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2014-12-11 02:05:14

PAP-589 DM III, Exam 1, Hematology/Oncology
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  1. Cellular components of blood
    • Erythrocytes
    • Leukocytes
    • Thrombocytes
  2. Fluid elements of blood
    • Plasma (with coagulation factors)
    • Serum (after clotting element removed)
  3. Neutrophils
    • “Segs”, “polys”, “PMNs”
    • Phagocytes
    • Polymorphonuclear
    • Bacterial infection, etc
    • Viral diseases, etc
    • Band forms (3-5%)
  4. Left Shift
    • Differential:
    • >20% band forms, OR
    • Total of polys + bands are >80%
    • May also indicate a predominance of immature cells
    • May be the earliest sign of a WBC response
  5. Eosinophil
    • “Eos”
    • Ag-Ab reactions
    • Active in allergic reactions and parasitic infections
    • Granules are acidic, contain peroxidases
    • : Eosinophilia
  6. Basophil
    • “Basos”
    • Mast cells when found in connective tissues
    • Contain heparin, histamines and serotonin
    • Role in hypersensitivity
    • : Basophilia
  7. Monocyte
    • “Monos”
    • Macrophage in tissue
    • Fx in immunity and phagocytosis
    • Mononuclear, agranular
  8. Lymphocyte
    • “Lymphs”
    • Three types - natural killer cells, B cells, T cells
    • Immunoglobulins
    • Immune response
    • Mononuclear, agranular
  9. RBC Maturation Order
    • Rubriblast
    • Prorubricyte
    • Rubricyte
    • Metarubricyte
    • Basophilic erythrocyte (Reticulocyte) once it leaves bone marrow, nucleus is gone
    • Erythrocyte
  10. Reticulocyte count
    • “Retic count”
    • Percentage of total RBC count, normally 1-2%
    • ↑ represents conditions of ↑ red cell production
    • “Polychromasia” reported on smear suggests ↑ retics
    • Newborns have more retics in circulation
  11. Microcytic
    • RBC smaller than normal size
    • MCV value in CBC
  12. Normocytic
    • RBC normal size
    • MCV value in CBC
  13. Macrocytic
    • RBC larger than normal size
    • MCV value in CBC
  14. Anisocytosis
    • RBCs of unequal size
    • RDW Values >15% indicates anisocytosis
    • All RBCs should be the same size
  15. RDW
    • RBC Size Distribution Width
    • The RDW measures the variation in size of the red blood cells. Usually red blood cells are a standard size. Certain disorders, however, cause a significant variation in cell size.
  16. Poikilocytosis
    • Variation in RBC shape
    • eg:
    • Spherocytes - membrane integrity is compromised, trauma, lose biconvacity
    • Ovalocytes or elliptocytes - membrane defects -> thalassemia, Fe deficiency
    • Sickle cells - B chain mutation
    • Target cells - Mexican hat
    • Spiculated cells - serrated edges
    • Schistocytes - fragments/pieces of RBCs, often seen with spiculated cells - indicates trauma from burn, artificial valve chewing up cells, DIC, TTP
  17. DIC
    • Disseminated Intravascular Coagulation
    • A serious medical condition that develops when the normal balance between bleeding and clotting is disturbed. Excessive bleeding and clotting injures body organs, and causes anemia or death.
  18. TTP
    • Thrombotic Thrombocytopenic Purpura
    • a form of thrombotic microangiopathy marked by thrombocytopenia, hemolytic anemia, neurological manifestations, azotemia, fever, and thromboses in terminal arterioles and capillaries
  19. RBC Color
    • Correlates to Hemoglobin content
    • Hypochromic
    • Normochromic
    • Hyperchromic
    • Polychromasia (indicates retics)
    • Represented by MCH & MCHC in CBC
  20. Hemoglobin
    • (Hgb or Hb)
    • Oxygen carrying capacity directly proportional to the Hgb concentration
    • Normal values vary in males and females, age, race and ethnicity
  21. Hematocrit
    • (Hct, “crit”)
    • % of RBCs in a volume of whole blood
    • Normal values vary
    • Reflects the # of RBCs as well as their volume
  22. Rule of three
    • 3 x RBC count = Hgb
    • 3 x Hgb = Hct (+/- 3%)
  23. MCV
    • mean corpuscular volume
    • Average volume of the RBCs (in cubic micrometers)
    • MCV measures the average volume of a red blood cell by dividing the hematocrit by the RBC. The MCV categorizes red blood cells by size. Cells of normal size are called normocytic, smaller cells are microcytic, and larger cells are macrocytic. These size categories are used to classify anemias. Normocytic anemias have normal-sized cells and a normal MCV; microcytic anemias have small cells and a decreased MCV; and macrocytic anemias have large cells and an increased MCV. Under a microscope, stained red blood cells with a high MCV appear larger than cells with a normal or low MCV.
  24. MCH
    • mean corpuscular hemoglobin
    • Average weight of Hgb of each RBC (in picograms)
    • The average weight of hemoglobin in a red blood cell is measured by the MCH. The formula for this index is the sum of the hemoglobin multiplied by 10 and divided by the RBC. MCH values usually rise or fall as the MCV is increased or decreased.
  25. MCHC
    • mean corpuscular Hgb concentration
    • Average Hgb concentration in the RBC compared to its size
    • A ratio of weight to volume (%)
    • Hgb/Hct
    • The MCHC measures the average concentration of hemoglobin in a red blood cell. This index is calculated by dividing the hemoglobin by the hematocrit. The MCHC categorizes red blood cells according to their concentration of hemoglobin. Cells with a normal concentration of hemoglobin are called normochromic; cells with a lower than normal concentration are called hypochromic. Because there is a physical limit to the amount of hemoglobin that can fit in a cell, there is no hyperchromic category.
    • Just as MCV relates to the size of the cells, MCHC relates to the color of the cells. Hemoglobin contains iron, which gives blood its characteristic red color. When examined under a microscope, normal red blood cells that contain a normal amount of hemoglobin stain pinkish red with a paler area in the center. These normochromic cells have a normal MCHC. Cells with too little hemoglobin are lighter in color with a larger pale area in the center. These hypochromic cells have a low MCHC. Anemias are categorized as hypochromic or normochromic according to the MCHC index.
  26. Ferritin
    • Primary storage form of iron in the body
    • Plasma level correlates well with iron stores
    • “Best” test for iron deficiency anemia
    • If normal – do more work up
    • If low treat with iron supplement/multivitamin
  27. Serum Iron
    Measures the iron bound to transferrin
  28. Transferrin
    • A plasma iron-transport protein
    • In healthy people, about 20-50% of available sites are used to transport iron
    • Iron binding glycoprotein produced in the liver
    • Indirect measure of liver function
  29. TIBC
    • total iron binding capacity
    • Test that measures the blood’s capacity to bind iron with transferrin
    • Indirect measure of transferrin ($$$$)
    • Inverse response with ferritin in iron deficiency
    • Young age, pregnancy and drugs may increase TIBC
    • Very Low TIBC = Anemia of Chronic Disease
    • Normal to low = Sideroblastic Anemia
  30. Vitamin B12 and Folate
    • Not part of initial anemia work-up
    • Usually ordered together to identify nutrient deficiency in macrocytic megaloblastic anemia
    • The most common cause of folate deficiency is EtOH
    • Vitamin B12 Deficiency would have neurological deficiencies – parathesesia, weakness, balance/gait, proprioception
  31. Hemoglobin Electophoresis
    • Types of Hemoglobin
    • Hgb A, normal, 95-99%
    • Hgb A2, normal variant of A, small %
    • Hgb F, fetal
    • Hgb S, sickle cell
    • Hgb C, found in African Americans
    • Hgb H, Alpha Thalessemia
  32. ESR
    • “Sed rate”
    • Non-specific test for inflammation
    • No indication of cause/effect relationship
    • What is normal? Esp in elderly females
    • Relatively sensitive sick/not sick gate
    • Other acute phase reactants may be better to follow acute inflammation (CRP)
    • Anemia and macrocytosis increase ESR
    • Not ordered routinely, generally ordered with joint pain or other complaints by pt.
  33. Platelets
    • Thrombocytes
    • : Thrombocytosis
    • : Thrombocytopenia
    • Platelet estimates from smears
  34. Clotting study - PT
    • Prothrombin Time (Protime)
    • Extrinsic pathway
    • Compared with control times
    • Variations with methods
    • INR reported
    • Coumadin therapy
  35. Clotting study - PTT/APTT
    • Partial Thromboplastin Time
    • Intrinsic pathway
    • Compared with control times
    • Variations with methods
    • Heparin therapy
  36. D-Dimer
    • Elevated in DIC, used to monitor treatment
    • Elevated in DVT or arterial thrombosis
    • Used to help rule out pulmonary embolus, DVT, stroke
  37. Anemia
    • Is not a diagnosis per se, it's a sign (decrease in O2 carrying capacity)
    • Laboratory finding
    • Based on Hgb and/or Hct below lower threshold of normal
    • Commonly asymptomatic unless acute and/or severe
  38. Symptoms of Anemia
    • Central - Dizziness, fatigue, fainting
    • Low BP
    • Heart - Palpitation, rapid heart rate, chest pain, angina, MI
    • Icterus (2° to hemolytic anemia which causes jaundice)
    • Skin - pallor, cool, yellow
    • Respiratory - SOB
    • Muscle weakness
    • Instestinal - changed stool color
    • Enlarged spleen (sickle cell, autoimmune types of anemia, hemolytic anemias)
  39. RBC survival issues
    • Being destroyed too soon
    • Loss due to bleed
  40. RBC production issues
    Not enough folate, iron intake
  41. Microcytic Anemia
    • Iron Deficiency – Most common! (low ferritin)
    • Don't order retic count, supplement with iron to see if it rebounds, then further work up for thallassemia, anemia of chronic disease or sideroblastic anemia
    • Thalassemia (normal to high ferritin, elevated Hgb A2, erythrocytosis, target cells, tear drop cells)
    • Anemia of chronic disease (normal to high ferritin, no thallassemia, really low TIBC)
    • Sideroblastic anemia (normal to high ferritin, no thallassemia, low to normal TIBC)
  42. Macrocytic Anemia
    • Megaloblastic anemia (1-6% hypersegmented polys):
    • Vitamin B12 deficiency (Pernicious anemia due to lack of intrinsic factor or Malabsorption - determine with Schilling test) - treat with B12
    • Folate deficiency - treat with folate
    • Non-Megaloblastic anemia (no hypersegmented polys):
    • Myelophthisis (very low retic count, tear drop cells)
    • Sideroblastic anemia (acquired) (low retic count, B6 deficiency)
    • Differentiate between Myelophthisis and Sideroblastic anemia by marrow biopsy
    • Liver disease (Low or normal retic count, check LFT)
    • Myxedema (Low or normal retic count, check TSH)
    • Hemorrhage or hemolysis (high retic count)
  43. Normochromic-Normocytic Anemia
    • Renal, endocrine or liver disease (normal retic count)
    • Anemia of chronic disease (normal retic count)
    • Early iron deficiency anemia (then progresses to microcytic)
    • Hemorrhage (elevated retic count)
    • Pancytopenia (no retics, check CBC, do marrow biopsy)
    • Hemolytic anemia (elevated retic count, first rule out hemorrhage!!)
    • 4 Types of hemolytic anemia:
    • Drug induced, Autoimmune - check with Direct Coombs
    • Sickle Cell - check with Sickledex
    • G6PD - check with G6PD screen
  44. Schilling Test
    • used to determine whether the body absorbs vitamin B12 normally
    • a test for vitamin B12 absorption employing cyanocobalamin tagged with Co-57; used in the diagnosis of pernicious anemia and other disorders of vitamin B12 metabolism
    • If it’s an intrinsic factor issue then the radioactive B12 isn’t absorbed. Once intrinsic factor is given then the radioactive material comes out in the urine.
  45. Direct Coombs Test
    a test for detecting sensitized erythrocytes in erythroblastosis fetalis and in cases of acquired immune hemolytic anemia: the patient's erythrocytes are washed with saline to remove serum and unattached antibody protein, then incubated with Coombs anti-human globulin (usually serum from a rabbit or goat previously immunized with human globulin); after incubation, the system is centrifuged and examined for agglutination, which indicates the presence of so-called incomplete or univalent antibodies on the surface of the erythrocytes.
  46. Haptoglobin
    • Protein produced in the liver
    • Binds free hemoglobin
    • Haptoglobin-hemoglobin complex is removed by the RE system (mostly the spleen) to conserve hemoglobin
    • Decreased or “zero” level noted in the serum with hemolytic anemia
  47. Tumor marker
    • Substances, usually proteins, produced by the body in response to cancer growth or by the cancer tissue itself
    • Can be measured in blood or body fluids
    • Can be detected histologically or molecularly in cells or tissues
    • Quantitative/Qualitative measures
  48. Screening Marker
    • Serum and urine based
    • Designed to detect presence of cancer at an early stage
    • eg PSA
  49. Prognostic Marker
    • Indicate the severity and risk of dying from the disease
    • Growth and spread of disease
  50. Predictive Marker
    Indicate the likelihood that the tumor will respond to a specific type of therapy
  51. Monitoring Marker
    Indicate the current status and therapy response
  52. Tissue Marker
    • Assist in determining the type of cancer and can be prognostic or predictive
    • Dose specific
  53. Lung Cancer Marker
    • CA125
    • CEA
    • CA 27-29
  54. Liver Cancer Marker
    • AFP
    • CA 27-29
  55. Prostate Cancer Marker
  56. Testicular Cancer Marker
    • AFP
    • HCG
  57. Breast Cancer Marker
    • CA125
    • CEA
    • HER2
    • CA 27.29
    • CA 15.3
  58. Stomach Cancer Marker
    • CEA
    • CA 27-29
  59. Pancreatic Cancer Marker
    • CA125
    • CEA
    • CA 19.9
    • CA 27-29
  60. Colon Cancer Marker
    • CEA
    • CA 27-29
  61. Ovarian Cancer Marker
    • CA125
    • CEA
    • CA 27-29
    • AFP
  62. Kidney
    CA 27-29
  63. Uterus
    CA 27-29
  64. CA 19.9 Tumor Marker
    • Used to monitor treatment and to watch for recurrence of PANCREATIC Cancer
    • Not sensitive or specific enough to be used as a screening tool
    • Not initially elevated in all pancreatic cancers and only useful as a marker if so
    • By the time a patient has symptoms and significantly elevated levels, the pancreatic cancer is usually at an advanced stage
  65. CA 15-3
    • Monitors patient’s response to breast cancer tx and assess for recurrence
    • Monitoring begins a few weeks after treatment due to initial levels fluctuating
    • Not seen with CA detected early and 25-30% of breast cancers do not have increased levels
    • May aid in dx of breast ca metastasis
    • Not sensitive or specific enough for screening
    • ***Mild to moderate elevations can be present in benign breast disorders
  66. CA 27-29
    • Similar to CA 15-3
    • Used in conjunction with other studies to assess for recurrence in women treated for stage II- III breast cancer
    • May be elevated by cancers of the colon, stomach, kidney, lung, ovary, pancreas, uterus, and liver
    • Also elevated in first trimester pregnancy and other noncancerous disease processes
  67. CA 125
    • Used monitor treatment of ovarian cancer and its effectiveness (1st do U/S)
    • Also used to detect if cancer returns after treatment is completed
    • Used to follow high risk females with a positive family hx
    • Moderate elevations indicate a high cancer risk
    • High levels are ovarian cancer specific, also breast cancer, lung cancer, pancreatic cancer
    • ***Can be high in normal/benign conditions (pregnancy, menstruation, endometriosis and PID)
  68. CEA
    • (Carcinoembryonic Antigen)
    • Useful in monitoring treatment and disease recurrences
    • Can be used to determine stage and extent of disease
    • Originally thought to be colon cancer specific but also seen in lung, breast, pancreas and ovary
    • High levels are GI associated
    • Not all cancers produce CEA so not useful for screening
    • ***Elevated levels also seen in smokers
  69. PSA
    • (Prostate Specific Antigen)
    • Screening tool for prostate cancer
    • DRE can cause PSA elevation so blood test should be done 1st
    • Also useful in monitoring treatment and detecting recurrence
    • If PSA <20 ng/ml, bone mets unlikely
    • ***Levels can rise in benign conditions
  70. AFP
    • (Alpha-fetoprotein)
    • Used to detect tumors of the liver and testes/ovaries (germ cell)
    • The higher the AFP level, the bigger the tumor
    • Used to monitor response to therapy
    • AFP decreases when body responds to therapy, returning to normal in about 1 month
    • Used in pregnancy to detect neural tube defects & Downs Syndrome in utero
    • ***Slightly increased levels seen in chronic hepatitis or cirrhosis
  71. HCG
    • (Human chorionic gonadotropin)
    • Useful in confirming pregnancy
    • Useful in dx and monitoring of tx recurrence of germ cell tumors or trophoblastic disease
    • Levels fall in response to treatment