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Hematology and Oncology > EXAM #1: CLINICAL INTERPRETATION OF LAB EXAMS > Flashcards

EXAM #1: CLINICAL INTERPRETATION OF LAB EXAMS Flashcards

1
Q

What is the definition of normocytic?

A

Normal MCV/ size

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2
Q

What is the definition of normochromic?

A

Normal concentration of Hb

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3
Q

What is the definition of anisocytosis?

A

Blood cells are of UNEQUAL size

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4
Q

What is the definition of poikilocytosis?

A

Abnormally shaped RBCs

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5
Q

What is the normal MCV of a RBC?

A

80-100 FL

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6
Q

What is the definition of macrocytic?

A

MCV greater than 100 FL

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7
Q

What is the definition of microcytic?

A

MCV than 80 FL

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8
Q

How are anemias classified?

A

1) Etiology

2) Mean Corpuscular Volume (MCV)

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9
Q

What are the three classifications of anemia based on MCV?

A

1) Microcytic
2) Macrocytic
3) Normocytic

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10
Q

What are the three classifications of anemia based on etiology?

A

1) Impaired RBC production
2) Increased RBC destruction
3) Blood loss*****

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11
Q

What is the first lab test to order in a patient with suspected anemia?

A

CBC, Complete Blood Count

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12
Q

What are the elements of a CBC?

A

1) Hb= Hemoglobin
2) Hct= Hematocrit
3) PCV= Packed Cell Volume
4) RBC count
5) RBC indices
6) RDW= Red Cell Distribution Width
7) WBC count
- TLC= Total Leukocyte Count
- Diff= differential leukocyte count
8) Platelet count
9) PBS= Peripheral Blood Smear

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13
Q

What are the three RBC indices?

A

1) MCV= Mean Corpuscular Volume*****
2) MCH= Mean Corpusular Hemoglobin
3) MCHC= Mean Corupusuclar Hemoglobin COncentration

This is the most important value in differentiating anemias

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14
Q

What additional lab values would help to differentiate anemias secondary to a CBC?

A

1) Reticulocyte count
2) ESR= erythrocyte sedimentation rate
3) Bone marrow exam

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15
Q

What is the normal leukocyte differentiation?

A 
Neutrophil= 50% - 74% 
Lymphocyte= 26% - 46% 
Monocyte= 2 - 12% 
Eosinophil= 0.0 - 5.0% 
Basophil= 0.0 - 2.0%
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16
Q

What is a reticulocyte count?

A
  • Reticulocytes are precursors to RBCs –this is a count of reticulocytes
  • Used to determine the efficacy of erythropoiesis
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17
Q

What is the utility of the ESR?

A

Elevation indicates an underlying inflammation/ organic disease

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18
Q

What does an elevated reticulocyte count indicate? What is a normal retic count?

A

Anemia

Note that normal is 0.5-1.5%*

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19
Q

What do you need to remember about retic. counts in anemia?

A

These values need to be CORRECTED for the degree of anemia.

20
Q

How is a retic. count corrected?

A

(patient Hct/45) x retic count

21
Q

How are reticulocytes identified?

A
  • Retics have RNA while mature RBCs do NOT

- Stain with RNA stain to id. retics

22
Q

What are the four common causes of microcytic anemia? What is the most common?

A

1) Iron deficiency*****
2) Anemia of chronic disease –esp. renal failure
3) Thalassemia
4) Siderblastic anemia

**This is the most common cause of microcytic anemia*

Recall, microcytic anemia= MCV less than 80 FL

23
Q

What are the important lab values used to specifically evaluate microcytic anemia?

A

1) Serum iron
2) TIBC
3) % saturation
4) Serum ferritin**

24
Q

How do you tell the difference between IDA and ACD?

A

See ppt.

25
Q

What is hemolytic anemia?

A

Anemia caused by the destruction of blood cells

26
Q

What are the causes of immune hemolytic anemia?

A

1) Drugs
2) Auto-immune disease e.g. SLE
3) Allo-immune
- Hemolytic transfusion rxn
- Hemolytic disease of newborn

27
Q

What is the most common cause of autoimmune hemolytic anemia?

A

Systemic Lupus Erythematosus

28
Q

What is the difference between the direct and indirect Coombs test?

A

DCT=

  • Direct Antiglobulin Test (DAT)
  • RBC

ICT=

  • INdirect Antiglobulin Test
  • Patient serum i.e. antibodies
29
Q

Explain the DCT.

A

1) RBC sample from patient
2) Add anti-human antibodies (Coombs reagent)
3) Aggregation/ agglutination occurs indicating a positive test

30
Q

Explain the ICT.

A

1) Obtain patient serum
2) Add donor (control) RBC
3) Patient Ig attack RBC
4) Add Coombs reagent
5) Agglutination indicates positive test

31
Q

What is the difference between lymphoma and leukemia?

A

Lymphoma= lymphoid masses arising in discrete masses i.e. in a solid organ

Leukemia= lymphoid neoplasm with involvement of blood and bone marrow
- DOES NOT form a MASS

32
Q

What cells are typically present in the germinal center of a lymph node?

A

asdf

33
Q

What are the lab tests for diagnosing lymphoma?

A

1) Hematoxylin and Eosin (H&E)
2) Immunophenotyping= determining cell type via protein expression
- Immunohistochemistry
- Flow cytometry
3) Cytogenetics/ FISH= chromosomal abberations
4) Molecular diagnostics i.e. PCR

34
Q

What is the key part of diagnosing lymphoma?

A
  • Immunohistochemistry
  • Flow cytometry

This is done to tell the difference between T and B cells

35
Q

What are the symptoms of lymphoma?

A

1) PAINLESS, non-tender mass
2) Lymhadenopathy
3) Fatigue
4) Malaise
5) Night sweats
6) Fever
7) Weight loss

36
Q

What is the difference between a diffuse and nodular lymphoma?

A

This is just the difference between the gross structure of a mass

37
Q

What does polymorphic mean?

A

Cells are not of the same type

38
Q

What is the origin of an immature lymphoid cell?

A

Lymphoblast

39
Q

What is the origin of mature lymphoid cells?

A

Peripheral cells

40
Q

What is the key marker for B-cells?

A

CD20

  • CD19
  • Lambda positive light chain
41
Q

What is the key marker for T-cells?

A

CD3

42
Q

What are the WHO characteristics for lymphoma classification?

A
  • Clinical features
  • Morphology
  • Immunophenotype*****
  • Cytogenetics
  • Molecular analysis
43
Q

What are the five main categories of lymphoma?

A

1) Precursor B-cell/ immature B-cell
2) Peripheral B-cell/ mature
3) Precursor T-cell/ immature T
4) Peripheral T-cell and NK cell/ mature T and NK
5) Hodgkin

44
Q

Outline the staging of lymphoma.

A

I= single node, region, or extralymphatic site

II= 2+ regions on same side of diaphragm

III= BOTH sides of diaphragm

IV= Disseminated or diffuse involved

45
Q

What is the difference between A and B stages of lymphoma?

A

Asymptomatic= A

Symptomatic= B

46
Q

PET Scan example from powerpoint.

A

Stage III

47
Q

What are the defining characteristics of Hodgkin Lymphoma?

A

Reed-Sternberg cells and variants

Hematology and Oncology (38 decks)

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