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LabMedicine Heme

LabMedicine Test 1

Male RBC 4.3-5.9
Female RBC 3.5-5.5
Birth RBC 5-6.3
Hemorrhage Low RBC
Hemolysis Low RBC
Dietary deficiency (Iron or B12) Low RBC
Sickle Cell Low RBC
Medications Low RBC
Chronic disease (Cancer, sepsis) Low RBC
Renal Disease Low RBC
Pregnancy Low RBC
Prosthetic Valves Low RBC
Dehydration High RBC
Hypoxia High RBC
Polycythemia Vera High RBC
High Altitude High RBC
Medications High RBC
Smoking High RBC
MCV 80-100
MCH 27-32
MCV tells cell size
MCH tells amount or weight of Hb
MCHC tells percent of Hg within a single RBC; color - hyper or hypochromic
Chronic illness normocytic, normochromic anemia
acute blood loss normocytic, normochromic anemia
aquired hemolytic anemia (heart valve) normocytic, normochromic anemia
iron deficiency microcytic, hypochromic
thalassemia microcytic, hypochromic
lead poisioning microcytic, hypochromic
renal disease microcytic, normochromic
B12 deficiency macrocytic, normochromic
folate deficiency macrocytic, normochromic
liver disease macrocytic, normochromic
alcoholics macrocytic
iron deficiency decreased MCHC
lead poisoning decreased MCHC
thalassemia decreased MCHC
spherocytosis increased MCHC
RDW red blood cell distribution width
Increased RDW large variation in RBC size
Iron deficiency increased RDW
folate deficiency increased RDW
B12 deficiency increased RDW
hemolytic anemia increased RDW
transfusion increased RDW
alcohol abuse increased RDW
Male Hb 14-17
Female HB 12-15
anemia low Hb
erythropoietin deficiency low Hb
Transfusion reaction low Hb
bleeding low Hb
lead poisoning low Hb
malnutrition low Hb
nutritional deficiencies (iron, folate, b12, b6) low Hb
overhydration low Hb
congenital heart disease high Hb
cor pulmonale high hb
pulmonary fibrosis high Hb
polycythemia vera high Hb
excess erythropoietin high Hb
anabolic steroids high Hb
Hematocrit percent of whole blood that is RBC
male Hct 40-50
female Hct 36-44
1 unit of blood raises Hct 1.5-2
anemia low Hct
blood loss low Hct
bone marrow failure low Hct
destruction of RBC low Hct
malignancies low Hct
malnutrition low Hct
rheumatoid arthritis low Hct
Anemia of chronic diseases low Hct
dehydration high Hct
erythrocytosis high Hct
polycythemia vera high Hct
WBC 4,500-11,000
Neutrophils fighting cells
emotional disturbances high neutrophils
nausea/vomiting high neutrophils
physical exercise high neutrophils
acute infections high neutrophils
bacterial, mycotic, rickettsial, spirochetal (strep) infection high neutrophils
acute inflammatory disorders high neutrophils
rheumatoid arthritis, rheumatic fever, vasculitis, myositis high neutrophils
uremia, diabetes acidosis, thyroid storm, eclampsia high neutrophils
post hemorrhage high neutrophils
leukemia high neutrophils
myeloproliferative disorders high neutrophils
tissue necrosis, MI, burns, malignant neoplasia high neutrophils
smoking high neutrophils
allergy high neutrophils
appendicitis WBC 10,000-12,000
bacterial infections (typhoid fever, sepsis) low neutrophils
hepatitis low neutrophils
mono low neutrophils
measles, rubella, flu, HIV low neutrophils
radiation/chemo low neutrophils
lupus, rheumatoid arthritis, alcohol low neutrophils
lymphocytes increased with mostly viral diseases
hepatitis high lymphocytes
mono, CMV, zoster high lymphocytes
mumps, measles, viral pneumonia high lymphocytes
pertussis high lymphocytes
IBD, ulcerative colitis, chrons disease high lymphocytes
ALL, CML leukemia, multiple myeloma high lymphocytes
acute infections low lymphocytes
increased corticosteroids with tx or Cushings low lymphocytes
immunodeficiencies low lymphocytes
defects in lymphatic drainage low lymphocytes
debilitating disease (cancer, lupus, TB, renal failure) low lymphocytes
monocytes increase with everything!
TB, lupus, syphilis high monocytes
hepatitis, mumps high monocytes
malaria high monocytes
leukemia, lymphomas high monocytes
polycystemia vera high monocytes
collagen vascular disease high monocytes
Main causes of increased eosinophils parasitic diseases, allergies, fungal infections
parasitic diseases (trichinosis, intestinal) high eosinophils
allergic diseases (asthma, urticaria) high eosinophils
skin disorders (eczema, pemphigus, TENS) high eosinophils
drugs high eosinophils
fungal infections (aspergillius, histo) high eosinophils
malignancy (hodgkins, ovarian, lung cancer) high eosinophils
platelets 150,000-400,000
safe platelet count to operate for emergent procedures 30,000
aplastic anemia low platelets
radiation/chemo low platelets
acute leukemia, myelofibrosis, multiple myeloma low platelets
most common cause of low platelets thrombocytopenia
excessive pooling (hypersplenism) low platelets
post transfusion purpura low platelets
Idiopathicothrompocytopenic purpura low platelets
mono low platelets
drugs low platelets
Disseminated Intravascular coagulation (DIC) low platelets
sepsis low platelets
hemolytic uremic syndrome low platelets
heart valves low platelets
heparin low platelets
HIV low platelets
Causes of low platelets by decreased production, excessive pooling, increased destruction
Causes of high platelets by reactive or primary diseases
infection high platelets
acute blood loss high platelets
cancer high platelets
splenectomy high platelets
polycythemia vera high platelets
chronic leukemia high platelets
Normal Pt Hemoglobin differences High HbA1, low Hg A2, low Hg F, No Hb S or C
Newborn HgF 50-80%
6 month old HgF 8%
>6month old HgF 1-2%
Beta Thalassemia Major Increased HgF
Sickle Cell Increased HgF
Reticulocyte count measures percent of immature RBC
erythroblastosis fetalis high reticulocytes
most common cause of high reticulocytes hemolytic anemia
acute blood loss/post hemorrhage high reticulocytes
kidney disease (increased erythropoietin) high reticulocyte
infiltrative marrow disorders high reticulocytes
bone marrow failure (due to toxicity, tumor, fibrosis, infection) low reticulocytes
cirrhosis low reticulocytes
folate, iron, vit B12 deficiency low reticulocytes
drugs low reticulocytes
kidney disease (decreased erythropoietin) low reticulocytes
Factor V Leiden hypercoagulable state
malignancy hypercoagulable state
PT prothrombin time
Normal PT 11-12.5 seconds
If pt is anticoagulated, PT should be 1.5-2 times faster than the normal PT
PT extrinsic pathways
Vitamin K dependent factors II, VII, IX, X
Extrinsic pathway factors I, II, V, VII, IX, X
coumadin prolonged PT
heparin prolonged PT
vit K deficiency prolonged PT
liver disease prolonged PT
decreased fibrinogen prolonged PT
VWF deficiency prolonged PT
DIC prolonged PT
DIC disseminated intravascular coagulation
factor deficiency prolonged PT
coumadin increased INR
Vit K decreased PT
Normal INR 2-3
INR international normalizing ratio
INR for mechanical prosthetic valves 2.5-3.5
If INR is 1.8 increase coumadin dose
if INR really high (10 or 11) give Vit K
ETOH prolong PT/INR
high fat or leafy veg decrease PT/INR
diarrhea/malabsorption prolonged PT/INR
allopurinol, b-lactams, quinolones, thorazine, cimetidine prolong PT/INR
anabolic steroids, digoxin, benadryl, BC decrease PT/INR
PTT intrinsic
Coumadin extrinsic
heparin intrinsic
PTT partial thromboplastin time
Normal PTT 60-70 seconds
APTT or anticoagulated pt PTT want to be 2x faster than normal so 30-40 seconds
heparin increased PTT
vit k deficiency increased PTT
liver disease increased PTT
DIC increased PTT
lupus anticoagulant increased PTT
factor deficiencies increased PTT
thrombin time TT
normal TT 12-18 seconds
TT used to detect hypofibrinogenemia and presence of heparin
heparin prolonged TT
severe hypofibrinogenemia <80 mg/dL fibrinogen
severe hypofibrinogenemia prolonged TT
DIC prolonged TT
normal fibrinogen level 200-400 mg/dL
critical fibrinogen levels <100 mg/dL
liver disease decreased fibrinogen
DIC decreased fibrinogen
large volume blood transfusion decreased fibrinogen
estrogens and BC increased fibrinogen
FSP fibrin split producs
FSP Normal value <10 mcg/mL
DIC increased FSP
therapeutic throbolysis TPA
TPA increased FSP
thrombosis increased FSP
thrombotic thrombocytopenic purpura increased FSP
hemolytic uremic syndrome increased FSP
D-dimer normal values <250mg/mL
DVT increased D-dimer
PE increased D-dimer
sickle cell increased D-dimer
malignant thrombosis increased D-dimer
major surgeries increased D-dimer
Direct Coomb normal values negative
direct coomb normal values trace - 4
positive coomb normal values >4
erythroblastosis fetalis elevated direct coombs
incompatible blood transfusion reaction elevated direct coombs
lymphoma elevated direct coombs
autoimmune hemolytic anemia elevated direct coombs
infectious mono elevated direct coombs
mycoplasma infections elevated direct coombs
hemolytic anemia after CABG elevated direct coombs
drugs - ampicillin, captopril, cephalosporins, thorazine false positive elevated direct coombs
direct coombs checks for antibodies on RBC surface
indirect coombs checkes for antibodies in blood serum
good glucose control <5.9% HbA1C
fair glucose control 6-8% HbA1C
poor glucose control >8% HbA1C
Created by: jjohrden16