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Heme/Onc Exam 2 > RBC Disorders - Diagnostic studies > Flashcards

RBC Disorders - Diagnostic studies Flashcards

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1
Q

Contains EDTA as anticoagulant

A

“Purple top” or “Lavender top”
vacutainer tubes are used for CBC

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2
Q

A CBC with diff includes
_____, in addition to normal CBC
information:

A

WBC differentiation

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3
Q

When is CBC with diff indicated?

A

Generally costs a little more and is really only indicated when infectious processes are in question or in the case of leukemia/lymphoma

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4
Q

On a CBC, “Hgb” gives us the ____

A

total hemoglobin concentration

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5
Q

Hemoglobin & hematocrit are increased in

A

hemoconcentration (vomiting,
dehydration, burns), polycythemia, etc.

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6
Q

Hemoglobin & hematocrit are decreased in

A

hemodilution and macrocytic,
normocytic, and microcytic anemias

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7
Q

Critical low for hemoglobin

A

Critical low: Less than 7 g/dL

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8
Q

How is HgB measured?

A

It is measured by spectrophotometry on automated instruments after lysis of RBCs as part of the process

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9
Q

Hct

A

The percentage of whole blood
volume composed of erythrocytes.

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10
Q

How is Hct measured?

A

Nowadays, measured by automated
instruments with calculation of RBC
count X the MCV.
○ Normal for males: About 39-49%
○ Normal for females: About 35-45%

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11
Q

Anemia diagnosis with CBC

A

“Anemia” can be diagnosed based on
the H & H, but then further evaluation of the CBC (and possibly other tests) is needed to determine the type and cause of the anemia

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12
Q

Red Blood Cell Count

A

The actual number of red blood cells in a microliter of blood

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13
Q

RBC’s counting process and range

A

RBCs are counted by automated instruments using electrical impedance or light scattering.
○ Normal for males: About 4.3-6.0 x 10 6 /mcL
○ Normal for females: About 3.5-5.5 x 10 6 /mcL

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14
Q

RBCs increased in

A

Polycythemia vera, secondary
polycythemia, hemoconcentration (such as dehydration), etc.

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15
Q

RBCs are decreased in

A

most macrocytic, normocytic,
and microcytic anemias.

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16
Q

White Blood Cell Count measurement

A

Typically measured by an automated lab hematology analyzer in today’s day in age. Manual differentiation can be done.
○ Normal: About 4.5-11.0 x 10 3 /mcL. Critical: Less than 1.5

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17
Q

WBC count is increased in

A

acute infections, inflammatory disorders, leukemias, myeloproliferative
disorders, steroid use, allergies,
hypersensitivity reactions, stress, etc

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18
Q

WBC count is decreased in

A

infections, myeloid hypoplasia,
myelosuppression, hypersplenism, alcoholism, etc

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19
Q

Absolute counts of WBCs can be calculated from a combination of the
_____

A

WBC count and the percentage of each WBC type

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20
Q

Platelet count measurement

A

It is typically obtained by an automated CBC analyzer.
○ Normal: About 150-450,000 per mcL
○ Many labs are now reporting 100-500,000 as normal

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21
Q

Critical low platelets

A

Less than 25,000 per mcL

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22
Q

Critical low WBCs

A

Less than 1.5

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23
Q

WBC normal ranges

A

○ Neutrophils: 50-70%
○ Lymphocytes: 20-40%
○ Monocytes: 2-6%
○ Eosinophils: 1-4%
○ Basophils: 0-1%

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24
Q

Platelets can be increased in

A

some myeloproliferative conditions, some myelodysplastic disorders, acute blood loss, postsplenectomy,
reactive thrombocytosis, infection, some malignancies, etc

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25
Platelets can be decreased in
bone marrow suppression, chemotherapy, HIV, hypersplenism, disseminated intravascular coagulopathy, TTP, ITP, some drugs, etc
26
RBC Indices
Red Blood Cell indices are a group of blood tests included in the CBC that provide information about the hemoglobin content and size of red blood cells
27
What is included in the RBC indices
○ Mean Corpuscular Volume (MCV) ○ Mean Corpuscular Hemoglobin (MCH) ○ Mean Corpuscular Hemoglobin Concentration (MCHC) ○ Red Cell Distribution Width (RDW)
28
Abnormal values in RBC indices areas can indicate the presence of _____
certain types of anemia
29
The _____ is the average volume of the red blood cells.
Mean Corpuscular Volume
30
Helps us determine if an anemia is categorized as a macrocytic, normocytic, or microcytic anemia
MCV
31
Normal MCV
80-100 fl
32
Common microcytic anemias based on MCV
● Iron Deficiency ○ Chronic blood loss ○ Dietary ● Thalassemias ● Anemia of Chronic Disease (some) ● Lead toxicity
33
Common normocytic anemias based on MCV
● Anemia of Chronic Renal Disease ● Anemia of Chronic Disease (some) ● Aplastic Anemia ● Acute Blood Loss ● Hemolytic Anemia
34
Common macrocytic anemias based on MCV
● Vitamin B12 Deficiency ● Folate Deficiency ● Myelodysplasia ● Alcoholism related ● Aplastic Anemia (sometimes)
35
The Mean Corpuscular Hemoglobin indicates the amount of hemoglobin per RBC in absolute units
Mean corpuscular hemoglobin
36
MCH increased in
macrocytosis and hemochromatosis
37
Normal MCH =
26-34 pg
38
MCH decreased in
iron deficiency, thalassemia, lead poisoning, and anemia of chronic disease
39
The ____ represents the average hemoglobin concentration in RBCs
Mean Corpuscular Hemoglobin Concentration - MCHC
40
Normal MCHC
31-36 g/dL
41
MCHC increased in
autoimmune hemolytic anemia, as well as other forms of hemolytic anemia
42
MCHC decreased in
iron deficiency anemia, thalassemia, lead poisoning, anemia of chronic disease, etc.
43
The ____ is a measurement of the variability of RBC size
RDW - Red Cell Distribution Width
44
_____ means variability in the size of RBCs
Anisocytosis
45
Normal rance RDW
11.5-14.5
46
The higher it is, the more variation in size describes what
RDW
47
Normal RDW And elevated MCV =
Aplastic anemia
48
Normal RDW And normal MCV:
Normal (obviously), or it could be anemia of chronic disease, acute blood loss, hemolysis, thalassemia, etc
49
Elevated RDW and elevated MCV:
Vitamin B12 deficiency, folate deficiency, autoimmune hemolytic anemia, liver disease, etc
50
Elevated RDW and normal MCV:
EARLY iron deficiency anemia, folate deficiency anemia, or vitamin B12 deficiency anemia
51
elevated RDW and decreased MCV:
Iron deficiency anemia, certain forms of Thalassemia (uncommon).
52
Serum Vitamin B12 Level is increased in
Leukemia, marked leukocytosis, and polycythemia vera (not diagnostically useful, however).
53
Serum Vitamin B12 Level is decreased in
Pernicious anemia, gastrectomy, gastric carcinoma, malabsorptive conditions (such as Celiac Disease), pregnancy, dietary deficiency, and some drugs (such as omeprazole, metformin, carbamazepine).
54
Folate can either be measured as a _____ or _____
plasma level or from the red blood cells (both automated processes)
55
Folic acid is decreased in
folic acid deficiency (inadequate intake, malabsorption), alcoholism, some drugs, vitamin B12 deficiency (50-60%, since cellular uptake of folate depends on Vitamin B12).
56
_____ is very important for maintaining several functions in the body, especially the production of functional hemoglobin
Iron
57
Serum iron is increased in
excessive iron states, hemolytic anemia, pernicious anemia, thalassemia, hemochromatosis, etc.
58
Serum iron is decreased in
iron deficiency anemia, nephrotic syndrome, chronic renal failure, and active hematopoietic states
59
_____ is a measurement of the maximum amount of iron the blood is able to bind/carry
Total Iron Binding Capacity - TIBC
60
an indirect measure of available Transferrin
TIBC
61
Each Transferrin is able to bind ____ Iron molecules
two
62
Normal TIBC
About 250-460 mcg/dL
63
TIBC is increased in
iron deficiency anemia, infancy, acute hepatitis, late pregnancy, and some oral contraceptives
64
Decreased in _____
hypoproteinemic states (malnutrition, nephrotic syndrome), hemochromatosis, thalassemia, etc.
65
Normal ferritin level
○ Normal for males: About 16-300 ng/mL ○ Normal for females: About 4-161 ng/mL
66
In the absence of liver disease and infection/inflammation, _____ is a more sensitive test for iron deficiency than TIBC and serum iron levels
Ferritin
67
Ferritin is decreased in
iron deficiency
68
Ferritin is increased in
Hemochromatosis, acute or chronic liver disease, alcoholism, inflammatory conditions, some malignancies, etc.
69
Similar to and based off the TIBC, the _____ is an estimate of the percentage of Transferrin that is saturated with iron
percent of iron saturation
70
Percent iron saturation is increased in ____
hemochromatosis, excessive iron intake, hemolytic anemia, recent transfusion, thalassemia, etc.
71
Percent iron saturation is decreased in ____
hypochromic anemias, such as iron deficiency anemia (usually saturation less than 16%).
72
Peripheral Blood Smear
Also sometimes called a Blood Film or Manual Differential, this test involves examining a whole blood sample under a microscope
73
The peripheral blood smear should be examined when the CBC _____
reveals abnormal blood counts.
74
T/F No evaluation of anemia is complete without inspection of the blood smear
T
75
Poikilocytosis
Variability in RBC shape
76
Spherocytes
Small, spherical RBCs
77
_____, a familial hemolytic disorder caused by hemolytic destruction of abnormally shaped RBCs (a form of hemolytic anemia)
Hereditary spherocytosis
78
Target Cells are
RBCs with small amounts of Hgb Seen sometimes with Hemoglobinopathies, such as Thalassemia, sickle cell disease, etc
79
_____: Fragmented RBCs, appearing in various “jagged” shapes
Schistocytes
80
____: Inclusions within RBCs composed of denatured Hgb
Heinz Bodies
81
____: Damaged RBCs, with chunks taken out.
Bite Cells (Degmacyte) ○ Fairly characteristic of hemolytic anemia secondary to G6PD deficiency
82
_____: Nuclear remnants (clusters of DNA) in RBCs
Howell-Jolly Body
83
_____: Stacks or linear aggregates of RBCs
Rouleaux Formation
84
Characteristic of Multiple Myeloma (or preparation artifact)
Rouleaux Formation:
85
_____: Small peripheral dots in the RBCs (ribosomes)
Basophilic Stippling
86
Several potential causes of basophilic stippling
Hemolytic anemia, lead poisoning, heavy metal poisoning, alcohol abuse, Myelodysplastic syndrome, etc
87
A reticulocyte count measures ____
how rapidly these are produced by the bone marrow and released into circulation ○ Reflects the erythropoietic activity of the bone marrow
88
Reticulocyte count is increased in
hemolytic anemia, acute blood loss, and response to therapy from iron, vitamin B12, or folate
89
Reticulocyte is decreased in
iron deficiency anemia, aplastic anemia, anemia of chronic disease, megaloblastic anemia, bone marrow suppression or infiltration, myelodysplastic syndrome, etc
90
Normal reticulocyte count
33-137K / mcL
91
Hemoglobin Electrophoresis
A blood test that can detect different forms of Hemoglobin found within a patient’s blood sample
92
Coomb’s Test two types:
Also known as Antiglobulin Test (AGT) ○ Direct Coomb’s Test (DCT) / Direct Antiglobulin Test (DAT) ○ Indirect Coomb’s Test (ICT) / Indirect Antiglobulin Test (IAT) ● The Direct Coomb’s Test is more sensitive and specific for diagnosing Autoimmune Hemolytic Anemia.

Heme/Onc Exam 2 (7 decks)

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