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409 Cards in this Set
- Front
- Back
true positive rate
|
Sensitivity
|
|
ability of the test to identify positive results in pts who have disease
|
Sensitivity
|
|
lower chance of false negative result
|
higher sensitivity
|
|
higher cange of false negative result
|
lower sensitivity
|
|
% of negative results in people without disease
|
Specificity
|
|
true negative rate
|
specificity
|
|
the higher the chance of a false positive result
|
specificity
|
|
PSA-specific for prostate but not prostate carcinoma
|
specificity
|
|
ESR- erythrocyte sedimentation rate
|
specificity
|
|
contains nothing or something to activate formation of clot
|
red top tube
|
|
anticoagulant, EDTA, prevents blood from clotting, cells separate
|
purple top tube
|
|
preserves the cells so they can e identified by how they look with stains
|
purple top tube
|
|
anticoagulant, sodium citrate, preserves more clotting factors
|
blue tube
|
|
tube is used to evaluate the ability of the blood to clot
|
blue tube
|
|
plain, blood clots, provides serum for testing
|
red top tube
|
|
fel forms barrier between serum and cells during centrifugation
|
tiger top tube
|
|
serum separator tube
|
tiger top tube
|
|
sodium fluoride oxalate, prevents glycolysis, glucose tolerance testing
|
gray top tube
|
|
EDTA prevents clottign, used in hematology for CBCs
|
purple top tube
|
|
sodium citrate, used for coagulation (Pt/INR, prothrombin times, (PTT)
|
blue top tube
|
|
used for blood culture collection, may use aerobic and anaerobic bottles
|
Yellow top
|
|
heparin, prev clotting, provides plasma-ammonia &carboxyhemoglobin test
|
Green top tube
|
|
liquid portion of the blood
|
plasma
|
|
the clot forming components
|
platelets
|
|
the infection fighers
|
WBC
|
|
the oxygen transporters
|
RBC
|
|
serum or plasma portion of blood after centrifugation (depends on if anticoagulant was used)
|
top layer
|
|
consists of WBCs and platelets after centrifugation
|
buffy coat - middle layer
|
|
consists of rbc after centrifugation
|
bottom layer
|
|
blood collected without an anticoagulant produces
|
serum
|
|
blood collected with an anticoagulant produces
|
plasma
|
|
contains fibrinogen and clotting factors
|
plasma
|
|
does NOT contain clotting factors, they are used up with clotting factors to form clot
|
serum
|
|
amt of blood made up of RBCs (erythrocytes), WBC(leukocytes), and platelets
|
45%
|
|
amt of blood made up of plasma of which 90% is H2O 10% proteins salts, CHO, enymes lipids
|
55%
|
|
oxygen from lungs to tissue
|
transport funct of blood
|
|
water and nutrients
|
transport funct of blood
|
|
cellular elements that fight infection and aid coagulation
|
transport funct of blood
|
|
waste products for excretion through skin, kidneys, lungs
|
transport funct of blood
|
|
the process of blood development and production
|
hematopoiesis
|
|
produced from a multi-potential stem cell in the bone marrow
|
all cells
|
|
colony stim factors and inerleukins infl stem cell to div and diff into two major cell lines - irreversible
|
myeloid or lymphoid
|
|
leukocytes are divided into 2 groups
|
granulocytes & agranulocytes
|
|
include neutrophils(segs, polys, PMNs), eosinophils and basophils
|
granulocytes
|
|
possess multi-lobulated nuclei and derive their name from the granules found in their cytoplasm
|
granulocytes
|
|
a granular, mononuclear cells
|
lymphocytes
|
|
production of neutrophils, eosinophils, basophils, and monocytes
|
myelopoiesis
|
|
process of development from immature blast to mature cell takes approx
|
7-10dys
|
|
at the end of DNA synthesis they (blood cells) are in a
|
maturation pool
|
|
once matured they(blood cells) become part of a functional
|
functional pool
|
|
percentage of blood circulating and percentage of blood adhere to lining of vessel walls
|
50%
|
|
adequate ratio of blood sample to anticoagulant is required for
|
sample collection
|
|
tot WBC reported as
|
#wbc/mm3
|
|
highest at birth then slow fall to adult levels, lymphocytes predominate from 2wks to age 5-7, then PMN predomin
|
WBC
|
|
highest at birth, lowest at 3 mnths, higher in males, nl decreases in pregnancy
|
hemoglobin (g/dl)
|
|
conjugated protein consisting of globin, protoporphyrin, and iron
|
hemoglobin (g/dl)
|
|
depends on adequate Fe supply & delivery, synthesis of protoporphyrins, and globin synthesis
|
hemoglobin (g/dl)
|
|
<8 and >20g/dl
|
panic values of hemoglobin
|
|
package cell volume =usually 3 X hemoglobin, reported as a %
|
hematocrit
|
|
<24%
|
panic value of hematocrit
|
|
inc'd in polycythemia vera, smokers, high altitude(hypoxia stim RBC prod), dehydration (dec fluid & vol, same #rbc
|
hematocrit
|
|
dec'd in megaloblastic anemia(folate or B12 def), blood loss, drug/alcool addic, Fe def, sickle cell anem, pregnancy
|
hematocrit
|
|
40-54%
|
hematocrit male value
|
|
37-47%
|
hematocrit female value
|
|
50-62%
|
hematocrit hewborn values
|
|
14-18 g/dl
|
nl male value hemoglobin
|
|
12-16 g/dl
|
nl females hemoglobin values
|
|
17-23 g/dl
|
nl newborns hemoglobin value
|
|
12-14.5 g/dl
|
nl kid hemoglobin values
|
|
mean cell volume, avg volume of rbc, kids have lower values than adults, for every yr under 10 subtract 1 from 80
|
MCV
|
|
Hct/RBC
|
MCV
|
|
mean cell hemolgobin - the weight of hemoglobin of averg RBC
|
MCH
|
|
Hgb/RBC
|
MCH
|
|
mean cell hemoglobin conc- the avg concentration of hemoglobin in a given vol of red cells
|
MCHC
|
|
Hgb/Hct
|
MCHC
|
|
red cell distribution width a measure of the degree of anisocytosis, measured by automated counters
|
RDW
|
|
variation in RBC size
|
anisocytosis
|
|
nl 11.5-14.5%
|
RDW
|
|
helpful with distinguishing unclomplicated thalessemia from early iron def anemia
|
RDW
|
|
low MCV/nl RDW
|
uncomplicated thalessemia
|
|
low MCV/high RDW
|
early Fe def anemia
|
|
critical value- <50,000 or >1million, nl(140-400,000)
|
platelets
|
|
formed in bone marrow from megakaryocytes, role in hemostasis forming a plug to ensure vascular integrity
|
platelets
|
|
manual counts done on Neubauer hemocytometer. These are est as part of the differential
|
platelets
|
|
100 wbcs are counted and # represent a % is reported. RBC morph and platlet est also given
|
differential
|
|
red blood cells production in the
|
bone marrow
|
|
rbc controlled by erythropoietin (procrit) produced in the
|
kidneys
|
|
7-8um in size, biconcave disc, capable of altering shape, avg lifespan is 120dys, old/damaged recycled in spleen
|
RBCs
|
|
7-8 microns RBC
|
normocytic RBC
|
|
<7 microns, MCV <80, Fe def anemia, thalessemias, children
|
microcytic RBC
|
|
>8microns, MCV >101, liver disease, B12/folate def, newborns
|
macrocytic RBC
|
|
variation in shape of RBC
|
poikilocytosis
|
|
no central area of pallor, no biconcavity, MCHC>36%, osmotic fragility, can easily burst
|
spherocyte-RBC morph
|
|
breakdown of RBCs can develop gallstones, hereditary sperocytosis, hemolytic anmeia, ABO transfusion reactions
|
spherocyte-RBC morph
|
|
oval shaped RBC with white area in the center, hereditary ovalocytosis, sickle cell, Fe def, thal, megaloblastic anem
|
ovalocytes - RBC morph
|
|
small clump of Hgb in center surrounded by area of pallor, a thin rim of Hgb,
|
target cells(leptocytes) rbcmor
|
|
cells appear larger since it is flatter than nl, liver disease, thal, hemoglobinopathies, post-splenectomy
|
target cells(leptocytes) rbcmor
|
|
abnl hemoglobins, liver disease, thalassemias
|
target cells(leptocytes) rbcmor
|
|
hereditary conditions, some anemias
|
elliptocytes -RBC morph
|
|
sickle cell anemia (Hb SS), Hb SC, Hb S/thal
|
sickle cells - RBC morph
|
|
fragmented or pieces of cell, prosthetic heart valves
|
schistocytes - RBC morph
|
|
RBC with evenly placed blunt or rouned projections, more thorny projections
|
burr cells (acanthocytes)
|
|
severe liver disease, uremia, DIC, TTP, carcinoma. Anorexia, severe burns and hypothyroidism
|
burr cells (acanthocytes)
|
|
tennis racket, "pt crying for a bone marrow",fibrotic bone marrow, ineffective erythropoesis
|
tear drop cells -rbc morph
|
|
"smiley cells-slitlike areas of central pallor, liver disease, artifact, lupus
|
stomatocytes-rbc morph
|
|
bite cells, pac man, G6PD crisis, DIC, pulmonary emboli
|
helmet cells-RBC
|
|
RBC fragments found in severe burn pts, disseminated intravascular coagulation
|
schistocytes - RBC morph
|
|
spiked red cells are observed in liver disease, asplenic pts (spleens removed)
|
acanthocytes
|
|
red cells without a pale center are seen in hereditary spherocytosis, some immune-mediated hemolytic anemias
|
spherocyte-RBC morph
|
|
normochromia, hypochromia, polychromasia or hyperchromia, anisochromia
|
hemoglobin content
|
|
decreased hemoglobin concentration in pale cells
|
hypochromic RBC
|
|
nl area of central pallor should be about one third of the cell's diameter
|
Nl red blood cells
|
|
numerous dark purple dots throughout the RBC, Lead or heavy metal poisoning-blue/back gume lines
|
basophilic stippling
|
|
pale and filled cells can both be seen following blood transfusion
|
Anisochromia
|
|
small dark purple dot near RBC periphery, represent a DNA remnant, post splenectomy
|
Howell-Jolly bodies
|
|
pappenheimer bodies blue purple dots in sm groups in RBC, repres iron particles in the RBC
|
siderocytes
|
|
can be confirmed with Prussian blue reaction
|
siderocytes
|
|
denatured or percipitated protein seen in G6DP def, drug incuded hemolytic anemia
|
Heinz Bodies
|
|
stack of coins, due to abn proteins found in blood such as in multiple myeloma
|
rouleaux formation
|
|
last stage of dev prior to becoming a mature RBC, have reminant of RNA circulate for 24hrs,
|
reticulocytes
|
|
reflects responsiveness and potential of bone marrow (erythropoitic activity)
|
reticulocytes
|
|
they are suggested by basophilia or polychromasia on Wright's stain
|
reticulocytes
|
|
after adequate dosing of Fe supplementation for Fe def anemia, reteic may rise to >20% indicates
|
good response to therapy
|
|
reported count X pts HCT/nl HCT
|
RI reticulocytes
|
|
nl range .5-2% for adults 2.5-6.5% in newborns, .5-3.1 infants of tot RBCs
|
RI reticulocytes
|
|
measures the ability of the bone marrow to react to anemia and make RBCs
|
Reticulocyte count
|
|
monitors (5-7dys) response to anemia therapy
|
Reticulocyte count
|
|
is an immature RBC that still has some microsomal & ribosomal material detected with methylene blue
|
reticulocyte
|
|
1(this calculated by multiplying the retic count% X pt's HCT/nl HCT
|
reticulocyte index
|
|
the rate at which RBCs settle out of anticoagulated blood in one hr (mm/hr)
|
erythrocyte sed rate
|
|
inflammation and necrotic processes cause an alteration in blood proteins resulting in …(positive changes)
|
aggregation of red cells
|
|
the red cells become heavier and fall more rapidly leading to a …
|
higher ESR
|
|
nonspecific and non-dx and doesn't correlate directly to the severity of the disease
|
ESR
|
|
nl ranges by westergren method is men 0-15, women 0-20, kids 0-10 mm/hr
|
ESR
|
|
should not be performed on blood oler than 12 (4) hrs
|
sed rates
|
|
it is most useful with polymyalgia rheumatica and temporal arteritis
|
ESR
|
|
useful test to monitor inflammation (non cardio-specific CRP)
|
C-reactive protein
|
|
incr'd in infection, inflammation, multiple myeloma, macrocytic disorders, acute MI, pregnancy
|
ESR (erythrocyte sed rate)
|
|
dec'd in microcytic disorders, polycythemia vera, hereditary spherocytosis, sickle cell anemia, hemoglobin C disease
|
ESR (erythrocyte sed rate)
|
|
nl in allergies, viral infections, cirrhosis, malaria
|
ESR (erythrocyte sed rate)
|
|
5% daily requirement (20-25mg)-1mg newly absorbed (recycled), 2mg menstruating females
|
iron def anemia
|
|
stored as ferritin and hemosiderin (insoluble form)
|
iron def anemia
|
|
inc'd transferrin sythesis
|
iron def anemia
|
|
total iron binding capacity of transferrin TIBC
|
iron def anemia
|
|
dec'd % saturation (<15%)
|
iron def anemia
|
|
most common cause of microcytic anemia
|
iron def anemia
|
|
supply vs demand- neg Fe balance first detected by low ferritin (iron stores).
|
iron def anemia
|
|
when all stores are depleted then see dec serum Fe (bound) & inc TIBC (transferrin), %sat dec, anemia develops
|
iron def anemia
|
|
most common cause of Fe def in adults
|
chronic blood loss(gi, menses)
|
|
most common cause of Fe def in kids
|
deficient diets
|
|
symptoms fatigue, dypsnea on exertion, pica-hallmark, may crave ice or complain of a sore mouth
|
iron def anemia
|
|
signs- pallor, epithelial cell shedding-atrophic glossitis, cheilitis, spooning of nails
|
iron def anemia
|
|
lab- microcytic hypochromic anemia, inc RDW, retic monitors response to tx, ferritin, TIBC, serum Fe, %saturation
|
iron def anemia
|
|
tx-iron repalcement(slow Fe, feosol) given between meals, Colace better tolerable, constipation,
|
iron def anemia
|
|
consider transfusing pack RBCs if Hgb is <6 gms/dl
|
iron def anemia
|
|
cobalamin
|
vit b12
|
|
nl daily requirement 2-5 ug, stored in liver (1 ug/g liver tissue), ingested in meats, eggs, dairy products
|
vit b12
|
|
gastric acid and pepsin hydrolyze vit from protein which binds it
|
vit b12
|
|
atrophy of gastric mucosa (parietal cell) leads to lack of intrinsic factor and HCL secretion
|
b12 pernicious anemia
|
|
b12 needs for absorption
|
intrinsic factor
|
|
impaired DNA synt results in RBC with immature chromatin and appears enlarged or megaloblastic from nonabsorp b12
|
b12 pernicious anemia
|
|
average age 60yrs, fam history, associated with autoimmune diseases
|
b12 pernicious anemia
|
|
alcoholism, ascorbic acid, cimetedine (tagamet) oral contraceptives, strict vegens, gastric bypass
|
b12 pernicious anemia
|
|
MCV>95, dec'd retics, hypersegmented neutrophils, howell-jolly bodies (DNA remnant)
|
pernicious anemia
|
|
schillings test
|
pernicious anemia
|
|
tx- IM or SC B12 (byanocobalamin) once weekly for eight wks, then one monthly lifelong
|
pernicious anemia
|
|
meds(folic acid antagonists)-methotrexate, trimethoprim-sulfamethoxazole, triamterene
|
folic acid def
|
|
phenytoin and phenobarbital-interfere with intestinal absorption of folic acid
|
folic acid def
|
|
abnl synthesis of alpha or beta subunits of hemoglobin
|
hemoglobinopathies
|
|
sickle cell trait-substitution of valine for glutamate on beta chain
|
hemoglobinopathies
|
|
thalassemias-deficiency or absence of subunit, mediteranean ancestry
|
hemoglobinopathies
|
|
rigid, lifespan (20dys)
|
sickle cells disease
|
|
autosomal recessive, trait A/S 8-10% AA carry trait
|
sickle cell disease
|
|
inflexible rigid, inc viscosity, stasis, mech obstruction of sm arterioles leading to ischemia
|
sickle cell
|
|
occurs when deoxygenation is present due to vasoconstriction due to de temp or presence of acidotic state
|
sickle cell
|
|
painful swelling (hand-foot synd), delayed puberty, dactylitis, priapism
|
sickle cell
|
|
Hgb 5-11 gms/dl, normochromic, normocytic, inc retics, smear reveals sickle cells and nucleated RBCs
|
sickle cell
|
|
sodium metabisulfite reduction test -25%
|
sickledix
|
|
hemoglobin electrophoresis (gold std)
|
sickle cell
|
|
in disease all s and no A, trait will show S and A
|
sickle cell
|
|
tx hydroxyurea or butyrates will inc hemoglobin F, HLA compatible donors
|
sickle cell
|
|
hereditary hemoglobinopathies, defect prod of globin chains - alpha or beta
|
thalassemia
|
|
due to a deletion - SE asians, chinese, AA
|
alpha thalessemias
|
|
due to a gene mutation - mediterranean desent, chinese, asian, AA
|
beta thalessemias
|
|
@@/@@' B/B
|
nl
|
|
-@/-@' B/B
|
alpha thal trait
|
|
- - /@@'
|
alpha thal minor
|
|
--/--'
|
alpha thal major
|
|
bart's disease still birth
|
alpha thal major
|
|
--/-@
|
Hgb H disease
|
|
beta thalessemia major- cooley's anemia
|
homozygous
|
|
RDW nl as all RBCs are small no variation in size
|
thalassemia
|
|
RDW can help differentiate from Iron Def Anemia (IDA)
|
thalassemia
|
|
more anisocytosis, more variation, inc RDW
|
iron def anemia
|
|
hemoglobin electrophoresis- will see increased A2
|
beta thalessemias
|
|
acquired or genetic pancytopenia-dec in all cell lines due to dam to hematopoietic stem cells
|
aplastic anemia
|
|
may be due to toxic compounds, DDt, benzene, antibiotics, infections, hep, EBV, immuno changes graft vs host, pregnancy
|
aplastic anemia
|
|
CBC-pancytopenia, hematuria on UA, MCV >104, nl TIBC, dec retic, elevated erythropoietin levels, bone marrow biopsy
|
aplastic anemia
|
|
Fe overload due to inc'd Fe absorption in the gut, body can't exrete Fe and excess stored in liver, heart, pancreas. 20g<
|
hemachromatosis
|
|
genetic, ages 40-60, males to females 8:1, women lag due to menstruation
|
hemachromatosis
|
|
greatest risk if untreated is hepatomas
|
hemachromatosis
|
|
Fe usually stored as ferritin, now also deposited as hemosiderin
|
hemachromatosis
|
|
lab- ferritin> 300 ug/L men, >120 for women is dx, % sat>62% is confirm for homozygous state, def dx with liver biopsy
|
hemachromatosis
|
|
tx-phlebotomies, one unit contains 250 mg of Fe, may need 80 phlebotomies initially, 2-4 yearly
|
hemachromatosis
|
|
if induced by transfusions and is not hereditary then use chelating agents (tea aslo chelates Fe), screen fam members
|
hemachromatosis
|
|
incd CFU results in unregulated proliferation in absence of erythropoietin leading to inc'd blood viscosity and dec'd cerebral flow
|
Polycythemia Vera
|
|
mean age 60, s/s h/a, tinnitis, "fullness in head and neck" epitaxis, pruritis after bathing is characteristic
|
Polycythemia Vera
|
|
WBCs>12,000, inc'd RBCs, platelets>500,000, large bizarre forms, inc'd LAP, nl erythropoietin level
|
Polycythemia Vera
|
|
tx-phlebotomy to reduce symptoms, cytoreductive drugs (hydroxyurea or interferon. After"spent phase" terminates in leukemia
|
Polycythemia Vera
|
|
most common anemia seen in hospital pts
|
anemia of chronic disease
|
|
seen in pts with malignancies, diabetes, chronic inflamm disease, bacterial infections
|
anemia of chronic disease
|
|
caused by production of lactoferrin, a storage protein with greater affinity for Fe than transferrin
|
anemia of chronic disease
|
|
labs, hematocrits generally >25%, MCV is nl to low, nl RBC morph and retics, dec serum Fe, dec transferrin, inc ferritin
|
anemia of chronic disease
|
|
tx of primary disorder, don't give Fe supplementation as this can cause Fe overload
|
anemia of chronic disease
|
|
x-linked, more severe forms occur in Mediterranean and middle eastern men
|
G6PD def
|
|
RBC can not deal with oxidative changes damaged hemoglobin accumulates in RBC as heinz bodies, removed by spleen
|
G6PD def
|
|
oxidation and hemolysis occur when pt ingests oxidative drugs such as antimalarials, ASA, sulfa drugs
|
G6PD def
|
|
fava beans, febrile illness, or acidotic states can also cause a hemolytic crisis
|
G6PD def
|
|
s/s palpitations, SOB, dizziness, 1-3 dys after ingestion of an oxidant. Jaundice and splenomegaly common
|
G6PD def
|
|
labs- helmet and heinze bodies (special stain, assay G5DP levels
|
G6PD def
|
|
other cause of anemia- RBCs are fragmented by shear forces or turbulence, aortic stenosis, prosthetic heart valve
|
mechanical hemolysis
|
|
drugs act as haptens- bind to RBC membrane and induce synthesis of anti-drug antibodies
|
drug induced anemia
|
|
formation of immune complexes with immunoglobulins, fix complement-hemolysis
|
drug induced anemia
|
|
induced synthesis of Rh antibodies e.g. L-dopa and alpha methydopa, hemolysis may continue after d/c
|
drug induced anemia
|
|
anti-RBC IgG- (warm reacting antibodies) above 31 deg c, RBCs removed by spleen leading to anemia
|
autoimmune hemolysis
|
|
cold reaction antibodies (IgM) formed RBC complexes below 31 deg C can cause either hemolysis or agglutination of RBC
|
autoimmune hemolysis
|
|
primary tx is avoidance of cold temp exposures
|
autoimmune hemolysis
|
|
dominantly inherited defect in RBC membrane proteins -result in spherical RBCs, function nl but get trapped and dest in spleen
|
hereditary spherocytosis
|
|
major finding is splenomegaly, may also see hepatomegaly and choleithiasis
|
hereditary spherocytosis
|
|
lab- spherocytes and reticulocytosis, negative Coomb's
|
hereditary spherocytosis
|
|
tx is splenectomy for severe anemias as this will stop emolysis, underlying defect is not changed
|
hereditary spherocytosis
|
|
classification-myeloid vs lymphoid, acute (immature cells) ALL, AML vs chronic (mature different cells) CLL, CML
|
leukemias
|
|
T or B cell, 80% or all childhood leukemias, peak ages 3-7, 80% B cell origin
|
acute lymph leukemia ALL
|
|
labs- WBC low to high, blasts, dec'd RBCs and platelets as bone marrow is taken over by lymphocytic cells
|
acute lymph leukemia ALL
|
|
tx- chemo, cure rate 50-60% in kids, 40% in adults, bone marrow transplant
|
acute lymph leukemia ALL
|
|
more common in adults, may see DIC, inc'd risk of infection due to neutropenia
|
acute myelogenous leuk, AML
|
|
labs- auer rods are pathognomic, bone marrow stains inc myelopreroxidase or paraminosalicylic acid
|
acute myelogenous leuk, AML
|
|
tx- chemo -relapse 12-18mnths, long term 15 yr survival) is only 10-15%
|
acute myelogenous leuk, AML
|
|
more mature myeloid cells rather than the blasts seen in AML
|
chronic myelogenous leuk, CML
|
|
younger middle aged adults
|
chronic myelogenous leuk, CML
|
|
philadelphia chromosomes- acuried translocation of chromosome 9 & 22, pathogenomic, presents in 95% of cases
|
chronic myelogenous leuk, CML
|
|
stable and then disease progresses to acute leukemia
|
chronic myelogenous leuk, CML
|
|
lab-inc'd WBCs (usually greater than 150,000/uL), dec'd or absent LAP (leukocyte alkaline phosphatase),
|
chronic myelogenous leuk, CML
|
|
southern blot tests for philadelphia chromosome
|
chronic myelogenous leuk, CML
|
|
tx-chemo and alpha-interferon for acute phase-palliative not curative, eventually progresses to blast crisis
|
chronic myelogenous leuk, CML
|
|
survival is 4 yrs after onset. Bone marrow transplant increases survival time but is rarely curative
|
chronic myelogenous leuk, CML
|
|
pt with infection or severe inflam disease have inc'd wbcs and blasts. This can be confused with CML
|
leukemoid reaction
|
|
has dec'd or absent LAP
|
chronic myelogenous leuk, CML
|
|
demonstrated an inc'd LAP
|
leukemoid reaction
|
|
may also be seen in polycythemia vera and third trimester pregnancy
|
inc'd LAP
|
|
neoplastic disorder of mature B cells (T cell types are very rare)
|
chronic lymphocytic leukemia
|
|
B cells don't differentiate into plasma cells and B cells create autoantibodies to RBCs and platelets
|
chronic lymphocytic leukemia
|
|
more common in men, older>50 with median age at dx is 65yrs, often asymptomatic
|
chronic lymphocytic leukemia
|
|
labs-inc'd WBc inc'd lymphs-more mature lymph is seen on smear, smudge cells are pathognomonic
|
chronic lymphocytic leukemia
|
|
tx- palliative, median survival is 6yrs, unlike CML, there is no blast crisis transforamtion to acute leukemia
|
chronic lymphocytic leukemia
|
|
b cells - fine hairlike projections
|
hairy cell leukemia
|
|
middle aged men
|
hairy cell leukemia
|
|
usually no adenopathy, all pts have splenomegaly
|
hairy cell leukemia
|
|
lab-pancytopenia (inc'd WBCs in 25%pts), hairy cell on smear, infiltration of red pulp on spleen (lymphomas infiltrate white pulp
|
hairy cell leukemia
|
|
tx- chemo with complete remission in 80% of pts, indolent course, survival is 10+ yrs
|
hairy cell leukemia
|
|
cancer of macrophage origin
|
hodgkin's lymphoma
|
|
bimodal distribution ages 20's and 50's
|
hodgkin's lymphoma
|
|
painless adenopathy (neck), night sweats, pruritis
|
hodgkin's lymphoma
|
|
labs-lymph node biopsy reveals Reed-Sternberg cells-lg multinucleated reticular cells-pathognomonic
|
hodgkin's lymphoma
|
|
tx-radiation and chemo-good prognosis, cure rates 80% even for stage III disease
|
hodgkin's lymphoma
|
|
single node - lymphoma staging
|
stage I
|
|
two or more nodes on same side of diaphragm - lymphoma staging
|
stage II
|
|
both sides of the diaphragm - lymphoma staging
|
stage III
|
|
involvement of extralymphatic organs, eg. Bone marrow, liver, lung - lymphoma staging
|
stage IV
|
|
neoplasm of lymphocytes
|
non-hodgkin's lymphoma
|
|
prognosis is poorer than for hodgkins disease
|
non-hodgkin's lymphoma
|
|
lab-smear can be nl, LDH inc if disease has spread. Dx is with lymph node biopsy
|
non-hodgkin's lymphoma
|
|
Tx is palliative, chemo, radiation
|
non-hodgkin's lymphoma
|
|
form of NHL affects B cells
|
burkitt's lymphoma
|
|
endemic in parts of Arfica, more common in kids and young adults
|
burkitt's lymphoma
|
|
US - abd pain and fullness
|
burkitt's lymphoma
|
|
Africa - jaw involvement
|
burkitt's lymphoma
|
|
assoc with chromosomal translocation of 8 and 14. African form is related to EBV
|
burkitt's lymphoma
|
|
neoplastic proliferation of plasma cells and monoclonal immunolobulin
|
multiple myeloma
|
|
affects men and women equally with peak incident 50-60 years old
|
multiple myeloma
|
|
monoclonal IgG more common than IgA
|
multiple myeloma
|
|
monoclonal kappa or lamda chains - bence jones proteins in urine
|
multiple myeloma
|
|
bone pain, pathologic fractures, bone marrow is preplaced with plasma cells, frequent infection with encapsulated organisms
|
multiple myeloma
|
|
lab-SPEP(serum protein electrophoresis) reveals paraproteins, abn plasma immunoglob, rouleaux form of RBC,
|
multiple myeloma
|
|
x-ray shows osteolytic bone lesions, hypercalcemia
|
multiple myeloma
|
|
inc'd b cell line, inc'd monoclonal IgM production
|
waldenstrom's macroglobulinemia
|
|
hyperviscosity
|
waldenstrom's macroglobulinemia
|
|
lab-rbc show rouleaux formation, bone marrow shows inc'd plasma cells, no osteolytic lesions, SPEP monoclonal IgM spike
|
waldenstrom's macroglobulinemia
|
|
tx-plasmapharesis to dec viscosity, chemo, survival 3-5 yrs from dx
|
waldenstrom's macroglobulinemia
|
|
neoplastic CD4 T cells
|
mycosis fungoides
|
|
infiltrates dermis and epidermis may involve lymph nodes and viscera
|
mycosis fungoides
|
|
can be confused with eczema and psoriasis
|
mycosis fungoides
|
|
dx with skin biopsy
|
mycosis fungoides
|
|
tx with topicals and phototherapy
|
mycosis fungoides
|
|
the process of blood development and production
|
hematopoiesis
|
|
all cells are produced from a multi-potential stem cell in the
|
bone marrow
|
|
granulocytes (phagocytes) and lymphocytes (recognition of non-self)
|
white blood cells
|
|
retain neutral stain and appear light tan
|
neutrophil
|
|
segs or polymorphonuclear cells - PMNs, "polys"
|
neutrophil
|
|
90% stored in bone marrow, adhere to endothelium
|
neutrophil
|
|
6-8hrs in circulation-migrate to tissues phagocytosis/apoptosis
|
neutrophil
|
|
the more mature, the more lobulations of the nuclei
|
neutrophil
|
|
the more mature forms of neutrophils are called
|
segs
|
|
the more immature forms of neutrophils are called
|
stabs or bands
|
|
left shift of neutrophils release of less mature forms and is def as when more than 12% bands are seen when tot PMN count
|
infect/inflammat/hemorrhage
|
|
-shift of neutrophils or hypersegmented can be seen in megaloblastic anemiaa and liver disease
|
right shift
|
|
inc'd in absolute # in response to invading organisms or tumor cells, kids respond to infect with higher degree than adults
|
neutrophilia
|
|
may be due to dec'd production excess stored in blood vessel margin, or too many called into action and used up
|
neutropenia
|
|
in interstinal mucosa and lungs in large numbers, allergies, parasitic infections, lower in morning, rise from noon to midnight
|
eosinophils
|
|
capable of phagocytosis (Ag-AB complexes) not bacterial -cidal
|
eosinophils
|
|
becomes active in later stages of inflammation
|
eosinophils
|
|
respond to allergic and parasitic conditions
|
eosinophils
|
|
counts are lower in the morning rise from noon until after midnight, nl 1-4%
|
eosinophils
|
|
NAACP-neoplasm, allergy, addison's disease, collagen, vasc disease, and parasites, PIE pulm infiltrate eosion
|
eosinophilia
|
|
due to inc'd adrenal steroids (cushing's), drugs- ACTH, epi, prostaglandins, stressful situations, burns, labor postop states
|
eosinopenia
|
|
small number in peripheral blood
|
basophils
|
|
long-lasting in blood with ciruclating lifespan of 2 wks
|
basophils
|
|
contain heparin, histamine, serotonin, and leukotriene B4
|
basophils
|
|
immediate and delayed hypersensitivity reactions
|
basophils
|
|
phagocytic basophils are called this when found in tissues
|
mast cells
|
|
nl .5-1%
|
basophils
|
|
CML, hodgkin's disease
|
basophilia
|
|
hyperthyroidism, acute phase of infection, stress
|
basopenia
|
|
leave circulation in 16-36hrs, enter tissues, mature into mascrophages
|
monocytes
|
|
present in lymph nodes, alveoli, spleen, liver, bone marrow
|
monocytes
|
|
APC antigen presenting cell/dendritic cells
|
monocytes
|
|
the largest cell of nl blood
|
monocytes
|
|
body's second line of defense against infection
|
monocytes
|
|
mobile via pseudopods, removed injured or dead cells, microorganisms, and insoluble particles from circulating blood
|
monocytes
|
|
monocytes migrate to the tissues where they become
|
macrophages
|
|
recovery state of acute infection, TB, subacute endocarditis
|
monocytosis
|
|
prednisone tx, RA, hairy cell leukemia
|
monocytopenia
|
|
t cells predominant, B cells, Nk cells (20-40%)
|
lymphocytes
|
|
not phagocytic but can be cytotoxic-complement activation, antibody dependent cellular cytotoxicity
|
lymphocytes
|
|
membrane markers CD ( clusters of differentiation)
|
lymphocytes
|
|
T cell CD4 or CD8 cell mediated immunity
|
lymphocytes
|
|
B cells CD 20 antibody production
|
lymphocytes
|
|
NK cells CD56 cytotoxic for virus - infected cells and cancer cells
|
lymphocytes
|
|
inverted or reversed diff-more lymphs than neutrophils(nl in a kid), ALL, CLL, viral infection
|
lymphocytosis
|
|
chemo, radiation, nl in 22% of pop
|
lymphopenia
|
|
found in infectious mono, CMV infection, viral hepatitis, toxoplasmosis
|
atypical lymphocytes
|
|
impt in hemostasis, may be nl in count but not in function
|
platelets
|
|
abn in funct can be assessed with bleeding time
|
platelets
|
|
sudden exercise, post trauma, post surgical, esp after splenectomy
|
thrombocytosis
|
|
ITP, TTP, DIC, burns, snakes and insect bites, marrow suppressants-chemo radiation, alcohol addiction
|
thrombocytopenia
|
|
chromosome 9 and 22
|
philadelphia chromosome
|
|
dec RBC, dec Hgb,
|
anemias
|
|
b12/folate def, drug induced marrow toxicity - MCV >100fl
|
macrocytic RBC
|
|
acute blood loss, hemolytic anemia, anemia of chronic disease MCV 81-99 FL
|
normocytic, normochromic
|
|
Fe def, anemia of chronic disease MCV<80 FL
|
microcytic RBC
|
|
vascular system, platelets, coagulation (fibrin forming system), fibrinolysis (clot degradation), all involved in maintaining
|
hemostasis
|
|
imbalance can result in excessive bleeding or thrombosis
|
hemostasis
|
|
involves consumption of platelets and coagulation factors
|
hemostasis
|
|
vascular system acts to prevent bleeding by
|
vasoconstriction
|
|
diversion of blood away from damaged area, contact activation of platelets, activation of the coagulation syst to form fibrin clot
|
vasoconstriction
|
|
induces aggreagation of platelts and also releases tissue thromboplastin, which initiates fibrin formation
|
ADP (granules
|
|
140,000-440,000/ul
|
platelets
|
|
counts<20,000/uL at risk for spontaneious bleeding, sites not severity predictable
|
platelets
|
|
automated counts more accurate, interruption of electrical impulses
|
platelets
|
|
HIT- 30% patients
|
platelets
|
|
inhibits enzyme cyclooxygenase, which blocks the formation of prostaglandins, preventing platelet aggregation
|
aspirin
|
|
irreversibly acetylates cyclooxygenase-lasts lifespan of platelet
|
ASA
|
|
will have inc'd Bleeding time 4-7 dys after ingestion
|
ASA
|
|
reversibly inhibit COO and inhibits aggregation as long as drug remains in plasma
|
NSAIDs
|
|
nl 7-11 FL
|
mean platelet volume
|
|
relationship between platelet size and count
|
MPV
|
|
assess disturbances of platelet production
|
MPV
|
|
high MPV at 6 mnths postinfarction predictor of
|
reinfarction
|
|
elevated in hyperthyroid patients
|
MPV
|
|
ypothyroid-high plateley counts and low
|
MPV
|
|
all factors are produced in the liver except factor VIII-produced by platelets
|
coagulation factors
|
|
VIII produced by
|
platelets
|
|
the end stage of both the intrinsic and extrinsic coagulation cascades, product meshes into platelet plug stabilizing it
|
fibrinogen
|
|
I-fibrinogen, II-prothrombin, III-tissue factor(thromboplastin), IV-Ca, V-proaccelerin, VII-stable factor, VIII-antihemophilic factor
|
coagulation factors
|
|
IX-christmas factor, X-stuart factor, XI plasma thromboplastin antecedent, XII hageman factor, XIII fibrin stabilizing factor
|
coagulation factors
|
|
measures the extrinsic factors that are vit k dependent-these factors are I,II,V,VII, and X
|
prothrombin time
|
|
PET protimes monitor oral anticoagulant therapy to
|
warfarin (coumadin)
|
|
acts as vit K antagonist thus inhibiting the synthesis of these clotting factors.
|
warfarin (coumadin)
|
|
for excessive warfarin therapy the antidote is
|
vitamin K
|
|
protimes are drawn in a tub that contains sodium citrate as anticoagulant
|
blue tube
|
|
specimens should not be older than 12hrs, some las will reject if more than 4hrs
|
prothrombin time
|
|
std the reuslts from lab to lab, regardless of reagents or methods used for testing, ranges 2-3
|
INR(internat NL ratio)
|
|
Alcohol, diarrhea/malabsorption, drugs with ASA, allopurinol
|
prolonged Prothrombin time
|
|
diet high in fat or leafy green veg, benadryl (diphenhydramine), OCPs
|
shorten Prothrombin time
|
|
meaures the intrinsic system
|
PTT(partial thromboplastin time
|
|
used to monitor heparin
|
PTT(partial thromboplastin time
|
|
immed short life, inactivates prothrombin fact 2, and prevent formation of thromboplastin
|
Heparin
|
|
Reverse heaprin effects with
|
protamine sulfate
|
|
products of X,D,E,Y usually cleared by macrophages, inhib conversion of fibrinogen to fibrin, can't stabilize clot and exer anticoag
|
fibrin split products
|
|
increased in DIC and thromboembolic conditions such as DVT, MI, PE, and hepatic dysfunction
|
FSP or FDP
|
|
false positive healthy women immediately before and during menstruation, cirrhosis, metastaic CA
|
FSP or FDP
|
|
nl (blue, green, or purple top)
|
fibrin D-dimers
|
|
is acted on by plasmin to produce D-dimer fragments
|
fibrin
|
|
increased iin DIC, PE, and DVT
|
fibrin D-dimers
|
|
most sensitive test for DIC
|
fibrin D-dimers
|
|
qualitative negative
|
fibrin D-dimers
|
|
quantitative<250 SI Units
|
fibrin D-dimers
|
|
protein usually associated with adv mailignancies/shock/sepsis, attack fib to interrupt clot form and only second att-no FDPs
|
primary fibrinolysins
|
|
(plasmin) occur nl in response to blood clotting and primarily work on fibrin=FDP
|
secondary fibrinolysins
|
|
adult 200-400ng/dl, newborn 125-300ng/dl, <100mg/dl will result in spontaneous bleeding
|
Fibrinogen-factor I
|
|
part of common pathway of coagulation cascade will affect PT and PTT
|
Fibrinogen Factor I
|
|
produced by liver, is an acute phase reactant protein. Sharp rises in tissue inflammation and necrosis
|
Fibrinogen Factor I
|
|
may see reduced levels in malnourished states, liver disease, and consumption coagulopathies
|
Fibrinogen Factor I
|
|
low levels with large volume blood transfusions as banked blood does not contain fibrinogen
|
Fibrinogen Factor I
|
|
inc'd with estrogen and BCP, dec'd with Depakote, androgens and dilantin
|
Fibrinogen Factor I
|
|
nl 8-12sec, 25-35sec, plasma sample +thrombin=clot
|
thrombin time
|
|
assesses only final phase of common pathway, thrombin acts on fibrinogen's conversion to fibrin clot
|
thrombin time
|
|
used to detect presence of heparin, dec'd fibrinogen, aids in evaluation of prolonged PTT
|
thrombin time
|
|
nl 18-22sec, variation of the Thrombin Time in which venom from a pit viper is used instead of thrombin
|
reptilase time
|