What does a CBC include that is not part of a hemogram?
WBC Differential Count/Schilling Differential
Define hematocrit
% volume of RBC in blood
List 4 RBC Indices
MCV, MCH, MCHC, RDW
Define anemia
Decreased RBC count, Hb, Hct
Decreased oxygen carrying capacity of blood
What would cause a relative polycythemia?
Dehydration
What is another name for primary polycythemia?
Polycythemia Vera, True Polycythemia
What would cause a secondary polycythemia?
Altitude increase and smoking
How is MCV calculated?
Hct/RBC
How is MCH calculated?
Hb/RBC
How is MCHC calculated?
Hb/Hct
Define macrocytosis
RBCs are larger than normal
Define microcytosis
RBCs are smaller than normal
How is MCV affected in a microcytic anemia?
MCV decreases
Define Hyperchromic
Having higher than normal amounts of Hb in RBC
Name an anemia with an increased MCHC
Hereditary Spherocytosis
Name an anemia with a decreased MCHC
Iron Deficiency Anemia, Chronic Blood Loss Anemia, Thalassemia
What is RDW?
RBC Size Distribution Width - Gives coefficient of variation of size of RBC
Define anisocytosis
Variation in RBC size
How does hemolysis affect RDW?
Increases RDW
Define poikilocytosis
Variation in RBC shape
Define schistocytosis
Fragmentation of RBCs
What is the reference range for the WBC count?
5000-11,000 WBCs/mm3
List 3 granulocytes
Neutrophils, Eosinophils, Basophils
List 2 agranulocytes
Lymphocytes and Monocytes
How many lobes are there on the nucleus of a normal neutrophil?
3
Define leukemoid reaction
Increase in RBC count due to infection and other diseases. It is temporary and not due to cancer
Define leukocytosis
Increased WBC production (>11,000/mm3)
Define erythrocytosis
Increased RBC production
Name an anemia associated with leukopenia
Pernicious Anemia, Folate Deficiency Anemia, Myelopthisic Anemia
How is WBC count affected with bacterial infection?
Increased WBC
How is absolute value of a specific type of WBC calculated?
Relative value x WBC Count
List several other names for neutrophils
Polymorphonuclear Neutrophils, PMN, Segs, Polys
List two names for immature neutrophils
Band and Stab Cell
Eosinophilia and basophilia are often associated with which two pathologies?
Allergies and Parasites
Increased atypical lymphocytes often indicate what disease?
Infectious Mononucleosis
Shift to the Left
Increase in number of immature neutrophils
Shift to the Right
Increase in number of mature neutrophils
What would cause a shift to the left?
Bacterial Infection
What would cause a shift to the right?
Megaloblastic Anemia and Cancer
What is another name for platelets?
Thrombocytes
What is the follow up test for an increased/decreased platelet estimate?
Order Platelet Count
What is the approximate ratio of RBC count to WBC count?
1000 RBC : 1 WBC
50% of patients with an unexplained platelet increase have what condition?
Malignancy
Myeloproliferative neoplasms affect what tissu?
Bone Marrow
What are the normal types of hemoglobin in adults?
A1, A2 and F
Hemoglobin A1
2 alpha and 2 beta
Hemoglobin A2
2 alpha and 2 delta
Hemoglobin F
2 alpha and 2 gamma
What does an elevated ESR indicate?
Infection, Inflammation and Malignancy
ESR
Erythrocyte Sedimentation Rate - abnormal plasma proteins cause rouleaux formation and faster settling
What does polychromatophilia or polychromasia indicate?
Abnormally high number of immature RBC (change in colour)
0.5-1.5% if circulating RBCs are what type of cell?
Reticulocytes (immature)
Heme is composed of which two components?
Iron and Porphyrin Ring
How is the reticulocyte count affected by effective treatment of a deficiency anemia?
Increased
Name the microorganism associated with malaria
Plasmodium falciparum
What is the most common type of anemia?
Iron Deficiency Anemia
What is the number one cause of iron deficiency anemia?
Chronic Blood Loss
What is the second most common type of anemia?
Anemia of Chronic Disease
Name the test that would identify an abnormal type of hemoglobin
Hemoglobin electrophoresis
Name three hemoglobinopathies
Hemoglobin S, Hemoglobin C Increase in Hemoglobin A2 (Thalassemia)
Which protein the blood carries iron?
Transferrin
What does TIBC measure?
Amount of transferrin the blood
How is percent saturation calculated?
(Serum iron/TIBC) x 100
Name two abnormal types of hemoglobin
Hemoglobin S and Hemoglobin C
How are serum iron levels affected with anemia of chronic disease?
Serum Iron decreases
Where is the most of iron in the body located?
RBCs
What are two storage forms of iron?
Hemosiderin and Ferritin
What is hemochromatosis?
Iron Overload
How does iron deficiency affect TIBC levels?
Increase
Which hormone stimulates increased RBC production?
Erythropoietin
Hematopoiesis that takes place in the liver, spleen and lymph nodes is called what?
Extramedullary Hematopoiesis
Extravascular hemolysis mainly occurs in which organ?
Spleen
What is the most common familial hemolytic anemia?
Thalassemia
Describe the changes to the globin chain in the case of sickle cell anemia
Valine substituted for glutamate @ 6th position of beta chain
How does hemochromatosis affect percent saturation?
Increase
What is the best relatively non invasive test of storage iron?
Serum Ferritin
A positive Coomb's test indicates what type of anemia?
Autoimmune Hemolytic Anemia, Hemolytic Disease of Newborn
What is another name for Vitamin B12?
Cobalamine
What is the most common cause of folate deficiency anemia?
Dietary Insufficiency
Name two causes of macrocytic anemia
B9 and B12 Deficiency Anemia
Which sub-category of neutrophils are increased with megaloblastic anemias?
Hypersegmented Neutrophils
Which vitamins are required for remethylation of homocysteine to methionine?
B9 and B12
Gastric parietal cells synthesize what that is needed for B12 absorption?
Intrinsic Factor
Folic acid supplementation can mask this deficiency
B12 Deficiency
What is the confirmatory test for hereditary spherocytosis?
Osmotic Fragility Test
Which isoform of LDH is elevated with RBC lysis?
LDH Isoenzyme 1
Which test has been used in the past to determine the etiology of B12 deficiency anemia?
Schilling Test
Which vitamin is required for the reaction that converts methylmalonyl CoA to succinyl CoA?
B12
Pica, Pagophagia and Koilonychia are associated with severe cases of which type of anemia?
Iron Deficiency Anemia
What is koilonychia?
Spoon nails
Why might serum ferritin be elevated in anemia of chronic disease?
Iron is low, more is stored in ferritin
Which blood cells may be elevated with acute blood loss anemia?
Leukocytes and Thrombocytes
The anti-intrinsic factor antibody test may be elevated with which anemia?
B12 Deficiency Anemia
Exposure to toxic chemicals drugs, or radiation may cause which type of anemia?
Aplastic Anemia (Marrow Failure)
What causes myelopthisic anemia?
Replacement of bone marrow by infiltrative process such as metastatic carcinoma and granulomatous disease
Name an abnormal RBC type associated with pyridoxine responsive anemia
Siderocytes
Which type of bilirubin is elevated in the blood with acute hemolytic anemia?
Indirect Bilirubin
How is urine urobilinogen affected with acute hemolytic anemia?
Increased urobilinogen
Basophilic stippling with chronic hemolytic anemia may be due to what cause?
Lead Poisoning
What do RBC survival studies indicate in the case of chronic hemolytic anemia?
Lifespan of RBCs
How would you describe bone marrow in the case of B12 deficiency anemia?
Megaloblastic/Hypoplastic
What is deficient in the case of alpha thalassemia?
Reduces production of hemoglobin. No alpha polypeptide chain synthesis
Does the word trait usually indicate the homozygous or heterozygous form of an anemia?
Trait usually means heterozygous form and asymptomatic
Describe the findings for RBC count and MCV in Thalassemia Minor
Increased RBC and Decreased MCV
Should a patient with Thalassemia be given iron supplements?
No
Jaundice, leg ulcers, cholelithiasis and splenomegaly are most likely seen with which 3 anemias?
Thalassemia Major, Sickle Cell Anemia, Hereditary Spherocytosis
Severe abdominal and bone pain crises are a feature of which anemia?
Sickle Cell Anemia
What is different about Hemoglobin C compared to Hemoglobin S?
Lysine is substituted for glutamate @ 6th position of beta chain
Which anemia is more serious? Sickle Cell? Hemoglobin C Disease?
Sickle Cell
What is an AKA for hereditary spherocytosis?
Congenital Hemolytic Anemia
What is different about cell membranes in the case of hereditary spherocytosis?
Abnormally impermeable to sodium
Which anemias are microcytic hypochromic?
Iron Deficiency Anemia, Anemia of Chronic Disease, Thalassemia, Pyridoxine Response Anemia
Which anemias are macrocytic?
B9 and B12 Deficiency
Which WBCs elevate with allergies and parasites?
Eosinophils and Basophils
Why do anemias such as sickle cell and thalassemia remain in the gene pool?
Protection against malaria
Which enzyme deficiency leaves older RBCs more sensitive to oxidative damage?
Glucose 6 Phosphate Dehydrogenase
What is the most common cause of B12 Deficiency Anemia?
Lack of Intrinsic Factor
What conditions would elevate serum ferritin?
Hematochromatosis, Inflammatory Disease, Malignancy
Name two negative acute phase reactants
Albumin and Transferrin
Name two positive phase reactants
Ferritin and CRP
How does dehydration affect most lab values?
Increase
How does overhydration affect most lab values?
Decrease
Which lab value is abnormal with secondary polycythemia?
Increased RBCs
How would +4 schistocytosis affect RDW?
Increased
Most hemoglobin in the blood is which type?
Hemoglobin A1
What is the confirmatory test for sickle cell anemia and hemoglobin C disease?
Hemoglobin Electrophoresis
Deficiency of which two vitamins interferes with blood cell production?
B9 and B12
Which cell types increase with primary polycythemia?
RBC
List 3 confirmatory tests for infectious mononucleosis
Paul Bunnel Test, Monospot, Heterophil Agglutination