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From Flashcardlet > Clinical Lab Med 3 > Flashcards

Clinical Lab Med 3 Flashcards

1
Q

What are we worried about when WBCs are impaired?

A

Infection and malignancy

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2
Q

What does a WBC look like?

A

Fluffier and rounder than a RBC

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3
Q

What cells make us assume infection is present?

A

Neutrophils, Lymphocytes, and Monocytes

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4
Q

What cells make us assume an allergic reaction is happening?

A

Eosinophils and basophils

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5
Q

Where are all white blood cells produced?

A

Bone marrow

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6
Q

What hormones stimulate the production of neutrophils?

A

Hematopoeitic growth factors

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7
Q

What kind of cell does a neutrophil mature from?

A

Myeloblast, then myelocyte, through mitosis

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8
Q

How many days does it take for a neutrophil to mature?

A

12 days

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9
Q

What happens to the maturation of neutrophils if the body has an increased demand for them?

A

Mitosis will increase and maturation time will decrease

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10
Q

What is the main goal of a neutrophil?

A

To remove and kill bacteria and foreign bodies

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11
Q

What ability does a neutrophil have that makes it a good first responder?

A

Ability to produce and mature quickly if the body calls for more response

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12
Q

How long do neutrophils last in peripheral circulation?

A

8 hours

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13
Q

Do neutrophils return to circulation after they enter the tissues?

A

Never reenter the circulation

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14
Q

What substances call a neutrophil to a specific site?

A

Chemotactic substances like complement or platelet activating factor

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15
Q

What do the cytoplasmic components of neutrophils do?

A

Responsible for bactericidal activity

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16
Q

Do all WBCs originate from the same stem cells?

A

No, all have different progenitor cells

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17
Q

What is the main function of eosinophils?

A

Attracted to tissue invasion from parasites and allergic reactions

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18
Q

How do eosinophils know where to migrate?

A

Chemotactic factors released by tissues attract their presence

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19
Q

What does prolonged existence of eosinophils cause?

A

Can cause inflammation damage at the site if they are there too long

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20
Q

What do the cytoplasmic granules of eosinophils do?

A

Damage parasites and impede their replication

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21
Q

How long before basophils enter the tissues?

A

Within several hours after the release into circulation

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22
Q

How do basophils react to antigens?

A

Basophils bind to antigens

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23
Q

What substance do basophils release?

A

Histamine

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24
Q

What cell is related to the basophil?

A

Mast cell

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25
Q

What happens during a type I hypersensitivity reaction?

A

Antigen cross linking of IgE to basophils and mast cells causes the release of histamine

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26
Q

What symptoms does histamine cause?

A

Symptoms of hypersensitivity:

  • Hives
  • Watery eyes
  • Itchy nose
  • Coughing etc.
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27
Q

How long does it take for monocytes to mature?

A

4 days

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28
Q

What is the main function of monocytes?

A

Break up foreign particles for lymphocytes

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29
Q

Do we have storage for monocytes in the body?

A

No, monocytes are only produced when we need them

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30
Q

How long before monocytes enter the tissues?

A

3 days in circulation before entering the tissues

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31
Q

What kind of cells are monocytes in the tissues?

A

Macrophages (specialized Kupffer)

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32
Q

How can monocytes function to have no stores in the bone marrow?

A

They are able to proliferate in tissues, outside of bone marrow

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33
Q

What do monocytes secrete in terms of inflammation?

A

Mediators of inflammation

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34
Q

What do monocytes do to red blood cells?

A

Remove old RBCs from circulation

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35
Q

What are monocytes role in the immune response?

A

Present and process antigens to both T and B lymphocytes

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36
Q

Where do B lymphocytes differentiate and mature?

A

Bone marrow

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37
Q

Where do T lymphocytes differentiate and mature?

A

Thymus

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38
Q

Where are lymphocytes typically found?

A

After maturation they migrate to occupy peripheral lymphoid tissue, including lymph nodes, spleen, tonsils, and mucosal sites

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39
Q

Where are lymphocytes found during an immune response?

A

Freely move in circulation and tissues

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40
Q

What percentage of lymphocytes are T cells?

A

70-80%

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41
Q

What percentage of lymphocytes are B cells?

A

20-30%

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42
Q

What do lymphocytes determine, in terms of a immune response?

A

Difference between self and non self

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43
Q

How long is a lymphocytes half life?

A

Long half life

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44
Q

What two types of T cells do lymphocytes divide into?

A

CD4 and CD8

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45
Q

What are CD4 and CD8 cells named after?

A

Glycoproteins in the cells

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46
Q

What T cells are CD4 associated with?

A

Helper T cells

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47
Q

What T cells are CD8 associated with?

A

Cytotoxic T cells

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48
Q

What do CD4 cells do?

A
  • Signal other immune cells
  • Assist in production of antibodies by B cells
  • Activate macrophages
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49
Q

What do CD8 cells do?

A

Able to lyse viral and bacterial infected cells

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50
Q

What is signaled to the body with a decrease in CD4 cells?

A

The body needs to replicate and send in reinforcements

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51
Q

What do B cells differentiate into?

A

Plasma cells

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52
Q

When do B cells differentiate into plasma cells?

A

After interaction with an antigen

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53
Q

What are natural killer cells?

A

Able to cause cell lysis without prior antigen exposure

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54
Q

Is there a reference range for NK cells?

A

No, there is great variability in people’s numbers of NK cells

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55
Q

What kind of blood do we use to pull for labs?

A

Venous blood

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56
Q

What kind of anticoagulant can’t we use when drawing WBCs?

A

Heparin

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57
Q

Why can’t we use heparin?

A

It causes WBC clumping and a blue background when examining which clouds the ability to see WBCs

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58
Q

What temperature does a specimen need to be stored at?

A

Counts can be performed up to 24 hours after collection at 4 degrees Celsius

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59
Q

What happens if venipuncture was traumatic or difficult?

A

Coagulation cascade could be activated

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60
Q

What happens to WBC levels if the coagulation cascade is activated?

A

Cascade traps WBC and platelets due to vasoconstriction, producing falsely low levels

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61
Q

What patients might have a difficult or traumatic blood draw?

A

Children

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62
Q

How do we count WBCs?

A

Automated instruments can determine WBC concentration by electrical impedance or light scattering charactertistcs

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63
Q

What three components presence may create a falsely elevated WBC count?

A
  • Reticulocytes
  • Giant platelets
  • Blood born parasites
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64
Q

What causes a falsely low WBC count?

A

WBC fragility from leukemia or presence of paraproteins

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65
Q

Why do the presence of reticulocytes, giant platelets, or parasites cause falsely elevated WBC counts?

A

They can look like WBCs to the automated instrument - peripheral blood smear to determine what the cells really are

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66
Q

Why does WBC fragility cause falsely low WBC counts?

A

WBC count is actually high but WBCs aren’t recognized due to fragility

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67
Q

When does a patient have paraproteins?

A

When they have cancer

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68
Q

What is a differential count?

A

Determines the percentage of each WBC

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69
Q

When is a peripheral blood smear indicated?

A
  • Verify erroneous results
  • Evaluate for morphologic WBC abnormalities
  • Look for suspected undetected low concentration of abnormal cells
  • Evaluate for suspected circulating parasites or other microorganisms
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70
Q

When do we do a bone marrow biopsy and aspirate?

A

When we don’t have an answer after a peripheral blood smear

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71
Q

What is a bone marrow aspirate?

A

Removal of a small amount of bone marrow fluid through a needle put into a bone

72
Q

What is a bone marrow biopsy?

A

Removal of a small amount of bone along with bone marrow fluid

73
Q

Where is bone marrow aspirate done?

A

Iliac crest

74
Q

What are indications for bone marrow examination?

A
  • Anemia, leukopenia, thrombocytopenia
  • Polycythemia, leukocytosis, thrombocytosis
  • Leukemia
  • Staging for tumors
  • Obtain culture material for suspected chronic infections
  • Support diagnosis of anemias
75
Q

What is neutropenia?

A

Low neutrophil count

76
Q

What infections cause neutropenia?

A
  • Bacteria
  • Viruses
  • Rickettsia
  • Protozoa
77
Q

What kind of patients present with neutropenia?

A
  • Debilitated patients
  • Nutritional deficiencies
  • Myelotoxic medications
78
Q

What is a myelotoxic medication?

A

Hurts the bone marrow and impedes WBC production

79
Q

What conditions present with neutropenia?

A
  • Leukemia

- Myelodysplasia

80
Q

What is neutrophilia?

A

High neutrophil count

81
Q

What are two common causes of neutrophilia?

A

Infection or inflammation

82
Q

What can neutrophilia present with?

A
  • Acute infection
  • Tissue damage or necrosis
  • Acute hemorrhage
  • Eclampsia
  • Exercise
  • Seizures
  • Steroids
83
Q

What is eclampsia?

A

High blood pressure during pregnancy along with seizures

84
Q

How do steroids relate to neutrophilia?

A

They calm inflammatory response, but also increase the production of neutrophils

85
Q

What is lymphocytosis?

A

Increased lymphocytes

86
Q

What is the character of lymphocytosis in children or young adults?

A

Almost always non-neoplastic

87
Q

What is the character of lymphocytosis with increased age?

A

Incidence of neoplasm increases with age

88
Q

When would you think that a neoplasm is present in a patient with lymphocytosis?

A

When infection is not present

89
Q

What disorders commonly present with lymphocytosis?

A
  • Pertussis
  • Chronic lymphocytic leukemia
  • Mononucleosis
  • Infectious hepatitis
90
Q

What does lymphocytosis probably present with in young people?

A

Viral infection

91
Q

What is lymphocytopenia?

A

Decreased lymphocytes

92
Q

When would a patient have lymphocytopenia?

A

If an infection persists, lymphocytes can decrease because they body has been fighting for so long and gets tired or runs out of stores of lymphocytes

93
Q

What conditions present with lymphocytopenia?

A
  • Infections
  • Immune disorders
  • Medications
  • HIV infection
94
Q

What kind of medications cause lymphocytopenia?

A

Chemotherapy, some antibiotics

95
Q

What is a monocyte disorder?

A

Monocytosis - high monocyte counts

96
Q

Why doesn’t a patient have monocytopenia?

A

The body doesn’t keep stores of monocytes, so it is normal to have a low level

97
Q

When does a patient get a monocyte disorder?

A

Numerous infections and neoplasms

98
Q

What are some infections associated with a monocyte disorder?

A
  • TB
  • Malaria
  • Syphillis
  • Thyphus
99
Q

What are some cancers associated with a monocyte disorder?

A

-Hodgkin’s disease
-Multiple myeloma
-Melanoma
-Sarcoidosis
CML
AML

100
Q

What are eosinophil disorders?

A

High eosinophil levels

101
Q

Are high eosinophil levels always shown in abnormal conditions?

A

No, some people have naturally elevated eosinophil counts

102
Q

When are eosinophil disorders seen?

A
  • Allergic reactions
  • Parasitic infections
  • Neoplasm like CML
  • Acute inflammation or stress
  • Corticosteroid use
103
Q

What is a basophil disorder?

A

High basophil levels

104
Q

When is a basophil disorder most commonly seen?

A

Inflammatory response or allergic reaction

105
Q

What are some conditions in which basophil disorders present?

A 
-CML
0Ulcerative colitis
-Chronic sinusitis
-Iron deficiency
-Smallpox
-Hodgkin's disease
106
Q

How does a leukemia develop?

A

Unregulated proliferations of hematopoeitic cells in the bone marrow

107
Q

What is acute leukemia characterized by?

A

Proliferations of immature or precursor cells, with a rapid clinical course

108
Q

What is chronic leukemia characterized by?

A

Proliferations of mature cells, with a longer clinical course

109
Q

What might a patient present with in terms of signs and symptoms with a chronic leukemia?

A

May be asymptomatic

110
Q

What are the goals of a leukemia workup?

A
  • Establish diagnosis
  • Subtype leukemia
  • Perform cytogenic studies
  • Perform molecular genetic studies
  • Examine extramedullary tissues and fluids for involvement
  • Evaluate effectiveness of therapy
111
Q

Why do we need to subtype a leukemia?

A

To determine the best treatment and prognosis

112
Q

Why do we examine the extra medullary tissues and fluids with leukemia?

A

To see if the cancer has spread

113
Q

What tests do we use to achieve the goals of a leukemia workup?

A
  • Peripheral blood smear
  • Bone marrow biopsy
  • Bone marrow aspirate
114
Q

What does acute leukemia present with?

A

Nonspecific complaints like fatigue and persistent infection

115
Q

When would you order a CBC for a patient suspected of leukemia?

A

When they have come in numerous times for persistent infection or they are constantly sick and barely recovering

116
Q

What kind of anemia presents with acute leukemia?

A

Normocytic normochromic anemia

117
Q

What happens to the WBC count with acute leukemia?

A

Could be high or low depending on the stage of the disease

118
Q

How do we make a diagnosis of acute leukemia?

A

30% of all marrow cells must be blast cells

119
Q

What are blast cells?

A

Immature WBCs

120
Q

What are two types of acute leukemia?

A

Acute lymphoblastic leukemia

Acute myelogenous leukemia

121
Q

What is ALL?

A

Acute lymphoblastic leukemia

122
Q

What type of patient gets ALL?

A

Commonly seen in children

123
Q

What type of patient has a favorable prognosis with Acute lymphoblastic leukemia?

A

Females age 2-10, with a WBC count less than 10

124
Q

What do cells look like with Acute lymphoblastic leukemia?

A

Small and have a suspicious nuclei

125
Q

What is AML?

A

Acute myelogenous leukemia

126
Q

What type of patients get Acute myelogenous leukemia?

A

Predominantly a disease of middle aged and older adults, also presents in newborns and infants

127
Q

What does the sub typing of AML depend on?

A

Tendency toward differentiation

128
Q

What do the cells look like with AML?

A

Cells have large nuclei and multiple nuclei

129
Q

What is the indicative characteristic of AML?

A

Presence of Auer rod

130
Q

What are two types of chronic leukemias?

A

Chronic myelongenous leukemia

Chronic lymphocytic leukemia

131
Q

What do the blood findings of chronic leukemias present with?

A

Pancytopenia or marked leukocytosis

132
Q

What type of patients get Chronic myelongenous leukemia?

A

Affecting adults with median age of 50, slightly greater in males

133
Q

What are the symptoms with Chronic myelongenous leukemia?

A

Nonspecific symptoms like weight loss and fatigue - half of patients are asymptomatic

134
Q

What is common with the spleen in Chronic myelongenous leukemia?

A

Splenomegaly

135
Q

What is CML?

A

Chronic myelongenous leukemia

136
Q

What do the labs look like with Chronic myelongenous leukemia?

A
  • Neutrophilia
  • WBC count greater than 25 (half of cases present with greater than 100)
  • Myelocytes and neutrophils predominate
  • Eosinophils and basophils are typical
  • Thombocytopenia
137
Q

What type of anemia is associated with Chronic myelongenous leukemia?

A

Normochromic, normocytic anemia

138
Q

What chromosome is present in Chronic myelongenous leukemia?

A

Philadelphia chromosome present in 90%

139
Q

How long does the initial phase of CML last?

A

3-4 years

140
Q

What happens in the initial phase of CML?

A

Nothing, patient is asymptomatic

141
Q

What develops after the initial phase of CML?

A

Blast crisis

142
Q

What is a blast crisis?

A

Accelerated phase where the patient suddenly has dysfunctioning WBCs - all cells released from the bone marrow are blast cells

143
Q

How long does a patient typically survive after a blast crisis?

A

2-6 months

144
Q

What is CLL?

A

Chronic lymphocytic leukemia

145
Q

What is the most common adult leukemia?

A

Chronic lymphocytic leukemia

146
Q

What type of patient gets Chronic lymphocytic leukemia?

A

Age 55, males outnumber females 2.5:1

147
Q

What occurs in Chronic lymphocytic leukemia?

A

Result of accumulation of small round lymphocytes in the blood, bone marrow, and organs

148
Q

What does the WBC count look like in Chronic lymphocytic leukemia?

A

Greater than 600

149
Q

What do WBCs look like in Chronic lymphocytic leukemia?

A
  • Small
  • Condensed
  • Blotchy chromatin
  • Inconspicuous nuclei
  • Scant cytoplasm
150
Q

What other blood disorders does Chronic lymphocytic leukemia present with?

A

Anemia and thrombocytopenia

151
Q

What blood disorder may develop with Chronic lymphocytic leukemia?

A

Neutropenia may develop as bone marrow infiltrates become more extensive

152
Q

What organs are infiltrated in Chronic lymphocytic leukemia?

A

Splenomegaly and lymphadenopathy

153
Q

What other malignancies are seen with Chronic lymphocytic leukemia?

A
  • Melanoma
  • Carcinomas of GI tract and lungs
  • Sarcoma
154
Q

What is the staging system for CLL?

A

Rai system or Binet system

155
Q

What are the two types of lymphoma?

A

Hodgkins and non Hodgkins

156
Q

Which lymphoma prognosis is better?

A

Hodgkin’s

157
Q

What cell on biopsies confirm Hodgkin’s lymphoma?

A

Reed Sternerg cell

158
Q

Where do lymphomas present?

A

Lymph nodes

159
Q

What are two strange presentations of lymphoma?

A
  • Itching in hands and feet, due to released histamine from lymph nodes
  • Pain after drinking until alcohol is metabolized
160
Q

What are the three components needed for hemostasis?

A
  • Vessel wall
  • Platelets
  • Coagulation
161
Q

What happens if there is a dysfunction in any three components for hemostasis?

A

Inability to clot properly

162
Q

What are the four functions of platelets in hemostasis?

A
  • Adhesion to collagen
  • Aggregation of additional platelets
  • Release of platelet contents to promote hemostasis
  • Provision of phospholipid surface to assemble proteins of coagulation cascade
163
Q

Where do platelets adhere to?

A

Collagen at the site of vascular injury - when endometrium is disrupted, collagen is exposed

164
Q

How do platelets adhere to collagen?

A

Adhere to endothelial cells based on reaction between glycoprotein Ib and Von Willebrand factor

165
Q

What happens after platelets adhere to collagen?

A

They activate other platelets to bind soluble molecules like fibrinogen

166
Q

What substance do platelets bind to?

A

Fibrinogen

167
Q

What does fibrinogen do in hemostasis?

A

Acts as a bridge between the interacting platelets and the activated platelets at the binding site

168
Q

What substances are platelets rich in?

A
  • ATP
  • ADP
  • Calcium
  • Enzymes
  • Clotting factors
169
Q

What do the release of platelets contents promote?

A

Platelet aggregation

170
Q

What substance results in vasoconstriction?

A

Release of platelet factors combined with prostaglandin thromboxane A2

171
Q

What does a platelets phospholipid layer do?

A

Crucial for organizing and promoting interactions of clotting factors - activates coagulation cascade

172
Q

What is the reference range for platelet counts?

A

100-450

173
Q

What level of platelet count is dangerous?

A

Below 50

174
Q

When is a platelet count of below 50 dangerous?

A

Surgery or trauma

175
Q

What level of platelet count is extremely dangerous?

A

Below 20

176
Q

What does a platelet count of less than 20 result in?

A

Spontaneous bleeding

From Flashcardlet (133 decks)

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