Labs for Heme onc

Question 1

What is a left shift and when do you see it

Answer 1

Increase in number of immature WBC types (an example is in bandemia, which is an increase in band neutrophils)
Common in infection and inflammatory disorders

Question 2

What is the normal vs clinically significant value for a left shift

Answer 2

Normal: <1%
Significant: >10%

Question 3

What is bandemia

Answer 3

an excess or increased levels of band cells (immature white blood cells) released by the bone marrow into the blood.
Type of left shift

Question 4

What are the 3 measures looked at to examine the class of RBCs as a whole most commonly

Answer 4

RBC count, hemoglobin, hematocrit

Question 5

Which value do we use to assess anemia

Answer 5

Hemoglobin almost exclusively

Question 6

What measures examine RBCs individually (morphology)

Answer 6

MCV (how big or small the RBC is)
MCHC (hemoglobin within each RBC concentration)
MCH (Hemoglobin per RBC)
RDW (RBC uniformity. If higher value, you have more variability between size and shape of RBCs)

Question 7

If someone is microcytic, what measure of RBC morphology is being examined, and what does this indicate

Answer 7

They are looking at MCV ( average volume) and they have low size / volume

Question 8

If someone is hypochromic, what is this measuring and what is wrong

Answer 8

Measures Average hemoglobin content in RBC
Hypochromic= low levels of Hgb

Question 9

What is anisocytosis

Answer 9

elevated RDW (size dysregulation of RBCs)

Question 10

If someone has normocytic, normochromic anemia, what do their labs look like and what causes this

Answer 10

Normal MCV and MCHC,
Acute blood loss, Aplastic anemia, leukemia, bone marrow problem.

Question 11

If someone has microcytic, hypochromic anemia, what do their labs look like and what causes this

Answer 11

MCV decreased, MCHC decreased
Iron deficiency, thalassemia, lead poisioning, anemia

Question 12

If someone has microcytic, normochromic anemia, what do their labs look like and what causes this

Answer 12

MCV decreased
MCHC normal
Examples: Iron deficiency, thalassemia

Question 13

If someone has macrocytic, normochromic anemia, what do their labs look like and what causes this

Answer 13

MCV increased
MCHC normal
Folate deficiency, Vitamin B12 deficiency, pernicious anemia

Question 14

Hgb and Hct vs RBC indices

Answer 14

Whole blood vs individual RBCs morphology

Question 15

What does EPO do

Answer 15

stimulate bone marrow to make RBCs and Reticulocytes

Question 16

People who have chronic anemia might have which factor deficiency

Answer 16

EPO deficiency

Question 17

Poikilocytosis is what

Answer 17

a term that indicates the presence of abnormally shaped red cells like dacryocytes (teardrop shaped red cells), schistocytes (fragmented red cells) and elliptocytes

Question 18

When do you see Dacryocytes

Answer 18

mylofibrosis

Question 19

What is a Spherocyte characteristic of

Answer 19

Spherocytosis, immune hemoytic anemia

Question 20

What is an Echinocyte characteristic of

Answer 20

Renal failure, malnutrition

Question 21

What are acanthocytes characteristic of

Answer 21

Spur cell anemia, abetalipoprotenimia

Question 22

Renal toxicity can lead to what type of RBCs

Answer 22

Echinocytes (renal failure is characteristic of these)

Question 23

Target cells are assocaited with which disease

Answer 23

thalassemia and iron deficiency

Question 24

What does alcoholism cause

Answer 24

Macrocytosis from B12 folate deficiency

Question 25

Where is a bone marrow biopsy done most commonly in adults

Answer 25

PSIS

Question 26

What does flow cytometry identify

Answer 26

cells via surface proteins

Question 27

What does cytoenics identify

Answer 27

metaphase cells and chromosomal analysis(helps to identify protective factors of cancer vs leukemias or other cancers)

Question 28

What does FISH identify

Answer 28

Chromosomal deletions, duplications, translocation

Question 29

What does NGS identify

Answer 29

genome or gene panel Sequence genetic profile of abnormal cells, look for genes associated with leukemias/lymphomas

Question 30

Which iron test is the most sensitive to order

Answer 30

ferritin--> iron storage protein, levels indicative of body's iron stores

Question 31

Low vs high ferritin measures what

Answer 31

Low ferritin- very sesnitive for iron deficiency high ferritin- iron overload, measures end organ damage (BUT, it is also an acute phase reactant, so can be elevated in patients who have liver disease).

Question 32

If someone has a high Total iron binding capacity, what is occurring?

Answer 32

Still many binding sites available for iron on transferrin, which indicates an iron deficiency. Transferrin has a higher capacity for binding because they can still be filled by iron.

Question 33

If someone is iron deficient, what do you expect their ferritin and TIBC to look like

Answer 33

Low Ferritin (low iron stores) High TIBC (high affinity because many of the binding sites are empty since there is a lack of iron)

Question 34

Which pathways is PT evaluating

Answer 34

Extrensic and common coagulation pathways 2, 7, 9, 10

Question 35

What pathways is PTT evaluating

Answer 35

intrensic and common coagulation pathways 12, 11, 9, 8

Question 36

What does the presence of D-dimers indicate

Answer 36

Fibrin degredation product D-dimers indicate that a fibrin clot was formed, and then subsequently degraded Elevated when the coagulation system has been activated, followed by fibrinolysis

Question 37

If you suspect that a patient has auto antibodies to RBCs, which test do you order

Answer 37

Coombs/DAT

Question 38

When do you order a Coombs/DAT test

Answer 38

When you want to detect if the patient has auto antibodies to RBCs

Question 39

Which Ig's activate B cells

Answer 39

IgM and IgD

Question 40

Which antibodies cross the placenta into the fetus

Answer 40

IgG

Question 41

Which antibodies are attached to the surface of a B cell or secreted in an early immune response

Answer 41

IgM

Question 42

Which Ig blocks transport of microbes across mucosal surfaces

Answer 42

IgA

Question 43

Which immunoglobulin makes up the majority of serum Ig's

Answer 43

IgG