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Clin. Lab Medicine Quiz 2
everything on quiz 2
183
Health Care
Professional
01/24/2012

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Term
What is involved with renal function?
Definition
Excretion
Reabsorption
Acid-base homeostasis
Water and sodium metabolism
Vascular tone
Erythropoesis
Calcium homeostasis
Term
What does the renal system keep balanced?
Definition
fluids, acid/base, electrolyte
Term
What does the renal system conserve?
Definition
glucose, amino acids, proteins
Term
What does the renal system excrete?
Definition
wastes
Term
What does the renal system produce?
Definition
-erythropoietin
-1,25-dihydroxy vitamin D
Term
What are some symptoms of renal disease?
Definition
-malaise, HA, visual disturbance, N/V
-flank pain, renal colic, dysuria
-oliguria or anuria
-hematuria
-discolored or malodorous urine
-elevated creatinine or BUN
-Malar rash
-Hypertension
-unexplained hypo- or hyper kalemia, hypocalcemia, hypomagnessemia, acidosis, anemia, edema or bleeding
Term
What does it mean if labs have Azotemia increased BUN and creatinine?
Definition
prerenal: reduced blood flow to kidney, reduced UOP, retention of waste

renal: kidney is dysfxnal (glomerulonephritis, acute tubular necrosis)

postrenal: obstruction (renal lithiasis, tumor, congenital)
Term
What is one of the reasons why we do serum ammonia levels?
Definition
-to measure kidney fxn
Term
What is occurring when symptomatic end state renal failure is present?
Definition
uremia
Term
What is uremia, and what are its signs and symptoms?
Definition
-waste from urine backs up into the blood
-malaise, HA, restlessness, altered sensorium, N/V/D, edema, SOB, bleeding
Term
What happens to platelets during uremia?
Definition
-stickiness decreased, so fxn decreased
-so if get cut, bleeding could be prolonged
Term
When does renal failure become chronic?
Definition
>3 mos
-loss of functioning nephrons
-cause of this is independent of renal disease
Term
What are some causes of renal disease?
Definition
hypertension, non-compliant, possibly alcoholic pts, some drugsW
Term
What acids, bases and electrolytes does the kidney balance?
Definition
Na
K
Cl
CO2
BUN
CRE
Ca
Glu
Term
What does a chem 8 include that a chem 7 does not?
Definition
Ca
Term
What are most people in renal failure going to also be?
Definition
anemic
Term
What test can you do to test acid base balance?
Definition
ABG
Term
What is creatinine the breakdown of?
Definition
creatine and phosphocreatine
Term
Where is creatinine produced?
Definition
skeletal muscle (due to forming of new muscles)
kidney
pancreas
production occurs at a constant rate
Term
What are creatinine measurements inversely related to?
Definition
GFR


-If GFR declines by 50%, Plasma Creatinine doubles
-Clearance of creatinine by kidney is suitable estimate of GFR
Term
What does it mean when GFR is declined?
Definition
-increases retained wastes
-may lead to end stage renal failure
-the lower the GFR, the more significant the kidney failure
Term
What are the GFRs at each of the 5 stages of chronic kidney disease? (5 being the worst)
Definition
Increased risk: 90-130
1- above 90
2-60-89
3-30-59
4-15-29
5-below 15
Term
What are urea and BUN?
Definition
The byproducts of ammonia
BUN is the breakdown of blood

both produced in the liver.
Term
What is occurring clinically if urea and BUN levels are increased? decreased?
Definition
-dehydration, protein intake, large amounts of blood in GI tract
-malnutrition, liver failure
Term
What's so great about a urinalysis?
Definition
cheap
simple
yields a lot of information
Term
What are the 3 ways in which you can analyze urine?
Definition
visual (clear- no infection, amber-infection or deyhdrated)
chemical (dipstick)
microscopic
Term
What is the gold standard?
Definition
Do a renal disease work up for every renal pateint
Term
What are the components of a urinalysis?
Definition
-color (due to drugs, poisoning or physical condition)
-clarity (clear? cloudy? crystals?)
-specific gravity
Term
What is used to perform a urinalysis?
Definition
-reagent strip
-sediment exam
-dipstick
Term
Why does urine have color?
Definition
-oxidation of urobilinogen (urobilin in urine)
Term
What is urine specific gravity?
Definition
-measure of weight of solutes in water in the urine (Uosm)
-solutes include urea, chloride, sulfate and phosphate
-measured by reagent strip
Term
What are some things that cause the urine to have an odor?
Definition
UTI, DKA (diabetic ketoacidosis), Asparagus
Term
What does the chemical portion (dipstick)of the urinalysis measure?
Definition
protein
pH
glucose
ketones
blood
nitrites
bilirubin
leukoesterase
Term
What might abnormal protein values be indicative of?
Definition
-proteinuria (excessive exercise, high/low temp, pregnancy)
-pathological proteinuria (multiple myeloma)
-renal (early renal failure, pyelonephritis, glomerulonephritis)
Term
When pt has multiple myeloma, wha do you want to run?
Definition
-Bence jones test
detects immunoglobulins
Term
What all does albumin do?
Definition
helps maintain water from leaking out of tissues
Term
What does electrophoresis measure?
Definition
specific components of protein
Term
What if someone has persistent alkaline urine (pH 7-8)?
Definition
-possible UTI
-vegetarian diet
-alkalosis
-pyloric stenosis/ obstruction
-vomiting
-alkalizing drugs
-Proteus infection (converts urea to ammonia, producing an ammonia odor)
Term
What might a pt with a persistent acid urine (pH 5-7) present?
Definition
-gout
-fever
-predisposition to uric acid caliculi (kidney stones)
Term
What is the pH of most urine?
Definition
5-6.5
Term
What might abnormal glucose levels in the urine be indicative of?
Definition
Renal Glycosuria
Diabetes Mellitus
Renal glycosuria during pregnancy
After excessive consumption of carbohydrates
Gestational diabetes
Term
What is the renal threshold for glucose?
Definition
160-180 L/dL
Term
Why might ketones be in the urine?
Definition
-pts with poorly controlled diabetes and hospitalized pateints who are not eating well:

Diabetic ketoacidosis
Insulin overdose
Insufficient food intake
Nausea and vomiting
Starvation
Strict dieting
Severe stress
Severe fever due to infection
Term
What 3 types of ketones are in the body, and which two are picked up by the dipstick?
Definition
-acetone, acetoacidic acid, beta hydroxybuteric acid
-first two are picked up by dipstick
Term
What might it mean if there is Hbg in the urine?
Definition
-anticoagulants & other drugs
-bladder CX
-hematuria
-hemoglobinuria
-myoglobinuria (structure similar to Hbg)
Term
What is myoglobinuria?
Definition
-muscle breakdown of Hbg
-someone who has recently broken down a lot of muscle
-important bc is a protein and can be hard n kidney
Term
What is Ribdomyalisis? "Ribdo"
Definition
- condition with myoglobinuria
-treated by hydration
Term
What tests can be used to evaluate hematuria?
Definition
Complete UA (dipstick and microscopic)
Culture (usually in chronic hematuria)
KUB (ultrasound)
IV Pyelogram
Cystoscopy (scoped in the bladder)
Urine cytologic exam
Renal biopsy
Term
What might abnormal nitrite levels in the urine be indicative of?
Definition
-gram negative bacteria-bacterial infection (e. coli, salmonella, citrobacter, proteus)
-bacteria changes nitrites to nitrates
'bacteriuiria' (gram test will be pink to red color), so a UTI
Term
What if there is mixed flora in a urine culture?
Definition
test probably was not clean
-abnormal to see 10 to 20 epithelial cells ina urine test on the microscope
Term
Is a urine nitrite test more sensitive or specific?
Definition
91% sensitive
-not very specific
Term
What do increased levels of bilirubin in the urine mean?
Definition
-bilirubin is the breakdown of Hgb in the liver
-gall bladder diseases
-sat around in the light too long in the lab
Term
Abnormal levels of bilirubin in the urine can be indicative of pre-hepatic, hepatic or post-hepatic issues, what are some clinical diseases of each?
Definition
pre-hepatic: anemias due to excessive breakdown of RBCs
hepatic: hepatitis, cirrhosis, obstruction of biliary duct
post-hepatic: biliary tree obstruction
Term
In the intestines, bacteria form urobilinogen from conjugated bilirubin, then what happens to the urobilinogen?
Definition
-absorbed, passed to the liver and out in the urine.
Term
What do increased values of urobilinogen mean? decreased? normal is 0-8 mg/dl
Definition
-overburdening of the liver, excessive RBC breakdown, reabsorption of a large hematoma, restricted liver fxn, hepatic infection, poisoning, liver cirrhosis
-failure of bile production, obstruction of bile passage
Term
What does urine leukocyte esterase text tell you? what might cause contamination of this?
Definition
wheteher white blood cells are present at the time
-vaginal discharge
-must read test within 2 minutes
Term
What might abnormal leukocyte values by indicative of?
Definition
-kidney infection
-cystitis
-urethritis
-STIs
Term
What if you see a lot of white cells without any bacteria?
Definition
chlamydia
Term
What does specific gravity show in the urine?
Definition
-value of solutes in the urine
so, the concentrating or diluting ability of the kidney
Term
What clinical manifestations might occur if specific gravity is reduced? raised?
Definition
-diabetes insipidus, certain renal diseases, excess fluid intake, diabetes mellitus
-dehydration, adrenal insufficiency, nephrosis, congestive cardiac-failure
Term
What do you use to test urine specific gravity?
Definition
urorefractometer or a urine osmolality test
Term
What does the ictotest measure?
Definition
-bilirubin
-will be purple if present on cloth
Term
What does the Clinitest test?
Definition
for reducing sugars
-also tests for reducing analytes
-used a lot of time in newborns to see if they can breakdown lactose to glucose
Term
What is galactosemia?
Definition
inability to breakdown simple sugars like galactose
-builds up in your system and can lead to blindness and death
Term
What does an SSA test confirm?
Definition
protein in the urine, will be hazy
Term
What does an acetest confirm?
Definition
ketones in the urine, will come up purple
-can be used with serum or urine
Term
How can you differentiate a WBC from a RBC?
Definition
WBCs have granules and a nucleus
Term
What does a Kova stain highlight?
Definition
-all cellular components
-epithelial cells are seen as large with a nucleus and irregularly shaped
Term
What would you use to treat bacteria vaginalis or trichomona vaginalis?
Definition
Flagyl or clindomyosin
Term
What do you use to treat yeast?
Definition
Diflucan
Term
If a reading says, few, amorphous crystals, should you be concerned?
Definition
no
Term
What could yellow, rhombic shaped crystals be an indicator of?
Definition
-food products
-altered urine pH
-gout
Term
When are cystine crystals seen?
Definition
in acidic urine
-can be due to a rare inborn error in metabolism or defective renal tubular absorption
Term
When can cholesterol crystals be seen?
Definition
degenerative renal disease
Term
What do phosphate crystals look like?
Definition
they have coffin lids
-in any pH of urine
-could be proteus vulgaris
Term
What do leucine crystals look like?
Definition
maltese crosses.
-typically found in hereditary disease such as maple syrup disease
Term
When are tyrosine crystals found?
Definition
liver disease
Term
What do white cell casts indicate?
red cell casts?
hyaline casts?
granular or waxy casts?
Definition
-UTI, interstitial nephritis
-glomerulonephritis
-not significant, small amount of protein, dehydrated
-acute or chronic renal failure
Term
What is urine hemosiderin?
Definition
-protein storage of iron (from microhemorrhages)
normal: negative
adnormal: positive, paroxysmal nocturnal hemoglobinemia, chronic hemolytic anemia, hemochromatosis

*iron deposits from breakdown of red cells
Term
What is a normal urine osmolality?
Definition
50-1200 mOsm/kg
-similar to specific gravity, more accurate.
Term
What are the clinical manifestations if urine osmolality is increased? decreased?
Definition
-syndrome Inappropriate ADH Secretion (SIADH), dehydration, glcosuria,adrenal insufficiency, high protein diet
-diabetes insipidus, excessive hydration, acute renal insufficiency, glomerulonephritis
Term
What could you prescribe for UTI? polynephritis?
Definition
macrobid, Bactrum
cipro
Term
What is Kussmaul breathing?
Definition
-breathing hard and fast, going into DKA
-indicative of diabetes
Term
What is the second most common CX in men?
Definition
prostate
-incidence increases with age
-challenge with this: rapid progressive vs. indolent forms
Term
What clinical manifestations make you suspect prostate cx?
Definition
frequent urination
blood in urine or semen
urinary pain
Term
What do potentially curable CXs have?
Definition
increased PSAs
-elevated with any type of prostate inflammation
Term
What are 4 ways in which you can detect prostate cx early?
Definition
-DRE (most CXs will be picked up)
-PSA (sensitive for inflammation)
-Transrectal U/S
-Biosy
Term
Where is PSA synthesized and then secreted?
Definition
prostate and secreted into seminal fluid
Term
What does PSA relate to? when does this increase? When are PSA elevations confirmed?
Definition
-relates to prostate size
-after exam, surgery or infection
-after has been checked and then stays elevated and checked again after 2-3 months
Term
The slower the PSA level rises over the years the ___ ____ CX is.
Definition
less agressive
Term
In what dx is PSA rarely greater than 20 ng/mL and 10% of the time is greater than 10ng/mL?
Definition
BPH (Benign Prostatic Hyperplasia)
Term
Is distant metastases for prostate CX rare?
Definition
yes- PSA <20 ng/mL
PSA used widely for monitoring
-99% of cancer produce PSA
Term
What should happen to PSA levels once the prostate is removed?
Definition
-PSA levels should then go undetected
-If are detectable, then Cx is recurring, and should consider radiation therapy
Term
What is the gleason scale?
Definition
-measures levels of prostate cx aggressiveness.
1- tissue looks normal
2-4 patterns vary between normal and abnormal
5- most abnormal and undifferentiated cx cells
Term
Where do 90% of testicular cxs arise from?
Definition
germ cell tumors
Term
Germ cells produce substance that can be used as markers to evaluate what?
Definition
-complete tumor removal
-recurrent cx
-monitor tx for residual/ recurrent tumor
Term
What do 90% of germ cell tumors have increases in? (these are good markers for cx?
Definition
-hCG
-AFP (alpha fetal protein)
-LDH-1 (lactodehydregnase)
Term
When do you typically see testicular cx and how?
Definition
-late teens, early 20s
-typically is a non-tender nodule on the testical
Term
How do prostate and testicular tumor markers differ in: screening, diagnosis, indicator of disease extent, monitoring response to tx, monitoring recurrence?
Definition
screening- controversial for P, not useful for T
diagnosis- not useful for P, can assist in T germ cell tumor for T
indicator of disease extent- PSA (if less than 20 ng/mL, bone metastases not likely for P; for T may ID metastatic disease
monitoring response to tx- useful in both
monitoring recurrence- useful in both
Term
What can male gonadal dysfn be due to?
Definition
low androgen
Term
What does male gonadal dysfxn cause deficiency in?
Definition
mood change
sexual dysfxn
Term
What hormone rises at the end of follicular phase?
Definition
estradiol
Term
What 2 hormones rise during ovulation?
Definition
LH and FSH
Term
What hormones are high in the luteal phase/
Definition
estradiol (still)
progesterone
Term
At what phase in the female cycle are all hormones low with no jumps?
Definition
menstruation
Term
What produces FSH and LH secretion?
Definition
hypothalamus --> GnRH-->pituitary-->LH and FSH
Term
What do FSH and LH stimulate in a male? female?
Definition
-leydig (secrete testosterone) and sertoli cells
-ovary
Term
What is hCG?
Definition
-hormone produced in the placenta
Term
What is alpha fetoprotein (MSAFP)?
Definition
protein produced by the fetus
Term
What is estriol?
Definition
estrogen produced by the fetus and the mother
Term
What is included in the triple screen test?
Definition
hCG, MSAFP, estriol
-uses amniotic fluid or chorion
Term
What are the hCG levels at each week in pregnancy?
Definition
[image]
Term
If someone's having a miscarriage, how can you tell? Until how many weeks is there not much you can do about it?
Definition
hCG levels
20 weeks
Term
hCG levels ______ as a pregnancy goes on. At what level can you do an ultrasound?
Definition
increase
2,000 or higher
Term
When is Alpha fetoprotein (MSAFP) increased?
Definition
-neural tube defects
-multiple gestation (twins, triplets..)
-fetal death
-placental abnormalities.
Term
When is MSAFP decreased?
Definition
down syndrome
trisomy 18
Term
When is estriol (E3) decreased?
Definition
fetal distress
Term
How can you tell if someone is pregnant?
Definition
hCG > 10 IU/L
-this should increase every 2 days x 8 wks
Term
What routine tests can you do during the first trimester?
Definition
-Beta hCG
-PAPP-A (assesses for trisomy 21)
Term
What are routine tests you can do during the 2nd trimester?
Definition
-hCG
-AFP (assesses for trisomy 21 & neural tube defects)
-estriol
-inhibin A (also detects down syndrome)
-1 hr glucose loading test (if concerned about gestational diabetes)
Term
What should normal glucose loading tests say after 60 minutes?
Definition
<140 mg/dL
Term
A hematocrit will read what in a normal pregnancy?
Definition
-36-48%
-most women will be slightly anemic with some pitting edema in feet
Term
What are the 4 routine blood tests that can be done during pregnancy?
Definition
-hematocrit
-blood type
-Rh type
-antibody screening (should be negative)
Term
What is fetal fibronectin and what can it be used to predict?
Definition
-component of amniotic fluid
-can be used to predict delivery
<0.05 ug/mL (delivery unlikely in the next 14 days)
>0.05 ug/mL (delivery likely in the next week or so)
Term
What are abnormal results that can be read in CVS (Chronic Villous Sampling)?
Definition
-abnormal fetal tissue
-chromosomal abnormalities
-fetal metabolic and blood disorders
-fetal infection
Term
When is CVS typically done? amniocentesis?
Definition
-around 10-12 weeks
-around the 16th week
Term
What is the L/S ratio, and what do you want it to be?
Definition
-lecithin-sphingomyelin ratio, lecithin (greasy component that decrease alveolar friction) sphingomyelin (from brain and spinal cord)... as baby grows, lecithin should increase and sphingomyelin should decrease
-want the ratio to be 2:1 to be indicative of fetal lung maturity
Term
What are other routine tests during pregnancy that test the health of the mother so she does not hurt her fetus?
Definition
-rubella
-toxoplasma IgG (from litter box, can cause fetal death)
-Treponema pallidium IgG (syphilis)
-HBsAb (have been immunized against Hep B)
-HBsAg (have had Hep B)
-HIV Ab
-cervical culture for GC/ Chlamydia
-Group B strep (25% of women are carriers in their vaginal area)
Term
Why run a hematocrit on a pregnant woman?
Definition
to see if they're anemic
-most will be slightly
Term
Why test coagulation factors on a pregnant woman?
Definition
-see if they have potential for clotting (worried about DVT or PE)
Term
Lipids ______ during pregnancy.
Definition
increase
Term
Thyroxine-binding globulin (Total T3 &T4) has the potential to be _________ during pregnancy, causing a ________ risk for Grave's Disease.
Definition
-higher
-higher
Term
You should not see alkaline phosphatase in a non pregnant person, but if you do what do you suspect? What if you alkaline phosphatase in pregnant people?
Definition
-gall bladder or bone CX
-normal, alkaline phosphatase is the byproduct of bone production (occurring in the fetus)
Term
Why should you monitor BUN or creatinine levels in pregnant women?
Definition
preeclampsia
Term
In a pregnant woman, 1, 25- Dihydroxy vitamin D tends to be __________.
Definition
INCREASED
Term
In a pregnant woman, PTH tends to be __________.
Definition
-increased, along with Ca.
Term
What is HELLP syndrome?
Definition
-occurs during 27 and 36 weeks of preg.
-may be associated with preeclampsia
-elevated liver NZs and low platelets
Term
How do you test infertility in a male? female?
Definition
male: sperm count
female: midluteal progesterone, basal body temperature, LH surge, Day 3 FSH, estradiol, prolactin, TSH
Term
What is the difference bw cystitis (bladder infection, UTI) or polynephritis or a kidney stone?
Definition
cystitis is in the lower urinary tract where as polynephritis comes form the upper urinary tract (WILL HAVE LOWER FLANK PAIN HERE)
Term
What is the difference in labs between pyelonephritis and cystitis? (card not finished)
Definition
pyelonephritis:
-Azotemia (increased creatinine and BUN levels)
-increased albumin (protein) levels in the urine
-WBCs and casts in the urine
-positive nitrite levels
cystitis:
-elevated urine leukocyte esterase (dipstick)
-urine nitrites
-WBCs in urine (microscope)
-positive nitrite levels
Term
what is a kidney infection?
Definition
"pyelonephritis"
-bacterial infection in kidney, usually from the lower urinary tract and bladder
-if not treated immediately (antibiotics) can permanently damage kidney function
Term
What can be tested on a dipstick (chemical portion of the urinalysis)?
Definition
protein
pH
glucose
ketones
blood
nitrites
bilirubin
leukoesterase
Term
What if the protein is high on a dipstick?
Definition
a 24 hour urine specimen should be collected
-monitors renal disease and tx
-can measure protein's molecular weight with electrophoresis
Term
What should you do if glucose is present in the urine? (in a fresh specimen)
Definition
-suspect diabetes mellitus
-confirm glucose intolerance by fasting glucose tests or finger sticks to test blood glucose levels
Term
What should you do if WBC casts are present in the urine? What about RBCs in the urine?
Definition
-a clean catch urine culture should be done for further analysis
-microscopic analysis of blood.
Term
What should you do if urine nitrites on the dipstick are positive?
Definition
-need for a urine culture
Term
What should you do if a leukocyte esterase (WBC) test is positive?
Definition
-microscopic examination of urine.
Term
What if billirubin is off in the urine dipstick, what should you do?
Definition
Run an Ictotest
take a venous blood sample and examine it.
Term
What if specific gravity is off on the dipstick?
Definition
-more precise in an osmolality test
Term
Why do we do a specific gravity test?
Definition
-to get the concentrating and excretory power of the kidney
-if low: renal disease
-if little variation in specific gravity levels: kidney is not responding to hydration or solute loads (think diabetes insipidus)
-Patient could just be too hydrated or dehydrated
Term
If urine stands for a long time and begins to decompose what does it smell like?
Definition
ammonia.
Term
If let urine stand too long, is it more alkaline or acidic?
Definition
alkaline.
Term
What pH does ingestion of large amounts of citrus fruits, dairy products and vegetables produce?
What pH does a diet high in meat and foods like cranberries produce?
Definition
-alkaline urine
-acidic urine
Term
What might transient proteinuria be associated with?
Definition
-severe emotional stress, excessive exercise and cold baths.
Term
What other factors might contribute to proteinuria?
Definition
-radiopaque contrast media
-contamination by prostate or vaginal secretions
-Hbg may cause a positive result on the dipstick
-Bence Jones may not appear with the dipstick method.
Term
What may play a factor in skewed specific gravity results?
Definition
-radiographic dyes
-cold temperatures
-drugs: dextran, mannitol and sucrose
Term
What may play a factor in skewed leukocyte esterase results?
Definition
-vaginal secretions containing WBCs (false positive)
Term
What can affect various billirubin levels?
Definition
alkaline urine- higher urobilinogen levels
acidic urine- lower urobilinogen levels
Term
What are the 2 major fxns of blood?
Definition
-transports nutrients through the body
-defends the body against infection
Term
Define the components of the CBC and their normal values?
Definition
RBCs (4.35-5.72 X 10^12/L)
WBCs (3.5-10.5 X 10^9/L)
Hemoglobin (13.5-17.5 f/dL)
Hematocrit (38.8-50%)
Platelets (150-450 X 10^9/L)
MPV (average volume size of platelets)
Term
What is MCV?
Definition
-RBC volume
-tells a lot of info on iron deficient anemia
-worried about alcoholics and vegetarians
-80-100fL
Term
What is MCHC?
Definition
-average concentration of hemoglobin in a given volume of red cells
-worried about spherocytosis
-32-36 g/dL
Term
What is MCH?
Definition
-average amount of hemoglobin per red cell
-tell color of RBCs
-28-34 pg/cell
Term
What is RDW?
Definition
-measures the range of sizes of RBCs in a blood sample
-worried about anisocytosis
-11-15
Term
Why would you order a reticulocyte count?
Definition
-measures reticulocytes (slightly immature RBCs) in the blood
-when looking for a cause of anemia
-tests bone marrow function
-tests erythropoietic activity
Term
What is the significance of sickle cell screening?
Definition
-this is a Hgb solubility test
-marked turbidity=positive screen
-can also look at a peripheral smear (10% of cells must be Hgb S)
-neither of these look at the genetics of sickle cell (electrophoresis does)
Term
What does electrophoresis look at when screening for sickle cell?
Definition
-uses lysed RBCs
-distinct band patterns of the following genes:
Hgb A,F,S,C
Thalassemia
Rare Hemoglobinopathy
Term
When do you want to do sickle cell screening?
Definition
after 1 year, infants still have fetal Hgb
-electrophoresis can be done on any age.
Term
What is the importance of osmotic fragility testing?
Definition
-looks at the membrane of the RBC as it undergoes lysis in a hypotonic environment
-spherocytic red cells will lyse quicker than normal cells
-this is an autoimmune hemolytic anemia (AIHA)
Term
What is ferritin and when would you need to measure this?
Definition
-chief iron-storage protein in the body.
-to predict and monitor iron levels
-determine response
-differentiate iron deficiency vs chronic disease as cause of anemia
-monitor status
Term
What is total iron binding capacity (TIBC) and when would you want to measure this?
Definition
-extent to which transferrin in serum can bind to serum iron
-order in combination with serum Fe
-if increased:iron deficiency, acute/chronic blood loss
-if decreased: thalassemia, anemias of infection/ chronic disease.
Term
What do serum iron levels reflect?
Definition
Fe bound to transferrin
-always measure with TIBC
-majority found as a constituent of Hgb
Term
What do serum iron levels indicate?
Definition
increased: excessive iron intake, hemolytic anemias, decreased formation of RBCs, iron overload (which can lead to idiopathic hemochromcytosis

decreased: iron-deficiency, menstruation
Term
What is transferrin?
Definition
transports circulating Fe molecules.
Term
Define the relationship between B12, folate and megaloblastic anemia.
Definition
Megaloblastic anemia causes folate deficiency
B12 deficiency causes megaloblastic anemia
Term
What is folate deficiency?
Definition
folate deficiency- impairs DNA synthesis of cells-->erythropoiesis becomes ineffective/ neural tube defects
Term
What is a B12 deficiency?
Definition
-result of malabsorption or deficiency in gastric intrinsic factor for absorption of B12 (pernicious anemia)
-produces degenerative neurologic syndrome
Term
How does lead poisoning affect heme synthesis?
Definition
inhibits it.
--> micro-hypochromic anemia
Term
What is billirubin and how is it used in lab testing?
Definition
-degradation product of heme
-not a sensitive indicator of hepatic dysfxn (could be viral, alcohol, or extrahepatic biliary obstruction)
->2.5 mg/dL (clinical jaundice)
Term
What tests are involved in working up an anemic patient?
Definition
macrocytic anemia-start with a retoculocyte count->blood smear or b12/folate tests->RBC/platelet counts->liver fxn tests

microcytic anemia- start with serum ferritin then serum iron tests

normocytic anemia-reticulocyte count->blood smear or WBC work up-> serum Fe/TIBC->renal fxn tests
Term
What is the Schilling test, and when would you use it?
Definition
urine test
-to detect B12 absorption (so testing for pernicious anemia)
Term
What is the direct Coombs test? Indirect?
Definition
-detects Abs already bound (autoimmune/acquired hemolytic anemia, drug induced hemolytic anemia, SLE, rheumatic, syphilis, blood transfusion)

-detects unbound circulating Abs (blood transfusion)
Term
What is the Kleihauer-Betke test?
Definition
-indicates fetal cells in maternal circulation with a peripheral smear stained with acid elution
-indicated need to give Rhogam 72 hrs postpartum
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