Clinical Diagnostics Exam 1

Front 1

A test can be precise but not accurate? True or False

Back 1

True

Front 2

The proportion of patients with disease that test positive shows the ______ of the test?

Back 2

Sensitivity

Front 3

The proportion of patients without disease who test negative shows the ______ of the text?

Back 3

Specificity

Front 4

What is included in a CBC

Back 4

White blood cells, Hemoglobin, Hematocrit, Platelets

Front 5

WBC Count = Total number of leukocytes, what is normal?

Back 5

4400-11000 cells/mm3

Front 6

Leukocytosis =

Back 6

elevated WBC count

Front 7

Leukopenia =

Back 7

decreased WBC count

Front 8

What are the two types of lymphocytes?

Back 8

B cells and T cells

Front 9

Lymphocytopenia is

Back 9

having less than 1500/uL

Front 10

What are the causes of lymphocytopenia?

Back 10

Retroviral, sarcoidosis, auto/immune D/O

Front 11

Lymphocytic leukocytosis is?

Back 11

Leukocytosis due to lymphs greater than 4800/uL

Front 12

What are the causes of lymphocytic leukocytosis?

Back 12

Infectious mononucleosis, pertussis, lymphoproliferative disorders.

Front 13

________ travel through blood and enter tissues, where they differentiate into macrophages.

Back 13

Monocytes.

Front 14

Monocytic Leukocytosis is

Back 14

due to monocytes being greater than 800/uL

Front 15

What are the causes of monocytic Leukocytosis?

Back 15

Monocytic variants of leukemia, acute bacterial infection, tuberculosis

Front 16

_______ play a role in allergic reactions and parasitic infections.

Back 16

Eosinophils

Front 17

Eosinophilic leukocytosis is

Back 17

Due to Eosinophils being over 450/uL

Front 18

What are the causes of Eosiniphilic leukocytosis?

Back 18

Variants of chronic leukemia, solid tumors, infection with parasites, allergic reactions, and following treatment with IL-2.

Front 19

______ play a role in allergies.

Back 19

Basophils

Front 20

Basophilic Leukocytosis is

Back 20

Leukocytosis due to basophil count being over 200/uL If the WBC is normal, then consider Basophilia

Front 21

Neutrophils are also known as?

Back 21

Polymorphonuclear Leukocytes

Front 22

When ______ is enhanced, as during infection, immature forms of neutrophils often enter circulation.

Back 22

Neutrophil

Front 23

Immature forms of neutrophils are called?

Back 23

Bands

Front 24

When an increase in circulating bands is > _____ it is known as a "left shift" or "bandemia".

Back 24

700/uL

Front 25

Neutrophilic leukocytosis is due to ANC of >?

Back 25

7700/uL

Front 26

What are the causes of Neutrophilic Leukocytosis?

Back 26

Infection, Stress, Smoking, Pregnancy, Following Exercise, Chronic Myeloproliferative disorders (CML,PV)

Front 27

Neutropenia is when you have an ANC of ?

Back 27

< 1500

Front 28

Neutropenia predisposes someone to _______.

Back 28

Infection

Front 29

ANC of 500 - 1000 =

Back 29

Moderate level of Neutrophils, risk of infection begins in this range.

Front 30

an ANC of ___ is severe neutropenia.

Back 30

500

Front 31

What are the causes of neutropenia?

Back 31

Benign familial, decreased production, ineffective granulopoiesis, shift to tissue pools, or enhanced destruction.

Front 32

A reduction in the absolute number of red blood cells is?

Back 32

Anemia

Front 33

Anemia has been defined as a reduction in three things, what are they?

Back 33

Hemaglobin Concentration
Hematocrit
RBC Count

Front 34

What is a percentage of total blood volume made up by RBCs?

Back 34

Hematocrit

Front 35

Hematocrit is generally __ the hemoglobin.

Back 35

3X

Front 36

Normals for males are ?
Normalrs for females are?

Back 36

46 +/- 4%
40 +/- 4%

Front 37

What three things make up the direct measurement of hematocrit?

Back 37

1. A sample of blood in a test tube is centrifuged.
2. The blood then separates into heavier compnents (cells) at the bottom, and lighter components (plasma) at the top.
3. The percentage of the total blood volume that is made of the RBCs is the hematocrit.

Front 38

Low HCT, HBG, or RBC = ?

Back 38

Anemia

Front 39

What are the causes of anemia?

Back 39

There are several causes that include decreased RBC production and increased RBC destruction, as well as loss of blood. There are also physiologic reasons, such as pregnancy.

Front 40

Elevated HCT, HGB, or RBC = ?

Back 40

Polycythemia

Front 41

Measurement of the total amount of Hgb in blood gives the ______ value.

Back 41

Hemoglobin (HGB)

Front 42

Normal HGB values for males are? and females?

Back 42

Males: 15.7 +/- 1.7g/dL
Females: 13.8 +/- 1.5g/dL

Front 43

Generally 3XHGB = ?

Back 43

Hematocrit (HCT)

Front 44

Falsely high HCT and HGB readings can be the result of?

Back 44

Dehydration, Relative Polycythemia

Front 45

Falsely low HCT and HGB readings can be the result of?

Back 45

Fluid-overloaded patient

Front 46

A falsely normal HCT and HGB reading can mean?

Back 46

That someone has just suffered a hemorrhage.

Front 47

What is the RBC?

Back 47

The number of RBCs in 1mm3 of blood

Front 48

What are the normals for RBC count in men and women?

Back 48

Men 5.2 =/- 0.7 million/uL
Women 4.6 +/- 0.5 million/uL

Front 49

Used to calculate Red blood cell indices, what is MCV, MCH, MCHC, RDW

Back 49

MCV = Mean Cell Volume
MCH = Mean Cell Hemoglobin
MCHC = Mean Cell Hemoglobin Concentration
RDW = Red Cell Volume Distribution Width

Front 50

What is the MCV?

Back 50

Mean Corpuscular Volume

Front 51

Mean corpuscular volume is also known as the ?

Back 51

Mean Cell Volume

Front 52

What does the MCV measure?

Back 52

The average volume (size) of RBC

Front 53

What is the normal value for MCV?

Back 53

88 +/- 8fL

Front 54

Low MCV =

Back 54

Microcytic <80

Front 55

High MCV =

Back 55

Macrocytic >100

Front 56

Normal MCV is known as?

Back 56

Normocytic

Front 57

MCV is low in the presence of?

Back 57

Iron deficiency anemia, thalassemia, anemia of chronic disease

Front 58

MCV may be elevated in the presence of?

Back 58

Alcoholism, liver disease, b12 or folate deficiency (or methotrexate), cold or warm agglutinins (RBC clumps), reticulocytosis

Front 59

MCV may be normal in the presence of?

Back 59

Blood loss (hemorrhagic or hemolytic), mixed anemia (microcytic + macrocytic), above causes seen on smear

Front 60

What is the MCH?

Back 60

Mean Cell Hemoglobin

Front 61

The average weight of Hb within RBC is called?

Back 61

MCH, Mean Cell Hemoglobin

Front 62

What is the normal value of MCH?

Back 62

30.4 +/- 2.8pg/RBC

Front 63

Low values of MCH are seen in ____ _____ and _______.

Back 63

Iron Deficiency
Thalassemia

Front 64

Increased values of MCH occur in _______?

Back 64

Macrocytosis

Front 65

MCHC is known as the?

Back 65

Mean Cell Hemoglobin Concentration

Front 66

What is the normal for MCHC?

Back 66

34.4 +/- 1.1g/dL of RBC

Front 67

Normal MCHC values means you are?

Back 67

Normochromic

Front 68

Low MCHC values means you are?

Back 68

Hypochromic

Front 69

Hypochromic conditions are caused by the same things that cause low ___ and ____?

Back 69

low MCV and MCH.

Front 70

Elevated values of MCHC?

Back 70

Hyperchromic

Front 71

What causes hyperchromic conditions?

Back 71

Occur almost exclusively with sphenocytosis or abnormal dessication of RBCs (sickle cell)

Front 72

What is RDW?

Back 72

Red Cell Volume Distribution Width

Front 73

RDW is calculated by machine using ___ and ___?

Back 73

MCV and RBC

Front 74

The RDW indicates variation in ___ size?

Back 74

RBC

Front 75

What is normal RDW?

Back 75

13.1 +/- 1.4%

Front 76

Normal RDW does not mean all cells are normal size, rather it just implies that most cells are the ____ ____.

Back 76

same size

Front 77

Elevated RDW means that there is a variation in ___ ____.

Back 77

RBC size

Front 78

What is a variation in RBC size known as?

Back 78

anisocytosis

Front 79

What are the causes of increased RDW?

Back 79

Iron, B12, or folate deficiency anemias, Hemoglobinopathies, Hemolytic anemias, Post-hemorrhagic anemias, chronic liver disease

Front 80

If MCV is normal, but RDW is elevated, this implies that there are what?

Back 80

Small and large cells averaging out to give a normal MCV.

Front 81

Reticulocytes are normally present in males and females at what levels?

Back 81

Males 1.6 +/- 0.5%
Females 1.4 +/- 0.5%

Front 82

What are immature RBC that still contains microsomal and ribosomal material?

Back 82

Reticulocytes

Front 83

Reticulocytes are a good indicator of what?

Back 83

red cell production by marrow, they should increase in response to bleeding or hemolysis

Front 84

If a patient is anemic and reticulocyte count is normal or low, then the marrow response is ______

Back 84

Inadequate

Front 85

The marrow response can be inadequate with reticulocytes if there is? 5 possible things.

Back 85

Marrow failure (aplastic anemia)
Malignancy
Chronic Disease
Nutritional Deficiency
Following Chemotherapy or Radiation Therapy

Front 86

Formed in bone marrow, most exist in the bloodstream; also stored in spleen, what are they?

Back 86

Platelets

Front 87

Platelets function to help ___ ______.

Back 87

Clot Formation

Front 88

Platelets are removed by the ____ and _____.

Back 88

Spleen and Liver

Front 89

Normal platelet count is?

Back 89

150,000-450,000 cells/mm3

Front 90

Less than 150,000 platelets is known as ?

Back 90

Thrombocytopenia

Front 91

Greater than 500,000 platelets is known as ?

Back 91

Thrombocytosis

Front 92

Over 1 million platelets is known as?

Back 92

Extreme Thrombocytosis

Front 93

A reaction to a surgical condition, infection, surgery, trauma, malignancy, post-splenectomy, acute blood loss, or iron deficiency is seen with what type of platelet disorder?

Back 93

Reactive Thrombocytosis

Front 94

Chronic myelogenouc leukemia, polycythemia vera, essential thrombocythemia is seen with what type of platelet disorder?

Back 94

Autonomous Thrombocytosis

Front 95

Mixed cryoglobulinemia, cytoplasmic fragments, are seen with what platelet disorder?

Back 95

Spurious Thrombocytosis

Front 96

Pseudothrombocytopenia, decreased platelet production, increased platelet destruction, dilutional thrombocytopenia, and distributional thrombocytopenia are all forms of what?

Back 96

Thrombocytopenia

Front 97

Bone marrow problems, certain infections, b12/folated deficiency, chemo/radiation therapy are all possible causes of?

Back 97

Decreased platelet production

Front 98

ITP, SLE, alloimmune, DIC, TTP-HUS, HELLP, drugs, certain infections, physical (CP-bypass) are causes of?

Back 98

Increased platelet destruction

Front 99

A massive blood transfusion could cause?

Back 99

Dilutional thrombocytopenia

Front 100

Splenomegaly could be a sign of?

Back 100

Distributional thrombocytopenia

Front 101

This test detects abnormalities not detected by automated machines?

Back 101

Peripheral blood smear

Front 102

Peripheral blood smears are particularly important in the evaluation of what three things?

Back 102

Thrombocytopenias
White Cell Disorders
Hemolytic Anemias

Front 103

With pseudothrombocytopenia, a peripheral blood smear will show?

Back 103

Platelets clumped

Front 104

Large platelets in a peripheral blood smear suggests heightened _______ response secondary to a _______ process.

Back 104

Marrow
destructive

Front 105

With WBCs in a peripheral smear you can see atypical lymphocytes, blast cells which can indicate?, toxic granulations aka ?, and Hypersegmented neutrophiles which too many lobes is seen in ?

Back 105

Can indicate Leukemia
White cell inclusions
seen in B12 or folate deficiency

Front 106

What type of RBCs aren't normally found in the circulation?

Back 106

Nucleated RBCs

Front 107

When you have nucleated RBCs, _______ disease or a life-threatening disease such as _____ may be at play.

Back 107

Hematologic
Sepsis

Front 108

With Hemolytic anemias, in a peripheral blood smear, _______ and _______ could be present.

Back 108

Schistocytes
Spherocytes

Front 109

These are hyperchromic w/loss of central pallor, appear as dense dark cells, seen in hereditary spherocytosis and autoimmune hemolytic anemia.

Back 109

Spherocytes

Front 110

Hemolytic anemias can also result from red cell ______ and ______ that cause problems such as babesiosis, and malaria)

Back 110

inclusions
parasites

Front 111

This exam generally offers little additional diagnostic info in more common forms of anemia?

Back 111

Bone Marrow Exam

Front 112

Unexplained cytopenias or elevations, presences of abnormal cell (blast), diagnosis and staging of malignancy, evaluation of iron metabolism and stores, suspected deposition and storage disease, fever of undetermined origin, suspected infection or granulomatous disease, unexplained splenomegaly or confirmation of normal in potential donor are all indications for what?

Back 112

Bone Marrow Exam

Front 113

Thrombocytopenia, regardless of severity, is not a contraindication for what? Although, _____ may need to be given first.

Back 113

Bone Marrow Exam
Platelets

Front 114

You can not do a biopsy, with a bone marrow exam, at what part of the body?

Back 114

The Sternum

Front 115

Primary Hemostasis: ____ _____
Disorders: Mucocutaneous bleeding, usually immediately following _____.

Back 115

Platelet plug
Trauma

Front 116

Secondary Hemostasis: ________
Disorders: Bleeding into _____ or major _____ _____, which may be delayed.

Back 116

Coagulation
Joint
Body Cavity

Front 117

Formation of platelet plug comes from what three things?

Back 117

Adherence, Activation (release) and aggregation (the ability for platelets to stick to each other)

Front 118

Thrombocytopenia and Bleeding Risk
> 50,000 =
30,000-50,000 =
10,000-30,000 =
<10,000 =

Back 118

1. Virtually Never Bleed
2. Rarely bleed, even with sig. trauma
3. May bleed with more ext. trauma
4. Commonly have spontaneous bleeding

Front 119

These tend to overestimate platelet count in samples that contain cellular debris. (TTP) These also tend to underestimate platelet count in patients with large platelets (ITP).

Back 119

Automated Cell Counters

Front 120

What is the gold standard for counting platelets?

Back 120

Peripheral smear

Front 121

What are two other counting methods?

Back 121

Optical Counting and Flow Cytometric methods

Front 122

What is often ordered to look for antibody-mediated platelet destruction?

Back 122

Anti-Platelet Antibodies

Front 123

Idiopathic Thrombocytopenic Purpura, Drug Induced, Transfusion Induced, and Neonatal are all forms of what?

Back 123

Antibody mediated platelet destruction

Front 124

What are two problems with anti-platelet antibody tests?

Back 124

Low sensitivity and low specificity limits usefulness

Front 125

This is used to screen for inherited disorders of platelet function, not generally affected by coagulation, and many variables affect accuracy.

Back 125

Bleeding time

Front 126

Prolonged bleeding time can mean that there is thrombocytopenia, a problem with a ______, due to constriction or fragility. Inherited or acquired abnormalities of ______ function, as seen in vWD, Bernard-Soulier, Glanzmann's, and others. This can also mean SEVER _______ deficiency.

Back 126

Vessel
Platelet
Fibrinogen

Front 127

LIMITATIONS of BLEEDING TIME:
Normal value should NOTE preclude testing for ___.
Norman BT does NOT predict safety of ______ procedures.
Abnormal BT does NOT predict ________ bleeding.

Back 127

vWD
Surgical
Excessive

Front 128

What is a test that could potentially replace bleeding time to screen for platelet dysfunction?

Back 128

Platelet function analyzer

Front 129

What is the gold standard for platelet function testing?

Back 129

Platelet aggregometry

Front 130

What is something important to know before ordering platelet aggregometry?

Back 130

Must avoid use of meds that can affect results prior to testing.

Front 131

The coagulation cascade consists of what two things?

Back 131

Intrinsic Pathway
Extrinsic Pathway

Front 132

The intrinsic pathway, and the extrinsic pathway both lead to the activation of Factor _ into __.

Back 132

X
Xa

Front 133

The common pathway of the coagulation cascade is initiated by what?

Back 133

Factor Xa

Front 134

What is the gold standard for counting platelets?

Back 134

Peripheral Smear

Front 135

What is the gold standard for evaluating platelet function?

Back 135

Platelet Aggregometry

Front 136

What converts Fibrinogen into Fibrin?

Back 136

Thrombin

Front 137

What are three tests of coagulation?
HINT: PT/INR, PTT, TT

Back 137

Prothrombin Time, International Normalized Ratio
Partial Thromboplastin Time
Thrombin Time

Front 138

The endpoint for the PT, PTT, and TT is the time it takes (in seconds) for recalcified citrated plastma to form a clot in the presence of a reagent. Each measures a different aspect of the ________ _______.

Back 138

Coagulation Cascade

Front 139

Prothrombin time is used to assess _____ and _____ pathways. To monitor ______ therapy. A patient's plasma is re-calcified in presnece of reagent (tissue factor + calcium + phospholipids). The endpoint is the time it takes for clot to form.

Back 139

Extrinsic
Common
Warfarin (Coumadin)

Front 140

The W.H.O. developed an international reference thromboplastin (currently recominant tissue factor) to allow for direct comparison of PT values from different labs. This is known as the?

Back 140

International Normalized Ratio (INR)

Front 141

What is the normal range for the International Normalized Ration?

Back 141

0.8-1.2

Front 142

When is a situation when you want to prolong INR?

Back 142

When giving Coumadin or Wafarin

Front 143

Common Goal INRs:
DVT Prophylaxis ____
DVT/PE ___
Atrial Fibrillation _____
Mechanical Heart Valve _____

Back 143

1.5-2
2-3
2-3
2.5-3.5

Front 144

Warfarin, Vitamin K deficiency, Factor VII deficiency or inhibitor, Chronic Liver Disease, Massive Blood Transfusion, Tansiently after heparin bolus, all can be causes of what?

Back 144

Prolonged PT/INR

Front 145

Partial Thromboplastin Time PTT is used to do what three things?

Back 145

To assess intrinsic and common pathway, and to monitor heparin

Front 146

What test is much more specific than the PTT for a therapeutic heparin level?

Back 146

Anti-Factor Xa assay

Front 147

What test measures conversion of fibrinogen into fibrin, by thrombin (final common pathway) - checked if PT and PTT are both prolonged?

Back 147

Thrombin Time TT

Front 148

This test is similar to thrombin, but resists inhibition by heparin. It is found in venom of Bothrops snakes.

Back 148

Reptilase Time RT

Front 149

This test is used to check for Factor XIII deficiency.

Back 149

Urea Clot Solubility Test

Front 150

This test differentiates between clotting factor deficiency and inhibitor. Patient's plasma mixed in 1:1 ratio with normal pooled plasma - if clotting normalizes, then deficiency was cause, if not then inhibitor was the cause.

Back 150

Mixing Studies

Front 151

This test is used to monitor heparin during CABG or percutaneous coronary artery intervention.

Back 151

Activated whole blood clotting time (ACT)

Front 152

This test is used to assess global function of fibrinolytic system.

Back 152

Euglobulin Lysis Time

Front 153

What test specifically reflects fibrinolysis of cross-linked fibrin: thus, elevated levels suggest actual presence of a clot?

Back 153

D-Dimer

Front 154

If this test is elevated, it is a pretty good sign that a blood clot is present.

Back 154

D-Dimer

Front 155

This test is more sensitive to D-Dimer for defect of fibrinolysis.

Back 155

FDP Assays