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139 Cards in this Set
- Front
- Back
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What is the average blood volume of a person?
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Averages 70 ml/kg of body wight - ~7% of total body weight. A 70kg person has approx 5L
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**What is hematopoiesis?
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Blood cell formation. Includes proliferation, differentiation, morphogenesis, functional maturation and death.
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**During embryonic period, where does blood cell development begin? What is this area mostly responsible for?
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Blood islands of the yolk sac - remains active through 8th through 12th week of gestation. Primarily responsible for rbc production but some white cell production and platelet production.
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**Where is the second area that blood cell development begins in the embryo?
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Liver (hepatic period) begins during 5th and 6th week of gestation and remains primary site of blood cell production until 6th month. But, the liver may continue to produce small # of cell until 1st or 2nd week after birth. Still mostly RBCs
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**What areas also become active in blood cell production during the hepatic period?
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Spleen, thymus and lymph nodes
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**During the 5th month of gestation, where does blood cell production begin?
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Bone marrow becomes main site of blood cell production (myeloid period). After birth, marrow only normal site and remains that way through life.
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**What happens to the bone marrow throughout life?
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Fat replaces it over time and by age 18, only active hematopoietic sites are pelvis, vertebrae, ribs, sternum, skull and proximal extremities of long bones.
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**What happens in blood cell production in times of crisis?
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Liver, spleen and lymph nodes may produce blood cells (just enough to keep us alive). If that's the case, these organs become enlarged because they are performing more than their normal role.
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**What is it called when hematopoiesis occurs outside of the bone marrow?
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Extramedullary hematopoiesis
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**What stimulates RBC production? In response to what?
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Erythropoietin in response to hypoxia
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**What is the normal value for RBCs and what is the rate of production?
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Average 5 million RBC/mm3 of blood. Rate about 35 trillion cells per day.
**Production can increase 6-8 fold at max stimulation. |
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**What is erythropoietin? What does it do?
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Renal factor/hormone w/ globulin protein from the liver. Accelerates production, differentiation and maturation of RBCs. Reduces time for RBCs to enter circulation and facilitates incorporation of iron into RBC.
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What can increase erythropoietin activity and what can decrease it?
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Testosterone can increase activity and estrogens may decrease it.
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What is the sequence of RBC maturation?
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Pronormoblast --> Basophilic normoblast --> polychromatophilic normoblast --> acidophilic normoblast --> reticulocyte --> mature rbc
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**What is left in the reticulocyte?
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Aggregates of RNA
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**What is the retic count used for?
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To assess bone marrow erythropoietic activity. Best test to monitor pt's ability to naturally replenish their blood supply by increasing erythropoiesis.
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**What is the normal value for reticulocytes?
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0.5-1.5%
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If normochromic means normal color, hypochromic means under-colored, what is the term for over-colored RBC?
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polychromatophilic. Hyperchromic not a term used.
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**What are Howell Jolly bodies made of?
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DNA fragments
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**What is basophilic stippling made of?
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Aggregates of ribosomes
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**What are pappenheimer bodies made of?
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Siderotic granules - contain iron
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**What is still contained in polychromatophilic rbcs?
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RNA
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**What are cabot rings made of?
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Mitotic spindle. Remnant of microtubules
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**What are Heinz bodies composed of?
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Denatured globin
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What are 3 disease states that you might see Rouleaux in?
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Multiple myeloma, hyperproteinemia, Waldenstrom's macroglobulinemia
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What is an illness that might cause cold agglutinins?
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Atypical pneumonia (mycoplasma)
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What are the normal RBC values (male, female, in general) and how large is a typical RBC?
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Male: 4.7-6.1 mill/mm3,
Female: 4.2-5.4 mill/mm3, General: 4.5-6.2 mill/mm3, Size: 7 microns |
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In an RBC count, what is it counting?
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# of circulating RBCs in 1 mm3 venous plood
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What 5 things can cause increased RBC count?
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High altitude, congenital heart disease, polycythemia vera (stem cell malignancy), dehydration/ hemoconcentration, smoking
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**What is the definition of anemia?
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Decrease in RBC count more than 10% below expected normal value.
Anemia parameters: Hct, Hgb, RBC, indicies |
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What are 10 causes of anemia?
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Hemorrhage, Hemolysis, Diet deficiency, genetic aberrations, drug ingestion, marrow failure, chronic illness, other organ failure, gi bleed, pregnancy
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What 3 things can cause hemolysis leading to anemia?
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G6PD deficiency, heredetary spherocytosis, secondary splenomegaly
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What are 3 dietary deficiencies that can cause anemia?
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Iron, Vitamin B12 &/or folate
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What are two genetic aberrations that cause anemia?
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Sickle cell, thalassemia
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What are 3 drugs that cause anemia?
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Chloramphenicol, hydantoins, quinidine
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What are 3 marrow failures that can cause anemia?
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Fibrosis, leukemia, antineoplastic chemotherapy
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What are 2 chronic illnesses that cause anemia?
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Tumor, sepsis
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What organ failure can cause anemia?
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Renal (because erythropoietin comes from kidney)
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Why can leukemia cause decreased RBC?
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Proliferation of wbcs doesn't leave enough room in marrow for rbcs
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How does over hydration cause decrease in RBC?
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dilutional effect
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What are the normal hgb values and what is the critical value? (male, female, general)
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Male: 14-18 g/dl
Female: 12-16 g/dl General: 13.0-17.7 g/dl Critical: <5.0 g/dl |
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What are the normal adult and fetal hemoglobins and their percentages?
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Adult Hgb A (alpha2 beta2): 95%
Adult Hgb B (alpha 2 delta2): 1.5-3% Hgb F (alpha 2 gamma2): <1% |
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What are the number of amino acids in each Hgb A chains?
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Alpha chains = 141 amino acids
Beta chains = 146 amino acids |
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What happens to the blood volume during pregnancy?
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Increases
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What are 8 causes of increased hgb?
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Congenital heart disease, polycythemia vera, hemoconcentration, COPD, CHF, high altitude, severe burns, dehydration
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What are 8 causes of decreased hgb?
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Anemia, severe hemorrhage, hemolysis, hemoglobinopathies, cancer, nutritional deficiency, kidney disease, chronic disease
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What are the normal hct values for male, female and in general? What is the critical value?
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Male: 42-52%
Female: 37-47% General: 39-54% Critical: <15% |
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What needs to be the case in order for the rule of 3s to work?
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RBCs need to be normal size and contain normal amounts of hgb
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What are 7 causes of increased Hct?
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Congenital heart disease, polycythemia vera, severe dehydration, shock, burns, trauma, surgery
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What are 8 causes of decreased hct?
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Anemia, hyperthyroidism, hemorrhage, hemolytic reaction, dietary deficiency, bone marrow failure, normal pregnancy, leukemia
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What is normal MCV?
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80-100 microns3 (femtoliters)
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What is the normal MCH?
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27-31 pg
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What is the normal MCHC?
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30-36 g/dl
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What is the normal RDW?
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11.5-14.5%
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**What is the calculation for MCV?
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Hct/RBC x 10
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**What is MCH?
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Measure of average amount (weight) of hemoglobin w/in an RBC
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**What is the calculation for MCH?
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Hgb/RBC x 10
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**What is MCHC?
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Measure of average concentration or percentage of hgb w/in a single RBC Decreased MCHC --> hypochromic
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**Calculation of MCHC?
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Hgb/Hct x 100
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What are 4 disease processes or conditions that you might see an increased MCV?
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Liver disease, anti-neoplastic chmotherapy, alcoholism, vitamin B12 and folate deficiency
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What are two conditions you might see a decreased MCV?
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Iron deficiency anemia, thalassemia
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In what condition might you see an increased MCH?
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Macrocytic anemia
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In what two conditions might you see a decreased MCH?
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Microcytic anemia, hypochromic anemia
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In what condition might you see increased MCHC?
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Spherocytosis
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In what condition might you see a decreased MCHC?
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Iron deficiency anemia, thalassemia
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What is the normal value for WBC count? Critical?
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Normal: 4,000-11,300 mm3
Critical: <2,500 or >30,000 mm3 |
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**What are the normal % in a WBC diff?
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Neutrophil: 25-75%
Lymph: 20-53% Mono: 1-12% Eos: 0-10% Baso: 0-2% |
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How long does it take to produce neutrophils? How long do they live in circulation?
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Produced in 7-14 days and exist in circulation for 6 hours
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What are Dohle bodies made of?
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remnants of free ribosomes of RER.
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**What are the T cells and B cells each primarily involved with?
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T cell: cellular-type immunity
B cell: humoral-type immunity (ab production) |
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**What is the primary function of lymphs?
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Fight chronic bacterial infections and acute viral infections
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What are 8 conditions in which you might see lymphocytosis?
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Viral infections, mono, pertussis, mumps, rubella, TB, brucellosis, hepatitis
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What is the lifespan of monos?
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In circulation 1-3 days then move to tissue and become macrophage. Can produce more rapidly and spend more time in circulation than neutrophil
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What are macrophages called in lungs, liver, spleen and brain?
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Alveolar macrophages, Kupffer cells, splenic macrophages, and oligodendrocytes or glial cells
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What are 7 diseases or conditions you might see eosinophilia?
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Allergic reactions, parasitic, drug reactions, skin disorders, collagen vascular disease, Hodgkins, lung disease (Loeffler's syndrome - occupational lung disease)
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What do basophil granules contain?
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Histamine, heparin, hyaluronic acid
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In what 4 conditions might you see Basophilia?
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Allergic reactions, CML, polycythemia vera, myeloid metaplasia
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What are 7 conditions you might see decreased WBC count?
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Drug toxicity, bone marrow failure, overwhelming infections, dietary deficiency, autoimmune disease, bone marrow infiltration (myelofibrosis), sepsis
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What are the normal and critical platelet counts?
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Normal: 150,000-450,000 mm3
Critical: <50,000 and > 1 mm3 |
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What are 5 causes of decreased platelets?
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Reduced production of platelets, sequestration of platelets (pulled out of circ), accelerated destruction, consumption (DIC), platelet loss from hemorrhage
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What are 10 clinical conditions where you would see decreased platelets?
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Hypersplenism, hemorrhage, ITP, leukemias, liver disease, kidney disease, DIC, SLE, hemolytic anemia, cancer chemo
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What are 4 causes of increased platelets?
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Malignant disorders, polycythemia vera, leukemia, post spenectomy syndrome
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What are the normal Sed rates for male and female?
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Male: 0-15 mm/hr
Female: 0-20 mm/hr |
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What are 6 causes of increased ESR?
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Fever, anxiety, infection (bacterial), cancer, rheumatoid arthritis, temporal arteritis/ polymyalgia rheumatica
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What 3 things can cause decreased ESR?
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CHF, mono, angina pectoris
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What is CRP?
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Abnormal protein produced primarily by the liver under influence of IL-6 (produced by macrophages). Produced during acute inflammatory response. Similar to IgG but not antigen specific. Reacts w/ complement system.
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What is CRP often used for?
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Evaluating pts w/ acute MI. CRP correlates w/ peak levels of CK MB but peaks 1-3 days later. Also used postoperatively to detec wound infections. CRP levels increase w/in 4-6 hrs after surg and decrease after 3rd postop day - failure to decrease could indicate infection or pulmonary infarction
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What are 11 causes of increased CRP?
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RA, acute MI, postop wound infection, pulmonary infarction, malignant diseases, bacterial infection, viral infections, vasulitits syndromes, SLE, Tissue necrosis or trauma, DM type 2
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**What kind of things would you see in acute bleed anemia as opposed to chronic blood loss anemias?
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Greater than 15% blood volume lost, hypovolemia --> vasocronstriction and tachycardia. Initially RBC parameters normal. Once volume replaced: normocytic/ normochromic anemia.
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**What is the pattern seen with reticulocytes after acute blood loss?
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Reticulocytosis occurs in 1-2 days, peaks at 4-7 days, should stop by 30 days
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What are 4 causes of iron deficiency anemia?
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Poor iron intake, inadequate absorption, increased requirement (i.e. pregnancy), increased loss (i.e. GI bleed)
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What lab values would you expect to see in iron deficiency anemia?
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Decreased Hgb, Hct, RBC. Decreased ferritin. Low iron. Iron binding normal to high. Low MCV, MCH, MCHC.
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What are hemoglobinopathies? What are the 2 categories?
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Change in amino acid sequence in beta chains.
If 1 chain affected --> heterozygous. If 2 chains affected --> homozygous |
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What is sickle cell anemia?
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Homozygous S. Symptoms after 6 months due to decreased fetal hemoglobin, increased hgb S.
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What would you see in electrophoresis of Hgb S?
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90-100% Hbg S, remainder Hgb F
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What causes actual sickeling?
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Decreased O2. Sickle cell crisis. Severe abd pain, bone, joint pain. Plugging of small vessels w/ masses of sickle cells. Spleen may become fibrotic due to masses of infarcts.
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What would a smear look like in sickle crisis?
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sickle cells, NRBC, target cells, poikilocytosis
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What would Sed rate and bone marrow look like in sickle cell anemia?
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Sed rate normal. Bone marrow hypercellular.
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**How is a diagnosis of sickle cell made?
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Hemoglobin electrophoresis
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What is the sickle cell trait?
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Heterozygous 20-40% Hgb S; 60-80% Hgb A
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What do you see in homozygous hemoglobin C disease?
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100% hgb C or small amt of Hgb F. Targe cells, 4+ aniso, 4+ poikilo, may have rod shaped crystals.
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What do you see in heterozygous hemoglobin C?
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Few target cells
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What do you see in aplastic anemia?
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Markedly decreased to absent formation of all blood lines; pancytopenia. Cause unknown. Exposure to ionizing radiation or drugs?
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What is pernicious anemia?
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Megaloblastic anemia. Gastric mucosa can't secrete intrinsic factor to absorb B12.
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What are some symptoms you might see in pernicious anemia?
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Age >60, weakness, icterus, sore tongue, brittle nails, abd pain, nausea, anemia, diarrhea, lemon yellow pallor, numbness/ tingling in extremeties.
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**What lab data might you see in pernicious anemia?
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Macrocytes/ megalocytes, hypersegment neutrophils, decreased RBC, Hct, Hgb, WBC, increased MCV. Decreased B12. Anti-intrinsif factor level elevated.
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**By what 5 things can you diagnose B12 deficiency?
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B12 level, Homocysteine level increased, anti-intrinsic factor antibody, methylmalonic acid levels, schilling test
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What is another name for Beta Thal Major?
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Cooley's anemia
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What clinical findings would you see in beta thal major?
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Failure to thrive, marked hepatosplenomegaly, severe anemia; life-threatening. Mongoloid appearance.
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What lab values would you see in beta thal major?
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Microcytic, hypochromic, 4+ aniso, 4+ poikilo, 4+ micro, NRBC, increased retic, basophilic stippling, H-J bodies. Low H&H, high bilirubin, target cells.
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**How would you diagnose beta thal major?
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Hemoglobin electrophoresis. Would see 40-60% hgb F and increased levels of Hgb A2
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What would you see on electrophoresis and on a periph smear in beta thal minor?
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Electrophoresis: 2-6% hgb F; >5% hgb A2.
Periph: basophilic stippling, H-J bodies, target cells |
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**What 5 things would you see in hemolytic anemia?
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Splenomegaly, increased bili/ decreased rbc, **decreased haptoglobin, typical anemia picture, can be intrinsic or extrinsic
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What are 5 types of intrinsic hemolytic anemia?
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Intrinsic to the cell, membrane abnormalities (hered spherocytosis/ elliptocytosis), abnormal hemoglobins (sickle), defective glycolysis, enzyme deficiency (G6PD, PK)
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**What 6 things would you see in hereditary spherocytosis?
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Cell membrane permeable to sodium, membrane loss, causes spherocytic cells - destruction in spleen, increased osmotic fragility and increased retics, typical anemia picture, increased bili
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**What 4 things would you see in elliptocytic hemolytic anemia?
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maybe asymptomatic but can be severe, membrane leaky to sodium, ellipical cells, reticulycytosis and increased bili
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What are 5 types of extrinsic hemolytic anemia?
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Extrinsic to the cell, damage by abs, mechanical damage, alterations in plasma lipids, infectious agents and toxins
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What is infectious mono?
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Epstein barr virus, herpes-like virus, cmv, disease of young adults (15-30 yrs) causes tonsilitis, lymphadenopathy. 6-12 week incubation. Usually gone in 6 weeks.
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**What would you see on periph smear in infectious mono?
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Increased lymphs and atypical lymphs
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What are the 3 phases of mono?
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Prodromal period, Mid-stage and acute phase
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What 3 things do you see in the first phase of mono (prodromal period)?
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Irregular fever, non-spec malaise, mild sore throat (pharangitis)
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**What do you see in the 2nd stage of mono (mid-stage)?
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Temp 100-103 degrees, enlarged cervical glands, marked pharyngitis, prop >40% of lymphs atypical, positive mono spot
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What do you see in the 3rd phase (acute phase) of mono?
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Fever, sore throat, 10% of pts get liver involvement, fatigue-most prominent symptom, jaundice, abdom discomfort englarged liver, lasts 4-20 days Watch for hepatosplenomegaly
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What is ALL?
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Usually children 3-4 years old. Present w/ swollen lymph nodes, mild anemai, bacterial infections, viral infections.
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How do you diagnose ALL?
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Bone marrow biopsy
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**What is the most prominent indication of ALL in lab values?
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Lymphoblasts - 60%
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What is the treatment for ALL?
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Chemo, RT to spine
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What is AML?
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Adults, lots of bone marrow involvement, spleen, liver involvment may cause abd pain and swelling. Diagnosis by bone marrow biopsy
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**What are the two most prominent indications of AML in lab values?
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Myelblasts 70%, Auer rods
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What is the treatment for AML?
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Chemo
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What is CLL?
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Elderly, usually >60yo, uncontrolled prolif of B lymphs, originates in bone marrow, splenic and lymph node involvement, fatigue, loss of appetite, fever, enlarged lymph nodes, prone to bacterila and viral infections (usually die of infection).
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How is CLL usually diagnosed?
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Periph smear. Don't usually need bone marrow bx.
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**What are the most prominent indications of CLL in lab values?
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Lymphocytes 100% small. smudge cells
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What is the treatment for CLL?
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None. Or sometimes chemo.
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**What are 3 major indications of CML?
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Splenogmegaly (massive - sequestering bad cells), abnormal 22nd chromosome - Philadelphia chromosome, bone marrow packed causing lot of bone pain.
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What are some other features of CML?
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bone marrow, spleen, liver producing malignant prolif of granulocytes, fatigue, weight loss, fever, loss of appetite, 30-50yo, often progresses to AML, decreased platelets due to crowding out in BM - leads to bleeding, bruising (esp of eyes, gums, GI), left shift, decreased platelets
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How is a diagnosis of CML made?
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Bone marrow bx
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What would you see on a periph smear in CML?
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WAAAAY high wbc count, low plt, left shift with a lot of very immature cells.
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What is treatment for CML?
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chemo - could lead to more of a decrease in plt and rbc req transfusions
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