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Interpretation of lab

Terms in this set (122)

slightly immature cells (band/seg neutrophils, Reticulocytes of RBC's, megakaryocytes of platelets) appear when the mature cell count is?
Abnormally low
MORE immature cells (-blasts) appear in ----------------- disorders?
Myeloproliferative disorders - overproduction (leukemias/lymphomas, polycythemia vera)
what stimulates production of hematopoiesis?
Erythropoietin and androgens -RBC's
Thrombopoietin - platelets
interleukins
colony stimulating factors
what inhibits hematopoiesis?
interferons and lymphotoxins
nano- unit of volume is
10^-9
Femto-
10^-15
A CBC includes what?
Total WBC count
RBC count
Hemoglobin (HB)
Hematocrit (HCT)
RBC Indices (MCV, MCH, MCHC, RDW)
Platelet count
Mean platelet volume (MPV)
What is the range for total WBC count?
4.5 - 10.5
Which WBCs are Granulocytes?
Neutrophils, Eosinophils, Basophils
Which WBCs are Agranulocytes?
lymphocytes and Monocytes
WBC differential shows what? how are values displayed?
WBC differential shows relative percentages of each type (neutrophils, Lymphocytes, monocytes, Eosinophils, Basophils)
Absolute count on WBC differential tells you what?
The number of cells (for that type of WBC you're calculating). using the relative percent given and multiplying by total WBC
If absolute neutrophil count is too low (ANC < 1,500) is concerning why?
if too low (neutropenia), susceptibility to infection is high
what is the Critical/panic value for neutrophils?
< 500 cells
increased neutrophils-Segs and bands are what's elevated. This a rise in -------- and indicated by a --------- shift?
immature cells, left shift
which type of WBC destroys cancer cells/foreign cells?
Lymphocytes
leukocytosis of ------#------- or less, is called reactive and can be caused by what?
Reactive = <50,000 WBC count (caused by allergies, parasites, medication, dehydration/hemoconcentration effect
Leukocytosis of 100,000 WBC's or more is called ------------, and associated with what conditions?
Malignant Leukocytosis, associated with Leukemias and Lymphomas
what two general processes lead to leukopenia (decreased WBC's)?
Decreased production in bone marrow OR increased consumption/destruction of the ones being made
what are the 3 types of disorders/conditions leading to inadequate production of WBC's by the marrow (leukopenia)?
Aplastic Anemia -marrow just doesn't produce enough blood cells-pancytopenia

myelo-dysplastic syndrome - altered qualitative/quantitative defects of blood cells

Myelo-pthisic type anemias - marrow is replaced by fibrosis/tumor (less room to make now)
why might you see leukopenia from increased consumption/destruction of WBC's?
using them all up to fight - Sepsis/Aids
Hypersplenism - spleen is recycling at too high of a rate
Immune mediated destruction - self is accidentally knock out
what is the range for RBC count in males? females?
Males 5-6
Females 4-5
An-iso-cytosis means what?
too much variability in SIZE of RBC
poikilocytosis means what?
too much variability in SHAPE of RBC
What are the two general processes for decreased RBC's (erythropenia)?
underproduction of RBC's or increased destruction of the RBC's being made (hemo-lysis)
what are the two main reasons for an UNDERPRODUCTION of RBC's?
Factor Deficiencies
Production Defect
What are the 4 types of "factor deficiencies" that lead to underproduction of RBC's (and hence will present as Erythropenia-decreased RBC's)
Iron deficiency anemia
B12 deficiency anemia
Folic acid deficiency anemia
Sideroblastic anemia
what is a sideroblastic anemia? (think: why is it a type of factor deficiency)
sideroblastic anemia -problem with incorporation of iron into hemoglobin
Background: Aside from "factor deficiencies", the other reason we may see underproduction of RBC's (and hence will present as Erythropenia on a CBC) is a "production defect". Production defects are associated with SYSTEMIC DISEASE or HYPOPLASTIC MARROW (with conditions falling under these labels).
Question: Anemia of --------- disease, falls under Systemic Disease as being the associated reason for the production defect.
Anemia of Chronic Disease
What are the 4 conditions/disorders that fall under HYPOPLASTIC MARROW (below-great working marrow) as the associated cause for production defect
Aplastic Anemia
Myelodysplastic Anemia
Myelo-phthisic Anemia
Marrow Toxicity
What are the two types of "problems" leading to an INCREASED DESTRUCTION (HEMOLYSIS) of RBC's which also present as erythropenia?
Intracorpuscular problems (problems inside the Red blood cell): hemoglobin, enzymes, membranes

Extracorpuscular problems (outside the RBC): Antibodies, complement, toxins, parasites
what are the clinical conditions/disorders classified as intracorpuscular problems?
-Sickle Cell Anemia (abnormal hemoglobin structure)
-Thalassemia A & B (abnormal hemoglobin synthesis)
-G6PD enzyme deficiency
-Hereditary Spherocytosis (abnormal RBC membrane)
what are the main clinical conditions/disorders classified as extracorpuscular problems?
-Autoimmune disorder Antibodies (self is attacking RBC's)
-Attack by complement
-Lead poisoning (among other toxins that ruin RBC's)
-Parasites (malaria bursts out of RBC's)
-Hypersplenism (spleen is Over-recycling RBC's)
What are the OTHER causes for seeing decreased RBC's?
Hemorrhage
Medications
Overhydration or pregnancy (spurious effects)
So start thinking about all the RBCs causes of erythropenia we just went over: now give a differential list of the many possibilities for simply just seeing decreased RBC count on a CBC?
-Factor deficiencies
-sideroblastic anemia
-Anemia of chronic disease
-Aplastic Anemia, myelodysplastic anemia, myelopthisic anemia
-Marrow Toxicity
-Sickle Cell Anemia
-Thalassemia
-G6PD deficiency
-Hereditary Spherocytosis
-Autoimmune antibodies
-Malaria
-Lead poisoning
-Hypersplenism
-Hemorrhage
-Overhydration
-Pregnancy
True or false: A peripheral smear must be ordered separately from a CBC
TRUE
Hemoglobin (Hb) on a CBC is reported as the amount of -------- of hemoglobin protein contained in a given volume of whole blood
Mass of hemoglobin (Unit= grams/dL)
What are the normal Hb ranges in females? wb males?
Females: 12-15
Males: 14-17
What component on a CBC is reported as the percentage of the VOLUME of blood that is comprised of RBC's
Hematocrit (Hct). Unit= %
what are the normal hematocrit ranges for males and females?
Male: 40-50%
Female: 35-45%
The term: "packed red cell volume" is another name for ?
Hematocrit
while both hb and hct are used to evaluate anemias, which one also assesses severity of blood loss?
Hct
Over-hydration will (lower or increase??) hematocrit level
Lower hematocrit (bc same # of RBC's but more volume now)
which of the RBC indices range is normal at 80-100 fL/cell
Mean Cell volume (MCV)
Anemia of chronic disease will have a normal MCV or can also be -------
microcytic
MCV is low (below 80)....what conditions? TAILS = microcytic
Thalassemias, Anemia of chronic disease, Iron deficiency anemia, lead posioning, spherocytosis
MCV is high (above 100).....so what conditions are considered macrocytic? MMLP = macrocytic
-Megaloblastic anemias (folic acid or b12 deficiency)
-Medications (phenytoin)
-Liver disease
-Pseudo-Macrocytosis (clumping, or reticulocytosis)
MCHC tells you what?
(Average concentration of hb in an average RBC) A.K.A the color of the RBC
MCHC is normochromic in what kind of anemia?
Megaloblastic -B12 and Folic Acid deficiency
macrocytic & normochromic - think?
B12 or Folate deficiency
MCHC is hypochromic...what conditions? think "SIA-O"
Sideroblastic anemias
Iron deficiency
Alpha or beta thalassemias
Other disorders of hb synthesis
What two conditions will have low MCV and low MCHC (microcytic hypochromic)?
Iron deficiency and Thalassemia
what is the only anemia in which MCHC is routinely/repeatedly low
Iron deficiency
MCHC is hyperchromic? think what condition
Hereditary Spherocytosis
what indices is the average mass of hb in one average RBC
MCH -mean cell hemoglobin
if MPV (mean platelet volume) is too high...what two things could be going on?
-any condition causing platelet clumping/aggregation
-Myeloproliferative disorders that increase megakaryocytes (immature platelets are larger)
Reticulocyte count should RISE in all anemias except???
Factor deficiencies (iron, B12, folate)
The reticulocyte production index (RPI) calculation uses a ------------factor to correct for what?
Maturational correction factor in order to get a recticulocyte count that accounts/corrects for the premature entry and longer life of reticulocytes when marrow is strongly stimulated
if RPI is less than ----#----, then you know there's an inadequate marrow response (marrow production issue)
less than 2 RPI means marrow issue (>3 normal marrow response)
Which of the iron deficiency anemia tests tells you the amount of iron bound to transferrin?
Serum iron concentration
serum ferritin tells you what?
tells you total body stores of iron
TIBC (total iron binding capacity) will be highest when what is low?
when serum iron is low (so when the amount of iron bound to transferrin is low)= higher binding affinity
% transferrin saturation will drop when what two things occur?
serum iron is low and TIBC is high
what percentage of transferrin saturation is indicative of Iron Deficiency Anemia?
LESS than 15% of transferrin saturation
an INCREASED Free Erythrocyte Protoporphyrin (FEP) test is used to detect what?
Lead poisoning in children (not a typical test for iron deficiency anemia)
when you suspect a possible B12 deficiency (macrocytic normochromic) you will get a serum B12 test (not super sensitive) and then tests for what two other levels?
MMA - Methylmalonic Acid test (this builds up when B12 is low)

Homocysteine - B12 is required for homocysteine to be broken down. So if increased levels, then theres not enough B12
Why do you order an Intrinsic Factor Antibody test in B12 deficiency? what does positive mean?
To determine if it's a dietary deficiency, or B12 is low due to your body attacking intrinsic factor. Positive result means you have antibodies so it's attacking/reducing your intrinsic factor, and blocking your ability to absorb B12 regardless of how much you're eating
What tests should be ordered in suspected folic acid deficiency?
serum folate level and RBC folate level
Which test will show early folic acid deficiency versus long term?
Early folic acid deficiency will show up on a serum folate test, while it will take at least 2-3 months to start impacting RBC folate stores.
in folic acid deficiency, MMA will be -------- while homocysteine will be -----------
MMA will be normal (unlike B12 deficiency), while Homocysteine will be elevated (same as in B12)
Reticulocytes will be (increased or decreased?) in hemolytic anemias?
Reticulocyte rises in hemolytic anemias (to compensate for loss of RBC's)
In hemolytic anemias, the level of Haptoglobin (which will bind to hb of lysed RBCS) , will be increased or decreased? Also what will happen to LDH levles (normally found INSIDE RBCS)
Decreased, bc when bound haptoglobin isn't measurable. And if less is measurable than normal, that means haptoglobin is handling an abnormal amount of lysed RBC's. LDH levels will increase bc more RBC's are being lysed than normal.
Furthermore, in hemolytic anemias, Indirect bilirubin will (increase or decrease?) and if the hemolytic anemia is due to an immune mediated attack on RBC's the Direct Coombs test will be (positive or negative?)
Indirect bilirubin will increase, and if hemolysis is due to immune attack the coombs test for antibodies will be positive
What is the most prevalent type of adult normal hemoglobin?
Hemoglobin A1 (2 alpha globin proteins, 2 beta globin proteins)
How many genes control the alpha globin protein production/resulting protein?
4 genes (while only 2 genes regulate the Beta globin protein)
if three of four Alpha globin genes is mutated, this will result in what disease? wb two out of the four?
Hemoglobin H disease is 3/4 (while 2/4 causes alpha thalassemia)
Hemoglobin S is only seen in what dz and trait?
Sickle cell Disease - normal alpha globins, both beta globins are abnormal

Sickle cell trait - normal alpha globins, only one of two beta globins is abnormal
If you suspect a hemoglobinopathy, what test should you order?
Hemoglobin electrophoresis
In sickle cell trait you will see ------- HbA?
some amount since they still have 1 normal beta, so can produce some amount of the normal hemoglobin (2 alpha chains 2 beta chains). In sickle cell disease they have no normal Beta, so will see no HbA produced
In which hemoglobinopathy will you see an adult have hemoglobin that is almost totally hemoglobinF? (normally only seen in infants)
Beta thalassemia major
difference btwn Bands vs segs vs poly's hypersegmented will show up on what test?
peripheral smear
band neutrophils have one "C" like structure inside=no lobes and are immature, while segmented neutrophils have a segmented C like structure= 1 or 2 lobes and slightly immature, while a poly (PMN) neutrophil is mature and will have how many lobes?
3-4 lobes=mature (so PMN)
a hypersegmented neutrophil will have how many lobes? when you see hypersegmented neutrophils you should think of what?
5+ which is why its HYPERMATURE. When you see hypersegmented NEUTROPHILS, you should think megaloblastic anemia
what are bluish-red rods seen in the cytoplasm of myeloblasts that are pathognomonic for Acute myeloid Leukemia (AML)?
Auer Rods
target cells are seen in what?
IDA, hemoglobinopathies, liver disease
What are the bleeding disorders?
Vonwillebrand dz, hemophilias, Acquired (Liver failure or vitamin K deficiency), DIC
bleeding disorders with issues of primary hemostasis have a platelet/vonwillebrand issue, while issues of secondary hemostasis is a -------- issue.
Coagulation
How do you test platelet function?
PFA (platelet function analyzer) test
what test result indicates either platelet aggregation (clumping) or myeloproliferative disorders (specifically ones that increase megakaryocytes)?
Increased MPV.
(if myeloproliferative, then making more immature megakaryocytes which are larger-so makes sense)
platelet count may be decreased due to reduced production from bone marrow failure. The bone marrow failure may be congenital (like in lupus we see reduced platelets), or the failure could be acquired as seen in what conditions?
Aplastic anemia, MDS, myelophthisic anemia, CHEMOTHERAPY
platelet count may also be low (thrombocytopenia) due to increased destruction. Heparin may cause drug induced destruction, while ITP is immune mediated and less severe in comparison to non-immune mediated ---------
TTP = Thrombotic thrombocytic purpura
Low platelet count may also be due to Psuedo-thrombocytopenia when their MPV looks high (concerning) but their platelet count is low, which this combo indicates a lab error in which blood collection tubes had what added to it causing clumping?
EDTA anticoagulant - purple top tubes
in response to chronic inflammation, platelet count will (increase or decrease?)
increase
MPV is too low, always think what?
conditions of Bone marrow FAILURE
what is the most common inherited bleeding disorder?
Von Willebrand disease (which is due to either a quantitative or qualitative abnormality of von willebrand factor)
von willebrand factor antigen test is a measurement of --------
Quantity of vwf
Ristocetin Cofactor Activity assay measure Quality/vwf Activity. In this test, no agglutination means lack of clotting is due to ------------
defective vwF
Factor 8 activity is an indirect measure of what? if factor 8 is low this indicates?
Factor 8 activity test is an indirect measure of vwF activity, if factor 8 is low then this indicates either vwf disease (or hemophilia A)
what tests are on a von willebrand factor panel?
vwf antigen
vwf activity (ristocetin)
factor 8 activity
in Vw disease, a platelet function tests would be normal or abnormal??
abnormal- bc it may "appear" like platelets are not working right but really it's vwf
Warfarin, which block vitamin K synthesis, is monitored by what test?
PT - bc K dependent factors are 2, 7, 10 (extrinsic/common) and 9 (intrinsic) - 3 factors against 1 is reasoning for PT
the earliest indication of liver disease is also assessed by what ?
PT
The international normalization ratio (INR) is a internationally recognized way to report PT results in what instance/case only?
for monitoring warfarin therapy
low intensity warfarin therapy has an INR target range of 2-3 while high intensity dose warfarin therapy has a INR target range of ------?
2.5-3.5
PTT, aside from testing intrinsic pathway, it is also used to monitor what?
Heparin therapy
What is the 3rd type of secondary hemostasis test, and is done typically after a prolonged PT or PTT is noted?
Specific Factor tests
Will you see mucocutaneous bleeding in hemophilias?
No (uncommon)
DIC is an "acquired clotting factor deficiency" that UNIQUELY results in extensive intravascular thrombi, why is it considered a clotting factor deficiency?
Disseminated Intravascular Coagulation (DIC) leads to all available factors and platelets being consumed in the extensive thrombi being made, once all consumed then have uncontrollable bleeding
what are the inherited types of thrombophilias?
factor5vl mutation
prothrombin mutation
anti-thrombin III deficiency
Protein C deficiency
Protein S deficiency
what is the most common type of inherited thrombophilia?
Factor V Leiden
if you see recurrent venous thromboemboli, or VTE during pregnancy or with oral contraceptives you should think
Factor5leiden
what test will you do to determine factor5v ledien?
APC resistance assay (ratio less than 2 = Factor 5 leiden mutation)
Gene mutation in prothrombin results in -------- prothrombin function?
increased
thrombin (2a), and factor 12, 11, 10, and 9 are deactivated by what?
Anti-thrombin III
What is the main test for antithrombin III deficiency?
Antithrombin activity test - Qualitative (functional activity)
if patient has recurrent VTE, but their PT and PTT are not affected what should you think?
maybe anti-thrombin III deficiency
how do you test protein C deficiency?
Protein C functional Assay (make sure pt has been off warfarin for 2 weeks)
how do you test protein S deficiency?
Protein S free antigen test (also discontinue warfarin before doing)
What are the 2 types of acquired thrombophilias?
DIC and APS
pt has DVT and pregnancy related problems/fetal morbidity (you suspect a thrombophilia), after getting a platelet count you notice thrombocytopenia.... think what?
APS -antiphospholipid syndrome (bc consuming all the platelets)
What are the requirements for diagnosis of APS?
clinically: must have either vascular thrombosis or pregnancy morbidity

Lab: must have at least one positive antibody to phospholipids(one of the 3 antibody tests), one more than one occasion, 12 weeks apart
Hypercoagulable disorder that manifests with uncontrollable bleeding from low platelets and clotting factors being consumed from internal thrombi
DIC
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