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From Flashcardlet > Clinical Lab Med 2 > Flashcards

Clinical Lab Med 2 Flashcards

1
Q

Normal range for hemoglobin male

A

13.5 - 16.5 g/dl

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2
Q

Normal range for hemoglobin male

A

13.5 - 16.5 g/dl

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3
Q

Normal range for hemoglobin female

A

12 - 15 g/dl

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4
Q

Normal range for hematocrit male

A

41 - 50%

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5
Q

Normal range for hematocrit female

A

36 - 44%

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6
Q

RBC count for male

A

4.5 - 5.5 x 10^6/ml

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7
Q

RBC count for female

A

4.0 - 4.9 x 10^6/ml

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8
Q

RDW (RBC distribution width)

A
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9
Q

MCV

A

80 - 100

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10
Q

MCH

A

26 - 34

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11
Q

MCHC

A

31 - 37 %

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12
Q

Platelet count

A

100,000 - 450,000

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13
Q

Ferritin

A

13 - 300 ng/ml

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14
Q

Folate

A

3.6 - 20 ng/dl

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15
Q

Glucose, fasting

A

60 - 110 mg/dl

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16
Q

Glucose (two hours postprandial)

A

up to 140 mg/dl

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17
Q

Hemoglobin A1c normal

A
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18
Q

Hemoglobin A1c High risk/prediabetes

A

5.5 - 6.4 g/dl

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19
Q

Hemoglobin A1c Diabetes

A

> or = 6.5 g/dl

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20
Q

Iron

A

65 - 150 mcg/dl

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21
Q

Cholesterol, total

A
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22
Q

HDL cholesterol

A

> or = 35 mg/dl

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23
Q

What is the negative risk factor for HDL cholesterol

A

> or = 60 mg/dl

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24
Q

LDL cholesterol

A

65 - 180 mg/dl

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25
Q

Triglycerides normal

A
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26
Q

Triglycerides borderline high

A

150 - 199 mg/dl

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27
Q

Triglycerides high

A

200 - 499 mg/dl

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28
Q

Triglycerides very high

A

> 499 mg/dl

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29
Q

Total T4 (TT4)

A

4.5 - 11.5 ug/dl

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30
Q

Free T4 (FT4)

A

0.8 - 2.8 ng/dl

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31
Q

Free T4 index (FT4I)

A

1.0 - 4.3 U

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32
Q

Total T3 (TT3)

A

75 - 200 ng/dl

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33
Q

Resin T3 Uptake (RT3U)

A

25 - 35 %

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34
Q

TRH

A

5 - 25 mlu/ml

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35
Q

TSH

A

0.5 - 4.7 ulU/ml

recently changed to 0.3 - 3.04 ulU/ml

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36
Q

Thyroglobulin

A

5 - 25 ng/ml

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37
Q

Radioactive iodine uptake (RAIU)

A

5 hour - 5 - 15 %

24 hours - 15 - 35 %

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38
Q

What does Thyroglobulin measure?

A

Nonspecific test that is elevated when the thyroid gland is inflamed or enlarged

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39
Q

What does Thyroglobulin measure?

A

Nonspecific test that is elevated when the thyroid gland is inflamed or enlarged

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40
Q

Normal range for hemoglobin female

A

12 - 15 g/dl

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41
Q

Normal range for hematocrit male

A

41 - 50%

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42
Q

Normal range for hematocrit female

A

36 - 44%

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43
Q

RBC count for male

A

4.5 - 5.5 x 10^6/ml

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44
Q

RBC count for female

A

4.0 - 4.9 x 10^6/ml

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45
Q

RDW (RBC distribution width)

A
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46
Q

MCV

A

80 - 100

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47
Q

MCH

A

26 - 34

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48
Q

MCHC

A

31 - 37 %

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49
Q

Platelet count

A

100,000 - 450,000

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50
Q

Monocytes

A

3 - 6 %

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51
Q

Folate

A

3.6 - 20 ng/dl

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52
Q

Glucose, fasting

A

60 - 110 mg/dl

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53
Q

Glucose (two hours postprandial)

A

up to 140 mg/dl

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54
Q

Hemoglobin A1c normal

A
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55
Q

Hemoglobin A1c High risk/prediabetes

A

5.5 - 6.4 g/dl

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56
Q

Hemoglobin A1c Diabetes

A

> or = 6.5 g/dl

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57
Q

Iron

A

65 - 150 mcg/dl

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58
Q

Cholesterol, total

A
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59
Q

HDL cholesterol

A

> or = 35 mg/dl

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60
Q

What is the negative risk factor for HDL cholesterol

A

> or = 60 mg/dl

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61
Q

LDL cholesterol

A

65 - 180 mg/dl

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62
Q

Triglycerides normal

A
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63
Q

Triglycerides borderline high

A

150 - 199 mg/dl

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64
Q

Triglycerides high

A

200 - 499 mg/dl

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65
Q

Triglycerides very high

A

> 499 mg/dl

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66
Q

Total T4 (TT4)

A

4.5 - 11.5 ug/dl

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67
Q

Free T4 (FT4)

A

0.8 - 2.8 ng/dl

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68
Q

Free T4 index (FT4I)

A

1.0 - 4.3 U

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69
Q

Total T3 (TT3)

A

75 - 200 ng/dl

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70
Q

Resin T3 Uptake (RT3U)

A

25 - 35 %

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71
Q

TRH

A

5 - 25 mlu/ml

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72
Q

TSH

A

0.5 - 4.7 ulU/ml

recently changed to 0.3 - 3.04 ulU/ml

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73
Q

Thyroglobulin

A

5 - 25 ng/ml

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74
Q

Radioactive iodine uptake (RAIU)

A

5 hour - 5 - 15 %

24 hours - 15 - 35 %

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75
Q

What does TSH measure?

A

Best measure to determine thyroid function

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76
Q

What does Thyroglobulin measure?

A

Nonspecific test that is elevated when the thyroid gland is inflamed or enlarged

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77
Q

Free T3

A

2.3 - 4.2 pg/ml

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78
Q

Total iron binding capacity (TIBC)

A

250 - 420 mcg/dl

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79
Q

Transferrin

A

> 200 mg/dl

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80
Q

Uric acid (male)

A

2.0 - 8.0 mg/dl

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81
Q

Uric acid (female)

A

2.0 - 7.5 mg/dl

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82
Q

What is present in the lavender top tube for collection of a CBC?

A

Anticoagulant, so the cells don’t stick together and clot

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83
Q

Segmented neutrophils

A

54 - 62 %

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84
Q

Band forms

A

3 - 5 %

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85
Q

Basophils

A

0 - 1 %

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86
Q

Eosinophils

A

0 - 3 %

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87
Q

Lymphocytes

A

24 - 44 %

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88
Q

Monocytes

A

3 - 6 %

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89
Q

What is predominantly found in RBCs?

A

Hemoglobin

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90
Q

What is the function of hemoglobin?

A

Needed for delivery of oxygen to tissues

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91
Q

Do RBCs divide?

A

No

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92
Q

What is the lifespan of a RBC?

A

100-120 days

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93
Q

Where are RBCs produced?

A

Bone marrow

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94
Q

Where are RBCs destroyed?

A

Spleen

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95
Q

What happens to the function of RBCs as they age?

A

They don’t function as well

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96
Q

Why does HbA1c measure sugar over a three month period?

A

Because that is the age of a RBC

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97
Q

What are the characteristics of a healthy RBC?

A 
Concave
Fluffy
Bright red
Buoyant
Round
98
Q

What are the characteristics of a sick RBC?

A

Sunken in
Pale
Different abnormal shape

99
Q

What cells do RBCs stem from?

A

Bone marrow stem cells

100
Q

Why are RBCs called erythrocytes?

A

They contain erythropoietin

101
Q

Where is EPO produced in adults?

A

Renal cortex

102
Q

Where is EPO produced in the fetus?

A

Liver

103
Q

What is EPO?

A

The hormone that stimulates the production of RBCs in the bone marrow

104
Q

Do we have free reticulocytes as a healthy individual?

A

Yes, low percentage of cells are reticulocytes

105
Q

What percentage of a RBC protein is hemoglobin?

A

95%

106
Q

What is the size and color of a RBC dependent on?

A

How much hemoglobin the cell has

107
Q

What color is a RBC with little hemoglobin?

A

Pale pink

108
Q

What are the two parts to a Hgb molecule?

A

Iron and protein chains

109
Q

What are the two chains in Hgb?

A

alpha and beta

110
Q

What happens if the Hgb chains are deficient?

A

The Hgb is unable to bind with iron

111
Q

What happens to a RBC as it ages, in terms of its shape?

A

They lose enzymes and surface membranes making them lose their shape, and so they are less able to pass through the spleen

112
Q

What happens when the spleen detects the wrong shaped RBC?

A

It traps the cell and destroys it

113
Q

What are the components of the RBC once the spleen destroys it?

A

Heme and protein

114
Q

What are the two components of heme?

A

Free iron and bilirubin

115
Q

What are we usually testing for if we use a RBC test?

A

Anemia

116
Q

What is anemia?

A

Deficiency of red blood cells

117
Q

What is polycythemia?

A

Excess red blood cells

118
Q

What does a complete blood count include?

A 
RBC count
WBC count
Platelet count
Hematocrit
Size and shape of RBC
119
Q

Which tube is a specimen collected in for a CBC?

A

Lavender top

120
Q

What is present in the lavender top tube for collection of a CBC?

A

Anticoagulant, so the cells don’t stick together and clot

121
Q

What are three collection problems of a specimen?

A
  • failure to mix tube with anticoagulant
  • inadequate filling of tube causing dilation from too much anticoagulant present (falsely low results)
  • patients who have been standing/have tourniquet on too long cause increase RBC
122
Q

What is the hematocrit?

A

Percentage of blood occupied by RBCs

123
Q

What does the serum iron concentration tell us?

A

Provides an indirect measure of the rate of delivery to the tissues

124
Q

What happens if a lab result comes back inconclusive or unreadable?

A

A pathologist will look at it under a microscope

125
Q

How is hemoglobin measured?

A

By its ability to absorb light

126
Q

What is hemoglobin converted to before it is measured?

A

Cyanmethemoglobin

127
Q

Which component of the CBC is the most reliable?

A

Hemoglobin, it is the easiest to measure and has the least error

128
Q

How are RBCs counted?

A

Determined by counting the cells as they pass through a sizing chamber or a laser beam

129
Q

What is also determined while RBCs are counted?

A

Size of RBCs

130
Q

What is MCV?

A

Mean cell volume - how big or small a RBC is

131
Q

What are two other tests that give the same information as the MCV?

A

MCH - mean cell hemoglobin

MCHC - mean cell hemoglobin concentration

132
Q

What do the MCV, MCH, and MCHC all refer to?

A

RBC size

133
Q

What is RDW?

A

Red cell distribution width

134
Q

How does RDW relate to MCV?

A

RDW is the standard deviation of the MCV

135
Q

What does RDW measure?

A

The degree of uniformity in size of the RBCs (how close the RBCs are to the average median size of a RBC)

136
Q

What would happen to the RDW of a patient with microcytosis?

A

Increased RDW, because the cells are further away from the median size of a RBC

137
Q

What can we determine if a patient has a normal RDW?

A

The patient does not have iron deficiency or anemia

138
Q

What can we determine if a patient has a high RDW?

A

There is a huge differential diagnosis - we cannot specify one thing from this value

139
Q

What is a reliable measure of the rate of RBC production?

A

The number of reticulocytes in the blood

140
Q

What is a reticulocyte?

A

Immature RBC

141
Q

What might be happening in the patient if there are high numbers of reticulocytes in the blood?

A
  • Response to anemia or another condition that may demand more RBCs - bone marrow increases RBC production
  • RBCs are not maturing or being produced normally
142
Q

Do we have free reticulocytes as a healthy individual?

A

Yes, low percentage of cells are reticulocytes

143
Q

What is the most common cause of anemia?

A

Iron deficiency

144
Q

When is a peripheral blood smear used?

A

When etiology of anemia is unclear, to further evaluate for a disease

145
Q

Does a peripheral blood smear allow diagnosis of disorders directly?

A

No, but it is the first step towards ordering further diagnostic testing

146
Q

When is a peripheral blood smear usually used?

A

Usually with a malignancy, otherwise not often used

147
Q

What test is next after a peripheral blood smear?

A

Bone marrow aspirate and biopsy

148
Q

Why do we test the bone marrow?

A

In order to tell why a blood cell looks the way it does, we go to the source of where it is made

149
Q

What is a bone marrow aspirate?

A

Suck out the fluid in the bone marrow

150
Q

What is a bone marrow biopsy?

A

Sample of bone marrow tissue

151
Q

Are bone marrow aspirates and biopsies done together or separate?

A

Together, because it is painful to the patient - usually aspirate is enough but if it doesn’t have enough information, we need a biopsy and need to put the patient through pain again

152
Q

Where is a bone marrow aspirate and biopsy completed?

A

Iliac crest

153
Q

Why don’t we put patient’s under anesthesia for a bone marrow aspirate and biopsy?

A

Because the procedure is too quick and may need to be done often

154
Q

What are the alternatives to putting a patient under anesthesia during a bone marrow aspirate?

A

We numb the skin and can lightly sedate the patient, but the pain comes from the intense pressure put on the bone to penetrate it

155
Q

What do we do for children undergoing a bone marrow aspirate?

A

We put them under anesthesia, because it is so painful

156
Q

What motion must be used to get through the bone?

A

Twisting motion like a screw, which is the painful part

Aspirate is a needle, biopsy is taken with claws on the instrument to grab tissue

157
Q

What kind of anemia does iron deficiency cause?

A

Microcytic anemia

158
Q

What is the term for iron overload?

A

Hemachromocytosis

159
Q

What type of patients usually have hemachromocytosis?

A

Common congenital disorder of persons of European ancestry

160
Q

What does serum iron measure?

A

Iron bound to transferrin

161
Q

What does the serum iron concentration tell us?

A

Provides an indirect measure of the rate of delivery to the tissues

162
Q

When are iron levels higher?

A

40% higher in the morning

163
Q

How is serum iron concentration effected by menstruation?

A

Heavy bleeders have low iron

164
Q

What is folate needed for?

A

Cell division

165
Q

When do we test for serum iron?

A

In the morning - we know it will be higher but we can keep the values at a constant

166
Q

With what conditions can serum iron levels be low?

A

Acute inflammation/injury

Kidney and liver disease

167
Q

What is transferrin?

A

Iron transporting protein

168
Q

How is transferrin measured?

A

TIBC - total iron binding capacity

169
Q

If the body has low iron stores, what will happen to the level of transferrin?

A

Low stores, high transferrin

170
Q

What is the TIBC level related to?

A

TIBC level is inversely related to body iron stores

171
Q

What is ferritin?

A

Iron protein complex containing 23% iron

172
Q

What is ferritin level related to?

A

Ferritin is directly related to the body iron stores

173
Q

What can cause falsely elevated serum ferritin levels?

A

Tissue damage

174
Q

What values will appear with iron deficiency?

A

Low iron serum
Low ferritin
Increased TIBC
Increased transferrin

175
Q

Why will most patients have acute anemia after admission to the hospital?

A

Fall in the number of RBCs and hemoglobin because their supine posture causes movement of fluid back into the vessels

176
Q

What are the two mechanisms for developing anemia?

A

Decreased RBC production

Decreased RBC survival

177
Q

What does a decreased RBC size indicate?

A

Defective synthesis of hemoglobin

178
Q

What are three causes of microcytic anemia?

A

Iron deficiency, thalassemia, iron poisoning

179
Q

What does the size of a RBC depend on?

A

The amount of hemoglobin - therefore microcytic anemia has small cells because of lack of hemoglobin

180
Q

Why do children get lead poisoning?

A

Sucking on toys or eating lead paint chips

181
Q

What is the most common cause of anemia?

A

Iron deficiency

182
Q

What two ways result in iron deficiency?

A

Decreased iron intake

Loss of iron due to chronic blood loss

183
Q

When would a patient be iron deficient due to chronic blood loss?

A

Heavy menstruation, internal bleeds, trauma

184
Q

What stores of iron are depleted first in iron deficiency?

A

Bone marrow and cellular iron stores

185
Q

What stores of iron are depleted second?

A

Iron stores in the body (liver)

186
Q

What happens thirdly in response to depleted iron stores?

A

Ferritin levels drop

187
Q

What does decreased marrow iron stimulates the production of?

A

Transferrin, and increases the rate of removal of iron from transferrin (the body is trying to get iron to the blood and cells)

188
Q

What is the best test for iron deficiency?

A

Ferritin levels

189
Q

What is thalassemia?

A

Inherited defect in the genes controlling globin chain synthesis, common in ethnic groups such as Southeast Asians, Africans, and Mediterraneans

190
Q

How are the types of thalassemia determined?

A

Based on which chain is defected, either alpha or beta thalassemia

191
Q

Why does thalassemia produce microcytes?

A

Because the whole hemoglobin molecule is not present

192
Q

What happens when there is a defect in the alpha or beta chain?

A

The molecule is unable to carry iron correctly

193
Q

What ethnic group is mostly effected by alpha thalassemia?

A

African ancestry

194
Q

What deficiency is present in alpha thalassemia?

A

Deletion of hemoglobin S chain, a part of the alpha chain

195
Q

What deficiency is present in beta thalassemia?

A

Deletion of hemoglobin A chain, a part of the beta chain

196
Q

What compound is increased when a child experiences lead poisoning?

A

Increased zinc present in anemia due to lead poisoning

197
Q

What are common causes of macrocytic anemia?

A

B12 or folate deficiency

Myelodysplastic disorder

198
Q

What is a myelodysplastic disoder?

A

Bone marrow disease or dysfunction

199
Q

What does a high MCV value often present with?

A

Alcohol abuse or liver disease

200
Q

What is the first thing we would do if we saw and increased MCV?

A

Usually high MCV is due to vitamin deficiency, so we would give supplements and retest in about three months

201
Q

What would we do if after three months the MCV values did not change?

A

Reevaluate the patient and possibly take a bone marrow biopsy
Be sure the patient is not abusing alcohol, because alcohol abuse prevents the ability to absorb folate

202
Q

What is folate needed for?

A

Cell division

203
Q

What is normocytic anemia due to?

A

Failure of the bone marrow to produce RBC

204
Q

What disease is normocytic anemia common along with?

A

Chronic illness

205
Q

What would the MCV values look like with a normocytic anemia?

A

Normal MCV, but low RBC and hemoglobin concentration

206
Q

How does renal failure influence anemia?

A

Decreased EPO production due to renal failure results in decreased RBC production

207
Q

Can we give patients in renal failure synthetic EPO?

A

Yes, but the use is limited because it can cause other problems, some patients are better suited for its use

208
Q

What happens to a patient with anemia of chronic disease?

A

Cells do not respond to the presence of EPO and bone marrow is not stimulated to produce RBCs
There is a defect in mobilization of iron from macrophages to transferrin

209
Q

What would iron panel values look like for a patient with anemia of chronic disease?

A

Low serum iron
Low transferrin
Low TIBC
*Serum ferritin is normal or increased

210
Q

How does bone marrow replacement effect anemia?

A

Any disorder in which a large percentage of the bone marrow is replaced by abnormal cells - usually cancer - causes deficient production of RBCs

211
Q

What is aplastic anemia?

A

Failure of bone marrow, decreased production of RBCs, accompanied by low WBCs and low platelets

212
Q

When might aplastic anemia be due to treatment?

A

Chemotherapy

213
Q

When is anemia related to RBC survival?

A

Normocytic anemia due to hemolysis

214
Q

What is an example of intrinsic hemolysis?

A

Our body kills our own RBCs (autoimmune)

215
Q

What is an example of extrinsic hemolysis?

A

Medications kill the body’s RBCs

216
Q

What does the MCV look like for normocytic anemia due to hemolysis?

A

Normal or slightly increased

217
Q

What is a hemoglobinopathy?

A

Decreased RBC survival is associated with hemoglobin variants of S and C chains

218
Q

What is the most prominent hemoglobinopathy?

A

Sickle cell anemia

219
Q

What is sickle cell anemia and who does it typically effect?

A

1/500 persons of African ancestry
Mutation in the beta chain that allows stacking of Hgb which changes the shape of the RBC. Stress causes the change of shape and the cell becomes sticky, so they get stuck in the spleen and spleen destroys them

220
Q

What type of people are effected by Glucose-6-Phosphate Dehydrogenase deficiency?

A

Mediterranean and African ancestry

221
Q

What does Glucose-6-Phosphate Dehydrogenase deficiency do to the body?

A

Causes hemolysis of RBC when exposed to infection or oxidant drugs

222
Q

What kind of enzyme is G6PD?

A

x-linked enzyme

223
Q

What happens to a person with Glucose-6-Phosphate Dehydrogenase deficiency if they get sick for just a few days?

A

The body can rebound and the patient may not know about their deficiency. It is genetic though so clinicians watch out for it if there is a family history

224
Q

What is autoimmune hemolytic anemia?

A

IgG antibodies develop against RBC causing decreased RBC survival

225
Q

How do we treat autoimmune hemolytic anemia?

A

Someone with an autoimmune disease probably has another autoimmune disease, so we treat the first occurring autoimmune disease and get it under control, hoping that the body will stop attacking blood cells as well

226
Q

What is another cause of autoimmune hemolytic anemia, besides the presence of the original autoimmune disorder?

A

Due to drugs that attach to RBC membranes

227
Q

What is hemolytic disease of the newborn?

A

IgG antibodies are capable of crossing the placenta. Maternal antibodies are present against cell antigens present on fetal RBCs, and so the maternal antibodies attack fetal cells and hemolyze

228
Q

When does hemolytic disease of the newborn usually occur?

A

Second pregnancy, because the mother developed antibodies in the first pregnancy after the mixing of the mother’s and baby’s blood

229
Q

What is polycythemia?

A

Increase in RBC mass over normal

230
Q

What will show on the CBC with polycythemia?

A

Increased hemoglobin and hematocrit, along with increased RBC count

231
Q

What is a primary blood disease?

A

When the issue originates in the bone marrow

232
Q

What is a secondary blood disease?

A

When the issue originates somewhere other than the bone marrow

233
Q

What is secondary polycythemia?

A

Increased RBC production due to the overproduction of EPO

234
Q

What are some possible causes of secondary polycythemia?

A
  • Renal cell carcinoma
  • Renal cysts
  • Hepatocellular carcinoma
  • Leiomyomas
235
Q

How do we treat secondary polycythemia?

A

Treat the initial cause (renal cell carcinoma) and the EPO level should decrease

236
Q

What is polycythemia vera?

A

Inappropriate overproduction of RBCs as part of myeloproliferative disorder

237
Q

What happens to EPO levels in polycythemia vera, and why?

A

EPO levels decrease because the bone marrow is already producing so many RBCs

238
Q

What does a CBC with polycythemia vera look like?

A

Increased RBC, WBC, platelets, EPO

Uncontrolled production of everything in the bone marrow

239
Q

What signs must be present to diagnose polycythemia vera?

A
  • Splenomegaly
  • Normal oxygen saturation
  • Two of the following:
  • thrombocytosis
  • leukocytosis
  • high alkaline phosphatase
  • high vitamin B12
240
Q

Why is splenomegaly present in polycythemia vera?

A

Because the spleen is overworked from having to destroy so many RBCs

From Flashcardlet (133 decks)

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