients (need enough iron, folic acid, and B12)
• would need to stimulate RBC production b/c of hemolysis

Question 8

Thrombocytes

Answer 8

Platelets

• regulated by thrombopoietin (hormone produced by liver and kidneys)
• main reason we have thrombocytes = hemostasis (arrest of bleeding)

Question 9

Two types of responses to bleeding:

Answer 9

1. Vascular response: vasoconstriction (slows blood from getting out) and endothelial wall stickiness, lasts 20-30min following vessel injury
2. Platelet response: activated by exposure to collagen. Platelets stick together (adhesiveness) and form clumps (aggregation or agglutination)
   - done through clotting cascade

Question 10

Clotting Cascade:

Answer 10

Plasma clotting factors - stimulated by activated plasma proteins by intrinsic (inside blood vessel) and extrinsic (outside blood vessel) pathways.
-ultimately thrombin converts fibrinogen to fibrin which is essential for clot

Prothrombin converted to thrombin (thrombin to fibrinogen)

Clots regulated by anticoagulation and fibrinolysis

• heparin = natural anticoagulant
• antithrombin and antithromboplastin help maintain blood flow through blood vessel (prevents clotting)

Question 11

Heme Problems: Subjective Questions to Ask

Answer 11

• c/o
• past health hx: anemia, blood disease, bleeding disorders, recurrent infections
• medications: Rx meds, OTC, supplements, vitamins, herbs (common cardiac meds: warfarin, plavix, aspirin, PPI’s H2 blockers, eliquis, heparin, xarelto)
• Surgical/procedural Hx: splenectomy, heart valve replacement, duodenectomy, blood transfusion

Question 12

Heme Problem: Objective Assessment

Answer 12

Complete physical exam

Lab tests: CBC with diff, ESR, CRP

Question 13

CBC Values

Answer 13

Erythrocytes:

• Males: 4.7-6.1 x 100,000/uL
• Females: 4.2-5.4 x 100,000/uL

Hgb:

• Males: 14-17 g/dL
• Females: 12-16 g/dL

Hct (% of RBC compared to total blood volume):

• Males: 42-52%
• Females: 37-47%

WBC: 5,000-10,000 /uL

Thrombocytes: 150,000-400,000/uL

Differential includes: segs, bands, monocytes, eosinophils, basophils

Question 14

RBC Lab Value Abnormalities

Answer 14

Increased = polycythemia, dehydration
Decreased = anemia, hemorrhage

-Sx: fatigue, pallor, tachycardia, tachypnea, DOE, decreased BP

Question 15

WBC Lab Value Abnormalities

Answer 15

> 10,000 = infection, inflammation, malignancy

<5,000 (leukopenia) = virus, bone marrow suppression

• Sx = signs of infection
• Neutrophils: shift to left - increase bands released to help fight infection.
• Neutropenia - <1,000 bone marrow does not produce enough

Question 16

Thrombocyte Lab Value Abnormalities

Answer 16

<100,000 at risk for hemorrhage

thrombocytopenia: not enough platelets to prevent hemorrhage
- Sx: petechiae, ecchymosis, bleeding of gingivae
- Sx of stroke: VS, change in mental status, loss of speech/sensory/motor functions

Increase: in platelet count

• pt at risk for thrombosis (clot)
• sx: VS and LOC change, circulation change in extremities, c/o pain

Question 17

PT/INR

Answer 17

lab value that evaluates bleeding/clotting status

PT (Prothrombin Time): evaluates a deficiency in clotting factors which causes prolonged PT (bleeding)

• monitor oral anticoagulant therapy (coumadin/warfarin)
• normal PT is 11-12.5 seconds

INR (international normalization ratio): standardized calculation of the PT used to monitor the effect of an oral anticoagulant

• normal range: 0.8-1.1
• therapeutic range (meaning pt is on anticoagulate): 2.0-3.0
• meaning if pt on warfarin/coumadin, PT should be 2-3 times the normal range or 20-42 seconds so they do not clot

Question 18

aPTT

Answer 18

activated partial thromboplastin time

• normal: 30-40 seconds
• tests the intrinsic clotting system of clotting factors
• more useful to screen general plasma deficiency
• it differs from PT which does not test the intrinsic clotting system
• in hospital setting, it is used to monitor heparin therapy (heparin increases aPTT).
• therapeutic level is 2.5-3 times the control (75-120 second )

Question 19

Erythrocyte Sedimentation Rate (ESR or Sed Rate)

Answer 19

indication of inflammation but can also indicate anemia, infection, pregnancy, or even aging.

Getting a good health hx is important when you get this lab value.

> 20 mm/hr indicates inflammation
*indicates cell destruction - acute and chronic inflammatory disease, malignancies, MI

Decrease indicates microcytic RBC or abnormally shaped rbc (sickle cell anemia)

Question 20

CRP

Answer 20

C-Reactive Protein

titer > 1.2 indicates inflammation
appears 6-10 hours after acute inflammation and peaks in 48-72 hours.