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chapt 1 Flashcards

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1
Q

BMP

A 
Basic Metabolic Panel
Glucose 
Na, K, Cl-, Ca, CO2
Creatinine
BUN blood urea nitrogen
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2
Q

Hepatic function

A

AST (in blood),ALT (in liver), GGT (in liver) Alkaline phosphatase
Albumin, Bilirubin, Prothrombin time
Total protein

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3
Q

CMP

A

Comprehensive metabolic panel

  • BMP+
  • AST,ALT
  • albumin, bilirubin
  • total protein
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4
Q

Lipid panel

A

Total cholesterol, Triglyceride level

HDL, LDL, VLDL-lipoprotein in liver

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5
Q

Peripheral smear

A 
complements RBC indices and RDW
poikilocytosis (abnormal shapes)
scale define % of cells affected
1+ 25% cells affected
2+ 50%
3+ 75%
4+ all cells affected
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6
Q

Target cells

A

hemoglobinopathies

thalassemia

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7
Q

Burr Cells

A

Uremia
Liver Disease
Post splenectomy
Image= blow fish

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8
Q

spherocytes

A

hereditary spherocytosis

acquired immunohemolytic anemia

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9
Q

Heinz bodies

A 
denatured hgb
G6PD deficiency
Alpha Thallasemia
small round inclusions w/in the red cell body
punticos
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10
Q

Thallasemia

A

(inherited) in which the body makes an abnormal form of hemoglobin

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11
Q

Components of CBC

A 
Red Blood cell count
Red blood cell indices: MCV, MCH, MCHC, RDW
Peripheral smear
Platelet count
Htc
Hgb
WBC count
WBC differential
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12
Q

Complaints supporting CBC

A

fever, fatigue, dizziness (not vertigo)
dyspnea, palpitations, angina
bleeding, bruising, heme +, jaundice-yellow
weight loss, lymphadenopathy

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13
Q

RBC Data

A

Total RBC count
Hgb/Hct
RBC indices: MCV, MCH, MCHC, RDW
Manual examination of peripheral smear

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14
Q

RBC COUNT

A 
circulating RBC'S in 1mm3 peripheral venous blood
M--4.7-6.1
F--4.2-5.4
ANEMIA = >10% below normal
Erythrocytosis = excess
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15
Q

RBC INDICES

A

helpful in categorizing anemias

Classifies RBC into size, [Hgb] : MCV, MCH, MCHC, RDW

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16
Q

Hct

A 
measures packed RBC vol (PCV)
% of total blood vol made up of RBC'S
M--42-52%
F--37-47%
CRITICAL  60%
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17
Q

Hgb

A

[Hgb] in peripheral venous sys
M–14-18 g/dL
F–12-16 g/dL
pregnant >11g/dL

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18
Q

Rule of Threes / Normal values

A

Checks for artifacts
Hct=3xHgb
Hgb=3xRBC count

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19
Q

Causes of decrease RBC, Hgb, Hct

A 
Hemorrhage, Hemolysis, Hemo-dilution
Dietary deficiency- B12
Getenic defect--sickle cell
Drugs
Marrow/organ Failure, chronic illness,
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20
Q

Causes of increase RBC, Hgb, Hct

A 
hemoconcentration
chronic hypoxia: COPD, smoking
Polycythemia vera
High altitudes
drugs
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21
Q

MCV

A

mean corpuscular value, red blood cell size
80-95 fL = normocytic
95 fL macrocytic cells

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22
Q

MCH

A

mean corpuscular Hgb
reflects ave. amount (weight) of Hgb in e/RBC
Parallels MCV–adds more info
Normal 27-31 pg

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23
Q

MCHC

A

mean corpuscular [hgb]
32-36%
<32% hypochromic
32-36% normochromic

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24
Q

RCDW

A

red cell distribution width
cell size variability
reference range 11-14.5%

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25
anisocytosis
elevated RDW | considerable variation in size of cells
26
peripheral smear
looks at abnormal shapes (poikilocytosis), staining patterns
27
scales for peripheral smear
1+ 25% of cells affected 2+ 50% 3+ 75% 4+ all cells
28
Target cells
hemoglobinopathies | thalassemia
29
Burr cells
spiky | Uremia, Liver disease, Post splenectomy
30
Spherocytes
"sphere shape" hereditary spherocytes acquired immunohemolytic anemia high osmotic fragility--degradation
31
Heinz bodies
``` bolita con la pepita roja G6PD deficiency Alpha Thallasemia denatured DNA Hgb component usually thru oxidations or the change of an internal amino acid residue from an inherited mutation ```
32
Howell-Jolly bodies
``` normal con un pedacito de morado Myelodysplasia Sjogren syndrome antibody Post Splenectomy Nuclear remnants ```
33
Basophilic stippling
lead poisoning puras pepitas purpuras=accumulations of rRNA always pathological
34
Schistocyte (Helmet cells)
``` Artificial valve Disseminated intravascular coagulation thrombotic thrombocytopenic purpura hemolytic uremic syndromes mitad de la luna ```
35
Reticulocyte count
baby RBCs mature into RBCs 2 days after release single best test to determine bone marrow response to anemia
36
Reticulocytes
Normal 0.5 - 2.0 % | > or = 1.0 is good response
37
reticulocyte if low in anemia
no bone marrow response not capable - aplastic (dying/sick) no materials - Fe, folate, B12 deficiency
38
reticulocyte if high in anemia
bone marrow is trying to compensate
39
ESR
erythrocyte sedimentation rate rate at which RBCs settle in saline sol or plasma over a specified amount of time M--15 mm/hr F--20 mm/hr Elevated in chronic / acute inflammation Can help determine if anemia is related to inflammation / chronic disease states
40
ESR
NON-SPECIFIC so not diagnostic Elevated in : occult neoplasms, necrotic diseases, renal failure used to monitor therapy
41
WBC
``` mobile units of body's immune system defend from pathogens id cancer cells remove body's litter by phagocytosis leave circulation and go to sites of invasion/tissue damage ```
42
WBC
``` count of total # WBCs differential counts (% for e/type) ```
43
types of leukocytes
granulocytes | nongranulocytes
44
granulocytes
stained--w/granules neutrophils basophils eosinophils
45
nongranulocytes
single, large,non segmented nucleus w/few granules monocytes lymphocytes
46
neutrophil
``` phagocyte specialist 1st on the scene infxn sites bact'l invasion important during inflammation 2-5 lobes ```
47
lymphocytes
smallest granulocytes b lymphocytes t lymphocytes
48
b lymphocytes
~5% | differentiate into antibody producing plasma cells (MEMORY)
49
t lymphocytes
``` ~90% cytotoxic T cells-->may attack: foreign bodies cancer cells infected cells ie: virus ```
50
eosinophil
larger, stain intensely than neutrophil | allergic rxns
51
basophils
purple granules, superimposed over the nucleus ? role synthesize and store histamine & heparin
52
monocytes
folded, lobulated nucleus, ground glass appearance to the cytoplasm chronic: infxns, inflammatory disorders form of MDS and myeloid leukemia
53
Elevations in WBC
persistent increase-- worsening infxous disease Appendicitis Pyelonephritis
54
Decrease in WBC
dramatic decrease: marrow failure as in chemo. patients w/ neutropenia
55
absolute Neutrophil count
ANC = WBC x (% Neutrophils + % Bands) | ANC 1,000> severe immunocompromised
56
Interfering factors that Increase in WBC counts
``` in the afternoon Eating physical activity stress pregnancy (final month & labor) newborns ```
57
pregnancy
final month and labor: increase WBC proteinuria cushing's disease--urine free cortisol elevated in pregnancy**give you a false +
58
Interfering factors that decrease in WBC counts
in the morning
59
Elderly
fail to respond to infxn w/ absence of leukocytosis | may not develop an elevated WBC w/infxn
60
leukocytosis
``` infxn leukemic neoplasia other malignancy trauma, stress, hemorrhage tissue necrosis inflammation dehydration (b/c of hemoconcentration) Thyroid storm steroid use ```
61
leukopenia
``` drug toxicity (chemo) bone marrow failure overwhelming infxns dietary deficiency congenital marro aplasia bone marrow infiltration autoimmune dis hypersplenism ```
62
anemia
generally as Hgb decrease of >10% OR Hgb < 12 g/dL (F) or 14 g/dL (M) OR Hct < 36% (F) or 42% (M)
63
3 general mechanism of anemia
``` decreased prodxn (hypoproliferation-bmarrow) Increased destruxn (hemolysis) blood loss (hemorrhage) ```
64
RBC prodxn
kidney senses hypoxia | increase EPO prodxn->stimulates bone marrow to produce more RBCs (Iron, folate, B12 into blood)
65
most common symptoms of anemia
often asymptomatic | weakness & fatigue
66
severity of anemia's symptoms reflect
degree of anemia rapidity of onset level of compensation (kidney & Bmarrow)
67
anemia due to decreased O2 transport present w/
fatigue, dyspnea, angina
68
anemia due to decreased blood vol present w/
pallor, postural hypotension, syncope, headache, tinnitus
69
anemias due to decreased cardiac output present w/
tachycardia, systolic ejection (heart murmur) | lightheadedness
70
anemias due to hemolysis of red blood cells present w/
jaundice | splenomegaly
71
Hgb & Hct values indicate anemia
WBC & platelet presence/absence of pancytopenia MCV RBC count
72
Where is Fe is absorbed?
duodenum and upper jejunum
73
transports Fe
transferrin (TIBC)
74
stores Fe
ferritin (ferritin test)
75
Iron def. anemia
``` blood loss increased iron demand malabsorption poor dietary intake hemolysis ```
76
iron def anemia
60-170 mcg/dl serum iron total iron binding capacity ferritin
77
serum iron decreased in
``` chronic GI blood loss chronic heavy menstrual bleeding inadequate absorption of iron insufficient dietary iron pregnancy anemia of chronic dis ```
78
serum iron increased in
``` hemochromatosis hemolysis hemolytic anemias hemosiderosis hepatic necrosis hepatitis vitamin B6 and B12 deficiency iron poisoning multiple blood transfusions ```
79
TIBC
total iron binding capacity indirect measurement of transferrin NORMAL 240-450 mcg/dl
80
Decreased TIBC
``` cirrhosis sickle cell anemia hypoproteinemia pernicious anemia hemolytic anemia ```
81
increased TIBC
iron def anemia (transferrin up) late pregnancy polycythemia vera OCPs
82
ferritin test
measures amount of ferritin in blood M 12-300 ng/ml F 12-150 ng/ml
83
Ferritin low levels
chronic GI bleed chronic heavy menstrual bleeding iron deficient anemia
84
Elevated ferritin levels
``` alcoholic liver disease hemochromatosis hemolytic anemia hodgkin's lymphoma megaloblastic anemia any inflammatory disorder ```
85
Pernicious anemia
decreased RBC bc intestines don't absorb B12
86
vitamin B12
needed for normal nuclear maturation & DNA synthesis, leads to slow cell division from diet-meats, cheese, milk, eggs absorbed in terminal ileum & stored in liver
87
B12 deficiency
impaired absorption: lack of intrinsic factor/autoimmune destrxn of parietal cells malabsorptions in patients w/sprue or IBD decreased intake--strict vegans
88
B12 def
diagnose w/CBC and serum B12 interfering factors: ETOH, aspirin, aminoglycoside antibiotics, anticonvulsants, OCPS collect in RED TOP BLUE normal 160-950 pg/mL
89
OCPs
interfere in B12 def test | increased TIBC
90
folate/folic acid
needed for synthesis of nuclear proteins vitamin B12 is req cofactor for folate metabolism diet obtained-green leafy vegs, liver, eggs
91
folate/folic acid
``` absorbed in proximal jejunum normal range 2.7 - 17 ng/ml CBC macrocytic anemia no fasting red top tube ```
92
red top tube
folate/folic acid | B12
93
urine specimen
renal/urinary tract disease monitor renal/urinary tract disease detect metabolic/ systemic disease (DM)
94
types of urine specimens
first morning specimen random urine specimen timed urine collection urine specimen for culture & sensitivity
95
first morning specimen
voids b4 going to bed first void immediate on rising container w/preservative ei: pregnancy test
96
random urine specimen
usually obtained during the day w/o prior notice | ei: drug test
97
timed urine collection
collection of urine for 24 hrs. carry container | 1st void not included. include next mornings
98
urine specimen for culture & sensitivity
``` examination of bact sterile container midstream collection specimen cultured w/in 1 hr of collection culture b4 giving antibiotics ```
99
midstream collection
catching the mid section of the urine flow, bact washed clear by the initial flow.
100
e-coli
UTI pathogen found in GI tract (feces) gram -
101
cloudy urine
presence: WBC RBC bact
102
normal urine color
clear, pale yellow to amber
103
urochrome
a pigment which is product of bilirubin metabolism
104
Red urine
bleeding-- dark red from kidney | --bright red from bladder
105
dark yellow
bilirubin
106
specific gravity
measures kidney's ability to concentrate urine compared to H2O affected by: amount of solutes & vol, hydration status
107
specific grav of H2O
1
108
low specific gravity
needs clean catch diabetes insipidus--watery urine chronic renal diseases --not enough wastes
109
diabetes insipidus
polydipsia, big volumes of urine that are almost all water.
110
glucose specific gravity
180 mg/dL
111
low specific gravity, low osmolality
less solute, more H2O
112
high specific gravity, high osmolality
more solute, less water
113
increased specific gravity and increased
diabetes mellitus dehydration increased secretion of antidiuretic hormone( retention of H2O)
114
urine osmolality
depends on # of particles in a unit of sol correlates w/spec gravity normal 50-1200 mOsm/kg random
115
pH
normal 4.6-8.0 (avera 6.0) indication of acid/base ability of tubule to maintain H+ in plasma & xtracellr fluid
116
acidic urine
diet high in cranberries | metabolic/respiratory acidosis
117
alkaline urine
bacteria, UTI | if crystals present= calcium phosphate or triple phosphate
118
protein
measured - to 4- renal disease-most important indicator normally not in urine--too big to pass glomerular injury-albumin
119
if protein +
24 hr UA collected to measure quantity
120
dipstick sensitive
>10-30 mg/100ml protein mostly albumin
121
proteinuria--
``` preeclampsia-HTN, edema, proteinuria---pregnant don't need to know: eclampsia-preeclampsia w/seizures complications of diabetes glomerulonephritis ```
122
UA
``` leukocytes nitrite urobilinogen protein pH blood specific gravity ketones bilirubin glucose ```
123
blood
measured - to 4+
124
hematuria
``` bleeding w/in UT: cystitis glomerulonephritis cancer beets! false positive UTI *send for microscopy ```
125
glucose
normal=negative positive reported as 100-2000 mg/dl diabetes if +, check w/glucometer
126
renal threshold
>180 mg/dl glucose levels in serum
127
ketones
normal urine - positive reported as 1+ to 4+ byproduct of fatty acid catabolism used as E source when glucose cannot be utilized
128
ketones present in urine
``` any that cause muscle to bk down poorly controlled diabetes, hyperglycemia diabetic ketoacidosis alcoholic ketoacidosis starvation high protein diets ```
129
diabetes
ketones, glucose, proteinuria
130
bilirubin
increased--disease affecting bilirubin excretion obstruction gallstones dipstick-yellow to dark orange
131
unconjugated bilirubin
fat sol | difficult to excrete by kidneys
132
conjugated bilirubin
H20 soluble | easily excreted by kidneys
133
bilirubin
bk down product of hgb | in liver--conjugated & excreted in bile (metabolized in sm intestines by bacteria=urobilinogen)
134
urobilinogen
bilirubin transformed by action of bac in intestines a portion is absorbed & carried to liver and excreted in bile and urine abnormal= >.2 mg/dL
135
abnormal urobilinogen
>.2 mg/dL
136
increased bilirubin & urobilinogen
hemolytic anemia
137
increased bilirubin, normal urobilinogen
obstruction of excretion (unable to get to bowels) gallstones
138
leukocyte esterase
urinalysis clean catch!!! screens for WBCs in urine (90% accurate) + = UTI MOST reliable test for UTI
139
nitrites
screening test for: UTI bacteria (gram - only)
140
UTI
wbc + and nitrites+ | cloudy urine
141
gram - bacteria
reductase reduces urinary nitrates to nitrites
142
microscopic examination of urine sediment
urine specimen centrifuged examined contamination: RBC & WBC counted / hpf, epithelial cells-squamous and renal tubular cells crystals
143
crystals in microscopy
abnormal think kidney stones (Ca oxalate) asymptomatic until stones type of crystal varies w/disease & pH of urine
144
crystals in acidic urine
uric acid crystals - gout | calcium oxalate -mostly kidney stones
145
crystals in alkaline urine
calcium phosphate | triple phosphate-a/w stones, chronic cystitis
146
cast
only in distal convoluted tubule/ collecting duct formation made due to decreased urine flow, increased [Na], & acidic pH usually associated w/some degree w/proteinuria and stasis w/in renal tubules
147
kinds of casts
``` hyaline cellular____only need to know 2 h & c granular fatty waxy ```
148
hyaline cast
protein mostly mucoprotein (tamm horsfall) normal in after strenuous exercise, dehydration
149
cellular casts
cells | in nephron for a long time, may degenerate into coarsely granular casts->finely granular casts->broad waxy cast
150
granular casts
degeneration cell'r material-->granular particles w/in WBC or epithelial cell cast
151
fatty casts
overprodxn of lipids HALLMARK OF NEPHROTIC SYNDROME fat w/in epith'l cell casts bcomes incorporated w/protein into casts/ coalesce to large droplets called oval fat bodies
152
waxy casts
cell/hyaline casts chronic renal disease & chronic renal failure diabetic nephropathy malignant HTN flow thru tubule diminished & gran'r casts degenerate
153
hyperglycemia
``` Diabetes Mellitus Cushings Disease -cortisol Pheochromocytoma –tumor Acute Stress Acromegaly-enlargement GH Glucagonoma Pancreatitis ```
154
hypoglycemia
``` Diabetes Tx Addison's Disease Liver Disease- glycogen storage Hypopituitarism Beta cell tumors Insulinoma Carcinoma ```
155
diabetes insipidus
Diabetes insipidus-no prodxn of antidiuretic hormone---w/o taste
156
diabetes mellitus
hyperglycemia and glycosuria and resulting from inadequate prodxn/utilization of insulin as sugar goes up, kidneys can not reabsorb so spills it in the urine
157
blood glucose values
70-100 mg/dL
158
prediabetes
101-125 fasting (impaired fasting glucose) | 140-199 2hrs after eating (impaired glucose tolerance)
159
diabetes mellitus
>or = 126 fasting (on 2/+ occasions) " 200 random w/presence of sympts " 200 at 2 hrs on 75 GTT Hgb A1c> or = 6.5% (on 2 or more ocassions)
160
panic values
400 mg/dL DKA
161
diabetes mellitus symptoms
polidypsia polyphagia weight loss polyuria
162
blood glucose collection
8 hr fast prior to test for "fasting levels" ------- 5-7 ml of venous blood red top/tiger top
163
glucometers
to measure blood glucose | measure whole/capillary blood samples but can calculate to give plasma
164
optimal blood sugs in Tx for DM | need to know?
Fasting and pre-meal : < or =110 mg/dl ideal <160 mg/dl acceptable
165
glucose tolerance test
fast 8-12 hrs prior test check fasting glucose level administer 75g oral glucose collect 5-7 ml in red top fasting, then at 1 and 2 hrs
166
HgbA1c (glycosylated hgb)
normal range 2.2-4.8% measures % of Hgb covered w/sugar index of average blood glucose levels over prior 2-3 mon improved gc c/w preventing / delaying progression of microvasc complications of DM
167
A1C goals
AACE than pt goal, intervention is warranted fasting not indicated lavender top tube
168
Insulin levels
``` evaluate for insulin deficiency, resistance, insulinoma fasting for 8 hrs ------ 5ml venous sample packed in ice normal=6-26 microunit/mL ```
169
elevated insulin levels
insulinoma | insulin resistance syndroms >20 fasting
170
decreased insulin levels
diabetes
171
c-peptide
identify sever insulin deficiency 8-10 hr fast red top
172
c-peptide elevated
insulinoma | insulin resistance
173
insulinoma
elevated c-peptide and insulin levels
174
decreased c-peptide
diabetes/insulin deficiency factitious hypoglycemia pancreatectomy
175
DKA
body starts burning fat & releases ketones for E, primarily fats but also proteins
176
ketones
urine dipstick not good for determining severity of DKA Tx of DKA ketoacids-raises acetone and acetoacetate but it's not bad so don't measure
177
nitroprusside rxn (happens on dipstick)
test for acetone and acetoacetate | not for beta hydroxybuterate
178
thyroid stimulating hormone tsh/thyrotropin
normal .5-5.5 mlU/L depends on lab!!! | red or marble top
179
interfering factors for TSH
increase--- lithium decrease---ASA (aspirin) NSAIDs heparin--clotting corticosteroids--prednizone RA
180
Thyroxine (T4)
most abundant--cleavage an iodine primary circulating hormone is independent and it can be measured
181
Triiodothyronine (T3)
does all the work! metabolically active hormone secreted in lesser amounts
182
Increases TBG
High estrogen states Infectious hepatitis genetic TBG excess
183
decreases TBG
``` liver disease malnutrition protein losing nephropathy androgens estrogen def menopause major stress ```
184
thyroglobulin
protein made by thyroid gland tumor marker for thyroid malignancy use for thyroidectomy elevations indicate residual thyroid tissue
185
thyroid stimulating immnoglobulin
hyperthyroidism --graves
186
thyroid antibodies
hypothyroidism Anti-TPO antibodies--most sensitive | antithyroglobulin antibodies --less sensitive
187
aldosterone
reabsorption of Na and secretion of K
188
cortisol
opposes insulin secretion increase hepatic gluconeogenesis stress response inhibits inflammation
189
androgens
testosterone androstenendione dheas
190
norepinephrine, epinephrine
elevate blood sugar
191
cortisol
timing is important to test cortisol levels measured in blood, urine, salivary elevated in the morning, peaks at night
192
increased cortisol levels
cushing's disease/ syndrome stress obesity
193
decreased cortisol levels
adrenal insufficiency congenital adrenal hyperplasia hypothyroidism
194
cushing's disease/syndrome screening test
1overnight dexamethasone SUPPRESSION test, 1mg dexamethasone at 11:30 pm and check am serum cortisol normal= cortisol levels should be normal cushing's -- elevated can be affected by estrogen states ------- 2 24 hr urine cortisol 3 11 pm salivary cortisol
195
factors influence cushing's dis screening
high estrogen states stress alcoholism, depression, anorexia nervosa certain drugs-- Increase: COPs hydrocortisone spironolactone decrease: dexamethasone, thiazides, ketoconazonle chronic corticosteroid use
196
elevated aldosterone
hyperaldosteronism --conn's congenital adrenal hyperplasia hyperkalemai hyponatremia
197
decreased aldosteron
addison's disease renin deficiency hypernatremia antihypertensive therapy
198
aldosterone test
``` only if concerned w/hyperaldosteronism position is important lower-supine higher-upright levels altered by Na in diet ```
199
pheochromocytoma
rare tumor of the chromaffin cells of the adrenal medulla | many go undiagnosed
200
catecholamines
dopamine (precursor), epi and norepi fleeting hormones--don't last very long in blood metanephrine- metabolite (longer lasting) normetanephrine- metabolite these metabolites are stable and thus can be more sensitive for diagnosis
201
what elevates catecholamine levels
``` acetaminophen antihypertensives aspirin stimulants foods: bananas, caffeine...ets too much stuff ALS brain lesions carcinoid eclampsia anxiety hypoglycemia pain psychosis renal failure ```
202
testing urinary and plasma metanephrines pts
avoid foods that can alter 2-3 days prior be drug free if possible be stress free Plasma: relaxed patient
203
hemostasis
the capacity to minimize loss of blood following injury to blood vessel
204
3 steps to hemostasis
vasospasm--vasoconstriction platelet plug formation coagulation
205
4 steps of platelet plug formation
adhesion platelet activation platelet aggregation platelet plug
206
vWF
protein that allows platelets to adhere to endothe'l cells
207
prostacyclin
inhibits platelet aggragation in healthy vessels
208
thrombin
has a + feedback effect on acceleration of factors 5,8,11 | activates factor 8 to further stimulate platelet aggregation and fibrin polymerization
209
extrinsic pathway
coagulation initiated by it
210
aPTT
``` intrinsic 12--> 12a 11-->11a 9-->9a 8-->8a (helper) ```
211
PT
EXTRINSIC FACTOR in the plasma--tissue factor 7-->7a
212
factors synthesized in the liver and require vitamin K and Ca
2, 7, 9,10
213
fibrinolysis
resorbs the clot that doesn't need to be there
214
Coagulation testing
CBC is first evaluator determines the nature & urgency of the bleeding condition reveals thrombocytopenia & assesses clinically significant anemia
215
coagulation tests
``` CBC- platelet count PT aPTT Platelet function analysis Fibrinogen D-Dimer ```
216
platelet count
normal range 150,000-450,000/uL | not a measure of functxn!!
217
platelet problems w/
superficial bleeding petechaie echymosis and/or purpura
218
low platelet count
thrombocytopenia ITP HUS heparin induce thrombocytopenia
219
normal platelet count and high BT
``` have platelets but can't make plug aspirin uremia genetic disorders vWF ```
220
BT
Bleeding test
221
prothrombin time
normal range 13-17 secs 5, 7, 10, prothrombin and fibrinogen measures extrinsic (tissue factor and 7)+common pathway (5, 7, 10, prothrombin, & fibrinogen) used to monitor coumadin therapy
222
aPTT
``` activated partial thromboplastin time normal range 25-36 w/o drugs intrinsic + common 12, 11, 9, 8 + 10, 5, 2, 1 used to monitor heparin ```
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aPTT prolonged in
hemophilia A He...............B Biliary obstruction hepatocell'r diseases
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heparin
inactivates prothrombin, prevents formation of thromboplastin
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PT and aPTT
ordered when Pt. not taking anticoagulant drugs has symptoms :nosebleeds,bleeding gums, bruising, heavy menstrual, heme+ or pt that will undergo surgery
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thrombin time
Need to know? measures common pathway measures fibrinogen conversion to fibrin
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bleeding differential diagnosis
``` CALFDIPS Cirrhosis Aspirin and NSAIDS Leukemia Factor deficiency Disseminated Intravasc. coagulapathy Idiopathic thrombocytopenic purpura Platelet deficiency Scurvy ```
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Aspirin
platelet function lost for life of platelet | anti platelet via inhibition of thromboxane A2
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NSAIDs
platelet function returns w/in 24 hrs of stopping med
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d-dimer
test for specific for FDP A test of fibrinolysis elevated in DIC and PE does not determine location of the clot, just indicates clot is being broken down
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von Willebrands disease
most common inherited severe congenital bleeding disorder problem w/platelet adhesion bleeding in nasal, sinus, vaginal, and GI mucous membranes deep tissue bleeding blood group O have significantly lower vWF
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lab for von willebrands
platelet count normal BT--prolongued aPTT- prolongued due to decreased level factor 8
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hemophilia A and B
``` X-linked recessive disorders Hemo A due to deficiency in factor 8 hemo b (christmas disease) factor 9 deficient ```
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factor 8 deficiency/hemo a
hemo A | deep bleeding--have bleeding into muscles, joints, soft tissue
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factro 8 def/hemo a
PT normal aPTT elevated thrombin time normal plat. normal
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hemophilia B/factor 9 def
bleeding into muscles, joints, and soft tissue
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factor 9 deficiency
PT normal aPTT elevated thrombin time normal plat. normal
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liver failure on factors
``` except for factor 8 decreased coagulation factors anticoagulation factors fibrinogen platelets affects factors 2,7,9,10 ```
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hypercoagulability/ PVCS
platelets too many /overactive vascular injury clotting factors-deficiency/non working factors, too many stasis & surgery
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virchow's triad
vessel wall injury+stasis+hypercoag=thrombosis
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DIC
``` Disseminated intravascular coagulopathy acquired thrombohemorrhagic disorder results in excess of thrombin & plasmin in circulation. thrombin to fibrin & clotting plasmin bks down fibrin and bleeding always 2dary to another condition ```
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DiC associated w/
catastrophic pregnancy metastatic malignancy massive trauma--burns bact'l sepsis
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DIC signs & symptoms
``` SIGNS OF THROMBI resp failure GI stress ulcers SIGNS OF BLEEDING petechiae purpura hematomas intracranial bleeding hematuria ```
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DIC for platelet count
<150,000
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Tx of DIC
treat the underlying cause

Lab Diagnostics (2 decks)

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