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Hematology CBC + Coagulation Studies
MPA 515 Clinical Skills Module 1 *slide on retics not included*
113
Medical
05/18/2009

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Term
anticoaglated specimen in which cellular components fall or centrifuged to bottom the remaining supernatant fluid
Definition
blood plasma
Term
does NOT contain fibrinogen- fibrinogen consumed in creation of fibrin clot
Definition
serum
Term
cell size or volume
Definition
cytic
Term
hemoglobin content
Definition
chromic
Term
small RBC's
Definition
microcytosis
Term
large RBC's
Definition
macrocytosis
Term
RBC with less hgb per cell
Definition
hypochromia
Term
too few RBCs
Definition
anemia
Term
too many RBCs
Definition
polycythemia
Term
series of tests of the peripheral blood that provide information about the hematological system
Definition
CBC
Term
most common order diagnostic lab study
Definition
CBC
Term
From where are cell derived in CBC?
Definition
cells are derived from the bone marrow
Term
How are specimens obtained in CBC?
Definition
Specimens may be obtained via venous, arterial or heelstick
Term
What are the 3 types of cells evaluated in CBC?
Definition
RBCs, WBCs, platelets
Term
What are the 6 components of the CBC
Definition
WBC (total + differential)
RBC
Hgb
HCT
Plts
MPV (Mean Platelet Volume)
Term
What are the 4 RBC indices in a CBC?
Definition
MCV
RDW (Mean Cell Distribution Width)
MCHC
MCH
Term
What are the 5 types of WBCs?
Definition
Lymphocytes
Monocytes
Eosinophil
Basophil
Neutrophil
Term
What is an automated or manual percentage of each type of WBC?
Definition
Differential count
Term
Normal values of WBC's differ for what population?
Definition
Differ for infants and very young children; in this population lymphocytes are higher than neutrophils
Term
Infection, Inflammation, Trauma, Medical Stress, Dehydration, Malignancy (leukemia), and Medications all cause what abnormality in a CBC?
Definition
Elevated WBC (leukocytosis)
Term
Decreased bone marrow cell production, Bone marrow failure (aplastic anemia), Malignancy, Chronic Disease, Severe sepsis, Hypersplenism, and Post-chemotherapy all cause what abnormality in a CBC?
Definition
Decreased WBC (leukopenia)
Term
What is the prevalence of the 5 WBC's in order of concentration from highest to lowest?
Definition
Highest concentration: Neutrophils
Lymphocytes
Monocytes
Eosinophils
Lowest concentration: Basophils
Term
What are PMNS?
Definition
polymorphonuclear leukocytes; neutrophils
Term
What is the cellular defense against acute bacterial infection?
Definition
neutrophils
Term
How do immature neutrophils, or "bands" associated with severe infections occur?
Definition
enhanced neutrophil production- earlier immature cells enter circulation
Term
What might precursor neutrophils indicate?
Definition
leukemia
Term
How is ANC calculated?
Definition
Absolute Neutrophil Count = WBC * (% neutrophil + % band)
Term
What is defined as a prominence of immature cells in the peripheral blood and is noted in the white cell differential?
Definition
Left shift
Term
What are the two types of lymphocytes?
Definition
B cells (antibodies) and T cells (cell mediated immunity)
Term
Are lymphocytes differentiated in the CBC testing?
Definition
Lymphocytes not differentiated in the CBC testing.
Term
Why might lymphocytosis indicate?
Definition
high lymphocyte count indicates viral infection (CMV, EBV, HSV)
Term
What are downy cells?
Definition
atypical lymphocytes
Term
What is the term for monocytes after they travel through blood and enter into tissue area of infection?
Definition
macrophages
Term
What abnormality in a CBC is caused by infections (TB, Hep, subacute bacterial endocarditis), collagen-vascular disorders, and lymphomas?
Definition
Monocytosis
Term
What WBC has a role in allergic reactions and parasitic infections?
Definition
Eosinophils
Term
What is caused by neoplastic disease, collagen-vascular disease, and hypereosinphilic syndromes?
Definition
Eosinophilia
Term
What role do basophils play in the body?
Definition
Role in allergic infections
Term
What abnormality in a CBC is seen with systemic mast cell disease and mloproliferative disease?
Definition
Basophilia
Term
How is Hct calculated?
Definition
Hct = Hgb * 3
Term
What is defined as the percentage of total blood volume made of RBCs?
Definition
Hct
Term
How is a spun Hct calculated?
Definition
Height of column of RBC / height of column of whole blood * 100
Term
What are the normal hct values for men and women?
Definition
Males 40-52%
Females 37-47%
Term
What is the oxygen binding component of RBCs that correlates with Hct
Definition
Hgb
Term
Hgb is equal to 1 gram of Hgb per what volume of blood?
Definition
Hgb = gram Hgb/100mL
Term
Normal values of Hgb for males and females
Definition
males: 14-18 g/dL
females: 12-16 g/dL
Term
What is the number of RBCs in 1 mm3 of blood, and is closely related to Hgb or Hct?
Definition
RBC count
Term
RBC indices include information about what 4 characteristics of RBCs?
Definition
size, weight, and Hgb concentration
absolute RBC values
Term
What is defined as the average size of RBCs?
Definition
MCV
Term
How is MCV calculated?
Definition
[HCT/RBC million/mm3] * 10
Term
What is defined as a variation in RBC size that measures the distribution around the mean of any given MCV?
Definition
RBC Distribution Width (RDW)
Term
How would a normal RDW differ from an elevated RDW?
Definition
normal: RBCs usually about the same size
elevated: 2 or more cell populations
Term
What is defined as the average concentration of Hgb per volume (dL) of blood divided by Hct?
Definition
MCHC
Term
Is hyperchromia a real entity?
Definition
Hyperchromia is not a real entity.
Term
What is the average weight of Hgb per RBC?
Definition
MCH- Mean Corpuscular Hgb
Term
How is MCH calculated?
Definition
MCH = (Hgb/#RBC) * 10
Term
MCH closely follows what other measurement?
Definition
MCV
Term
A decreased MCH is associated with what other values?
Definition
Small RBCs and diminished Hgb
Term
What are 3 diseases that may cause Low MCV?
Definition
Fe deficiency anemia, thalassemia, anemia of chronic disease
Term
What is the MCV in the following diseases:
Acute blood loss anemia
Hemolytic anemia
Anemia of chronic disease
Chronic renal or liver disease
Bone marrow failure
Red cell aplasia
Hypothyroidism
Mixed anemia (macrocytic and microcytic)
Definition
Normal MCV
Term
What is the MCV in the following diseases?
B12 or folate deficiency
Medications (cancer drugs- folate deficiency)
Alcohol use
Chronic liver disease
Hypothyroidism
Definition
High MCV
Term
What is the RDW in the following diseases?
Fe deficiency
B12 or folate deficiency
Sickle cell anemia
Hemolytic anemia
Post hemorrhagic anemia
Chronic liver disease
Definition
High RDW
Term
How would the RBC count differ in the following conditions?
High altitude
Chronic hypoxia
COPD
Dehydration
Congenital heart disease
Hematological disease (polycthemia vera and epogen secreting tumors)
Definition
polycythemia
Term
Reticulocytes are released into the blood under what conditions?
Definition
erythropoietic stress- precursor cells released from bone marrow into circulation- intense production, damaged bone marrow
Term
Where are platelets formed?
Definition
Formed from megakaryocytes in the bone marrow
Term
Are platelets nucleated?
Definition
No, they lack nucleus
Term
Where are platelets mostly found?
Definition
Most in blood circulation
Term
A small amount of platelets are found in what 2 organs?
Definition
Small amount in liver and spleen
Term
What blood level is altered with the following conditions?
Bone marrow malignancy
Medications
Alcohol
B12 deficiency
Definition
thrombocytopenia from decreased production
Term
Splenic sequestration causes what abnormality?
Definition
enlarged spleen
Term
What abnormality in the CBC is found with the following abnormalities?
ITP
lupus
lymphoma
drug induced
infectious (EBV and malaria)
DIC
TTP
vascular
Definition
thrombocytopenia- peripheral destruction
Term
What abnormality is seen with the following conditions?
Fe deficiency anemia
post-splenectomy
acute inflammatory process
essential thrombocytosis
Definition
thrombocytosis
Term
In what test is a Wright-Giemsa stain used?
Definition
Peripheral blood smear
Term
Peripheral blood smear evaluates what 3 blood components?
Definition
RBC, WBC, plateltet evaluation
Term
How is the WBC performed?
Definition
manual count
Term
Toxic granulation (WBCs) or basophilic stippling (RBCs) are examples of what?
Definition
cellular inclusions
Term
What stops blood loss from a damaged vessel?
Definition
In hemostasis, a fibrin clot stops hemorrhage and helps repair damaged vessels
Term
What process involves coagulation with platelets initiated less than or equal to 20 seconds of blood vessel injury?
Definition
primary hemostasis
Term
What process involves activation of coagulation cascade, the formation of fibrin (by coagulation factors) and strengthening of platelet plug?
Definition
secondary hemostasis
Term
What process involves the formation of plasmin for clot breakdown and is down regulated by anticoagulant pathways?
Definition
tertiary hemostasis
Term
What leads to fibrin formation and involves the following coagulation factors:
high-molecular weight kininogen
prekallikrein
Factors XII, XI, IX, and VIII
and cofactor VIII
Definition
Intrinsic pathway (contact activation pathway)
Term
What is a minor pathway that involves a 2nd rounte of intrinsic pathway stimulation that involves direct activation of factor IX by the tissue factor-factor VII complex?
Definition
alternate pathway
Term
What leads to fibrin formation and involves the following coagulation factors:
tissue factor
factor VII complex
activates factor X
Definition
Extrinsic pathway- Tissue Factor Pathway
Term
How does the extrinsic pathway generate thrombin?
Definition
primary conversion of fibrinogen to fibrin
Term
What involves factor X mediated generation of thromin from prothrombin, factor V, Ca2+, and platelet phospholipid
Definition
common pathway
Term
Fibrinolysis is involved in which stage of the coagulation process?
Definition
Final process of coagulation
Term
What are 4 clinical indications for obtaining coagulation studies?
Definition
Excessive bleeding
Increased risk of thrombosis
Therapeutic monitoring
Abnormal screening tests
Term
What are 2 coagulation system lab tests?
Definition
aPTT (activated partial thromboplastin time)
PT(INR) prothromin time (international normalized ratio)
Term
PT is often ordered with what other test?
Definition
PT and PTT are often ordered together
Term
What are 2 screening tests for problems in blood clotting process
Definition
Coagulation System Lab Tests (PT and PTT)
Term
PT and PTT detect most clotting proglem associate with what?
Definition
Detects most clotting problems associated with coagulation factors
Term
Does PT measure extrinsic or intrinsic pathway of coagulation?
Definition
extrinsic pathway
Term
How is the PT test performed?
Definition
Test is performed by adding tissue thromboplastin and Ca2+ resulting in plasma and measuring time and clot formation
Term
INR is usually reported with what value?
Definition
INR is usually reported with PT
Term
INR stands for what?
Definition
International Normalized Ratio
Term
How is INR calculated?
Definition
(Pt prothrombin time/control prothrombin time)^ISI
Term
What is defined as the function of the relationship btwn working and WHO thromboplastins?
Definition
ISI
Term
What test is indicated by the following:
Assess clotting tendencies
Liver damage
Vitamin K synthesis
Warfarin dosing
Definition
PT (INR)
Term
What abnormality occurs with the following conditions?
Warfarin therapy
Vitamin K deficiency
Poor factor VII synthesis
Increased consumption of extrinsic factors
Definition
Prologned PT (INR)
Term
What measures intrinsic pathway (and common pathway)?
Definition
aPTT or PTT
Term
What is formed by adding Factor XII activator, a phospholipid and Ca2+ ions?
Definition
aPTT assay
Term
What tests are indicated with the following:
Assess clotting tendency
Monitor liver damage
Monitor heparin therapy
Definition
aPTT or PTT
Term
What abnormal test result occurs with the following conditions:
Use of heparin
antiphospholipid Ab
coagulation factor deficiency (e.g. hemophelia)
Definition
prolongued PTT
Term
What is indicated when PTT or aPTT are about 1.5 to 2.5 times the normal values?
Definition
Heparin therapy
Term
What are 5 other coagulation system lab tests beside aPTT, PTT, and PT?
Definition
TCT (thrombin time)
Bleeding tme
D-dimer
FDP (fibrinogen degradation products)
Platelet function tests (uncommon)
Term
What are 3 etiologies of clotting disorders?
Definition
Platelet and vessel wall
coagulation and thrombosis
hypercoagulability
Term
What etiology of clotting disorder occurs with the following conditions?
ITP
TTP
HUS- Hemolytic-uremic syndrome
Glanzmann's thrombasthenia
Bernard-Soulier syndrome (abnormal glycoprotein IB-IX-V complex)
Definition
clotting disorders resulting from platelet and vessel wall
Term
What etiology of clotting disorders occurs with the following conditions:
DIC
Factor Deficiencies
Hemophilia A,B,C
Von Willebrand disease
Factor Inhibitors
Platelet Dysfunction
Definition
Coagulation and Thrombosis
Term
What etiology of clotting disorders occurs with the following conditions?
Heparin-induced thrombocytopenia and thrombosis ("white clot syndrome")
Antiphospholipid syndrome
Fator V Leiden
Prothrombin mutation
Protein C deficiency
Protein S deficiency
Antithrombin deficiency
Definition
Hypercoagulability
Term
* Iron deficiency anemia
* Pernicious anemia or folic acid deficiency
* Aplastic anemia
* Radiation therapy
* Bone marrow failure caused by infection or cancer
Definition
decreased retics
Term
* Bleeding: If you bleed (hemorrhage), then the number of reticulocytes will rise a few days later in an attempt to compensate for the red cell loss. If you have chronic blood loss, then the number of reticulocytes will stay at an increased level as the marrow tries to keep up with the demand for new RBCs.
* Hemolytic anemia
* Hemolytic disease of the newborn
Definition
incresed retics
Term
csf: yellowish, turbid. marked increase in polymorphonuclear cells. slightly increased or normal lymphocytes.
Definition
pyogenic pacterial meningitis
Term
csf: clear fluid. slightly increase or normal polymorphonuclear cell. marked lymphocyte increase.
Definition
viral meningitis
Term
csf: yellowish and viscous. slight increase or normal polymorphonuclear cell. marked lymphocyte increase.
Definition
TB or fungal meningitis