Mosby's Chapter 2 - Blood Studies Flashcards

Question

When should a lipoprotein draw be performed?

Answer 1

12-14 hours after fasting

Answer 2

1) Improper sample ID 2) Wrong collection tube used 3) Insufficient Blood Quantitiy 4) Hemolyzed Blood Sample 5) Improper transport of sample 6) Insufficient filling of anticoagulated blood

Answer 3

Elderly Men and African Americans Infants

Answer 4

Identifies hepatocellular diseases of the liver Injury or disease affecting the liver, heart, or skeletal muscles will cause a release of this enzyme into the bloodstream and an increased level

Answer 5

ALT/AST Is < 1 in hepatocellular diseases > 1 in hepatitis

Answer 6

Hepatitis Hepatic necrosis Hepatic ischemia

Answer 7

``` Cirrhosis Cholestasis Hepatic tumor Hepatotoxic drugs Obstructive jaundice Severe burns Trauma to striated muscle ```

Answer 8

``` Myositis Pancreatitis MI Infectious mononucleosis Shock ```

Answer 9

Used to detect and monitor disease of the liver or bone

Answer 10

Alkaline (pH 9-10)

Answer 11

Isoenzymes ALP1 and ALP2

Answer 12

Heat stable isoenzyme of ALP that is associated with the liver

Answer 13

Inactivated by heat and associated with bone

Answer 14

Enzyme found predominantly in liver If ALP and this are high = liver disease

Answer 15

These increased levels are normal due to children’s bones constantly growing and are especially high during the growth spurt

Answer 16

Ingestion of a meal

Answer 17

Primary cirrhosis Intrahepatic or extrahepatic biliary obstruction Primary or metastatic liver tumor ``` Metastatic tumor to the bone Healing fracture Hyperparathyroidism Osteomalacia Paget disease Rheumatoid arthritis Rickets Intestinal ischemia or infarction Sarcoidosis ```

Answer 18

``` Hypophosphatemia Hypophophatasia Malnutrition Milk-alkali syndrome Pernicious anemia Scurvy ```

Answer 19

Used to detect and monitor the clinical course of pancreatitis Often ordered when a patient presents with acute abdominal pain

Answer 20

During pregnancy and in older adults

Answer 21

IV dextrose

Answer 22

Pancreatic Acinar cells

Answer 23

``` Acute pancreatitis Chronic relapsing pancreatitis Penetrating peptic ulcer into the pancreas GI disease Acute cholecystitis Parotiditis (mumps) Ruptured ectopic pregnancy Renal failure Diabetic ketoacidosis Pulmonary infarction After endoscopic retrograde pancreatography ```

Answer 24

Calculation is used to evaluate patients with acid-base disorders Attempts to identify the potential cause of the disorder and can also be used to monitor therapy for acid-base abnormalities

Answer 25

Difference between the cations and anions in the extra-cellular space that are routinely calculated in the lab (Sodium + potassium) - (Chloride + Bicarbonate)

Answer 26

Venous CO2, not arterial bicarbonate

Answer 27

``` Lactic acidosis Diabetic ketoacidosis Alcoholic ketoacidosis Alcohol intoxication Starvation Renal failure Increased GI losses of bicarbonate (diarrhea or fistula) Hypoaldosteronism ```

Answer 28

``` Excess alkali ingestion Multiple myeloma Chronic vomiting or gastric suction Hyperaldosteronism Lithium toxicity ```

Answer 29

``` PH PCO2 HCO3- PO2 O2 saturation O2 content Base/Excess ```

Answer 30

Provides valuable information in assessing and managing a patients respiratory and metabolic acid-base and electrolyte homeostasis Also used to assess the adequacy of oxygenation

Answer 31

Kidneys will retain increased amounts of HCO3- to increase pH

Answer 32

Kidneys will excrete increased amounts of HCO3- to lower pH

Answer 33

Lungs “blow off” CO2 to raise pH

Answer 34

Lungs retain CO2 to lower pH

Answer 35

If there is no palpable pulse Cellulitis or open infection is present in the area being considered for access The Allen test is negative which indicates there is no ulnar artery and there is risk of using the radial artery There is an AV fistula proximal to the site or proposed access Patient has severe coagulopathy

Answer 36

Allen test

Answer 37

Evaluates patients with suspected hepatocellular diseases

Answer 38

In highly metabolic tissues like the heart, liver, skeletal muscle cells Also found in kidneys, pancreas, and RBCs

Answer 39

``` Hepatitis Hepatic cirrhosis Drug-induced liver injury Hepatic metastasis Hepatic necrosis Hepatic surgery Infectious mononucleosis with hepatitis Hepatic infiltration process Skeletal muscle trauma Recent noncardiac surgery Multiple traumas Severe, deep burns Progressive MD Recent convulsions Heat stroke Primary muscle disease Acute hemolytic anemia Acute pancreatitis ```

Answer 40

``` Acute renal disease Beriberi Diabetic ketoacidosis Pregnancy Chronic renal dialysis ```

Answer 41

Evaluates liver function In adult patients it evaluates for hemolytic anemia and in infants for jaundice

Answer 42

Form of bilirubin bound to albumin Total bilirubin - (direct bilirubin + indirect bilirubin)

Answer 43

``` Gallstones Extrahepatic duct obstruction Extensive liver metastasis Cholecstasis from drugs Dubin-Johnson syndrome Rotor syndrome ```

Answer 44

``` Erythroblastosis fetalis Transfusion reaction Sickle cell anemia Hemolytic jaundice Hemolytic anemia Pernicious anemia Large-volume blood transfusion Resolution of large hematoma Hepatitis Cirrhosis Sepsis Neonatal hyperbilirubinemia Critter-Najjar syndrome Gilbert syndrome ```

Answer 45

``` Gallstones Extrahepatic duct obstruction Extensive liver metastasis Cholecstasis from drugs Dubin-Johnson syndrome Rotor syndrome ```

Answer 46

No A or B antigens Yes anti-A and anti-B antibodies

Answer 47

A antigens | Anti-B antibodies

Answer 48

B antigen Anti-A antibodies

Answer 49

A and B antigens No anti-antibodies

Answer 50

Mother is Rh- and baby is Rh +

Answer 51

Recipients serum with donors RBCs in saline solution followed by Coombs serum

Answer 52

``` ABO typing Rh typing Rh antibody screen Hep A surface antigen Hep B core antigen Hep C antibody Syphilis HIV testing antibody 1 and 2 HIV antigen HTLV-1 testing Liver hepatocellular enzyme (ALT) ```

Answer 53

Serum calcium is used to evaluate parathyroid function and calcium metabolism by directly measure it the total amount of Ca in the blood Serum calcium levels are used to monitor patients with renal failure, renal transplantation, hyperparathyroidism, and various malignancies Used to monitor calcium levels during and after large-volume blood transfusions

Answer 54

Serum albumin because calcium decreases 0.8 mg for every 1 g decrease in albumin

Answer 55

If it is elevated on at least three separate determinations

Answer 56

``` Hyperparathyroidism Nonparathyroid PTH-producing tumor Metastatic tumor to bone Paget disease to the bone Prolonged immobilization Milk-alkali Syndrome Vitamin D intoxication Lymphoma Multiple myeloma Granulomatous infections such as sarcoidosis and TB Addison disease Acromegaly Hyperthyroidism ```

Answer 57

``` Hypoparathyroidism Renal failure Hyperphosphatemia secondary to renal failure Rickets Vitamin D deficiency Osteomalacia Hypoalbuminemia Malabsorption Pancreatitis Fat embolism Alkalosis ```

Answer 58

In peripheral venous blood this is used to assist in evaluating the pH status of the patient and to assist in evaluation of electrolytes

Answer 59

H2CO3 Dissolved CO2 Bicarbonate ion

Answer 60

``` Severe vomiting High-volume gastric suction Aldosteronism Use of mercurial diuretics Chronic Obstructive Pulmonary disease Metabolic alkalosis ```

Answer 61

``` Chronic diarrhea Chronic use of loop diuretics Renal Failure Diabetic ketoacidosis Starvation Metabolic acidosis Shock ```

Answer 62

``` Vitamin D = increase Excessive milk intake = increase Decrease in pH = increase Prolonged tourniquet time = increase Hypoalbuminemia = decrease ```

Answer 63

Performed as part of multiphasic testing for “electrolytes” Does not provide any information by itself but with interpretation of the other electrolytes, it can give an indication of acid-base balance and hydration status

Answer 64

Maintains electrical neutrality as a salt with sodium and follows sodium losses and excesses

Answer 65

``` Dehydration Excessive infusion of normal saline solution Metabolic acidosis Renal tubular acidosis Cushing syndrome Kidney dysfunction Eclampsia Respiratory alkalosis ```

Answer 66

``` Overhydration Syndrome of inappropriate secretion of ADH CHF Vomiting or prolonged gastric suction Chronic diarrhea or high-output GI fistula Chronic respiratory alkalosis Metabolic alkalosis Salt-losing nephritis Addison disease Diuretic therapy Hypokalemia Aldosteronism Burns ```

Answer 67

Measures the concentration of Factor II, V, VII, VIII, IX, X, XI, and XII

Answer 68

Many are heat sensitive and levels will decrease if left at room temp. Pregnancy and contraceptive use can increase levels of factors = VIII and IX Many are acute phase reactant proteins

Answer 69

Acute inflammatory reactions Trauma Coronary heart disease Cigarette smoking

Answer 70

Liver disease Consumptive coagulopathy Action of fibrinolysis

Answer 71

Vitamin K deficiency | Liver disease

Answer 72

Liver disease

Answer 73

Inherited deficiency Vitamin K deficiency Liver disease Coumadin therapy

Answer 74

Acute inflammatory reactions Trauma/stress Pregnancy

Answer 75

``` Inherited deficiency (hemophilia) Consumptive coagulation ```

Answer 76

Inherited deficiency | Autoimmune disease

Answer 77

``` Inherited deficiency Liver disease Nephrotic syndrome Coumadin therapy Consumptive coagulation ```

Answer 78

Inherited deficiency

Answer 79

``` INherited deficiency Vitamin K deficiency Liver disease Coumadin Therapy Consumptive coagulation ```

Answer 80

``` RBC count Hemoglobin Hematocrit RBC indices WBC could and differential count Blood smear Platelet count Mean Platelet VOlume ```

Answer 81

Mean Corpuscular volume Mean corpuscular hemoglobin Mean corpuscular hemoglobin concentration RBC distribution width

Answer 82

``` Neutrophils Lymphocytes Monocytes Eosinophils Basophils ```

Answer 83

Identifies immune hemolysis or to investigate hemolytic transfusion reactions

Answer 84

``` Fever Chills Rash Flank/back pain Bloody urine Fainting or dizziness ```

Answer 85

``` CBC Electrolytes BUN Direct Coombs test ABO blood typing on donor and recipient blood RH typing on donor and recipient blood Blood crossmatch Protime PTT Fibrin split products Haptoglobin Bilirubin Blood cultures on donor and recipient blood Urine for free hemoglobin dipstick ```

Answer 86

``` Hemolytic disease of newborn Incompatible Blood transfusion reaction Lymphoma Autoimmune hemolytic anemia Mycoplasma infection Infectious mononucleosis Hemolytic anemia after heart bypass Adult hemolytic anemia ```

Answer 87

Used to detect antibodies against RBCs in the serum Used most commonly for screening potential blood recipients

Answer 88

When the recipients blood has antibodies to the donor’s RBCs

Answer 89

Incompatible crossmatched blood Hemolytic disease of the newborn Acquired immune hemolytic anemia Presence of specific cold agglutinin antibody

Answer 90

An acute phase reactant protein used to indicate an inflammatory illness Believed to be of value in predicting coronary events

Answer 91

Acute, noninfectious inflammatory reactions Collagen-vascular diseases Tissue Infarction or damage Bacterial infections such as postoperative wound infection, UTI, or TB Malignant diseases Bacterial Infection Increased risk of cardiovascular ischemic events

Answer 92

Used to diagnose impaired renal function

Answer 93

Elderly and young children typically have lower levels as a result of reduced muscle mass

Answer 94

Diseases affecting renal function, such as glomerulonephritis, pyelonephritis, Acute tubular necrosis, urinary tract obstruction, reduced renal blood flow Rhabdomylosis Acromegaly Gigantism

Answer 95

Debilitation | Decreased muscle mass

Answer 96

Used to measure the GFR of the kidney

Answer 97

Adult values decrease 6.5 mL/min with each decade of life after age 20 because of a decrease in GFR

Answer 98

Exercise Pregnancy High cardiac output syndromes

Answer 99

Impaired kidney function | Conditions causing decreased GFR

Answer 100

Nonspecific test used to detect illnesses associated with acute and chronic infection, inflammation (collagen-vascular diseases), advanced neoplasms, and tissue necrosis or infarction Measurement of the rate at which the RBCs settle in saline solution or plasma over a specified time period

Answer 101

``` Chronic renal failure Malignant diseases Bacterial infection Inflammatory diseases Necrotic diseases Diseased associated with increased proteins Severe anemia ```

Answer 102

Sickle cell anemia Spherocytosis Hypofirbinogenemia Polycythemia Vera

Answer 103

An inherited abnormal form of factor V that has an amino acid switch at nucleotide 1691 in the gene for factor V This mutation causes this factor to be cleaved by Protein C at a slower than normal rate

Answer 104

Diagnose V-Leiden Thrombophilia

Answer 105

Direct measurement of the blood glucose level Most commonly used in the evaluation of diabetic patients

Answer 106

Serum glucose levels must be evaluated according to the time of day Glucose determinations must be performed frequently in new diabetic patients Many formed of stress can cause increased levels

Answer 107

``` Diabetes Mellitus Acute stress response Cushing syndrome Pheochromocytoma Chronic renal failure Glucagonoma Acute pancreatitis Diuretic therapy Corticosteroid therapy Acromegaly ```

Answer 108

``` Insulinoma Hypothyroidism Hypopituitarism Addison disease Extensive liver disease Insulin overdose Starvation ```

Answer 109

Values in children are age specific, with normal values varying throughout the first 18 years Values are slightly decreased in the elderly

Answer 110

Indirect measurement of RBC number and volume Used as a rapid measurement of RBC count Integral part of the evaluation of anemic patients

Answer 111

Normal values vary according to gender and age Pregnancy usually causes slightly decreased values because of chronic hemodilution The hematocrit is usually three times the hemoglobin concentration when RBCs are of normal size and contain normal amounts of hemoglobin In dehydration the hematocrit is falsely elevated; in overhydration, the value is decreased

Answer 112

``` Erythrocytosis Congenital heart disease Polycythemia Vera Severe dehydration Sever COPD ```

Answer 113

``` Anemia Hemoglobinopathy Cirrhosis Hemolytic anemia Hemorrhage Dietary deficiency Bone marrow failure Prosthetic valves Renal disease Normal pregnancy Rheumatoid/Collagen-vascular diseases Lymphoma Multiple myeloma Leukemia Hodgkin Disease ```

Answer 114

Measure of the total amount of hemoglobin the blood Used as a rapid indirect measurement of the RBC count It is repeated serially in patient with ongoing bleeding or as a routine part of the CBC Integral part of the evaluation of anemic patients

Answer 115

Dilutional overhydration decreases the hemoglobin concentration; dehydration tends to cause an artificially high value The hematocrit is usually three times higher than the hemoglobin concentration when RBCs are of normal size and contain a normal amount of hemoglobin Living at high altitudes causes increased hemoglobin values as a result of a physiologic response to decreased oxygen levels

Answer 116

``` Erythrocytosis Congenital heart disease Severe COPD Polycythemia Vera Severe dehydration ```

Answer 117

``` Anemia Hemoglobinopathy Cirrhosis Hemolytic anemia Hemorrhage Dietary deficiency Bone marrow failure Prosthetic valves Renal disease Normal pregnancy Rheumatoid/Collagen-vascular diseases Lymphoma Multiple Myeloma Neoplasia Leukemia Hodgkin Disease Splenomegaly ```

Answer 118

Enzyme linked immunoabsorbent assay (EIA)

Answer 119

Levels of specific IgM antibodies to the B. Burgdorferi spirochete = these peak during 3rd-6th week and then decline Levels of specific IgG antibodies = these stay elevated for years after

Answer 120

A western blot test to confirm a positive EIA result

Answer 121

Used to gain information about fluid status and electrolyte imbalance Helpful in evaluating illnesses involving antidiuretic hormone (ADH)

Answer 122

Difference of more than 10 mOsm/L

Answer 123

Test provides valuable information about fluid and electrolyte balance Osmolality increases with dehydration and decreases with overhydration The simultaneous measurement of urine osmolality helps in interpreting and evaluating problems with fluid balance

Answer 124

``` Hypernatremia Hyperglycemia Hyperosmolar nonketotic hyperglycemia Ketosis Azotemia Dehydration Mannitol therapy Ingestion of ethanol, methanol, or ethylene glycol Uremia Diabetes insipidus Renal tubular necrosis Severe pyelonephritis ```

Answer 125

Overhydration Syndrome of Inappropriate ADH secretion Paraneoplastic syndromes associated with carcinoma

Answer 126

Used to assess the intrinsic system and the common pathway of clot formation Also used to monitor heparin therapy

Answer 127

Used to monitor heparin therapy which is immediate and short lived If too much is given, it can be reversed by protamine Patients receiving heparin need to be monitored for bleeding tendencies

Answer 128

``` Congenital clotting factor deficiency Cirrhosis of the liver Vitamin K deficiency Diseminated intravascular coagulation Heparin administration Coumarin administration ```

Answer 129

Early stages of DIC | Extensive cancer

Answer 130

An actual count of the number of platelets per cubic milliliter of blood It is performed on patients who develop Petechiae, spontaneous bleeding, increasingly heavy menses, or thrombocytopenia Monitors the course of the disease or therapy for thrombocytopenia or bone marrow failure

Answer 131

High altitudes = increased Automated counting is subject to a 10-15% error Strenuous exercise = increased Before menstruation = decreased levels

Answer 132

``` Malignant disorders Polycythemia vera Postsplenectomy syndrome Rheumatoid arthritis Iron-deficiency anemia or following hemorrhagic anemia ```

Answer 133

``` Hypersplenism Hemorrhage Immune thrombocytopenia Leukemia and other myelofibrosis disorders Thrombotic thrombocytopenia Graves Disease Inherited disorders DIC Systemic lupus erythematosus Pernicious anemia Some hemolytic anemias Cancer chemotherapy Acute/Chronic infections ```

Answer 134

Test is routinely performed in most patients evaluated for any type of serious illness Potassium is important to cardiac function so it is part of all complete routine evaluations, especially in patients who take diuretics or heart medications

Answer 135

Potassium has profound effects on the heart rate and contractility = levels must be carefully monitored in patients taking digitalis like drugs and diuretics IV potassium may be indicated to prevent cardiac arrhythmias in hypokalemia; it is infused slowly to prevent irritation to the veins Serum levels are effected by acid-base balance; alkalotic states lower potassium and acidotic states increase potassium Hemolysis of blood during venipuncture or lab processing can cause elevations

Answer 136

``` Excessive dietary intake Excessive IV intake Acute or chronic renal failure Addison disease Hypoaldosteronism Aldosterone-inhibiting diuretics Crush injury to tissues Hemolysis Transfusion of hemolyzed blood Infection Acidosis Dehydration ```

Answer 137

``` Deficient dietary intake Deficient IV intake Burns GI disorders Diuretics Hyperaldosteronism Cushing syndrome Renal tubular acidosis Licorice ingestion Alkalosis Insulin administration Glucose administration Ascites Renal artery stenosis Cystic fibrosis Trauma/surgery/burns ```

Answer 138

Closely related to the hemoglobin and hematocrit levels and represents different ways of evaluating the number of RBCs in the peripheral blood It is repeated serially in patients with ongoing bleeding or as a routine part of the complete blood cell count Integral part of the evaluation of anemic patients

Answer 139

RBC decreases are seen during pregnancy Increased RBCs are seen in people living in high altitudes

Answer 140

``` Erythrocytosis Congenital heart disease Severe COPD Polycythemia vera Severe dehydration Hemoglobinopathies Thalassemia trait ```

Answer 141

``` Anemia Hemoglobinopathy Cirrhosis Hemolytic anemia Hemorrhage Dietary deficiency Bone marrow failure Prosethetic valves Renal disease Normal pregnancy Rheumatoid/collage-vascular diseases Lymphoma Multiple Myeloma Leukemia Hodgkin disease ```

Answer 142

Indication of the ability of the bone marrow to respond to anemia and make RBCs Used to classify and monitor therapy of anemias

Answer 143

Howell-Jolly bodies

Answer 144

Hemolytic anemia Hemorrhage Hemolytic disease of the newborn Treatment for iron, Vitamin B12, or folate deficiency

Answer 145

``` Pernicious anemia and folic acid deficiency Iron-deficiency anemia Aplastic anemia Radiation therapy Malignancy Marrow failure Adrenocorticol hypofunction Anterior pituitary hypofunction Chronic diseases ```

Answer 146

Test is part of routine lab evaluation of most patients It is one of the tests automatically performed when "serum electrolytes" are requested Test is used to evaluate and monitor fluid and electrolyte balance and therapy

Answer 147

Recent trauma, surgery, or shock may cause increased levels because renal blood flow is decreased Renin and angiotensin stimulate the secretion of aldosterone, which stimulates increased renal absorption of sodium

Answer 148

Increased Sodium Intake: Increased dietary intake Excessive sodium in IV fluids Decreased Sodium Loss: Cushing Syndrome Hyperaldosteronism ``` Excessie Free Body Water Loss: GI loss Excessive sweating Extensive thermal burns Diabetes insipidus Osmotic diuresis ```

Answer 149

Decreased Sodium Intake: Deficient dietary intake Deficient sodium in IV fluids Increased Sodium Loss: Addison disease Diarrhea, vomiting, or nasogastric aspiration Intraluminal bowel loss Diuretic administration Chronic renal insufficiency large volume aspiration of pleural or peritoneal fluid ``` Increased Free Body Water: Excessive oral water intake Hyperglycemia Excessive IV water intake Congestive heart failure Peripheral edema Ascites Pleural effusion Intraluminal bowel loss Syndrome of inappropriate or ectopic secretion of ADH ```

Answer 150

An indirect and rough measurement of renal function and glomerular filtration rate Measurement of liver function It is performed on patients undergoing routine laboratory testing Usually performed as a part of a multiphasic automated testing process

Answer 151

Almost all renal diseases cause an inadequate excretion of urea, which causes the BUN to rise; severe liver disease can therefore cause a decreased BUN BUN is directly related to the metabolic function of the liver and the excretory function of the kidney Changes in protein intake can effect BUN levels; low-protein = decrease and high protein = increase Hydration status can also effect levels; overhydration = dilute BUN and cause lower levels; dehydration = concentrates BUN and causes higher levels

Answer 152

``` Prerenal causes: Hypovolemia Shock Burns Dehydration Congestive heart failure MI GI bleeding Excessive protein ingestion Excessive protein catablosim Starvation Sepsis ``` Renal Causes: Renal disease Renal failure Nephrotoxic drugs Postrenal Azotemia: Ureteral obstruction from stones, tumor, or congenital anomalies Bladder outlet obstruction from prostatic hypertrophy or cancer or bladder/urethral congenital anomalies

Answer 153

``` LIver failure Overhydration because of fluid overload syndrome of inappropriate antidiuretic hormone secretion Negative nitrogen balance Pregnancy Nephrotic syndrome ```

Answer 154

Measurement of total and differential WBC count is a part of all routine lab diagnostic evaluations It is especially helpful in the evaluation of the patient with infection, neoplasm, allergy, or immunosuppression

Answer 155

WBC values tend to be age related Normal newborns and infants tend to have higher WBC values than adults It is not uncommon for the elderly to fail to respond to infection by the absence of leukocytosis; the elderly may not develop an increased WBC count even in the presence of a severe bacterial infection

Answer 156

Neutrophils and Lymphocytes

Answer 157

An increased WBC count usually indicates infection, inflammation, tissue necrosis, or leukemic neoplasia Serial WBC and differential counts have both diagnostic and prognostic value A drastic decrease in WBCs below the normal range may indicate bone marrow failure and subsequent high risk of septicemia and death

Answer 158

``` Infection Leukemic neoplasia or other myeloproliferative disorders Other malignancy Trauma, Stress, or Hemorrhage Tissue necrosis Inflammation Dehydration Thyroid storm Steroid use ```

Answer 159

``` Drug toxicity Bone marrow failure Overwhelming infections Dietary deficiency Congenital marrow aplasia Bone marrow infiltration Autoimmune disease Hypersplenism ```

Mosby's Chapter 2 - Blood Studies Flashcards

(190 cards)