Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
91 Cards in this Set
- Front
- Back
CBC
|
WBC, RBC, Plt, Hb, HCT, WBC diff, RBC morphology, Calculated indicies (MCV, MCHC, MCH, RDW)
|
|
Hemoglobin determination
|
cyanmethemoglobin method: reducing Fe in Hb from ferrous to ferric w/K ferricyanide and K cyanide.
|
|
Reticulocyte Count
|
New Methylene Blue stain mixed w/EDTA blood sit for 10 min. Count 1000 rbcs; norm Retic count= 0.5-1.5%
|
|
Reticulocyte Production Index
|
Shift retics ejected from marrow early in anemia, retain reticulum up to 2.5 days. RPI corrects retic count for and allows an accurate assessment of erythropoeisis in marrow.
|
|
RPI calculation
|
(%retics x actual Hct)/maturation time
RPI<2indicates inadequate response>3 indicates adequate response |
|
things that increase your ESR
|
Abnormal plasma proteins fibrinogen, beta globulins, immunoglobulins, can lead to rouleaux and faster sedimentation
|
|
Normal ESR values
|
children- <10mm/hr
men- <15 mm/hr women- <20 mm/hr |
|
Diseases with Elevated ESR
|
multiple myeloma, pelvic inflammatory disease, rheumatic fever, severe anemia
|
|
Rule of 3
|
RBC count x 3=Hb
Hb x 3=HCT |
|
Red Cell Indicies
|
MCV=vol of avg RBC=(Hct x 10)/RBC count
MCH=mean corpuscular Hb=(Hb x 10)/RBC MCHC=mean corpuscular Hb conc= (Hb x 100)/Hct |
|
Red Cell Indicies in classification of Anemias
|
hypochromic MCHC < 32 g/dl
normochromic MCHC 32-27 g/dl Hyperchromic-due to abnormal shape Microcytic MCV <80 fL Normocytic MCV 80-100 fL Macrocytic MCV >100 fL |
|
Granulocyte locations
|
Bone marrow, circulation, adhered to vessel walls, and in the tissues
|
|
Granulocyte Fxns
|
Phgocytosis and pinocytosis, oxidative killing (granules contain peroxide, myeloperoxidase, superoxide), degradation and detoxification of phagocytosed materials
|
|
Eosinophils granule characteristics
|
eosinophil granules contain major basic protein, acid phosphtase, arylsulfatase, peroxidase, phospholipase, B-glucaronidase, cathepsin effective against parasites
|
|
Basophil granules characteristics
|
granules contain heparin, chondroitin sulfate, histamine
|
|
Granulocyte Development stages
|
Myeloblast, Normal Promyelocyte, Normal Myelocyte, Normal Metamyelocyte, Normal Band, Neutrophil
|
|
Myeloblast
|
fine, evenly distributed chromatin, several nucleoli, non-granular basophilic cytoplasm; <1% of marrow cells
|
|
Promyelocyte
|
distinct primary azurophilic granules, indistinct nucleoli, coarsening chromatin
|
|
Myelocyte
|
secondary neutrophilic granules, dawn of neutrophilia, round to oval nucleus with flattened side, N/C ratio 1:1, no nucleoli
|
|
Metamyelocyte
|
indented nucleus, clumped chromatin, 13-22% norm marrow diff
|
|
Left Shift
|
appearance of immature forms of neutrophils in the peripheral blood
|
|
Cytokines in development of Platelets
|
Meg-CSF generated in bone marrow in response to low megakaryocyte mass
TPO generated by liver and kidney in response to demand for platelets IL-3 differentiates stem cells IL-6, IL-11 promote endoreplication |
|
Maturation Stages of Megakaryoctye
|
Megakaryoblast-looks like sml lymphocyte
Promegakaryocyte- 20-80 um cell, no nuclear lobes N:C 4:1 to 1:1 Basophilic megakaryocyte-2,4,8 lobed nucleus N:C 1:1 to 1:12 Megakaryocyte-mature, shedding platelets Platelets-150-450x10^3/ul 7-10 days in periph circulation |
|
Normal value for Platelet Size
|
giant platelet= >6.5 um
Normal platelets ~1-4um lg platelets=4-6.5 um |
|
Spleen fxn in Platelet storage
|
30% of platelets stored; when depleted from spleen thrombopoietin in the kidney, liver and spleen is made
|
|
Platelet adherence
|
1st step in aggregation; GPlb binds thrombin, GPllb-llla binds fibrinogen, GPlb/V/lX binds von willebrand factor
|
|
Monocyte development stages
|
monoblast, promonocyte, blood monocyte, free and fixed tissue macrophage
|
|
Monocyte characteristics
|
chromatin is lacy with clumps, ground glass appearance in cytoplasm, sml blue pink or lav granules,phagocytic vacuoles, <15% in diff is normal, normally largest WBC
|
|
Monocyte contents
|
transport proteins, inflammatory agents, coagulation factors, complement proteins, cytokines
|
|
Macrophage fxn
|
size varies 15-85 um, shape is variable due to motility, vacuolated cytoplasm, pseudopods
|
|
Site for bone marrow collection in children
|
anteriomedial surface of the tibia
|
|
Site for bone marrow collection in adults
|
Posterior superior iliac spine, anterior iliact crest
|
|
Indications for bone marrow analysis
|
multilineage abnormalities, circulating blasts (xcept in infants) pancytopenia (xcept when marrow is being suppressed), staging H and non H lymphoma and carcinoma
|
|
Bone Marrow Collection Procedure
|
patient may be sedated, site is clean with iodine and draped, local anesthetic, 3 mm cut with scalpel blade, bone cavity is penetrated, stylet is removed and replaced with 10 mm syringe, 1.5 ml marrow and sinusoidal blood is aspirated
|
|
Bone marrow samples
|
aspirate: cell types, proportions of cell types, iron stores
core biopsy: archiecture of focal lesions, spicules |
|
Bone marrow biopsy
|
helpful for diagnosis of leukemias, myelofibrosis, neoplasia, granulomatous disease
core sample expelled by stylet into formalin fixative and sent to histology for tissue processing |
|
Shifts in Marrow cellularity from infancy to adulthood
|
at birth granulocyte precursors predominate, w/in 1 month lymphoid cells predominate, lymphoid cells make up ~1/3 of marrow cells up to 3 yrs of age and decrease gradually, in adults lymphocytes are randomly throughout marrow 5-15%
|
|
Differential cell count of Bone Marrow Smear
|
myeloid/erythroid normal ratio is 1.5:1 to 3.3:1
|
|
special tests for bone marrow smear
|
FISH, cytogenetic or karyotype studies, flow cytometry, iron staining, bacterial or fungal cultures
|
|
MCV calculation
|
mean corpuscular volume=(Hct x 10)/RBC count
normal 80-100 fL |
|
MCH definition and calculation
|
mean corpuscular hemoglobin=(Hb x 10)/ RBC count
normal 28-32 pg |
|
MCHC definition and calculation
|
mean corpuscular hemoglobin concentration=(Hb x 100)/Hct
normal 32-37 g/dl |
|
RDW significance and normal value
|
an index of the variation in cell volume within the red cell population
normal 11.5-14.5% |
|
Classification of Severity for Anemia
|
mild-hemoglobin >10 g/dL
moderate-hemoglobin 7-10 g/dL severe-hemoglobin <7 g/dL |
|
Laboratory Diagnosis of Anemia
|
retic count, periph blood smear, bone marrow exam, urinalysis, fecal occult blood, ova and parasite exam, direct antiglobulin test, hemoglobin electrophoresis
|
|
Corrected Reticulocyte Count
|
assesses RBC production in bone marrow, normal 0.5-1.5% in adults
(%retics x hematocrit)/normal Hct |
|
Iron Deficiency Anemia
|
nutritional deficiency or blood loss, inadequate production of hemoglobin, hypochromic, microcytic, RDW high
|
|
Megaloblastic Anemia
|
vitamin B12 or folate deficiency, malabsorption, RDW high, hypersegmented neutrophils, target cells
|
|
Anemia of Chronic Disease
|
Microcytic, hypochromic, RDW is normal, does not respond to iron therapy, treated with erythropoietin
|
|
Hemolytic anemia
|
intrinsic cell defects, extrinsic cell defects, elevated retic count, usually normocytic, normochromic
|
|
Functional Iron
|
70% in Hb form, 5% myoglobin form and carries O2 to the tissues
|
|
Storage Iron forms
|
Hemosiderin, ferritin, transferrin (25%)
|
|
Dietary Iron
|
10-20 mg/day in avg Amer diet
1-2 mg/day are absorbed chelators can affect absorption |
|
Iron Deficiency Anemia stages
|
Depletion of Iron stores: ferritin and hemosiderin, Hb normal
Depletion of Transport Iron: transferrin, Hb normal Functional Iron Depletion: all stores and functional plus low Hb level |
|
Sideroblastic Anemia
|
inadequate heme w/adequate or excessive iron, ringed sideroblasts in bone marrow, hereditary and acquired forms
|
|
Anemia of Chronic Disease
|
lactoferrin, high levels of acute phase reactants (CRP, ferritin, cytokines, hepcidin), high ESR affect iron usage and erythropoiesis
|
|
Hereditary forms of Sideroblastic Anemia
|
x-linked and autosomal
|
|
Acquired forms of Sideroblastic Anemia
|
secondary sideroblastic anemia-alcohol, lead, drugs
|
|
Lead poisoning
|
interferes with porphyrin synthesis: ALA accumulates, iron and protophorphrin IX accumulate, basophilic stippling
|
|
Basophilic Stippling
|
appears as round, dark-blue granules in RBCs=ribosomes and mitochondria
|
|
Hereditary Hemachromatosis
|
mutant MHC class 1 gene single aa mutation, mutant HFE protein does not bind TFr so iron continues to be stored even when cells are overloaded
|
|
Diagnosis of HH
|
causes of organ damage include elevated AST, ALT, decrease albumin, elevated serum iron, ferritin and transferrin saturation
|
|
Absorption of Vit B12
|
bound to haptocorrin in saliva, released by trypsin in small intestine, bound to intrinsic factor, int factor required for absorption by ileal cells
|
|
Impaired Absorption of Vit B12
|
trypsin deficiency due to chronic pancreatic disease, lack of intrinsic factor, competition of vit from intestinal organisms
|
|
Pernicious Anemia
|
vit B12 deficiency caused by autoimmune attack on gastric parietal cells by achlorhydria and Abs to parietal cells and to intrinsic factor
|
|
Lab diagnosis of pernicious anemia
|
CBC: pancytopenia, decreased Hb and Hct, high MCV, high RDW and MCH, MCHC is usually normal
RBC morphology: oval macrocytes, target cells, and teardrops, anisocytosis, no polychromasia, decrease in reticulocytes Hypersegmented neutrophils 5+ lobes Bilirubin and lactate dehydrogenase both elevated |
|
Schilling Test for Pernicious Anemia
|
phase 1: patient is given labeled CobaltB12, if radioactivity in urine no PA is present.
phase 2: if no B12 detected 1st time, patient is given labeled B12 with intrinsic factor |
|
Treatment of Megaloblastic Anemia
|
replace folate or vit B12, monitor reticulocyte response
|
|
Causes of Bone Marrow Failure
|
stem cell failure, viral infection, infiltration of marrow space, drugs, chemicals, radiation, infections, platelets can harbinger pancytopenia due to short life-span
|
|
Aplastic anemia
|
anemia resulting from failure of the bone marrow to produce adequate quantities of essential blood components, red cells, white cells and platelets
|
|
Pancytopenia
|
deficiency of all cell elements in the peripheral blood, can be caused by aplastic anemia
|
|
Myelophthistic anemia
|
disorder characterized by immature granulocytes and nucleated red blood cells in the periph blood
caused by replacement of normal marrow cells with abnormal cells |
|
Diagnosis of Fanconi Anemia
|
depends on finding chromosome breakage or crosslinking after incubation of periph blood lymphocytes w/depoxybutane or mitomycin-C
|
|
Fanconi Anemia characteristics
|
usually appears before age 12, smaller than avg stature, extreme fatigue, squamous cell carcinoma
lab findings: low white cell, red cell and or platelet count, acute myelogenous leukemia |
|
Idiopathic Aplastic Anemia
|
40-70% of aplastic anemias are idiophathic
|
|
Causes of Secondary Aplastic Anemia
|
viral causes Hep A and B, EBV, CMV, parvovirus
TB, Brucellosis, parasites radiation |
|
Clinical and Laboratory Findings in Aplastic Anemia
|
spleen is not enlarged, pancytopenia, normochromic, normocytic anemia, decreased reticulocytes, petechiae, bleeding gums nose or eyes due to decreased platelet counts
bacterial infections increased serum iron due to delayed clearance |
|
Hypersplenism
|
spleen becomes a hyperactive housecleaner removing good and bad cells
|
|
Consumptive coagulopathies
|
intravascular coagulation destroys cells
|
|
myelophthistic
|
leukemia, lymphoma, metastatic carcinoma, multiple myeloma, myelofibrosis
|
|
Chronic Renal Disease
|
waste product build-up damages kidney's erythropoeitin production
|
|
Pure Red Cell Aplasia
|
affects erythroid precursors only, associated with thymoma, females predominate 2:1
|
|
Intrinsic Hemolytic Anemia
|
inherited: membrane defects, enzyme defects (G6PD, pyruvate kinase), globin structure and or synthesis defects
Acquired: paroxysmal nocturnal hemoglobinuria |
|
Extrinsic Hemolytic Anemia
|
inherited: abetalipoproteinemia, red cells bind cholestrol
acquired: immunohemolytic, traumatic, infectious agents, chemical or thermal damage |
|
Extravascular Hemolysis
|
90% of normal RBC degradation occurs extravascularly; mononuclear phagocyte system=reticuloendothelial system
|
|
Clinical Features of Hemolytic Anemia
|
pallor, tachycardia, jaundice, crises, splenomegaly, choleithiasis
|
|
Lab indicators of accelerated RBC destruction
|
serum: elevated unconjugated bilirubin, elevated lactate dehydrogenase, decreased haptoglobin, hemoglobinemia
EDTA blood: decreased Hb and Hct, decreased RBCs, elevated retic count Urine: increased urobilinogen, free Hb and Hemosiderin |
|
Diagnosis of Hemolytic Anemia
|
lab tests much show both increased erythrocyte destruction and a compensatory increase in erythropoeisis
|
|
Acanthocytosis
|
severe liver disease, abetalipoproteinemia, anorexia nervosa, decreased activity of lecithin cholesterol acyltransferase
|
|
Lab Tests to Differentiate Hemolytic Processes
|
exam of smear for RBC morph, direct antiglobulin test, osmotic fragility, autohemolysis, Heinz body test, red cell enzymes, flow cytometry
|
|
Heinz bodies
|
precipitated denatured Hb formed bc of RBC enzyme (G6PD) deficiency or unstable Hb, not stained by Wright stain, stain with methyl violet or new methylene blue, supravital stains
|