CBC

Question 1

How long does it take for RBCs to from from stem cells?

Answer 1

7 days

Question 2

How long do RBCs live?

Answer 2

~120 days

Question 3

How long does it take for reticulocytes to mature in circulation?

Answer 3

1 day

Question 4

What is a normal retic count? Why?

Answer 4

RBC production should equal destruction.

So, RBCs are destroyed at a rate of 0.8%-1%

Normal reticulocyte count 1-2%

Question 5

IF you have a high amount of reticulocytes, what will the CBC look like?

Answer 5

INCREASED MCV

INCREASED RDW

Question 6

Normal WBC

Answer 6

5,000-10,000/mm3

Question 7

Normal Hemoglobin

Answer 7

Men: 14-18 g/dL

Women: 12-16 g/dL

Question 8

Hematocrit

Answer 8

percentage of whole blood made up of RBCs

Question 9

Mean Cell Volume (MCV)

Answer 9

>100 = macrocytosis
80-100 = normocytic
<80 = microcytosis

(fL - fenoliters)

Question 10

Mean Cell Hemoglobin (MCH)

Answer 10

weight of the hemoglobin in the RBC

Question 11

Mean Cell Hemoglobin Concentration (MCHC)

Answer 11

Normal: ~31-35%

Question 12

Red Cell Distribution Width (RDW)

Answer 12

Range in cell size

Normal: 12-15%

Question 13

Anisocytosis

Answer 13

• abnormalities of size

- correlates with RDW

Question 14

Poikilocytosis

Answer 14

• abnormalities in shape

- suggests defect in the precursor cells

Question 15

Hyperchromasia

Answer 15

Causes:

1. dehydration
2. spherocytes

Question 16

Polychromasia

Answer 16

-blue staining RBCs

Question 17

Peripheral smear: target cells

Answer 17

Suggests:

1. Hemoglobinopathy
2. Thalassemia
3. Liver disease

Question 18

Peripheral smear: Basophilic stippling

Answer 18

• represent ribosomal precipitates
  1. Thalassemia
  2. Alcohol abuse
  3. Lead/heavy metal poisoning

Question 19

Peripheral smear: Rouleaux formation

Answer 19

Associated with Multiple myeloma

Question 20

Peripheral smear: Fragmented cells

Answer 20

1. Schistocytes
2. Helmet cells

Associated with:

• Mechanical heart valve
• DIC
• Thrombotic thrombocytopenic purpura (TTP)

Question 21

Heinz bodies

Answer 21

Aggregates of denatured hemoglobin

Seen in:

• G6PD deficiency**
• Autoimmune hemolytic anemia
• Thalassemia

Question 22

Bite cells

Answer 22

Removal of hemoglobin precipitate by macrophages

Seen in”

• G6PD deficiency**
• hemolytic anemia

Question 23

Howell-Jolly Bodies

Answer 23

Small, round remnants of DNA

Seen in:

• Sickle cell
• Splenectomy
• Hemolytic anemia
• Megaloblastic anemia

Question 24

Smudge cells

Answer 24

Indicates that the lymphocytes are fragile

Seen in:
Chronic lymphocytic leukemia (CLL)

Question 25

What conclusion is to be made from seeing blasts, immature cells (ex. lymphoblasts, or myeloblasts) on peripheral smear?

Answer 25

ALWAYS abnormal finding -suggests malignant hematologic disorder

Question 26

If you see reticulocytosis with anemia, what should you think?

Answer 26

- hemolysis | - blood loss

Question 27

Anemia with normal reticulocyte count. What does this suggest?

Answer 27

substrate problem (ex. Fe deficiency, Vitamin B 12 deficiency) or Maturation problem (ex. myelodysplastic syndrome)

Question 28

Corrected retic count

Answer 28

= reticulocyte% x (patient hematocrit/45) If corrected is >3 =normal If corrected is <2= inadequate

Question 29

Clinical pearl to see if bone marrow is compensating for the anemia

Answer 29

retic count + hemoglobin = should be close 15 Ex. 6.4 + 8.2 = 14.6 [this is normal! bm is compensating for anemia]

Question 30

Serum Iron (Fe)

Answer 30

amount of iron in blood, bound to transferrin | 70% of total iron

Question 31

Ferritin

Answer 31

Measure of stored iron | 30% of total iron

Question 32

Total iron binding capacity (TIBC)

Answer 32

-total potential space available on RBC for Fe to bind

Question 33

Transferrin

Answer 33

-protein that binds to iron and transports to the bone marrow to be incorporated in hemoglobin

Question 34

Transferrin saturation

Answer 34

Amount of transferrin available for binding mobile iron Ex. will be very HIGH in hemachromatosis. Also elevated in hemolytic, megaloblastic, sideroblastic anemia. <15% in Fe deficiency anemia Normal is 20-50%

Question 35

What is the most sensitive test to detect iron deficiency

Answer 35

Ferritin

Question 36

What does a low ferritin ssuggest

Answer 36

Fe deficiency

Question 37

What does a high ferritin suggest?

Answer 37

hemochromatosis

Question 38

Acute-phase reactants

Answer 38

Ferritin - elevated with inflammation and infection, but not iron storage issue Transferrin - decreased (negative acute-phase reactant) with acute inflammation. Can also be decreased if liver dx since transferrin is made in the liver

Question 39

What is the best iron test for hemochromatosis?

Answer 39

Transferrin saturation