CM hematology/oncology testing
What are the indications for a CBC?
to evaluate anemias, leukemias, infections
to monitor cancer patients on chemotherapy/radiation
to detect medication adverse effects or side effects
What does a CBC measure?
Hemoglobin, hematocrit, RBC count, RBC indices, WBC and differential count, peripheral smear, platelet estimate
A peripheral smear shows...
RBC morphology, WBC types and numbers, platelet estimate
what is aniscytosis
variations in RBC sizes
what is poikilocytosis
variations in RBC shapes
What is an example of inclusion bodies?
malarial parasites that invade the RBC, can be seen in peripheral smear
What is seen in a normal peripheral smear?
Mature RBCs, only slight variation in size and shape
Mature WBC, limited bands
What is seen in a peripheral smear of leukemia?
depending on the type:
-decrease or increase in WBC
-lots of mature or immature forms, including blasts
What is a reticulocyte count?
reticulocytes are immature RBC with residual RNA
-count indirectly measures hematopoiesis
can indicate a response to therapy
normally 0.5-1.5% of RBC
What tests are done to evaluate anemia?
CBC with RBC indices
-potentially bone marrow study
What tests are done to evaluate hemolytic anemia?
sickle cell prep
biochem: G6PD, Bilirubin
What tests are done to evaluate megaloblastic anemias?
CBC with RBC indices
serum Vit B12
stool for O&P
What test are done to evaluate leukemias?
CBC with peripheral smear
WBC with differential count
philadelphia chromosome study
bone marrow studies
Biochem: calcium/phosphorus, proteins/albumin/immunoglobulins
What is LAP?
Leukocyte alkaline phosphatase
used to differentiate CML from leukemoid rxn
-granulocytes have increased alkaline phosphatase activity, comes up as darker stained granules
What is protein electrophoresis?
principal: different proteins or particles migrate at different rates based on their net electrical charge
pathology: multiple myeloma (increased plasma cells, gamma globulins)
what is done in a WBC study?
Absolute WBC (lymphocyte) count
B cells /T cells
T cell population
In pt's with HIV what else is done with a WBC study?
WBC study performed with a viral load
what test are done to evaluate coagulation/bleeding problems?
specific factors, i.e. Factor VIII
fibrin degradation products (FDP)
what test are done to evaluate malignancies on asymptomatic individuals?
DRE and Hemoccult
monthly self breast exam
pelvic's and pap smears
Abnormal biochemical profiles associated with neoplasms
serum total proteins/albumin/AG ratio
electrolytes & urine/serum osmolality
serum Uric acid and renal function tests
serum acid phosphatase, PSA
What radiologic studies/nuclear scans are used in oncology?
CT scans--head, chest, bone, abdomen, pelvis, spine