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502 Lab Interpretation > Coagulation > Flashcards

Coagulation Flashcards

(108 cards)

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1
Q

Normal Platelet Count

A

150,000-300,000

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2
Q

How are platelets formed?

A

Platelets are formed in the bone marrow from large bone marrow cells called megakaryocytes. The dominant hormone controlling megakaryocyte development is thrombopoietin.

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3
Q

Conditions that Cause Increased Platelets

A

-Active bleeding (surgery, infection, trauma) -Polycythemia Vera -Postsplenectomy -Myeloproliferative diseases (chronic myeloid leukemia, other blood cancers)

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4
Q

Conditions that Cause Decreased Platelets

A

Disseminated Intravascular Coagulation, Thrombotic Thrombocytopenic Purpura, Heparin-Induced Thrombocytopenia, Idiopathic Thrombocytopenic Purpura, Drugs (ACEIs, Apap, Allopurinol, Anti-arrhythmics, antibiotics, diuretics, NSAIDs), EDTA-Dependent Agglutination

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5
Q

Disseminated Intravascular Coagulation

A

Systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndrome.

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6
Q

DIC Causes

A

Always secondary to an underlying disorder, generally involving systemic inflammation. Sepsis, trauma, organ destruction, malignancy, transfusion reaction, obstetric complications, vascular abnormalities, liver failure, toxic reactions, heat stroke.

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7
Q

DIC Pathophysiology

A
  1. Tissue factor mediated thrombin generation 2. Dysfunctional anticoagulant mechanisms 3. Impaired fibrin removal, however fibrinolytic activity may be increased and contribute to bleeding 4. Inflammatory activation
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8
Q

DIC Presentation

A

Bleeding, Petechiae and ecchymosis, Thrombosis, Renal failure, Respiratory symptoms, Neurologic changes, Hypotension, Tachycardia

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9
Q

DIC Workup

A
  • Thrombocytopenia
  • Schistocytes
  • Prolonged coagulation times (PT/PTT)
  • Elevated D-dimer
  • Fibrinogen may be low
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10
Q

Thrombotic Thrombocytopenic Purpura

A

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder characterized by clotting in small blood vessels of the body (thromboses), resulting in a low platelet count.

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11
Q

TTP Signs and Symptoms

A
  • Neurologic manifestations (change in mental status, seizures, hemiplegia, paresthesias, visual disturbance, aphasia)
  • Fatigue
  • Petechiae
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12
Q

TTP Workup

A
  • Normal or elevated WBC count
  • Hemoglobin concentration 8-9 g/dL
  • Platelet count 20-50,000
  • Schistocytosis
  • PT/PTT normal
  • D-dimer and fibrinogen may be elevated
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13
Q

TTP Treatment

A

Total plasma exchange

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14
Q

Normal Prothrombin Time (Used to monitor coumadin therapy)

A

11-14 seconds

Evaluates extrinsic and common pathway

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15
Q

Prothrombin Time Increased

A

Liver disease, coumadin therapy, antibiotics, DIC, hereditary factor deficiencies (II, V, VII, X), massive blood transfusions, vitamin K deficiency.

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16
Q

Normal Partial Thromboplastin Time (Used to monitor heparin therapy)

A

26-34 seconds

Evaluates intrinsic and common clotting pathway.

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17
Q

PTT Increased

A

Deficiency in coagulation factors in the intrinsic pathway (hemophilia) except factor 13.

DIC Nonspecific inhibitor (lupus anticoagulant)

Heparin therapy, coumadin, antibiotics, aspirin

Vitamin K deficiency

Liver disease

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18
Q

Normal Fibrinogen Level

A

150-400 mg/dl

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19
Q

Fibrinogen

A

Acute phase reactant synthesized in the liver, involved in forming the clot in secondary hemostasis.

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20
Q

Fibrinogen Increased

A

Inflammatory status, smoking, pregnancy, malignancy, nephrotic syndrome.

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21
Q

Fibrinogen Decreased

A

Liver disease, DIC, thrombolytic Rx (atenolol, cholesterol-lowering meds, corticosteroids, thrombolytics), hereditary dysfibrinogenemia, transfusion

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22
Q

Normal D-Dimer Level

A

Less than 500

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23
Q

D-Dimer

A

Represents fibrin degradation of a blood clot after fibrinolysis

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24
Q

D-Dimer Increased

A

DVT, DIC, PE, recent surgery, sepsis, malignancy

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25
D-Dimer High Sensitivity/Low specificity
A negative result rules out PE, DVT, but a positive does not confirm the diagnosis.
26
Normal WBC
1-10,000/mm3
27
Normal RBC
3.5-5.0 million/mm3
28
Normal Hgb
12-17
29
HCT
36-52%
30
MCV
82-94 fl
31
MCH
27-31 pg
32
MCHC
32-35%
33
RDW
10-12.5%
34
RBCs Elevated
Dehydration, Polycythemia Vera and other bone marrow disorders, hypoxia, high altitude
35
RBCs Decreased
Anemias, hemolysis, hemoglobinopathies, ETOH abuse, chronic renal failure, hemorrhage, iron deficiency anemia, liver disease, megaloblastic anemia, reticulocytosis.
36
MCV (Mean Corpuscular Volume)
A measure of the average volume of a RBC. Helpful for characterizing anemias. High: alcohol abuse, liver disease, megaloblastic anemia, reticulocytosis, sperocytosis. Low: Anemia of chronic disease, iron deficiency anemia, sickle cell, thalassemia.
37
MCH (Mean Corpuscular Hgb)
The amount of Hgb per RBC. Hgb/RBC. High: alcohol abuse, liver dz, megaloblastic anemia. Low: anemia of chronic disease, iron deficiency anemia, thalassemia.
38
MCHC (Mean Corpuscular Hgb Concentration)
The hemoglobin concentration per red cell. Hgb/Hct. Low: Anemia of chronic disease, thalassemia. High: hemolysis, spherocytosis
39
RDW
Measurement of variation in RBC size and shape. Assists in differentiating iron deficiency anemia from other microcytic anemias. High in ETOH abuse, hemolytic anemia, iron deficiency anemia, megaloblastic anemia, mixed anemias, reticulocytosis.
40
Anisocytosis
RBCs of unequal size. Commonly found in anemia
41
Poikilocytosis
Abnormally shaped RBCs. Dacrocytes (teardrop), elliptocytes, codocytes (target cells), Schistocytes (helmut cells)
42
Mature WBCs
Neutrophils (55-70%) Lymphocytes (30-45%) Monocytes (1-10%) Eosinophils (2-5%) Basophils (0-1%)
43
Immature WBCs
Band forms Metamyelocyte Myelocyte Blasts
44
Hgb/Hct Increased
P. vera, dehydration, burns, high altitudes, smoking/COPD
45
Hgb/Hct Decreased
Anemias, bleeding, hemoglobinopathies, DIC, bone marrow disorders.
46
Platelet Count Increased
Myeloproliferative disorders, acute bleeding, post-splenectomy
47
Platelet Count Decreased
ITP, TTP, HIT, Infection, ETOH, Drugs, Bone marrow disorders
48
Iron Studies Normal Values
Fe 150-175 mcg/dl TIBC 250-460 mcgdl Ferritin Males: 16-300 ng/mL, Females: 4-161 ng/mL
49
Iron Increased
* Hemochromatosis * Multiple transfusions * Lead poisoning * Hemolytic Anemia
50
Iron Decreased
* Iron deficiency * Nephrotic syndrome * Hypothyroidism * Anemia of chronic disease * Chronic renal failure * Infections
51
TIBC Increased
Iron deficiency anemia, acute hepatitis, pregnancy, drugs (BCPs)
52
TIBC Decreased
Low protein states such as nephrotic syndrome and malnutrition, anemia of chronic disease, hemochromatosis
53
Ferritin Increased
* Hemochromatosis * Thalassemia * Multiple Blood Transfusions * Chronic inflammatory disorders
54
Ferritin Decreased
Iron deficiency anemia
55
Reticulocyte Count Normal Value
40-135,000/mcl or 1-2%
56
Reticulocytes Increased
* Hemolytic anemia * Blood loss anemia
57
Reticulocytes Decreased
* Iron deficiency * Aplastic anemia * Myelodysplastic Syndrome (MDS) * Pure red cell aplasia * Bone marrow suppression
58
Haptoglobin (HP)
Transport glycoprotein synthesized by the liver that serves as a carrier for free hemoglobin. 27-139 mg/dL
59
HP Decreased
Hemolytic anemias such as transfusion reactions TTP Drugs (methyldopa) Artificial heart valves
60
Methylmalonic Acid Normal Value
\<0.4 mcg/dL; measured in serum or urine. Serum only accurate if renal fx normal. Standard is urine, which corrects for elevated creatinine
61
Methylmalonic Acid Increased
B12 deficiency, methylmalonic aciduria
62
Vitamin B12 Decreased
* Pernicious anemia * Vegans * IBS * Gastrectomy patients
63
Vitamin B12 Normal
180-400 pg/ml
64
Folic Acid Decreased
Malnutrition, excessive uptake (pregnancy), hemolytic anemia, acute leukemias, drugs (methotrexate, dilantin, ETOH)
65
Direct Coombs
Detects antigen-antibody complexes on the RBC. Antibody is produced that coats the patient's own cells. Positive in hemolytic anemia.
66
Normal SGOT (AST)
5-40 iu/L
67
Normal SGPT (ALT)
5-35 iu/L
68
Normal Direct (conjugated) Bilirubin
0.1-0.3 mg/dl
69
Normal Indirect (unconjugated) Bilirubin
0.2-0.7 mg/dl
70
Normal Alkaline Phosphatase
30-115 iu/L
71
Normal Total Protein
6.0-8.0 g/dl
72
Normal Albumin
3.4-4.7 g/dl
73
Increased AST/ALT
* Hepatocellular damage * Fatty liver * Viral hepatitis * ETOH hepatitis * AST/ALT ratio often \> 2:1 in ETOH hepatitis
74
Increased Direct Bilirubin
Hepatocellular damage, obstructive jaundice, drug-induced cholestasis, primary biliary cirrhosis.
75
Increased Indirect Bilirubin
* Gilbert syndome * Hepatocellular damage * Hemolysis * Primary biliary cirrhosis
76
Increased Alkaline Phosphatase
Hepatocellular jaundice, CBD obstruction, primary biliary cirrhosis
77
Decreased Total Protein and Albumin
Hepatocellular jaundice, malnutrition
78
Normal NA
135-145 meq/l
79
Normal K
3.5-4.5 meq/l
80
Normal Cl
98-102 meq/l
81
Normal CO2
22-28 meq/l
82
Normal BUN
8-20 mg/dl
83
Normal Creatinine
0.6-1.2 mg/dl
84
Normal Glucose
70-110 mg/dl
85
Na Increased
* Hyperaldosteronism * Dehydration from vomiting/excess sweating * Inadequate water intake
86
Na Decreased
* Adrenal insufficiency * Excess free water * SIADH Hyperglycemia (pseudo) Na falls 1.6 for every 100 mg/dl increase of glucose over 100 * Volume overload (CHF, ETOH disease) * Drugs (NSAIDs, diuretics, SSRIs)
87
K Increased
* Hemolysis * Rhabdomyolysis * Renal Failure * Addison Disease * RTA Type 4 * Drugs (ACEIs, ARBs)
88
K Decreased
* Poor oral intake * Drugs (diuretics, B agonists, insulin) * RTA 1 and 2 * Hyperaldosteronism * Cushings Syndrome * Familial Periodic Paralysis * Diarrhea * Low magnesium * Genetic Disorders
89
Cl Increased
* Renal failure * Nephrotic syndrome * Dehydration * RTA * Overrx with NS * Drugs (acetazolamide)
90
Cl Decreased
* GI losses * Diabetic ketoacidosis * Excess sweating * SIADH * Hyperaldosteronism
91
Increased CO2
* Metabolic acidosis * Volume contraction * Compensated respiratory acidosis
92
Decreased CO2
* Metabolic acidosis * Compensated respiratory alkalosis * Drugs (acetazolamide)
93
BUN Increased
* Renal failure * CHF * Dehydration * Shock * Burns * Upper GI Bleed * Urinary tract obstruction
94
BUN Decreased
* Hepatic failure * Cachexia
95
Creatinine Increased
* Renal failure * Urinary tract obstruction * Nephrotoxic drugs
96
Creatinine Decreased
Reduced muscle mass
97
Glucose Increased
* DM * Cushings Syndrome * Chronic Pancreatitis * Steroids
98
Glucose Decreased
* Diffuse liver disease * Insulinoma * Drugs (insulin, hypoglycemic agents)
99
Normal Calcium Level
8.5-10.5
100
Calcium Increased
* Hyperparathyroidism * Malignancies * Vitamin D excess * Paget disease * Milk alkali syndrome * Familial hypocalcuria * Drugs (thiazide diuretics, lithium)
101
Calcium Decreased
* Hypoparathyroidism * Vitamin D deficiency * Renal insufficiency * Massive transfusion * Magnesium deficiency * Hypoalbuminemia (For every decrease in albumin by 1 mg/dl, calcium should be corrected up by 0.8 mg/dl)
102
Normal Phosphorus Level
2.5-4.5
103
Phosphorus Increased
* Renal failure * Tumor lysis syndrome * Hypoparathyroidism * Sarcoid Cirrhosis * Drugs (Steroids, HCTZ, phosphate enemas)
104
Phosphorus Decreased
* Hyperparathyroidism * Rickets * Malabsorption * Acute pancreatitis * Severe hypercalcemia * Drugs (acetazolamide, thiazides, phosphate binding antacids)
105
Magnesium Normal Level
1.8-3.0
106
Magnesium Increased
* Renal failure * Dehydration * Tissue trauma * Hypothyroidism * Drugs (lithium, magnesium salts)
107
Magnesium Decreased
* Chronic diarrhea * Alcoholism * TPN without replacement * CHF * Acute Pancreatitis * Drugs (cisplatin, albuterol, calcium salts)
108

502 Lab Interpretation (1 decks)

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