Midterm Review Flashcards
(131 cards)
1
Q
- Which factor will have an increased PT but normal aPTT?
A
factor 7 (factor 7 has an extremely low half life)
2
Q
- What test is the most early and most sensitive indicator of iron deficiency?
A
ferritin
3
Q
- Chronic dz vs iron deficiency: (is the anemia d/t chronic dz or Fe deficiency?)
A
TIBC/transferrin and ferritin tests.
a. Transferrin levels will be low in chronic dz but high in Fe deficit
b. Ferritin testing: sensitive APR, up with inflammation but low in Fe deficit
4
Q
- Exudate vs Transudate
A
a. Exudate is cellular, “malignant” in nature, high cell and high protein (>3g), high LDH.
b. Transudate occurs under hydrostatic conditions (heart failure), has low LDH and low protein (< 3g) and low cell count.
5
Q
- Good marker for folate deficiency:
A
homocysteine concentration
6
Q
normal values white cells
A
4-11,000
7
Q
Immediate action PLT
A
< 50,000
8
Q
● Immediate action Hb (child vs adult)
A
<7 child, <5 adult
9
Q
● Immead action ANC
A
< 500 absolute count
10
Q
● INR should not be higher than…
A
> 4
11
Q
what is TACO
A
transfusion associated circulatory overload—too much fluid and it overflows them
- Common transfusion rxn, causes pulmonary edema due to volume excess or circulatory overload
- Causes hypoxia/hypertension, tachycardia, wide pulse pressure/JVD, S3 Heart sound, possible rales/wheezing
- Seen with pts who received large volume of transfused product over a short time or with underlying CV or renal disease.
- Slower to develop sxs, after multiple volumes of blood
12
Q
Rh antibodies are/are not naturally occurring?
A
Are NOT. Must be immunized against Rh to have Rh antibodies.
13
Q
O blood has what antigens
A
-A and -B
14
Q
what are minor RBC antigens (3)
A
kell, lewis, duffy
15
Q
● How do you get immunized against a minor RBC antigen?
A
Must be immunized with the red cells. Never match the minor Ab unless the person has a positive antibody screen whose been previously transfused. These minor Ab won’t cause a life-threatening immune rxn
16
Q
● Diagnostic sensitivity, definition and equation
A
TP/TP+FN
○ measures a test’s ability to detect positivity in the presence of dz. high rate of FN kills the sensitivity
17
Q
● Diagnostic specificity: definition and equation
A
TN/TN+FP; measure of a test’s negativity in absence of disease. high rate of FP kills the specificity
18
Q
● ROC curve: perfect test hugs __ then hugs ___ at the top. Area under curve tells you what cut off point gives you the idea sensitivity and specificity.
A
hugs y and then x
l~
19
Q
____________ is on the X axis and ________ is on the Y
A
X: specificity
Y: sensitivity
20
Q
Red tube additive, purpose, and example
A
no additive; allows blood to clot permits seperation of blood and serum (to test serum); for chemistry, billirubin, BUN, Ca+2
21
Q
red/black tube additive, purpose, and example
A
no additive; serum seperator tube; chemistry and serology
22
Q
purple/lavender tube additive, purpose, and example
A
EDTA added, prevents blood from clotting(preserves cellular morphology and suspension in solution); hematology CBC, platelet count
23
Q
gray tube additive, purpose, and example
A
sodium flouride oxalate added; prevent glycolysis(enzyme inhibitor); chem, glucose, lactose tolerance
24
Q
green tube additive, purpose, and example
A
heparin added; prevents blood from clotting to test plasma(does not change the pH); chem, ammonia, carboyhemoglobin, uric acid and blood gas
25
blue tube additive, purpose, and example
sodium citrate added; prevent blood from clotting when plasma needs to be tested (coag studies min fill level important); PT(prothrombin), PTT(partial thromboplastin time),
26
black tube additive, purpose, and example
sodium citrate; binds Ca+2 to prevent blood clotting; for ESR
27
yellow tube additive, purpose, and example
citrate added; preserves red cells; blood cultures
28
gold serum separator tube (SST) additive, purpose, and example
no additive; collects serum; chemistry
29
what tubes are in a "rainbow"
red, blue and purple tubes for blood testing; useful for ER and covers many hematology/chemistry and hemostasis tests
30
More confirmatory test, more ______, the _______ would lower most likely
more specific
| sensitivity would likely decrease
31
a ROC curve is used for....
Used for selecting a cutoff point that maximizes sensitivity and specificity
32
W/a ROC curve the area under the curve is good for...
Area under the curve is useful for estimating overall efficacy of the test
33
normochromic ____MCHC (mean cell Hb concentration) and normal color
32-36
34
hypochromic ___ MCHC with pale coloring
< 32
35
normocytic ___MCV
80-100 MCV
36
microcytic ____ MCV
<80
37
macrocytic ___ MCV
>100 MCV
38
Low MCV (microcytic) is indicative of...(2)
Fe deficiency, thalassemia
39
High MCV (macrocytic) indicates...(3)
folate/B12 deficit, liver dz, hyperlipidemia
40
central paleness of RBC shouldn’t be more than ___ of the diameter of the RBC
1/3 (hypochromic)
41
MCHC indicates...
shows mean concentration of Hb inside the RBC)
42
Norm Hb for women
12-16
43
norm Hb for men
13-17
44
immeadiate action values for Hb in child and adult
<7 in children
<5 in adult
>20
45
immead action value for hematocrit
>60%
46
Hb x __ = hematocrit (+/- 3 points)
3
47
Hematocrit/Packed Cell Volume (PCV) normal
36-54% (males higher)
48
hematocrit is...
the ratio of the volume of red blood cells to the total volume of blood
49
Normal Mean Cellular Hb (MCH)
27-33 pg
50
normal Mean cellular Hb concentration (MCHC)
32-36 g/dL (rarely see anything over 36, will indicate hereditary spherocytosis)
51
normal WBC
4000-11,000 (children will have more than adults)
52
WBC immediate action
>50,000 (varies)
53
immediate action ANC
<500 (absolute neutrophil count, normal is 60% of WBC)
54
norm PLT
150,000-400,000
55
risk for mucocutaneous bleeding if platelet is
<50,000
56
risk for intracranial bleeding if PLT
<10,000
57
risk for myeloproliferative dz if platelet is
>1,000,000
58
ESR norms for _____males, ____ females normals (increased with inflammation)
males: <10 mm/hr
females: <5 mm/hr
59
Reticulocyte Production Index :
___ in hypoproliferative anemias
___ in hemolytic anemias
<2% (not producing) - hypo
| >2% (premature destruction) - hemolytic
60
ANC (absolute neutrophil count)
neutropenia : ___
Agranulocytosis: ____ (increased risk of infection )
penia: <1500/uL
agranulocytosis: <500/uL
61
Reticulocytes are:______________
________ in hemolytic anemias (RBC destruction) ________ in hypo-proliferative anemia (“block” – vitamin/nutrient deficiency, anemia of chronic inflammation)
RBC freshly released from bone marrow
Increased in hemolytic
decreased in hypoprolif
62
how does ESR detect inflammation?
increased fibrinogen and IG in plasma
63
what are the three components of Iron testing?
serum iron, TIBC(transferin), and ferritin
64
Serum immunoglobulin and complement levels are useful in working up....
immunodeficiency
65
__________ and _________are best to discriminate Fe deficiency from ACI(anemia of chronic dz).
Total iron binding capacity (TIBC)(transferin) and ferritin
66
_______ can mimic Fe deficiency, CBC can show both.
anemia of chronic dz
67
__________ is the earliest and most sensitive indicator of iron deficiency
ferritin
68
Basophilic stippling is evident in....
RBCs with lead poisoning and also apparent in many forms of anemia (not in all anemias)
69
________ (crystallized granules) visible in blast cells in the cytoplasm -> pathopneumonic for AML
Auer-Rods
70
left shift inc the probability of.... (3) (when paired with meaningful vital signs
sepsis, meningitis or appendicitis when paired with meaningful vital signs and symptoms (90% sensitivity)
71
Classic left shift parameters (4)
Immature granulocytes, bands, myelocytes, promyelocytes
72
In regards to left shift you're likely to see:
- increased circulating WBC
- band count = ___(immature cells)
- _________ (“arming up” of neutrophils)
- ___________ (precipitated RNA)
- __________ (indicates active phagocytosis occurring)
increased circulating WBC
band count >700/ug--immature cells
Toxic granulation (“arming up” of neutrophils)
Döhle bodies (precipitated RNA)
Vacuoles (indicates active phagocytosis occurring)
73
If WBC counts are normal....
do not jump to rule out infectious disease if the WBC results are normal- do not use as sole parameter for left shift (can be low or normal in many infections)
74
Iron deficiency HALLMARK = ____ will be low, MCHC is _____
```
MCV low (microcytic)
MCHC <32 (hypochromic)
```
75
Megaloblastic Anemia: B12/folate deficiency:
MCV ___,
intramedullary hemolysis,
RPI (reticulocytes production index) is ______
MCV: >100 (macrocytic and normochromic)
RPI: <2%
76
```
Beta thalassemia major-
MCV _____
MCHC ______
normal iron status.
Electrophoresis to detect high ______
Do DNA testing.
```
MCV <80 (microcytic)
MCHC <32 (hypochromic)
Hgb f
77
sickle cell dz-
>10% of the Hb is ____- monoclonal antibodies are also helpful
1.family history
2. kids with 2 copies of succeptible Hb become _____ after 6 months of life
3. electrophoresis to determine
HgB S
| anemic
78
Anemia of chronic dz/inflammation:
RPI (reticulocytes production index) is ____
C-Reactive protein is more expensive
ESR - just as sensitive and cheaper
increase in ________ & immunoglobulins (>RVs) and increase APRs
______ levels: informative in working up inflammatory dx (H)
TIBC is ____(inc/dec) in inflammatory states
microcytic, hypochromic
______ and _________ are the two most important to determine inflammation vs. iron deficiency
```
<2%
fibrinogen
C3/C4
decreased
Ferritin and TIBC
```
79
G6PD deficiency:
RPI (reticulocytes production index) ___
________(identifies common G6PD deficiency mutations) - gold standard test should be performed on patients at risk before antimalarial therapy or prophylaxis is initiated to avoid reaction
>2%
| Rapid PCR
80
Ethnicities that are at risk for _________ are: North African, mediterranean, asian
G6PD deficiency
81
Aplastic/hypoplastic of the marrow:
RPI(reticulocyte production index) is ____
aplastic anemia = _______penia
Evaluate ________________ to diagnose
=2.0%
pancytopenia
core biopsy of bone marrow
82
chronic unresolved infections, constitutional symptoms, abnormal and reproducible WBC findings, bruising/bleeding, pancytopenia (RBC, PLT, WBC), presence of immature cells in peripheral blood including blasts and or immature granulocytes and acutely can present with high white counts.
What disease process is this?
Leukemia
83
What is sepsis? what should you order?
disseminated infection, left shift
| get a PT(prothrombin time)/aPTT (activated partial thromboplastin time)
84
Left shift and signs of ________ activation have 90% sensitivity for predicting neonatal sepsis
neutrophil
85
_____________ presents with left shift, high WBC (neutrophil), protein, sometimes low glucose.
what should you order?
Bacterial meningitis
| get a PT/aPTT
86
High RBC, Evidence of erythrophagocytosis
spinal tap: principle finding - red blood cells; same ratio of white to red, no platelets in any fluid.
what disease process is this?
hemorrhagic stroke
87
what is Thrombopoietin
TPO, aids in sensing of the platelet count.
88
Name 9 things that can cause thrombocytopenia
```
Heparin induced thrombocytopenia (HIT)
DIC
ITP--immune thrombocytic purpura
Hypersplenism- sequesters platelets in an enlarged spleen
Liver disease
leukemia
medications, chemotherapy
autoimmune dz (SLE, RA)
pregnancy
```
89
______ may be “platelet sensor” in the body = low Factor 7 (factor 7 has a short half life)
liver
90
what is ITP?
immune thrombocytic purpura: common in kids after a viral infection - then two weeks later platelets crash and that’s the only one that lowers
91
INR aka PT- prothrombin time
| tests what?
2, 5, 7, 10, fibrinogen
92
aPTT-activated partial thromboplastin time tests what?
factors 2, 5, 8, 9, 10, 11, 12, fibrinogen, prekallikrein and HMWK
93
Describe specimen collection protocol for drawing blood in tubes containing sodium citrate
(blue top)
a. must be drawn to precise amount--10:1 ratio
b. do not mix tubes
c. invert gently after draw (mix the blood & anticoagulant)
94
Define DIC
Acute disseminated intravascular coagulation (DIC) caused by: Brain injury, vascular injury (vasculitis, connective tissue diseases, infections), complicated pregnancy, malignancy, meningitis, sepsis, severe transfusion reaction, acute promyelocytic leukemia (APL) and other conditions
Simultaneous bleeding (and oozing of plasma) and clotting in microcirculation
Life-threatening disorder
Treatment depends on cause (ex. uterine evacuation for pregnancy complications)
95
Explain what you would expect for DIC tests (3)
prolonged clotting time tests (PT, aPTT) (takes you longer to clot because all your clotting factors are used up)
decreased (consumed) PLTs and fibrinogen
increased fibrin turnover (increased d-dimer levels- fibrin degradation product).
96
deficiency of _____ or ______ increases risk of DVT/clotting/PE
Antithrombin + heparin
97
what do protein C and protein S do?
(S acts a cofactor of protein C) deficiency increases risk of DVT/clotting/PE, both are VitK dependent
98
Name the 6 vitamin dep coagulation factors
Protein C, protein S, Factor: 2, 7, 9, 10
99
_______ doesn’t interfere with Vit K dependent clotting
| _________ does, low on protein C and other VitK dependent
Heparin
| coumadin(warfarin)
100
the most common inherited thrombosis risk is _____ mutation
factor 5 leiden
101
describe HIT (heparin induced thrombocytopenia)
d/t presence of autoantibody to PLT factor 4 (PF4) in complex with heparin.
Causes PLT activation→ clotting → consumption of clotting factors & platelets
20% mortality, use high or low molecular weight heparin to treat
102
what's vonwilibrand disease
inhibits PLT adhesion to injured endothelium (first step of platelet activation).
VWfactor binds and protects factor 8 from proteolysis from protein C.
With vW deficiency, factor 8 is destroyed (can’t start clotting cascade) and bleeding results (platelet adhesion/platelet plug cannot occur).
103
what is TTP?
Thrombotic thrombocytopenic purpura. Problem with the enzyme ADAMTS13. Clotting occurs abnormally. platelets clump together, leaving fewer available to clot other parts of the body, leading to bleeding (purpura) under the skin.
104
what is Warfarin induced skin necrosis?
warfarin causes easy bruising but rarely will cause necrotic purple lesions. Warfarin affects vitK (procoagulant) which is essential in making a functional protein C. He doesn’t think it has anything to do with clotting.
105
what are the two theories on how warfarin induced skin necrosis works?
Theory 1: Occurs d/t acquired deficiency of protein C. Imbalance btwn coagulation and anticoagulation creating a hypercoagulable state. Generation of thrombotic occlusions of microvasculature, resulting in necrosis
Theory 2: suggest warfarin has a direct toxic effect on capillaries. Capillaries dilate and rupture, petechiae develop. veins distal to injured capillaries thrombose, creating stasis and blood, causing tissue necrosis
106
How does coumadin/warfarin work to prevent clotting? risks/disadvantages?
decreases ability to form clots by blocking formation of vitamin K dependent clotting factors.
i. Side effects include bleeding, warfarin induced skin necrosis, hard to dose a person as well because we are genetically polymorphic for cytochrome P450 metabolism. A lot of trial and error and lab tests, to reach therapeutic range.
107
How does heparin work to prevent clotting? risks/disadvantages?
Increases binding of antithrombin to its targets by 1000x. Without heparin, antithrombin will not be an effective anticoagulant.
i. disadvantage: using higher molecular forms- the HIT causes clotting due to autoantibody that recognizes clotting factor 4 induces clotting mechanism
108
therapeaudic range for INR while on coumadin/warfarin?
INR: Therapeutic range 2-3, maybe 4
109
what's the physio behind factor V leiden mutation clotting?
Single amino acid substitution in factor 5 results in resistance to proteolysis by Protein C. Factor 5 builds up—promotes clotting
110
s/s for antiphospholipid antibody syndrome
DVT in weird places, multiple miscarriages, strokes, PE
111
labs for antiphospholipid antibody syndrome
i. Prolonged clotting time tests, esp. PTT? most sensitive, paradoxically prolong PTT. Snake venom is useful stimulator, factor 10 activator.
1. antibodies displace the coagulation complexes so it takes longer to clot
ii. Tests for anticardiolipin, beta-2 glycoprotein I (β2GPI), and lupus anticoagulant -> but they cause clotting.
112
what are lupus anticoags
Lupus Anticoagulants: cause clotting, only act as anticoagulant in low phosphate containing environments; better to call them phospholipid dependent anticoagulants
113
Extrinsic pathway starts with factor ____ then moves to factor ____
3 then 7 (calcium carries it into the common pathway)
114
INTRINSIC PATHWAY starts with ____ then moves to _____ next is ____
12, 11, 9 (factor 8 carries into the common pathway)
115
```
What are deficiencies in these factors called?
Factor 8?
Factor 9?
factor 11?
Factor 12?
```
Factor 8: classic hemophilia A
Factor 9: Christmas dz (hemophillia B)
factor 11: hemophilia C
Factor 12: bleeder not clotter
116
Increase TPA, but keep everything else constant, will it cause bleeding or clotting?
It causes bleeding, by increasing fibrinolysis
117
High levels of plasminogen activator = _________
| Not enough plasminogen activity = ___________
High levels of plasminogen activator: bleeding
| Not enough plasminogen activity: clotting
118
what is PAI1
risk assessment marker for coronary artery disease -> clotting
119
__________ expressed on the damaged tissue
Tissue factor (thromboplastin)
120
what is TRALI - Transfusion Related Acute Lung Injury?
- Respiratory distress/hypoxia, hypotension, fever, transient elukepenis, diffuse bilat infiltrates on CXR, high protein level, exudate in edema
- Occurs close in time to the initiation of the transfusion before significant volume is infused
121
_______ is the most important RBC parameter to evaluate
Hb
122
what is Physiologic anemia of infancy
baby is born with high Hb b/c they must be able to convert mothers Hb to fetal to receive O2. Hb tails off after birth (can be 11 when kids are 4-6 yr old) but creeps up through puberty when it plateaus (d/t androgen production).
123
```
WBC counts:
• Adult total
• Neutrophils %
• Lymphocytes %
• Monocytes %
• Eosinophils %
• Basophils %
```
```
Adult total: 4-11 x 10^3/μL
• Neutrophils: 50-70%
• Lymphocytes: 20-40%
• Monocytes: < 8%
• Eosinophils: < 5%
Basophils < 2%
```
124
___________ provide quicker index of recovery (1-2 weeks after therapy) in non-hemolytic anemia than CBC
Reticulocytes
125
anti ds-DNA/ and anti-Smith antibodies are useful in dx of _________
Lupus
126
anti-CCP is useful in dx of _____
RA
127
```
o Total Serum iron?
o Transferrin?
o Transferrin saturation?
o Ferritin?
Ferritin levels
```
o Total Serum iron: 30-170ug/dL F, 65-180 M
o Transferrin: 200-350ug/dL (total serum iron is carried on transferrin)
o Transferrin saturation: 25-45% (~1/3)
o Ferritin: 12-150 ng/mL W, 12-300 M
Ferritin levels <10 indicate depleted iron stores
128
o Common cause of megaloblastic anemia is __________ anemia (autoimmune)
-Test with _________ factor autoantibody (gold standard)
pernicious anemia
| -Test with anti-intrinsic factor autoantibody
129
Immeadiate action value for INR
>4
130
Patient has confirmed prolonged PT and normal PTT. Which coagulation factor deficiency can produce this result?
Factor 7
131
What if pt has prolonged PTT but normal PT?
think factor 8, 9—“intrinsic pathway factors”
