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AGACNP > Hematology 1 > Flashcards

Hematology 1 Flashcards

1
Q

Hgb: normal value

A

Hemoglobin: M) 14-18 g/dL F) 12-16 g/dL

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2
Q

Hgb: Interpretation

A

Increased: Long-term high-altitude (eg mountain) exposure or chronic hypoxia (secondary polycythemia)
* Hbg is the main component of RBC & serves as transporter of O2 & CO2 in the blood

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3
Q

Hct: normal value

A

Hematocrit: M) 42-52% F) 37-47%

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4
Q

Hct: Interpretation

A

The proportion of RBCs in 1 mL of plasma
Increased: May be 2/2 (but not limited) dehydration, congenital heart Dz, cor pulmonale, erythrocytosis, hypoxia (eg high-altitude)
Decreased: May be 2/2 (but not limited) anemia, bleeding, RBC destruction, bone marrow suppression or underproduction, infection, pregnancy

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5
Q

MCV: normal value

A

Mean corpuscular value: 80-100 fL (normocytic)

<80 fL microcytic; > 100 fL (macrocytic)

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6
Q

MCV: interpretation

A

Normocytic anemia: acute blood loss
Microcytic & hypochromic anemia: iron deficiency anemia, thalassemia
Macrocytic anemia: folate/B12 deficiency anemia, liver Dz, hypothyroidism

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7
Q

MCHC: normal value

A

Mean corpuscular Hgb concentration: Measure of the average color of the RBC in a blood sample.
Normal: 31-37 g/dL

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8
Q

MCHC: interpretation

A

Decreased in iron deficiency anemia & thalassemia

Normal in macrocytic & normocytic anemia

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9
Q

MCH: normal value

A

Mean corpuscular Hgb: Indirect measure of the average color of the RBC
Normal: 25-35 pg/cell

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10
Q

MCH: interpretation

A

Decreased value means pale or hypochromic RBCs. Decreased in iron-deficiency anemia and thalassemia. Normal w/ the macrocytic anemias.

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11
Q

TIBC: normal value

A

Total iron-binding capacity (TIBC): A measure of available transferrin that is left unbound to iron.
Normal value: 250-410 mcg/dL

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12
Q

TIBC: interpretation

A

Total iron-binding capacity (TIBC)
Elevated: iron deficiency, acute liver damage, progestrone birth control pills
Decreased: hemochromatosis, hemosiderosis
Normal: thalassemia, B12/folate deficiency anemia (bc iron levels are normal)

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13
Q

Serum ferritin: normal value

A

Serum ferritin is the stored form of iron. Stored in body tissue (eg spleen, liver, bone marrow). Most sensitive test for iron-deficiency anemia.
Normal: 20-400 ng/mL

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14
Q

Serum ferritin: interpretation

A

Markedly decreased in iron-deficiency anemia.
Normal to high in thalassemia.
* Avoid iron supplement before testing serum ferritin level.

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15
Q

Serum iron: normal value

A

Normal: 50-175 mcg/dL

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16
Q

Serum iron: interpretation

A

Decreased in iron-deficiency anemia. Normal to high in thalassemia and the macrocytic anemias. Affected by recent blood transfusions.

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17
Q

RDW: normal value

A

Red cell distribution width (RDW): A measure of the variability of the size of RBCs in a given sample.
Normal RDW-SD: 39-46 fL
Normal RDW-CV: 12-15% in adult

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18
Q

RDW: interpretation

A

Elevated in iron-deficiency anemia and thalassemia.

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19
Q

Reticulocyte: normal value

A

Retic: immature RBCs
Normal: 0.5-2.5% of total RBC count

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20
Q

Reticulocyte: interpretation

A

Elevated: When the bone marrow is stimulated into producing RBCs (eg post acute bleeding episodes, hemolysis, leukemia, EPO treatment, supplementation of iron/folate/B12 post deficiency)

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21
Q

Reticulocytosis: 1) definition 2) interpretation

A

1) >2.5% of total RBC count
2) If no reticulocytosis post acute bleeding episode, hemolysis, or after appropriate supplementation of deficient mineral (iron, folate, B12), or w/ EPO, rule out bone marrow failure by doing bone marrow biopsy.

22
Q

Poikilocytosis: definition

A

Presence of abnormal shape RBCs (poikilocytes) in the blood. Can be seen in the peripheral smear.

23
Q

Normal serum folate level

A

Normal folate level: 3.1 - 17.5 ng/mL

24
Q

Normal vitamin B12 level

A

Normal vitamin B12: > 250 pg/mL

25
Q

Normal WBC count

A

Normal WBC count: 5000 to 10000

26
Q

Normal neuts or segs

A

Normal neuts or segs: 55-70%

27
Q

Normal lymph

A

Normal lymph: 20-40%

28
Q

Normal monocyte level

A

Normal monocyte: 2-8%

29
Q

Normal eosinophils level

A

Normal eosinophils: 1-4%

30
Q

Hgb electrophoresis test: definition

A

Hgb electrophoresis: the gold-std test to diagnose hemoglobinopathies such as sickle cell anemia, thalassemia

31
Q

Secondary polycythemia: 1) definition and 2) indication

A

1) Hgb: M> 18.5%, F>16.5% Hct: M>52%, F>48%
2) Chronic smokers, Pts w/ long-term COPD, long-term residence at high altitude, or EPO Tx have higher incidence of secondary polycythemia

32
Q

Acute hemorrhage: 1) definition 2) S/Sx

A

1) =/>15% blood loss that results in orthostatic HoTN (systolic BP drop > 20mm Hg)
2) Shock, reticulocytosis
* Correct Hgb value will not show up until 24 hrs after onset of the hemorrhage

33
Q

Neutropenia: 1) definition 2) S/Sx

A

1) Absolute neurtophil count (ANC) < 1500/mm3
2) Frequent infections (esp. bacterial) w. fever, sore throat, oral thrush, etc.
* African Am may have a lower ANC count that is benign (normal bone marrow aspirate)

34
Q

B12 deficiency: 1) S/Sx 2) Lab findings

A

1) Gradual onset of symmetrical peripheral neuropathy starting in the feet and/or arms. Numbness, ataxia (+ Romberg test), loss of vibration and position sense, impaired memory/dementia
2) <250 pg; peripheral smear shows macro-ovalocytes, megaloblasts, and multisegmented neuts

35
Q

Hodgkin’s lymphoma: 1) definition 2) S/Sx

A

1) A cancer of the beta lymphocytes (B cells).
2) Night sweats, fevers, pain w/ ingestion of alcohol. Generalized pruritus w/ painless enlarged lymph nodes (neck). Anorexia and wt loss. More common in young (20-40) or older (>60) adults, white males.

36
Q

Non-Hodgkin’s lymphoma: 1) definition 2) S/Sx

A

1) A cancer of the lymphocytes (usually B cells) and killer cells. Has poor prognosis.
2) More common in a Pt > 65 yo; night sweats, fever, wt loss, generalized lymphadenopathy (painless)

37
Q

Multiple myeloma: 1) definition 2) S/Sx

A

1) A cancer of the plasma cells.
2) Fatigue, weakness and bone pain (usually in back or chest). Causes proteinuria w/ Bence-Jones proteins, hypercalcemia, normocytic anemia. More common in older adults.

38
Q

Bence-Jones protein test: indication

A

Used mainly to diagnose and monitor multiple myeloma

39
Q

Screening test for all anemias

A

CBC (Hgb/Hct)
Hgb: M) 14-18 g/dL F) 12-16 g/dL
Hct: M) 42-52% F) 37-47%

40
Q

Diagnostic test for thalassemia and sickle cell anemia

A

Hemoglobin electrophoresis

41
Q

Ferritin level low: interpretation

A

Iron-deficiency anemia

Normal serum ferritin: 20-400 ng/mL

42
Q

Ferritin level normal to high: interpretation

A

Thalassemia minor/trait

Normal serum ferritin: 20-400 ng/mL

43
Q

Best absorbed form of iron supplementation

A

Ferrous sulfate (OTC, cheapest)

44
Q

Key point to teach a Pt who takes iron pill

A

After taking antacid, wait 4 hrs to take iron pill

45
Q

Which meds does iron interact with? (three types)

A

Tetracycline, levothyroxine and bisphosphonates. Take iron pills 2 hrs before or after these meds.

46
Q

1) Meds and 2) conditions that can lower Hgb levels and worsen anemia

A

1) ARBs (losartan, valsartan), ACEIs (lisinopril)

2) CKD, diabetes, chronic HF, HTN

47
Q

Thrombocytopenia: 1) definition 2) S/Sx

A

1) Platelet count of < 150,000 /uL

2) Easy bruising, bleeding gums, spontaneous nosebleeds, hematuria

48
Q

Normal platelet count

A

150,000 - 450,000 /uL

49
Q

What to check for a easy bruising and initial lab order.

A 
Check meds (eg ASA, NSAIDs, heparin, warfarin, SSRIs, steroids.
Evaluate Pt for a possible coagulation disorder (eg Willebrand Dz, vit. C deficiency, scurvy).  
Initial lab order: CBC, PT, PTT.
50
Q

Anemia: definition

A

Decreased in the Hgb/Hct value below the norm for the Pt’s age and gender.

AGACNP (21 decks)

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