Hematology

Card Set Information

Author:
PNP9
ID:
251528
Filename:
Hematology
Updated:
2013-12-08 08:52:50
Tags:
Lab
Folders:
Lab
Description:
Lab
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user PNP9 on FreezingBlue Flashcards. What would you like to do?


  1. Blood component
    • Plasma - 54%
    • WBC - 1%
    • Redcells - 45%
  2. WBC flavors
    • White Blood Cells  4.5 - 11.0 K/uL                   Low = Leukopenia 
    • High = Leukocytosis

    WBC Differential

    Neutrophils - Segs  - bacteria eater

    Neutrophils - Bands - if band is high means that body is being attacked hugely = shift to the left. - SEPTIC!

    Lymphocytes - Lymphs - Go up in viral infection.

    Monocytes - Monos - goes up in chronic infection, TB, mono.

    Eosinophils - Eos - allergies, worms, parasites

    Basophils - Basos - go up in allergies, and anything weird --> refer to hematologist, they will do bone marrow biopsy if you cannot figure what's going on out.

    Atypical Lymphs - common in mono.
  3. Types of hemoglobin in the RBC (3) and where do they come from? Test for which hemoglobin you have?
    • Hem A - alpha beta
    • Hem F -alpha and gamma - transforms at 6 mo. to when you get the hg that you will have for the rest of your life.
    • ( In sickle cell this switch might stay on, and it is a good thing bc they don't sickle as much - hydroxyurea keeps switch on)
    • Hem A2 - alpha delta chains. -

    body compensate for when alpha or beta isn't enough. - make more Feta or more A2 to compensate ( Thalassemia alpha, beta)

    They come from chromosomes 11 and 16


    Hemoglobin electropheresis - all nb get screened for which hemoglobin they have.
  4. What are reticulocytes?
    When do we need and why do we need retics?
    • Reticulocytes, or Retics are young red cells just released from the bone marrow. The Retic
    • count is  the best indicator about how
    • the marrow factory is doing.

    - how is it responding to anemia.- when anemia ocurs, BM needs to be making more RBC.

    • If anemic and retic is high = bleeding - possibly GI tract.
    • or = Hemolytic anemia 

    Usually retic count is low when people are anemic

    • Reticulocyte Count  0.5 -1.5 %         
    • Low in anemia = low  marrow output        
    • High = RBC loss
  5. Signs that someone is hemolysing
    • high indirect bili
    • high LDH
    • high rectic count
  6. What is hepcidin?
    • hormone made in the liver to regulate iron
    • goes up when body is inflmmaed ( autoimmune disease, HIV, SLE, etc ...) --> and it increases levels of and block absorption of iron and cell release --> cause of anemia, all iron stored in bone marrow and cannot come out.
  7. What is Erythroprotein?
    • made in the kidner and tell BM to make more red cells. - when kidney are without O.
    • People can get anemic from kidney disease
    • Epo can be replaced
  8. What is Gilbert's disease?
    • people always hemolyzing bc bilirubin is not properly processed in the liver
    • harmless and does not require treatment
  9. hb, hct, rbc, cell count normal numbers?
    • Hemoglobin 
    • Male= 15.5 +/- 2 mg/dl  Low = Anemia
    • Female = 13.5  +/- 2  High = polycythemia

    • Hematocrit 
    • Male= 46.0 +/- 6%  " 
    • Female= 41.0 +/- 6%  "

    • RBC - Red Blood 
    • Male = 4.3 - 5.9 Million/uL  "

    • Cell Count 
    • Female = 4.0 - 5.2 “  High in Thalassemia

    Low hg and high red count = thalessemia
  10. MCH and MCHC
    • Mean Corpuscular Hg
    • 27 -32 pg
    • Low = Hypochromic
    • High = Hyperchromic
    • Mean Corpuscular  Hg concentration 30 - 36 gm/dl  
    • Low = R/O Fe def.
    • High = Spherocytosis
  11. MCV and RDW - How big are my red cells? - next big clue to know what's going on?
    • Mean Corpuscular Volume  80 - 94 fl             Low = Microcytosis   
    • High = Macrocytosis

    Red Cell Distribution Width  11.5 - 14.5  Variation in RBC size (High in Iron deficiency)

  12. Platelets - how low can you go?
    • normal: 150 - 400 K cell/uL    
    • Low = Thrombocytopenia - 20k
    • High = Thrombocytosis - 1 million
  13. Most lab do corect the retic, but if it is not corrected how do you correct it?
    reticulocyte (%) = absolute number of reticulocytes ÷ number of RBC × 100

    reticulocyte index = % reticulocytes × actual hematocrit ÷ normal hematocrit

    • corrected reticulocyte index (corrects for appropriate bone marrow release of
    • reticulocytes) = reticulocyte index ÷ maturation factor

    maturation factor = 3.25 – (actual hematocrit ÷ 20)

    • - if hematocrit 45, maturation factor = 1
    • - if hematocrit 35, maturation factor = 1.5
    • - if hematocrit 25, maturation factor = 2
    • - if hematocrit 15, maturation factor = 2.5

    Corrected retic index < 2 indicates bone marrow production problem

    Corrected retic index >2 indicates acute red cell loss (hemolysis or bleed)
  14. Microcytes reasons?
    • T-Thalassemias ( genetics)
    • I-Iron Deficiency
    • C-Chronic Inflammation
    • S-Sideroblastic - lead, drug,  or  hereditary
  15. What are some mycrocytic tests to order?
    • Serum Iron
    • TIBC = Total Iron Binding Capacity = Transferrin binding sites for transporting iron
    • % Saturation = Transferrin saturation with Iron
    • Ferritin = Storage Iron – best way to tell if iron is low. --> best peripheral blood test to see if you are iron deficient. ( after liver biopsy which is more invasive)
    • HBELP = Hemoglobin Electrophoresis --> best to check for Thalassemia
    • Lead level if exposed
  16. Thalassemia Syndromes
    • Hereditary – Alpha or Beta chain production - from electropherosis - iron is usually normal.
    • Decrease Hemoglobin A
    • Hemoglobin ELP and normal Iron are diagnostic
    • Supportive therapy or BMT
    • Target Cells
    • Hemolysis signs
    • Increased Red cell count
  17. Iron deficiency causes/ syndromes - what do you treat them with?
    Patient teaching?
    • Low Serum iron, Low Ferritin, High TIBC
    • Find out why –GI bleed, menses, diet
    • Treat FeSO4 300mg tid

    F/U in 2- 3 weeks for Retic and Ferritin – should be going up – and then discontinue
  18. Chronic Inflammation - Signs and treatment?
    • Block of normal iron stores transport  to bone
    • marrow factory
    • Normal Ferritin, serum iron and TIBC are low with a low saturation
    • 30% Microcytic, 70% Normocytic
    • High Sed rate or c-reactive protein
    • Treat inflammation – RA, SLE, HIV….
  19. Sideroblastic signs?
    • Ring sideroblasts in bone marrow
    • Serum iron is increased and TIBC normal resulting in a high saturation.  Serum ferritin is increased
    • Basophillic stippling - get the lead out! with killetic agents
    • Lead toxicity is suspect
  20. Normocytic Anemia?
    NORMOCYTIC = "NORMAL SIZE“

    • N-Normal Pregnancy
    • O-Over hydration
    • R-Renal Disease
    • M-Myelophthistic
    • A-Acute Blood Loss
    • L-Liver Disease

    • S - Systemic Infection
    • I- Inflammatory Block
    • Z-Zero Production- Aplastic anemia
    • E-Endocrine:Hypothyroid, hypoadrenal, hypoandrogen
  21. Normocytic anemia tests?
    • Blood Urea Nitrogen (BUN), Creatinine,  SGOT, Alkaline Phosphatase, Bilirubin, Erythrocyte Sedimentation Rate (ESR), Urinalysis, and Thyroid profile
    • Renal Function tests
    • Pregnancy Test
    • Bone Marrow Biopsy
  22. If anemia caused by renal failure ( normocytic) - what to do?
    • Anemia caused by decrease erythropoetin
    • production causing decreased bone marrow production

    Can monitor erythropoetin levels

    Treat with epoetin alfa injections  weekly or darbepoetin alpha every other week or monthly
  23. Aplastic anemia, causes and treatment?
    • idiopathic (78% cases)
    • hepatitis (5% cases) testing for known hepatitis viruses usually negative
    • drugs 
    • Parvo virus B19 (Fifths disease)
    • Check WBC and Platelet count
    • May need Bone Marrow Bx and supportive therapy
  24. Macrocytic Anemia
    • B-B12 Malabsorbtion
    • I-Inherited
    • G-Gastrointestinal disease or surgery

    • F-Folic Acid Deficiency
    • A-Alcoholism
    • T-Thiamine responsive

    • R-Reticulocytes miscounted as large RBCs
    • E- Endocrine - hypothyroid
    • D-Dietary

    • C-Chemotherapeutic Drugs
    • E-Erythro Leukemia
    • L- Liver Disease
    • L- Lesch-Nyhan Syndrome
    • S-Splenectomy
  25. Macrocytic Tests?
    • The peripheral blood changes include:
    • -Anemia with decreased reticulocyte count, -Increased MCV-
    • - Neutropenia with hypersegmented Neutrophils-- Thrombocytopenia with large platelets.

    LABS to order:B12, Serum Folate, RBC Folate if all normal, consider TSH, and a Bone Marrow Bx
  26. B12 Deficiency?
    • Physical signs:
    • edema, pallor, jaundice, smooth tongue, decreased vibratory and position sensation

    • Hypersegmented polys
    • Low serum B12 level
    • Metformin, Gastric bypass, or PPI as cause?
    • Methylmalonic acid and homocysteine levels
    • Pernicious anemia - anti- intrinsic factor antibodies Schilling's test

    • •Rx - cobalamin 1000 mg I.M., oral, or Nasal Spray - shots are monthly
    • Meds for life - bring them back to see if it is absorbing
  27. Folate Deficiency
    • Causes : - liver disease, diet vitamin B12 deficiency, and drugs such as methotrexate,
    • ethanol, and dilantin.

    • Lab – low serum and RBC Folate  - always check
    • B12 (needed for conversion)

    Elevated homocysteine (Heart disease?)

    Rx – Folate 1mg po qD
  28. Hemolytic = HEMATOLOGYST
    • H-Hemoglobinopathy: sickle cell disease
    •  - Hemoglobinuria: Paroxysmal Nocturnal      Hemoglobinuria
    • E-Enzyme Deficiency
    • M-Medication - drug induced:  aldomet, INH
    • A-Antibodies - Immune attack
    • T-Trauma to the red cells: D.I.C , artificial heart valves
    • O-Ovalocytosis
    • L-Liver disease
    • O-Osmotic fragility in Hereditary spherocytosis       and in Hereditary Eliptocytosis
    • G-G6PD Glucose-6-Phosphate Dehydrogenase       Deficiency
    • I-Infection: malaria, babesiosis
    • S-Splenic destruction in hypersplenism
    • T-Transfusion
    •   - Thalassemias
  29. Hemolysis ( HIT)
    • •Hereditary (HEM)
    • –Hemoglobin (sickle cell, thalassemia)
    • –Enzyme (G6PD deficiency)
    • –Membrane (Spherocytosis, Eliptocytosis)

    • •Immune attack – Coombs positive (transfusion, IgM – cold antibody-infections, IgG warm
    • antibody – Drug induced, Paroxysmal Nocturnal Hemoglobinuria – complement induced)

    •Trauma– Microangiopathic (TTP, ITP, HUS, DIC, HIT, HELLP- Eclampsia, Malaria, Splenomegaly)
  30. Hemolytic Signs
    • 1. Elevated reticulocyte count, with  stable
    • or falling hemoglobin.

    2. Elevated  indirect  bilirubin -

    3. Elevated  serum lactate  dehydrogenase (LDH)-

    • 4. Decreased Haptoglobin levels -  Haptoglobin
    • binds hemoglobin  released in the plasma
    • from red cell breakdown.

    5. Hemoglobinemia  and  hemoglobinuria

    6. Erythroid  hyperplasia in  bone  marrow

    7. Abnormal Hemoglobin Electrophoresis
  31. Hemolytic Tests
    • 1.The direct antiglobulin (Coombs') test   
    •    Direct Coombs test looks for antibody on the      red cells. The Indirect Coombs looks for           antibody in the serum.
    • 2. Hemoglobin electrophoresis - dx sickle cell and thalassemia

    3. Heinz body stain - for G6PD deficiency (test)

    4. Osmotic fragility

    5. Blood smear

    6. Platelet count in the CBC - thrombocytopenia

    anti-CD59 and flow cytometry for Paroxysmal nocturnal hemoglobinuria
  32. Hemoglobinopathy
    Sickle Cell Disease – SS, SC, SD, SE, SOarab, S beta Thal - type picked up at Newborn Screening or HbELP

    Rx: Daily Penicillin –birth -6yo

    TCD screen prevents strokes

    Hydroxyurea prolongs life, prevents complications. - is given as soon as 1 yo

    Hydration, Oxygen, Temperature, and Folate
  33. G6PD deficiency
    X linked genetic

    Precipitated by oxidant drugs

    Heinz body stain shows denatured Hb

    Avoid medications such as antimalarials, aspirin, sulfa drugs, and avoid eating fava beans.
  34. Immune Attack
    •Coombs Test: IgG and Compliment +/-

    •Transfusion reaction: immediate or delayed

    • IgM – (IgG Neg Comp +) cold antibody infections like, EBV (Mono), HIV, Mycoplasma pneumoniae,
    • influenza B, Cytomegalovirus (CMV), rubella virus, varicella-zoster virus (VZV), parvovirus B19, and Chlamydia psittaci

    • IgG warm antibody – Drug induced
    • – Antibiotics, Ibuprofen, Autoimmune diseases

    • PNH Paroxysmal Nocturnal Hemoglobinuria
    • Red cells attacked by complement. Lack of CD55 or CD59 on RBC surface
  35. Lymphadenopathy
    • L-Lymphoma, Leukemia
    • Y-Yersinia Pestis (Plague)
    • M-Mononucleosis or CMV
    • P-Parasite - Toxoplasmosis
    • H-Hodgkins Disease or HIV infection - syphilis
    • N-Neoplasm or metastisis
    • O-Obvious local infection or inflamation
    •    -Other systemic infections: Hep B, Rubella,      Tularemia, Cat scratch
    • D-Drug- Procainamide (Pronestyl), Phenytoin (Dilantin)
    • E-Endocrine- Addisons, Hypothyroid
    • S- Syphilis
    •    -SLE/Rheumatoid arthritis
    •     -Serum sickness
    •     -Sarcoid
  36. Multiple Myeloma
    • Symptoms and Signs - Itching, Bone pain, weakness, anemia, lytic bone lesions, increased
    • protein, M - Spike, Bence Jones protein in urine, Renal failure
    • Pop: older, more men than women
  37. Primary - Polycythemia
    Sx: Pruritis HA, Dizziness, vertigo, visual disturbance, tinnitus

    PE: Rubor, BP increased, splenomegaly or hepatomegally

    Lab: HCT >55 lncreased platelets and WBC count

    RX: Phlebotomy, Hydroxyurea

    • Blood is hyperviscosity.
    • Testosterone - nico epo filler.
  38. 2ndary Polycythemia
    • Increase erythropoietin due to hypoxia (COPD, smokers, high altitude), tumors of kidney,
    • ovary, liver, brain, drugs: steroids, androgen, dehydration, burns

    PE: No hepatospenomegaly unless tumor
  39. Leukemia and Lymphoma
    ALL: Acute Lymphocytic Leukemia (Usually in Children)

    AML: Acute Myelogenous Leukemia

    CLL: Chronic Lymphocytic Leukemia

    CML: Chronic Myelogenous Leukemia

    Lymphomas, Hodgkins

    HX:Fatigue, anorexia, wt loss, fever, bone pain, headaches, lymphadenopathy, non healing infections, thrush, bleeding

    • PE: Pallor, gingival hyperplasia, Candida infections, lymphadenopathy, hepatosplenomegaly,
    • lung infiltrates, bleeding, bruising

    • LAB:
    • CBC: elevated WBC/ low platelets, low Hct, WBC
    • Differential, Chem 18,
    • Bone Marrow Biopsy
    • Philadelphia Chromosome seen in CML
    • Auer bodies or rods in AML
    • Lymph node BX: Reed -Sternberg cells in Hodgkins Disease
    • CT - MRI chest and abdomen
    • CXR - Chest infiltation, pneumonias
    • RX: Chemotherapy, Bone Marrow Transplant
  40. Difference between Mono and Strept when it comes to lymphadenopathy
    • Mono ( runs with HIV and syphillis): posterior lymphadenopathy and axillary lymph nodes
    • Strep: anterior cervical chain, NEVER posterior chain

What would you like to do?

Home > Flashcards > Print Preview