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CLM Quiz 2

Terms in this set (74)

Which blood cells are actually circulating in our blood?
basophils
eosinophils
neutrophils (and N. bands)
monocytes
platelets
erythrocytes (and polychromatic erythrocytes)
lymphocytes
Complete Blood Count
RBC count
- RBC indices (MCV, MCH, MCHC)
- RBC distribution width (RDW)
Hemoglobin (HgB)
Hematocrit (Hct)
WBC count
Platelet count
- mean platelet volume (MPV)
Erythrocytes
most common blood cell

round/oval biconcave disks

flexible

no nucleus

has HgB

circulates 100-120 days
What recycles RBCs?
macrophages in the spleen
Erythropoiesis
process by which new RBCs are made

occurs in red bone marrow in adults

occurs in liver in embryos
What hormone stimulates erythropoiesis?
erythropoietin (EPO) in the kidneys
Reticulocytes
slightly immature RBCs

no nucleus but DOES have ribosomal RNA (Methylene blue stain)

.5-1.5% of RBCs
Reticulocyte Levels
indirect estimate of RBC production

good indicator of bone marrow function
Increased Reticulocytes
bleeding
hemolytic anemia
Decreased Reticulocytes
bone marrow not working well!

chemotherapy, aplastic anemia, problems with EPO production, mineral deficiencies
Mean Corpuscular Volume
Average measure of RBC volume

Normal: 80-100fL
MCV Abnormals
<80 = microcytic
>100 = macrocytic
Mean Corpuscular Hemoglobin
average amount of hemoglobin per RBC

Normal: 28-34 pg/cell
Mean Corpuscular Hemoglobin Concentration
average concentration of hemoglobin in a given volume of RBCs

Normal: 32-36 g/dL
Abnormal MCHC
decreased: microcytic anemia

increased: hereditary spherocytosis, sickle cell disease
Red Cell Distribution Width
measures range of sizes of red blood cells in a blood sample

Normal: 11-14.5%
Abnormal RDW
Increased= anisocytosis (RBC of unequal sizes)

Iron deficiency anemia- high RDW, low MCV

Folate and B12 deficiency- high RDW, high MCV

Recent hemorrhage- high RDW, normal MCV
RBC Indices
Mean Corpuscular Volume
Mean Corpuscular Hemoglobin
Mean Corpuscular Hemoglobin Concentration
Red Cell Distribution Width
Multiple Myeloma
protein causes RBCs to stick together

RBC morphology- agglutinate OR Rouleaux
Anemia
decreased Hgb/Hct
decreased O2 carrying capacity
Absolute Anemia
physiologic causes include stem cell disorders, DNA disorders, heme and globin disorders, RBC survival disorders
Relative anemia
dilutional
occurs in 3rd trimester
Microcytic Anemia
MCV <80

Iron-deficient, thallasemia, sideroblastic anemia, and lead poisoning
Normocytic Anemia
MCV 80-100 (normal range)
Macrocytic Anemia
MCV >100
Hypochromic Anemia
MCH < lower limit of normal

low Hgb=RBC loses some red color
Normochromic Anemia
MCH within normal range
Hyperchromic Anemia
MCH > upper limit of normal
Iron Deficiency Anemia
caused by insufficient diet, absorption issues, or bleeding

pallor, fatigue, SOB, pica (cravings)

spoon-shaped nails (koilonychia), esophageal webs, smooth tongue

tx: ferrous sulfate
Ferritin
iron-storing protein (basically just stored iron that we keep constantly, doesn't change on a daily basis)
Plasma ferritin
indirect marker of the total amount of iron stored in the body

Normal: 10-300 ng/mL

most specific lab test for iron deficiency anemia
Abnormals in Ferritin
Decreased: iron-deficiency anemia
Increased: iron overload disorders (hemochromatosis)
Transferrin
iron-binding blood plasma glycoproteins

increased in iron-deficiency anemia
Serum Iron
amount of circulating iron (must be bound to transferrin)

decreased in iron deficiency anemia

increased in hemochromatosis
Total Iron-Binding Capacity
blood's capacity to bind iron to transferrin

indirect but accurate measure of transferrin

increased in iron-deficiency anemia

cheaper than transferrin test!
Lab Findings in Iron-Deficiency Anemia (I starred this like 50 times in the ppt so maybe know this one hint hint wink wink)
Decreased Hgb/Hct (anemia)
Decreased MCV (small), MCH/MCHC (pale)
Decreased Ferritin (body store of iron)
Decreased Serum Iron
Decreased Reticulocytes
Increased transferrin (protein trying to transfer iron)
Increased TIBC
Possible increase in RDW
Possible mild thrombocytosis
Thalassemia
low MCV anemia
If not iron deficiency anemia, it's probably this
Genetic
Sideroblastic Anemia
disorder of excess iron

microcytic, hypochromic anemia

increased serum iron, decreased TIBC

bone marrow biopsy needed to confirm

will see ringed sideroblasts
Lead Poisoning
Plumbism

microcytic, hypochromic anemia

Basophilic stippling
Megaloblastic Anemias
results from inhibition of DNA synthesis during RBC production

Vitamin B12 and folate deficiencies

Lab: increased MCV, hypersegmented neutrophils, decreased reticulocytes, +/- large platelets
Vitamin B12 Deficiency
Schilling test
pernicious anemia, deficient intake, malabsorption
Folate deficiency
pregnancy
alcoholism
Pernicious Anemia
no intrinsic factor in the gut causes decreased iron absorption
Causes of Normocytic Anemia
chronic conditions (inflammatory, infectious, or malignant diseases)

acute blood loss

aplastic anemia

deficiency of EPO (kidney failure)
Polycythemias/Erythrocytosis
Elevated Hct (>55%)

Relative or Absolute
Relative Polycythemia
decrease in plasma volume

severe dehydration
Absolute Polycythemia
Increase in RBCs
Polycythemia vera
aka primary polycythemia (type of absolute)

Lab: erythrocytosis, thrombocytosis, low EPO

Tx: aspirin, phlebotomy
Heme
contains one iron atom held in a porhyrin ring

Disease: iron-deficiency anemia
Globin
protein subunits

diseases: hemoglobinopathy!
- thalassemia
- Hemoglobin S (sickle cell)
Hemoglobin A (starred this a bunch so know it)
most common adult Hgb

2 alpha and 2 beta subunits
Hemoglobin A2
2 alpha and 2 delta subunits
Hemoglobin F
fetal hgb

2 alpha and 2 gamma subunits
Carboxyhemoglobin (HgbCO)
CO variant of Hgb

Normal: <1%

smokers around 5%

Exposure to CO up to .1% can increase HgbCO by 50-70%
Sulfhemoglobin
Hgb variant due to addition of sulfur atom

result of exposure to chems or sulfur-based drugs (sulfonamides)
Methemoglobin (HgbM)
Hgb variant due to ferric valance (Fe+++)

inherited or acquired via antimalarials or sulfonamides

Tx w/ IV methylene blue of >30%

May see heinz bodies in RBC
Glycosylated Hemoglobin (HgbA1C)
Hgb with a glucose irreversibly attached

Normal: 3.5% in nondiabetics, 7.5% in diabetics
Sickle Cell Disease
mutation of the B-globin gene

Lab findings: sickled RBC, anemia, +/- reticulocytes elevated, abnormal S Hgb on electrophoresis
Alpha Thallasemia
defect in alpha chain

minor- 2 genes, mild microcytic hypochromic anemia

Hemoglobin H- 3 genes, moderate to severe

Hemoglobin Barts- 4 genes, fatal
Beta Thallassemia
defect in beta chain

minor- 1 gene, asymptomatic

major- 2 genes, severe, transfusion dependent
Thallassemia Lab Findings
microcytic anemia (low MCV)

normal iron studies

peripheral smear- target cells, increasing poikilocytosis with severity
Hemoglobin Electrophoresis
separates out proteins to ID abnormal proteins (Hgb S, thallassemia, other rare hemoglobinopathies)
Intrinsic Hemolytic Anemia
hereditary

defects in: RBC membrane, RBC metabolism, Hgb molecule (sickle cell, thallassemia)
Extrinsic Hemolytic Anemia
acquired RBC survival disorders
Hereditary Sperhocytosis
round RBC

patients develop splenomegaly

lab tests: blood smear and osmotic fragility test
Hereditary Eliptocytosis
>25% of RBCs are elliptocytes
Osmotic Fragility Test
use osmosis to determine concentration of a solute in the cell

used to detect hereditary spherocytosis (increased) and thalassemia (decreased)
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
African and Mediterranean cultures, fava beans

oxidized Hgb denatures and precipitates intracellularly as Heinz Bodies
Pyruvate Kinase Deficiency
mild to moderate hemolytic anemia
Extrinsic Hemolytic Anemias
prosthetic heart valves
autoimmune
infections
drugs- penicillin, cephalosporins
parasites- malaria
Haptoglobin
free-hgb-binding proteins in plasma (takes Hgb to liver to regenerate)

in hemolytic anemias, released Hgb is quickly bound to haptoglobin

decreased haptoglobin indicates hemolytic anemia!
Hemolysis Labs
CBC- anemia

Peripheral Smear- Schistocytes/helmet cells, increased reticulocytes

Serum Haptoglobin- decreased

Indirect Bilirubin- increased

Serum lactate dehydrogenase- increased (this should be inside RBCs, so in hemolysis it leaves the cell-->increased in serum)
Erythrocyte Sedimentation Rate
measure of rate with which RBC settles in saline or plasma over a time period

Normal: 0-20 mm/hr

positive indicates inflammation
Increased ESR
inflammation
pregnancy
anemia
autoimmune disorders
infections
cancers

Specimen: black top or EDTA container
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