Final lab q Flashcards
(146 cards)
1
Q
Hemoglobin anomalies are divided in what two groups?
A
Hemoglobinopathy group D, S, E
Abnormal-quantitative anomalies- thalassemia group ( high rate of Hg F; Hb A2)
2
Q
Hemolytic anemia
A
Lysis of RBC
It is the premature destruction of red blood cells
Anemia occurs when the bone marrow is unable to compensate for the premature destruction of RBCs
3
Q
Hemophilia B
A
Factor IX deficiency
Prolonged aPTT
normal PT and bleeding time reduced or absent factor IX
4
Q
Hemphilia A
A
Factor VIII deficiency
Prolonged aPTT
Normal PT and bleeding time Reduced or absent factor VIII
5
Q
High WBC indicates what?
Low WBC indicates what?
A
High WBC–> presence of an infection
Low WBC –> immune deficiency
6
Q
How is MCHC expressed?
A
Hypochromic -less color Hyperchromic -more color Normochromic -normal
7
Q
If there is more than 10% of abnormally shaped RBCs, what is that called?
A
poikilocytosis
8
Q
Effects of protein C/S deficiency:
A
pregnancy loss; strokes; DVT
9
Q
In general, what is ESR help for monitoring?
A
Inflammatory diseases
10
Q
In hemolytic anemia will the reticulocyte count be high or low?
A
HIgh
11
Q
In what cases would the ESR be elevated?
A
Temporal arteritis Rheumatoid arthritis polymyalgia rheumatica
12
Q
Iron deficiency
1) What is the MCV value?
2) What is the profile ordered?
A
Iron deficiency= MCV less than 80
Order: serum iron; ferritin(best test for anemia)
13
Q
Eosinophils are elevated due to what?
A
allergic reaction and parasitic infections
14
Q
Erythropoiesis
A
1) kidneys sensse hypoxia
2) Kidney increases endogenous erythropoeitin production
3) erythropoietin–> causes bone marrow to produce new red blood cells
4) Kidneys decrease erythropoeitin production as they sense increased tissue oxygenation
15
Q
Ferritin Test for anemia?
A
Measure iron stores in the body, for a female should be between 11-122
If low, replace irons for 6 months if less than 10!
16
Q
Prolongation of both aPTT and PT suggests?
A
Defect that lies in the common pathway
17
Q
A prolonged aPTT and a
normal PT is considered to have a defect in what pathway?
A
Intrinsic
18
Q
A prolonged PT and a normal aPTT has a defect in what pathway?
A
Extrinsic
19
Q
Red Blood Cells- Erythrocytes - Fxn? origin? Made from?
A
Carry oxygen from lungs Carry CO2 back to the lungs Normally live 120 days !!! Contain hemoglobin--> needs: iron, folic acid and b12 Made in the bone marrow !
20
Q
Reticulocyte count is used for what?
A
Test to determine bone marrow function
It measures the number of immature RBCS that are circulating
21
Q
Total iron binding capacity is used for what?
A
TIBC/transferrin
22
Q
What are acute phase reactants?
A
Proteins and chemical markers that rise in response to tissue injury/inflammation
They are nonspecific
Most commonly seen is the SED rate
23
Q
Magaloblastic anemia
- What is the MCV value?
- What are the two causes ?
A
- MCV greater than 95
- Causes:
1) Vit. B12 deficiency = cyanocobalamin -pernicious anemia, - malabsorption
- diet
2) Folate deficiency -diet/meds - increased need in pregnancy
24
Q
MVC normocytic
values: Macrocytic value: Microcytic value:
A
Normocytic= 80-100 macrocytic= greater than 100 microcytic= less than 80
25
Platelets testing- bleeding time
small puncture wound-- observe the time to see how long it takes till the patient stops bleeding
drugs may increase bleeding times such as NSAIDS and salicylates
26
Production of Red blood cells:
precursor stem cells --> erthyoid--> reticulocyte--> red blood cells
27
What are lymphocytes? What does a rise in lymphocytes indicate?
Lymphocytes are B cells and T cells
| Rise in lymphocytes= chronic bacterial infection or viral infection
28
What are monocytes? Cause of elevation?
Phagocytes
Live longer than neutrophils
Elevated in chronic inflam
Autoimmune diseases, TB, Syphillis
29
What are neutrophils bands? What do they indicate?
Neutrophil bands= immature cells
Usually high bands = bacterial infections
30
What are platelets?
Non nucleated, disc shaped cells Derived from bone marrow
| Platelets activated when endothelium is damaged
31
What are reticulocytes?
young red blood cells from the bone marrow
| Retic count --> best indicator of how the bone marrow is doing
32
What are thalassemias? Caused by what?
Hereditary anemias--> caused by genetically transmitted abnormalities
Caused by decreased or absent synthesis of Alpha or beta globin chains
33
What are the 2 tests for hemostasis/coagulation?
PT: prothrombin time ; monitored with coumadin
aPTT: partial thromboplastin time ; monitored with heparin
34
What are the 2 things you can determine from the CBC?
Enumerization- number/how many Characterization- shape
| Why: Both of those factors leads to disease, if number is too low or is the shape is abnormal = DISEASE
35
What are the causes of hemolytic anemia ?
Hereditary-- Sickle cell anemia; Hereditary sphereocytosis, G6PD
Acquired-medics, DIC, hemolytic uremia syndrome
36
eshsathaarne 5th%e) components of blood?
Plasma-55%
RBC-45%
WBC/Platelets- less than 1%
37
What are the components of the RBC count?
```
Hemoglobin (Hg or Hgb)
Hematocrit (Hct or "the crit")
Red cell size distribution width (RDW) Reticulocyte Count
Red blood cell -indices
Erythrocyte Sedimentation Rate (ESR)
```
38
What are the granulocytes?
Eosinophils
| Basophils Neutrophils
39
What are the non- granulocytes?
Lymphocytes and monocytes
40
What are the normal hemoglobin levels in males and female:
Male: 13.6-17.2 Females: 12-15
41
What are the normal Hgbs in an adult?
Hb F
Hb A2
HbA
Absent:HbC,D,E,H,S
42
What are the normal
| reticulocyte counts and abnormal?
- 0.5% to 1.5% of the total numbers of red blood cells in men
- -0.5% to 2.5% in women
- -If less than 0.5%--> bone marrow is not working properly
43
What are the % of each type of WBC intheWBC differential?
Lymphocytes: 20--40% Neutrophils: mature-50-70% and immature: less than 5% ( bands) Eosinophils: less than 5% Basophils: less than 2% Monocytes less than 7%
44
What are the panic Hemoglobin values ?
PANIC LEVEL: less than 5 or greater than 20 !!!!!
45
What are the symptoms of vit. B12 deficiency ?
Neuro complaints Neuropathy in the legs
46
What are the two types of CBCs that can be ordered?
1) CBC: WBC, RBC, Hb, Hct, RBC indices, RDW, Mean platelet volume
2) CBC with differential --> this includes the number of each WBC: Neutrophils, lymphocytes, monocytes, esosinophils, basophils
47
What can a decrease in
| Hematocrit and hemoglobin indicate?
Allows you to diagnose anemia! Does not tell you cause though
48
What can a high reticulocyute count indicate?
That the bone marrow is responding to the need for increased RB production
Person who recently donated blood--> high retic. count
Women after menses--> high retic. count
49
What can cause a decrease in the hemoglobin levels?
Iron def. anemia thalassemia liver disease hyperthyrodism
50
What can cause a decrease inthe reticulocyte count?
aplastic anemia, myxedema, radiation therapy, iron def. anemia,
51
What can cause an increase in
| reticulocyte count?
hemolytic anemia chronic hemorrhage sphereocytosis malaria
52
What can cause an increase in the hemoglobin levels?
COPD polycythemia vera CHF
| smokers
53
What causes an increase in
| erythropoietin levels ? a decrease?
Increase--> COPD, pregnancy, sickle cell
| Decrease --> chronic renal failure
54
What causes can increase in PT? Decrease in PT?
Increased with:
Some Factor deficiencies- Hemophilias (I,II,V, VII, X)
Alcoholism
Cirrhosis
Vitamin K deficiency
Coumadin (Warfarin)
Decreased with: Deep vein thrombosis Myeloma
55
What could decreased RBC count indicate?
anemia
56
What could increased RBC count indicate?
Polycythemia vera--> elevated RBC, face is flushed, excessive itching
57
What does a atypical
| lymphocyte indicate?
"Reactive lymphocyte" = "Downey cell" Suggests--> Mono
58
What happens if a pt is Rh - and is transfused with Rh+ blood??
Fever, anaphylaxis, severe hemolysis
59
What effect will a diet high in Vit k have on PT time?
It will shorten the PT time
60
What do we need for adequate hemostasis?
Platelets: proper number and fxn
| Humoral coagulation factors: intrinsic and extrinsic pathway
61
What do protein C and S do?
Help prevent blood clots
62
What does the CBC stand for?
Complete blood count
63
What does Rh- mean
antigen is absent
64
What does Rh+ mean
antigen is present
65
What does EDTA stand for? What is it?
It is an anticoagulant in the tubes for a CBC
| Stands for: Ethylenediaminetetraacetic acid
66
What does destruction of hemoglobbin produce?
Heinz Bodies!!!
67
What does an elevated ESR indicate?
inflammatory response --> makes RBCs heavier and more likely to fall rapidly when placed in a special vertical tube, rouleaux formation
68
What does a Hgb electrophoresis tell us?
Quantifies normal and abnormal forms of Hgb;
69
What is being looked at in
| the CBC? ( 3 things)
Red blood cells, white blood cells, platelets
70
Whatis critically low platelets? Critically high ?
critically Low: less than 30, 000 critically High: greater than 100,000
71
Whatis erythropoietin?
glycoprotein that is produced by the kidneys (renal cortex) in response to renal hypoxia -- > stimulates the formation and development of new erythrocytes in bone marrow
72
What is factor V leiden?
Abnormal form of gene for factor V Inherited defect in factor X --> leading to hypercoagulability
Factor V activity levels in patients with Factor X leiden are NORMAL
73
Whatis hemolytic
| anemia?
RBCs are lysing very rapidly --> causes buildup of bilirubin --> enlargement of liver and spleen --> Jaundice
74
Whatis leukemia?
Uncontrolled production of leukocytes Defects in bone marrow
| Smears show immature and abnormal cells WBC count can be greater than 100,000
75
Whatis leukocytosis? What does it indicate? Causes?
Elevated white count Greater than 11,000 Indicates--infection
Causes: infection, sepsis, abscess, cancer, stress
76
Whatis leukopenia?
Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy
77
What is a sign of folate deficiency ?
Spina bifida
78
What is a qualitative testing for platelets?
Aggregation using epi
| Principle of platelet aggregometer
79
What is another name for the WBC count?
Leukocyte count
80
What is another name for neutrophils?
PMN: polymorphonuclear neutrophils
81
What is another name for monocytes?
monomorphonuclear
82
What is anisocytosis? What are the two types?
abnormal variations in the size of RBCs
Macrocyte= larger than 9 microns [liver disease]
Microcyte=smaller than 6 micron [anemias]
83
What if a left shift?
Left shift means bandemia= high levels of bands--> high levels of immature neutrophils
Indication: Bacterial infection
84
What has a greater affinity for Hgb?
Carbon monoxide has a greater affinity for RBCs then oxygen
85
What happens if a pt is Rh - and is transfused with Rh+ blood??
Fever, anaphylaxis, severe hemolysis
86
What effect will a diet high in Vit k have on PT time?
It will shorten the PT time
87
What is the PT-prothrombin time? Normal and Panic values?
Vit. K dependent
During Clotting prothrombin is converted to thrombin
Part of the extrinsic pathway PANIC: greater than 40
adults should be 10-15 secs newborn: less than 17
child: 11-14````
88
What is the profile ordered for hemolytic anemia?
CBC
Retic count
Tests to determine problem: Peripheral blood smear
LDH
Coombs test
Urobilinogen in urine Haptoglobin decreased ( released in response to RBC lysing)
89
What is the profile of someone who has iron deficiency?
Hemoglobin - low Hematocrit -low Microcytic -low Hypochromic -low Iron -low
Ferritin -low
TIBC -HIGH
90
What is the partial thromboplastin time test? ( aPTT)
```
Measures intrinsic pathway
used to monitor heperarin
Normal: 20-36 seconds
Panic: greater than 70
Heparin--> prolongs the PTT time
aPTT increased with factor deficiencies: I, II, V, VIII, IX, X, XI, XII
```
91
What is the normal WBC reference level?
5,000-10,000/mm --> we call it between 5-10
92
What is the normal RBC count in males? Females?
Male: 4.5-6.2 Females: 4.0-5.5
| [ X10^9]
93
What is the normal Hgb in neonates?
Hb F
94
What is the normal concentration of platelets?
150,000-400,000
95
What is the mean corpuscular
| volume (MCV)?
Measures the average size and volume of the RBC
Normal is 80-100
Indicated the amount of volume occupied by a single erythrocyte
96
Whatis the mean corpuscular
| hemoglobbin ( MCH)?
Average weight if the Hgb per RBC
| decreased MCH--> in Iron def. anemia increased MCH --> macrocytic anemia, tabacco users
97
Whatis the MCHC?
Mean corpuscular hgb concentration
98
What is the main functon of
| Hemoglobin?
Carry oxygen away from lungs and carry CO2 to the lungs
99
What is the International
| Normalized Ratio?
INR; it is retrieved from the PT; should be 1
2 - 3 for management of DVT, prevention of systemic embolism and mitral or aortic prosthetic tissue valves
2.5 - 3.5 for post MI, mechanical heart valves, recurrent systemic embolism
100
What is the hematocrit? What is the ratio of hematocrit to hemoglobin?
Hematocrit= packed cell volume (PVC) or erythrocyte volume fraction (EVF)
Hematocrit is 3X more than hemoglobin
101
What is the Erythrocyte
| sedimentation rate?
If ESR is higher than your age= problem
ESR= rate at which erythrocytes settle out of anticoagulated blood in one hour
Reflect the acute phase reaction in inflammation and infection
Normally cells settle slowly
ESR= lacks sensitivity and specificity
102
What is the chief function of red
| marrow? Who has the most?
Fxn of red marrow= production of erythrocytes, leukocytes and platelets
Children have the most
103
What is RhIG Rhogam ?
It is a concentrated solution of IgG derived from human plasma cells
Sensitization: pregnancy, abortions, blood transfusions.
Given to women who is Rh- so that the body doesnt consider the fetus as foreign
104
What is protein S?
Co-factor for protein C
| ratio of protein C to protein S may ID carrier of congential protein C def.
105
What is protein C?
Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C's activity is enhanced by protein S
106
What is protein C?
Vit K dependent protein that prevents intravascular thrombi
It is autosomal dominant
Protein C's activity is enhanced by protein S
107
Whatis poikilocytosis?
Variation in the shape of RBCs
| Poikilocytosis --> causes an increase in the RDW
108
What is platelet formation essential for?
```
esential for blood clotting:
Homeostatis plug Vasocontrictors
Clot retraction
tissue repair
regulate local inflammation
```
109
Whatis leukopenia?
Decreased white count
Less than 5,000
Causes can be: viral infections, bone marrow suppression, medications, anemia, malaria and chemotherapy
110
What does Rh+ mean
antigen is present
111
What does EDTA stand for? What is it?
It is an anticoagulant in the tubes for a CBC
| Stands for: Ethylenediaminetetraacetic acid
112
What does destruction of hemoglobbin produce?
Heinz Bodies!!!
113
Whatis leukocytosis? What does it indicate? Causes?
Elevated white count Greater than 11,000 Indicates--infection
Causes: infection, sepsis, abscess, cancer, stress
114
Whatis leukemia?
Uncontrolled production of leukocytes Defects in bone marrow
| Smears show immature and abnormal cells WBC count can be greater than 100,000
115
Whatis hemolytic
| anemia?
RBCs are lysing very rapidly --> causes buildup of bilirubin --> enlargement of liver and spleen --> Jaundice
116
What is factor V leiden?
Abnormal form of gene for factor V Inherited defect in factor X --> leading to hypercoagulability
Factor V activity levels in patients with Factor X leiden are NORMAL
117
Whatis erythropoietin?
glycoprotein that is produced by the kidneys (renal cortex) in response to renal hypoxia -- > stimulates the formation and development of new erythrocytes in bone marrow
118
Whatis critically low platelets? Critically high ?
critically Low: less than 30, 000 critically High: greater than 100,000
119
What is being looked at in
| the CBC? ( 3 things)
Red blood cells, white blood cells, platelets
120
What does the CBC stand for?
Complete blood count
121
What do protein C and S do?
Help prevent blood clots
122
What do we need for adequate hemostasis?
Platelets: proper number and fxn
| Humoral coagulation factors: intrinsic and extrinsic pathway
123
Who should you check lead levels on?
Children who live in old houses, contruction material, or have envt exposure
124
Who would you order a CBC for?
```
Routine Che
ck ups
Suspect infections
Bleeding issues
Concerns about anemia--fatigue and dyspnea
```
125
Why do you do the CBC last?
Always do the CBC last --> because it contains an anticoagulant called: EDTA
Shake the tube after drawing blood to disperse the anticoagulant
126
Who needs to be blood typed?
Rh-- pregnant women
Type and screen - risk of transfusion [needs the blood right away ]
Type and cross- trauma,surgery, anemia [hold the blood]
127
Who needs the carboxyhemoglobin test?
Firefighters fire victims mechanics
128
Who needs coagulation studies?
Bleeders: critically ill; people on anticoagulants; unexplained bruising or bleeding
Clotters: DVT or PE
129
Who is the universal recipient ?
Type AB Rh+
130
Who is the universal donor?
Type 0 Rh-
131
Where are white blood cells made?
In the bone marrow; they move inside and outside of blood vessels
132
When should you check lead levels in children?
If they eat old paint, have GI symptoms or changes in mental status
Screen between ages 1-6 ! Levels should be less than 10, if the levels are higher than 20--> they need to be hospitalized
133
When is RDW usually measured ? (red blood cell distribution width)
only in the case of anemias
134
When is MCHC decreased? Increased?
MCHC decreased --> in thalasemia, iron def. anemia
| MCHC increased --> in hemolyusis, sphereocytosis
135
When is an essential time to check for platelets?
Before surgery
136
What would you order for a megaloblastic anemic pt?
1) CBC with differential 2) vit b12
| 3) folate levels
137
What symptoms suggest Von Willebrand Disease ?
Bleeding gums, recurrent nose bleeds,
cannot stop bleeding after giving birth
most common inherited bleeding disorder
138
What should you order for Von WIllebrand disease?
PTT/PT- normal
| Bleeding time - prolonged VWF antigen- decreased Ristocetin factor- decreased
139
What medications can cause a reaction in patients with G6PD deficiency?
What medications can cause a reaction in patients with G6PD deficiency?
140
What is transferrin?
blood protein that binds and transports iron
| in anemia, transferrin looks for more iron to bind
141
What is thrombosis?
formation of blood clot in a vessel which obstructs blood flow
142
What is thrombocytosis? Causes?
High platelet count greater than 400,000
Causes: infection inflammation multiple myeloma polycythemia vera oral contraceptives IDA
high altitudes RA
143
What is thrombocytopenia? Causes?
Low platelet count Less than 150,000
Due to: anemia-megaloblastic autoimmune metastatic cancer hemolytic diease of the newborn leukemia
malaria
Drugs
144
What is the test used to diagnose sickle cell ? What is present in Pts with sickle cell anemia?
Electrophoresis
| Hb S is present in patients with sickle cell
145
What is the term for abnormally shaped RBCs?
Poikilocytes
146
What is the red blood cell size distribution width ( RDW)
It is a measure of degree of anisocytosis;
** all RBCs have some degree of variations
Normal red blood cell size is 6-8 microns
