Hematology 2

Question 1

Normal range of WBC

Answer 1

4.4 – 11.3 x103 cells/ L

Question 2

two general groups of cells that make up WBC

Answer 2

Granulocytes (Neutrophils, eosinophils, basophils)

Non-granulocytes (Lymphocytes/ monocytes)

Question 3

Phagocytic cells which derive their name for the presence of granules within cytoplasm that store lysozymes and other chemicals needed to destroy foreign cells

Answer 3

Granulocytes

Question 4

Produced by bone marrow during bacterial infection

Answer 4

Neutrophils

Question 5

Normal range of Neutrophils

Answer 5

PMNs 45 – 73%; bands 3 – 5%

Question 6

↑ in “Bands” during an infection ONLY

Answer 6

a “left shift”

Question 7

‘margination’

Answer 7

Adhere to walls of vascular endothelium

Question 8

Causes for Elevations in Neutrophils

Answer 8

Increased production = Bacterial infections

Demargination = Trauma, acute MI, Drugs (i.e., Corticosteroids)

Question 9

Normal range for Eosinophils and basophils

Answer 9

eosinophils: 0 – 4%; basophils: 0 – 1%

Question 10

Eosinophils elevations are highly suggestive of

Answer 10

parasitic infections or allergic reactions

Question 11

Increase in Basophils are due to

Answer 11

allergic and hypersensitivity reactions (release histamine= causal)
May increase for chronic inflammatory diseases and leukemias

Question 12

Responsible for “phagocytosis” (ingestion) of substances labeled by antibodies or compliment proteins

Answer 12

Monocytes & macrophages

Question 13

Normal range of Monocytes & macrophages

Answer 13

2 – 8%

Question 14

Increased monocytes seen in

Answer 14

tuberculosis/ malaria/ rickettsia

Question 15

Give specificity & memory to foreign invaders

Answer 15

Lymphocytes

Question 16

Normal range for Lymphocytes

Answer 16

20 – 40%

Question 17

produce antibodies

Answer 17

B lymphocytes

Question 18

Cytotoxic through antibody & complement activation

Answer 18

T lymphocytes & Natural Killer Cells (NK cells)

Question 19

Effects of Infections on White Blood Cells

Answer 19

Increase in Neutrophils = Bacteria, and TB (lesser extent)
Increase in Lymphocytes = Viral
Decrease in Lymphocytes = HIV
Increase in Eosinophils = Parasites
Increase in Monocytes = TB

Question 20

Effects of Non- infectious factors on WBCs

Answer 20

Stressors increase Neutrophils
Corticosteroids increase Neutrophils, decrease Lymphocytes
Radiation decreases Neutrophils and Lymphocytes
Allergies increase Eosinophils
Chronic infections increase Basophils

Question 21

GW presents with fevers and severe body wide rash following initiation of Lyrica.
 No recent travel reported
WBC’s:		     14,000 cells/uL
Neutrophils (50%); Band (3%);
Lymphocytes (22%); Monocytes (4%)
Eosinophils (20%); Basophils (1%)
Which of the following caused elevated WBCs?
Bacteria infection
Viral infection
Parasitic infection 
Rash

Answer 21

Rash

Question 22

First to adhere to vascular injury

Form weak hemostatic plug= hemostasis

Answer 22

Platelets

Question 23

Normal range of Platelets

Answer 23

150,000 – 450,000 cells/L

Question 24

Platelet count < 150,000 cells/ μL

Answer 24

Thrombocytopenia

Question 25

Hyperdestructive causes of Thrombocytopenia

Answer 25

``` Drugs (e.g., heparin) Autoimmune disease (e.g., SLE) ```

Question 26

Hypoproductive cause of Thrombocytopenia

Answer 26

Aplastic anemia

Question 27

Risk of bleeding from trauma

Answer 27

Platelet count < 50,000

Question 28

Risk for spontaneous bleeding

Answer 28

Platelet count < 20,000

Question 29

Platelet count > 450,000 cells/ μL

Answer 29

Thrombocytosis

Question 30

Causes of Thrombocytosis

Answer 30

stress, infection, trauma, malignancy

Question 31

platelet count > 800,000 cells/ μL

Answer 31

Thrombocythemia | Risk of clotting (i.e., ischemic stroke) and bleeding (i.e., GI)

Question 32

Mean platelet volume (MPV)(for thrombocytopenia)

Answer 32

Normal range 7 – 11 fL (varies with laboratory)

Question 33

Cause of Thrombocytopenia + High MPV

Answer 33

hyperdestructive

Question 34

Cause of Thrombocytopenia + Low MPV

Answer 34

hypoproductive

Question 35

Measure the ability of the platelet to aid in clotting

Answer 35

Platelet Function tests

Question 36

Measure time to stop bleeding following an incision | Falling out of favor (lack of sensitivity/ specificity)

Answer 36

``` Bleeding time (BT) Normal range: 2 – 9 min ```

Question 37

Measures the ability of platelets to aggregate after a platelet agonist is added (i.e. epinephrine) Develop aggregation graph Slope and curve of over time identifies platelet disorders

Answer 37

Platelet aggregation

Question 38

Uses of Coagulation studies

Answer 38

Identify deficiencies in coagulation proteins | Monitor effects of anticoagulation therapy

Question 39

Identifies deficiencies extrinsic clotting cascade & common pathways (factors II,V,VII,X) Uses thromboplastin + Ca =promotes factor X to Xa

Answer 39

``` Prothrombin time (PT) Normal range = 10- 13 seconds ```

Question 40

Problem with PT

Answer 40

Clotting time dependent on thromboplastin source | Animal versus human thromboplastin differ in sensitivity

Question 41

‘PT’ test that accounts for thromboplastin sensitivity

Answer 41

International Normalized Ratio (INR) | Normal INR = 1.0 (0.9- 1.2)

Question 42

Best possible ISI

Answer 42

1 (range from 1- 3)

Question 43

Relation between thromboplastin and ISI

Answer 43

Larger the ISI, the less sensitive the thromboplastin

Question 44

PT = 10 sec (baseline); PT= 30 sec (day #3 on warfarin); ISI = 1.0 What is the INR ?

Answer 44

INR = { 30 (sec) /10 (sec) }^1.0 = 3.0

Question 45

Used in evaluating therapeutic effects of heparin

Answer 45

Antifactor Xa Assay

Question 46

Mechanism of Antifactor Xa Assay

Answer 46

Uses patient plasma + antithrombin III + factor Xa Heparin combines with antithrombin III to inhibit factor Xa Assay measures remaining levels of factor Xa Levels of factor Xa consumed are proportional to amount of heparin

Question 47

Therapeutic range of Antifactor Xa Assay

Answer 47

0. 5 – 1.0 units/mL = LMW Heparin (BID dose) | 0. 35 – 0.7units/mL = UF Heparin

Question 48

Byproduct of plasmin digestion of cross-linked fibrin

Answer 48

D- dimer (< 0.5 mcg/mL)

Question 49

Uses of D- dimer

Answer 49

Helps diagnose or rule out thromboembolic event e.g., DVT/ pulmonary embolism Sensitive but nonspecific marker

Question 50

Conditions where D-dimer is Falsely elevated

Answer 50

Malignancy, Infection, Pregnancy, & Acute Inflammation

Question 51

23 y/o female patient presents with sudden, stabbing chest pain and SOB; Wgt= 70 kg Medication Hx: Oral contraceptives/ Ibuprofen prn Proventil HFA inhaler (asthma) D-dimer = 7.0 mcg/mL 1) What thromboembolic event do you suspect? 2) What INR would you suggest on Warfarin? 3) Would anti-factor Xa level be necessary on LMWH?

Answer 51

DVT 2-3 Yes