Lab Med: CBC/Coagulation studies Flashcards
(106 cards)
1
Q
top of the fishbone…
A
hemoglobin
2
Q
bottom of fishbone
A
hematocrit
3
Q
left of fishbone
A
WBC
4
Q
right of fishbone
A
platelets
5
Q
What would you expect H/H to do in response to these conditions:
Dehydration
COPD
Polycythemia vera
High Altitude
A
Elevate
6
Q
What would you expect H/H to do in response to these conditions:
Anemia
A
Decrease
7
Q
This measures the average size of RBCs…
A
MCV
8
Q
This is an indicator of size variation of RBCs…
A
RDW
9
Q
Variation in size of RBCs is known as…
A
anisocytosis
10
Q
What is the primary cause of leukocytosis?
A
Bacterial infection
11
Q
What are common causes of leukocytosis
A
bacterial infx inflammation neoplasm leukomoid response steroid use
12
Q
What are common causes of leukopenia?
A
viral infx overwhelming bacterial infx bone marrow failure drug toxicity autoimmune disorder
13
Q
Neutrophils, Eosinophils, Basophils are all classified as ______ because they have _____ in their cytoplasm and ________ nuclei
A
granulocytes
granules in cytoplasm
multilobed nuclei
14
Q
PMNs or “polys” are…
A
polymorphonuclear leukocytes, aka granylocytes
15
Q
the most common PMN is…
A
neutrophil
16
Q
This granulocyte is involved in allergic and parasitic infx
A
eosinophil
17
Q
this granulocyte is the least common, and is involved in allergic reactions
A
basophils
18
Q
Neutrophilia occurs most common with…
A
bacterial infx
19
Q
neutropenia most commonly occurs with…
A
overwhelming bacterial infx
aplastic anemia
viral infx
20
Q
Eosinophilia is common with…
A
fungal, parasitic infx
allergic rxn
21
Q
Eosinopenia is common with…
A
CS use, acute inflammation
22
Q
Do eosinophils respond to bacterial or viral infx?
A
no
23
Q
Basophilia occurs when…
A
myeloproliferative disease
leukemia
24
Q
basopenia occurs with…
A
acute allergic rxn, stress
25
T-Cells and B-Cells are classified as ________ and work to fight _________ infections.
lymphocytes
fight acute viral infx
26
these phagocytic cells are capable of fighting bacteria directly...
monocytes
27
Lymphocytosis commonly indicates what diseases?
mononucleosis (EBV) and hepatitis
viral infx
28
Infections, CS use, immunodeficiency, lymphoma, chemo, radiation therapy can all cause what response with lymphocytes?
lymphocytopenia
29
What is a common cause of monocytopenia?
CS use
30
Chronic inflammatory disorders
viral and parasitic infx
TB
severe infx
These can all have what effect on monocytes?
monocytosis
31
These conditions can cause what type of thrombocytosis?
Acute blood loss
Malignancy
Inflammatory conditions
Trauma
Infx
Reactive thrombocytosis
32
What are common causes of thrombocytosis?
reactive
essential
polycythemia vera
CML, AML, MDS, Myelofibrosis
33
The following conditions have what effect on platelets?
ITP
TTP
drug induced immune
cancer s/ BM suppression
infx
chronic liver disease
DIC
aplastic anemia
inherited disorder
thrombocytopenia (reduced)
34
This disease is a chronic myeloproliferative neoplasm that causes clonal proliferation of myeloid cells and an elevated RBC...
polycythemia vera
35
a male patient presents with the following. What do you suspect, and what labs do you order?
Hb: 16.5
HCT: 49
thrombosis
pruritis
splenomegaly
headaches, parasthesias
polycythemia vera . evidenced by Hb and HCT
Labs:
Serum EPO
peripheral blood screening for JAK mutation
36
Females with polycythemia vera will have a Hb of _______ and a HCT of _______
Hb: 16 or higher
HCT: 48% or higher
37
The following are all examples of what type of condition?
platelet dysfunction
splenic sequestration
increased destruction
impaired production
platelet disorders
38
The following are all examples of what type of condition?
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
Factor V Leiden mutation
Prothrombin mutation
primary hypercoagulable disorders
39
What is a threat with primary hypercoagulable disorders?
DVT
40
The following are all examples of what type of condition?
Hemophilia A and B
Von Willebrand Disease
congenital coagulation disorders
41
which etiology of platelet dysfunction is more common:
Acquired or congenital?
Acquired
42
What drugs commonly cause acquired platelet dysfunctions?
abx, chemo
43
```
Drugs
Uremia
Liver disease
Von Willebrand
Myeloproliferative disease
```
These are common causes of...
acquired platelet dysfunction
44
How do you manage platelet dysfunction?
treat underlying cause
platelet transfusion
45
In this disease, cirrhosis caues vascular congestion leading to splenomegaly and thrombocytopenia...
Splenic sequestration
46
ITP
DIC
heparin induced thrombocytopenia
TTP
HUS
Other thrombotic microangiopathies
These can all cause what type of platelet disorder
increased destruction
47
this disorder occurs when:
antiplatelet Abs cause platelet activation.
increased platelet activation leads to increased risk of vascular thrombosis
thrombocytopenia and prothrombotic states can occur...
what drug is responsible and what is the disorder called?
Heparin induced thrombocytopenia
caused by UFH or LMWH
48
Can pts with hx of HIT have heparin again?
no!
49
TTP and HUS are examples of...
thrombotic microangiopathy
50
This disease occurs when platelets are incorporated into thrombi in microvasculature, contributing to microangiopathic hemolytic anemia.
thrombotic microangiopathy
51
what type of RBCs can you see in thrombotic microangiography?
RBC fragmentation, schistocytes
52
This type of thrombotic microangiopathy has the following etiology:
Medical Emergency
Caused by Abs against ADAMTS-13
TTP
53
This type of thrombotic microangiopathy has the following characteristics:
Microangiopathic hemolytic anemia
thrombocytopenia
acute kidney injury
neurological deficits
fever
Can also have purpura, petechiae, pallor, jaundice
TTP
54
this disease is common in pediatric patients with bloody stool as a result of shiga toxin producing E. Coli
Hemolytic Uremic Syndrome (HUS)
55
This disease presents with:
Microangiopathic hemolytic anemia
thrombocytopenia
acute kidney injury
hemolytic uremic syndrome
56
This disease presents with the following laboratory findings:
Schistocytes
Increased LDH, Indirect bilirubin
Decreased haptoglobin
coombs negative
thrombocytopenia (CBC)
Normal PT/aPTT
thrombotic microangiopathy (HUS, TTP)
57
How do you treat thrombotic microangiopathies?
plasma exchange, supportive care
58
Both HUS and TTP present with hemolytic anemia, thrombocytopenia, acute kidney injury.
What two signs/sxs occur in TTP that don't in HUS?
neurological deficits
Fever
59
What are the common causes of impaired platelet production?
bone marrow failure
chemo/radiation
B12, folate, iron deficiency
EtOH consumption
60
This coagulation study evaluates the intrinsic and common pathways, as well as monitors UFH therapy...
PTT/aPTT
61
This coagulation study is the preferred test to monitor UFH and LMWH therapy
anti-factor Xa
62
This coagulation study is used to evaluate the extrinsic and common pathways and to monitor warfarin therapy...
PT
63
This coagulation study is calculated as a ratio of the patient's PT to a control PT. It is used to monitor warfarin therapy.
The goal is depended on the underlying need for anticoagulation.
INR
64
This mixing test is used to differentiate between a coagulation factor deficiency vs. an inhibitor problem...
inhibitor screen
65
this test measures the conversion of fibrinogen to fibrin and isn't used as an initial screen.
thrombin time
66
Low levels of this can result in impaired clot formation and increased bleeding risk
fibrinogen
67
This panel of tests is composed of...
```
antithrombin
factor V-leiden
protein C
protein S
prothrombin gene mutation
lupus anticoagulant
MTHFR
```
hypercoagulable panel
68
What limits the use of the hypercoagulable panel?
it is expensive
69
the fast acting anticoagulants are...
UGH, LMWH (lovenox)
70
Long therm anticoagulants are...
Warfarin (coumadin)
Factor Xa inhibitors
Dabigatran (oral direct thrombin inhibitor)
71
What are the DOACs (direct oral anticoagulants)?
Factor Xa inhibitors
Oral direct thrombin inhibitors (dabigatran)
72
Anticoagulant DOC:
Cancer pts
lovenox (LMWH)
73
Anticoagulant DOC:
inability to have parenteral therapy...
Rivaroxaban, edoxaban (factor Xa inhibitors)
74
Anticoagulant DOC:
once daily, PO therapy
Rivaroxaban, edoxaban (factor Xa inhibitors)
Warfarin (vitamin K antagonist)
75
Anticoagulant DOC:
Liver disease + coagulopathy
Lovenox (LMWH)
76
Anticoagulant DOC:
Renal disease and creatinine clearance less than 30
Warfarin (vitamin K antagonist)
77
Anticoagulant DOC:
Coronary artery disease
Warfarin
Rivaroxaban, apixaban, edoxaban (factor Xa inhibitors)
78
Anticoagulant DOC:
Poor compliance
warfarin
79
Anticoagulant DOC:
need for reversal agent
warfarin
UGH
Dabigatran
80
Anticoagulant DOC:
Pregnancy
Lovenox (LMWH)
81
Which anticoagulants require 5-10 days of parenteral anticoagulation?
dabigatran
edoxaban
82
Anticoagulant DOC:
DVT, PE without underlying malignancy
DOACs
83
Anticoagulant DOC:
Patients with DVT, PE with underlying malignancy
Lovenox (LMWH)
84
A patient is on UFH... what baseline labs do you want? What do you want for monitoring
Baseline:
aPTT, PT/INR
CBC
Monitoring:
aPTT
Factor Xa
85
A patient is on LMWH. What baseline labs do you want? What do you order for monitoring?
Baseline:
aPTT, PT/INR
CBC
Creatinine
Monitoring:
none
86
A patient is on a DOAC. What baseline labs do you want? What do you order for monitoring?
Baseline:
PT/INR
CBC
Creatinine
Monitoring:
none
87
A patient is on a Warfarin. What baseline labs do you want? What do you order for monitoring?
Baseline:
aPTT, PT/INR
CBC
Creatinine
LFTs
Monitoring:
PT/INR
88
Can you do a loading dose for warfarin?
no
89
What is the initial dose of warfarin?
5mg/day
90
How long should parenteral therapy of UFH/LMWH overlap with warfarin?
at least 5 days, until INR is therapeutic for minimum of 24 hours or 2 consecutive days
91
What strategy of warfarin dosing should be considered to find optimum dose?
titrate to appropriate INR
92
How often should INR be monitored with warfarin therapy?
daily, then weekly
every 2-4 weeks once stabilized
93
Target INR for:
Propylaxis
1.5-2
94
Target INR for:
VTE
2-3
95
Target INR for:
afib
2-3
96
Target INR for:
mechanical mitral valve
2.5-3.5
97
Target INR for:
mechanical aortic valve
2-3
98
Patient on warfarin presents with an INR of 4.5-10 with no evidence of bleeding...
How do you treat?
Hold warfarin
Administer PO Vitamin K
99
Patient on warfarin presents with INR greater than 10, no evidence of bleeding. How do you treat?
Hold warfarin
give PO vitamin K
100
Patient presents with VKA associated major bleeding. How do you treat?
hold warfarin
Rapid reversal with PCC, give IV vitamin K
101
UFH and LMWH Reversal agent...
protamine
102
Warfarin reversal agent
Vitamin K
PCC
103
Dabigatran reversal agent
idarucizumab (praxbind)
104
Rivaroxaban (xarelto) reversal agent
none, supportive care
105
Apixaban (eliquis) and edoxaban (lixiana, savaysa) reversal agent
adexanet
106
Why do you give PCC and vitamin K to get the INR down in warfarin therapy?
PCC rapidly reduces INR as bridge until Vitamin K begins.
work synergistically
