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Diagnostics Exam 4 Shea > CBC & Iron > Flashcards

CBC & Iron Flashcards

1
Q

What 4 values are we looking at when ordering a CBC?

A
  • WBC abnormalities
  • Hemoglobin abnormalities
  • Hematocrit abnormalities
  • Platelet abnormalities
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2
Q

4 findings for WBC abnormalities

A
  • infection
  • inflammation
  • neoplasm/malignancy
  • drug rxns
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3
Q

2 findings for hemoglobin/hematocrit abnormalities

A
  • anemia

- polycythemia

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4
Q

2 findings with platelet abnormalities

A
  • bleeding disorders

- hypercoagulable states (excessive clot formation)

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5
Q

What are the 2 components of a White Blood Cell Count?

A
  • WBC count (total # WBC (leukocytes)

- The Differential (% of each type of leukocyte present in the sample)

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6
Q

WBC can be elevated in a certain age. How old and why?

A

Newborns (childbirth is stressful)

*will decline to normal range over 2 weeks

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7
Q

What is the most predominent lab value of a WBC Differential (CBC w/diff)?

A

Neutrophils (40-85%)

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8
Q

Definition: has granules in their cytoplasm and multilobed nuclei

A

granulocytes

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9
Q

What is a PMN?

A

-granulocytes

“polys” (polymorphonuclear leukocytes)

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10
Q

-Most common PMN –Primary job is phagocytosis of bacteria

A

Neutrophils

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11
Q

Involved in allergic rxns

A

Eosinophils

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12
Q

Involved in parasitic reactions and are also known as “mast cells”

A

Basophils

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13
Q

A bacterial infection will have elevated what?

A

Neutrophils

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14
Q

-Decrease in neutrophils
-Elevated lymphocytes (T and B cells)
What’s going on?

A

Acute viral infection
or
Chronic bacterial infection

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15
Q

Capable of fighting bacteria like neutrophils do

A

Monocytes (phagocytic cells)

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16
Q

Neutropenia

A

Decrease

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17
Q

Neutrophilia

A

Increase

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18
Q

Monocytosis

A

Increase

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19
Q

Monocytopenia

A

Decrease

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20
Q

Eosinophilia

A

Increase (granulocytes)

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21
Q

Eosinopenia

A

Decreased

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22
Q

Basophilia

A

Increase (granulocytes)

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23
Q

Basopenia

A

Decrease

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24
Q

The 3 granulocytes

A
  • Neutrophils
  • Eosinophils
  • Basophils
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25
Q

The 2 nongranulocytes (agranulocytes)

A
  • Lymphocytes (T and B cells)

- Monocytes

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26
Q

Leukocytosis, what type of infection is happening? (most common)
What cells would be increased?

A

Bacterial infection

Cytosis = increase in WBC (neutrophils)

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27
Q

Leukopenia, what type of infection is happening?

A

Viral infection

Penia= decrease in WBC

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28
Q

Which autoimmune disease is related to leukopenia and relates to destruction of WBC?

A

HIV

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29
Q

What does a “left shift” mean?

A
  • bacterial shift
  • (leukocytosis)
  • acute bacterial infection
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30
Q

baby neutrophils

A

bands

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31
Q

With leukocytosis and left shift, what cells decrease? What cells increase?

A

Lymphocytes decrease

Neutrophils increase (acute bacterial)

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32
Q

What increases w/ left shift?

A

neutrophils and bands

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33
Q
  • Can be confused w/ leukemia initially
  • Elevated WBC
  • Development of early neutrophilic cells (metamyelocytes)
  • Associated w/infection
  • Benign (resolves after condition resolves)
A

Leukemoid Response

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34
Q

Which 5 things cause neutrophilia (elevated neutrophil count)

A
  • Bacterial infections
  • Leukemia
  • Inflammation (RA)
  • Medications
  • Stress

LIMBS

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35
Q

Which 4 things cause neutropenia (decreased neutrophil count)

A
  • Viral infection
  • Aplastic anemia
  • Overwhelming bacterial infection (the elderly)
  • Drugs
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36
Q

Which 2 things cause lymphocytosis (elevated lymphocyte count)

A
  • Viral infections (mononucleosis and viral hepatitis)

- Lymphocytic leukemia

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37
Q

Which 2 things cause lymphocytopenia (decreased lymphocyte count)

A
  • Corticosteroids

- Immunodeficiency diseases (HIV)

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38
Q

Which 5 things cause eosinophilia (elevated eosinophil)

A
  • Neoplasm (leukemia)
  • Allergic rxn (drug allergies) and allergic CONDITIONS
  • Addison’s disease
  • Collagen vascular disease (autoimmune, lupus)
  • Parasites
  • NAACP*

AND, in the valley = Coccidiomycosis

39
Q

Which 3 things cause eosinopenia (decreased eosinophil count)

A
  • Corticosteroids (opposite of Addison’s disease)
  • Acute stress
  • Inflammatory conditions
40
Q

Which 2 WBCs DO NOT respond to bacterial or viral infections?

A
  • Eosinophils

- Basophils

41
Q

If a pt has an allergic rxn (hives), what do we give them?

A

Glucocorticosteroids (prednisone) for symptomatic relief

42
Q

Increasing WBCs means what about an infection?

A

Worsening infection

43
Q

Decreasing WBCs mean what about an infection?

A

Resolving infection

44
Q

If WBC count is abnormal and the clinical picture is benign, what is the next step?

A

Check medications (may cause increases/decreases in WBC)

45
Q 
A 15 y/o female presents after being sent home from summer camp for malaise, fatigue, sore throat. 
-Hepatomegaly
-Splenomegaly
-Increased lymphocytes
-Decreased neutrophils
What is the dx?
A

Viral infection

mono or viral pharyngitis

46
Q

What blood test do we get to test for mononucleosis?

A

Mono Spot

47
Q

What test do we do to test for mononucleosis?

What is a positive finding?

A

Peripheral Smear

Atypical lymphocytes

48
Q

In what type of reaction will you see metamyelocytes and bands on a peripheral blood smear, but RARELY myeloblasts (immature forms)

A

Leukemoid reaction

49
Q

In what condition would you see bone marrow w/predominance of myeloblasts (immature elements)

A

Acute leukemia

50
Q

Pt with splenomegaly, WBC count was elevated 2 years ago (pt didn’t follow up), currently w/scattered lymph nodes and no sxs (worrisome). Peripheral smear shows increased mature lymphocytes.
What does the patient NOT have?
What is the likely dx..?

A

This is NOT leukemoid rxn because the WBC was elevated 2 years ago and has since increased)

Leukemia

51
Q

What helps initiate a coagulation cascade?

A

Platelets (plts)

52
Q

Integral to hemostasis

A

Platelets (plts)

53
Q

If platelet count is under 50,000 (low) what are we concerned about?

A

Bleeding

54
Q

If platelet count is over 1 million, what are we concerned about?

A

Blood clots

55
Q

What platelet count is needed to maintain vascular integrity?

A

5 - 10K

56
Q

PLT 30 - 50K

A

moderately increased risk of bleeding

57
Q

PLT greater than 50K

A

Good, not a problem

58
Q

PLT 10 - 30

A

severely increased risk of bleeding (but don’t transfuse pt unless bleeding)

59
Q

PLT <10K

A

severely increased risk of bleeding (transfuse)

60
Q

Thrombocytosis
(increased or decreased PLT levels)?
What condition?

A

Increased PLT levels

-Malignancy

61
Q

Thrombocytopenia
(increased or decreased PLT levels)?
What condition?

A

Decreased PLT levels

-Purpura (either idiopathic or thrombotic)

62
Q

Common in children and AIDS patients

A

ITP (idiopathic thrombocytopenic purpura)

63
Q

-Pt presents with mucosal/skin bleeding due to low platelets
-petechia, purpura, epistaxis, menorrhagia
-Low platelets
-Other blood counts and peripheral smear is normal
Dx?

A

ITP (idiopathic thrombocytopenic purpura)

64
Q

Tx and Prognosis of ITP

-What % will develop chronic ITP?

A
  • Children get better on their own (self limited)
  • Tx adults with corticosteroids and if unresponsive possible splenectomy
  • 50-60% will develop chronic ITP
65
Q

RBC life span

A

120 days

66
Q

Key function of RBC

A

Transportation of O2

67
Q

Reticulocyte life span

What is it?

A

“baby RBC”

4 days

68
Q

A decreased O2 causes the kidneys to release what?

A

Erythropoietin

69
Q

What does erythropoietin do?

A

Triggers stem cell hematopoiesis (leads to increased erythrocyte production) and ideally increased O2.

70
Q

A life span of RBC is 120 days, what happens at the end of its life?

A

Extracted by the spleen

71
Q

Binds and transports oxygen

A

Hemoglobin (Hgb)

72
Q

A measure of the total amount of hemoglobin in the blood

A

RBC count - Hemoglobin

73
Q
  • A measure of the % of total blood volume that is made up by RBCs.
  • Is approximately 3 times that of Hgb concentration
A

RBC count - Hematocrit

74
Q

If underhydrated, hematocrit high or low?

A

High

75
Q

If over-hydrated, hematocrit high or low?

A

Low

76
Q

RBCs can vary by 2 things.
What is anisocytosis?
What is poiliocytosis?

A
  • Size

- Shape

77
Q

Anisocytosis correlates with what?

A

RDW (red diameter width) = size

78
Q

Poiliocytosis suggests what?

A

A defect in maturation of RBC precursors (shape is affected)

79
Q

A patient has thalasemia or liver disease. What will the cells look like on their peripheral smear?

A

Target cells

80
Q

A patient has foreign bodies in blood from a heart valve and thermal injury. What will the cells look like on peripheral smear?

A

Fragmented

81
Q

A patient has Sickle Cell Anemia, what will cells look like on peripheral smear?

A

Sickle cells

82
Q

Increased RBC count due to what 3 things?

A
  • Dehydration
  • COPD
  • Polycythemia vera (bone marrow disorder)
83
Q

Decreased RBC count due to what?

A

Anemia

84
Q

What do these cause?

  • B12/Folate deficiency
  • Cirrhosis
  • Bone marrow failure
  • Pregnancy
A

Anemia

85
Q

-Dehydration
-Polycythemia Vera
-Smoking/COPD
-High altitude
Cause what?

A

Polycythemia/Erythrocytosis

increased RBC/Hgb/Hct levels

86
Q

What are the 2 types of polycythemia?

A
  • Relative

- Absolute

87
Q

What are the 2 types of absolute polycythemia?

A
  • Polycythemia Vera

- Secondary Polycythemia

88
Q

Artifact of concentration due to decreased plasma volume (dehydration)

  • Elevated Hct
  • Normal RBC mass
A

Relative Polycythemia

89
Q

True increase in RBC mass

A

Absolute polycythemia

90
Q
  • Elevated Hct

- Increased RBC mass

A

Polycythemia vera (bone marrow disorder characterized by overproduction of erythroid cells)

91
Q
  • Increased erythropoietin production

- Tissue hypoxia is major cause (COPD/living at high altitude)

A

Secondary Polycythemia

92
Q 
Hx:
HA, dizziness, tinnitus, blurred vision, fatigue, pruritus following warm shower/bath
PE:
engorged retinal veins
-Thrombosis
-Splenomegaly
Dx?
A

Polycythemia vera

93
Q

-Elevated Hgb/Hct
-Increased RBC mass
-Leukocytosis
-Thrombocytosis
Dx?
Tx?

A
  • Polycythemia Vera

- tx w/ phlebotomy

Diagnostics Exam 4 Shea (3 decks)

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