CBC

Question 1

WBC Differential

Answer 1

WBC differential – percentage or absolute number of each type of WBC
Example: to get neutrophils, WBC * % of neutrophils

Leukocytosis or leukopenia - need to figure out which of the WBCs are changed to figure out the cause of the problem

Question 2

Neutropenia

Answer 2

Bone marrow suppression; toxicity
- chemotherapy, radiation, chemicals.

Stem cell disorder
- leukemia, myelodysplasia.

Increased utilization
- sepsis

Question 3

Neutrophilia

Answer 3

Increased production:

- bacterial infection
- differentiating myeloproliferative disorders.
- exogenous colony stimulating factors.

Shift from storage pools:
- stress, infection

Granulocyte stimulating factor – boost neutrophils formed and will overshoot then get neutrophilia and then corrects itself
Pediatrics: venipuncture cause their epinephrine to increase, then neutrophilia from traumatic venipuncture

Question 4

Lymphopenia

Answer 4

Decreased production:

- chemotherapy
- chemicals
- radiation
- viral infections

Question 5

Lymphocytosis

Answer 5

Increased production:

- some lymphoproliferative disorders    
- some bacterial/viral infections

Decreased removal:
- some lymphoproliferative disorders with reduced apoptosis

Question 6

Monocytopenia vs. Monocytosis

Answer 6

Monocytopenia – uncommon occurrence.

Monocytosis – transient increase common and nonspecific, prolonged increase seen in some myeloproliferative diseases like leukemia

Question 7

Eosinopenia vs. Eosinophilia

Answer 7

Eosinopenia – chemotherapy, radiation, chemicals.

Eosinophilia – NAACP

- some neoplasms, leukemia      
- allergies
- some autoimmune diseases
- some collagen-vascular diseases
- parasitic infestations (worms)

Question 8

Basopenia vs. Basophilia

Answer 8

Basopenia – uncommon occurrence.

Basophilia

- allergic reactions.
- some myeloproliferative diseases (CML)

Question 9

Left Shift

Answer 9

Increase in peripheral blood immature granulocytes, no matter what the cause.

Bands = stabs.

May indicate stress, infection or leukemia

Question 10

Erythrocytosis vs. Erythropenia

Answer 10

Erythrocytopenia indicates anemia, but [Hb] is a better measure of this

Erythrocytosis:
Increased production to make up for small RBC size (thalassemia).
Inadequate O2 carrying capacity of blood (secondary polycythemia).
Autonomous RBC production (primary polycythemia).
Exogenous EPO use

Question 11

Hb

Answer 11

Normal adult: 12-16 women, and 13 – 17 men (androgens receptors on hematopoietic cells)
All forms of Hb are included in the result (Hb-O2, Hb-CO2, Hb-CO).

Question 12

Low Hb

Answer 12

Anemia = Low Hb; Erythrocytosis = High Hb

Decreased production (a bone marrow problem)

Increased RBC loss (a vascular system problem)

A combination of both mechanisms

Question 13

Hct

Answer 13

Hematocrit – ratio of RBC volume to total blood volume.
Units: none.
Can be directly measured or calculated as: RBC x mean corpuscular volume (MCV)

Low: anemia
High: erythrocytosis/polycythemia

Question 14

MCV

Answer 14

Mean corpuscular volume
MCV = Hct/RBC
Normal Range: 80-100
Less than 80 = microcytic anemia
More than 100 = macrocytic anemia
Can use RBC size relative to a small lymphocyte to determine cytosis

Question 15

MCH

Answer 15

Mean corpuscular Hb
MCH: Hb/RBC

Low MCH – small cells and/or anemia.
High MCH – large cells, no anemia

Question 16

MCHC

Answer 16

MCHC – mean corpuscular hemoglobin concentration
MCHC = Hb/Hct

Low MCHC – anemia with disproportionate decrease in [Hb] compared to RBC size.
High MCHC – disproportionate quantity of Hb in RBC; indicates presence of spherocytes in blood

Question 17

RDW

Answer 17

RDW – red cell distribution width
A quantitative expression of the degree of RBC anisocytosis, the variability in RBC size

Elevated RDW = anisocytosis.
Useful in diagnosing some anemias

Question 18

Burr Cells

Answer 18

Plasma is hypertonic and water is leaving the cell

Sometimes caused in renal failure

Question 19

Schistocytes

Answer 19

High mortality rate and severe disorder
Intravascular Hemolysis – RBC fragments
Cell hits fibrin and fragments and the cells lyse

Question 20

Spherocytes

Answer 20

Increased in intra- and extravascular hemolysis

High MCHC - more Hb in RBC

Question 21

Sickle Cells

Answer 21

hemoglobinopathy from HbS

Question 22

Acanthocytes

Answer 22

Chronic liver disease, abetalipoproteinemia
Similar to Burr cell, but longer in diameter
Not seen often

Question 23

Ovalocytes

Answer 23

Nonspecific; an inherited form exists

Seen in many forms of anemia

Question 24

Dacrocytes

Answer 24

Teardrop Cells (dacrocytes)
Myelophthisic (bone marrow infiltration) diseases

Question 25

Target Cells

Answer 25

Nonspecific; thalassemias, iron deficiency

Question 26

RBC Chromicity

Answer 26

Normal RBC biconcave disk has central pale zone that is about 1/3 the diameter of the cell = normochromic. Central pale zone > 1/3 = hypochromic. MCH can be used as a quantitative surrogate for looking at the peripheral smear. Low MCH = hypochromic

Question 27

Polychromasia

Answer 27

Blue tint to young RBC that retain some tRNA and ribosomes used to manufacture Hb as seen on a Wright stain. Reticulocyte – a young RBC as seen on a Methylene blue stain in which the residual ribosomes clump to form reticular material

Question 28

Reticulocyte Count

Answer 28

Low retic count with anemia – hypoproliferation of the bone marrow (proteins, iron, folate, B12 not available) High retic count with anemia – appropriate hyperproliferation of the bone marrow

Question 29

Platelet Count

Answer 29

Thrombocytopenia - decreased production. - increased destruction or utilization Thrombocytosis - reactive, transient increased production - neoplastic, autonomous production

Question 30

Pancytopenia

Answer 30

Leucopenia, Anemia, Thrombocytopenia. Causes - myelotoxic agents, radiation, inherited. - splenic sequestration, ineffective erythropoiesis