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Clin Path 1

Quiz 1

Normal urine color? Yellow or Amber
Reddish amber urine color? urobilinogen
Milky urine color? infection/diseases
Brownish yellow or green urine color? bile
Red or smoky brown urine color? blood
Yellow foam in urine? bilirubin
White foam in urine? albumin
Coca-cola color of urine? AGN
Normal odor of urine? Aromatic
Ammoniacal odor of urine? bladdar retention
Fruity odor of urine? Ketone bodies = DM
Foul odor of urine? bacterial infection
Measurment of the dissolve substances present in the urine or expression of the concentration of urine? specific gravity
Normal ranges for specific gravity? 1.003 - 1.030
Low specific gravity indicates what? Diabetes insipidus
High specific gravity indiates what? Diabetes Mellitus
Fixed specific gravity at 1.010 indicates what? tubular injury/Advanced kidney failure
Normal pH levels? 4.5-8.0
Low pH levels of urine? acidosis, fever, increased protein diet
High pH levls of urine? alkalosis, infection
Presence of protein in urine is mostly indicative of what? renal disease
The apearance of protein urine means what? That it's not neccisarily renal disease
Urine strip for proteins is primarily sensitive to what protein? albumin
Dominant constituent in proteinuria? albumin because of its small molecular size
Type of proteinuria that is not associated with easily demonstrable systemic or renal damage and why? Causes of this type of proteinuria? functional because there are no tests or aha lesions; orthostatic proteinuria
Type of proteinuria that is associated with demonstrable systemic disease or rernal pathology? organic proteinuria
3 types of organic proteinuria? prerenal, renal, postrenal
Normal renal threshold of glucose is what? 180mg/100ml serum glucose level
Causes of increased glucose in urine? Any cause of increased blood glucose, endocrine disorders, major trauma, stroke, MI, burns, infections...
Causes of decreased glucose in urine? Treatment with ascorbic acid, levodopa, or mercurial diuretics
Most common cause of glucosuria? diabetes mellitus
Ketonuria appears when? When there is an increased use of fat instead of carb for metabolism
Conditions of ketonuria include what? DM, alcoholism, vomiting and inadequate intake of carbs due to starvation or weight reduction or pregnancy
Presence of intact RBC's in thet urine hematuria
Presence of free Hb in the urine hemoglobinuria
Causes of hematuria trauma or irritation
Causes of hemoglobinuria Lysis of RBC's in the urinary tract, intravascular hemolysis, or transfusion reactions. Very dilute or extremely alkaline urine can also lyse the cells.
Myoglobinuria indicates what and may appear in what? muscular destruction; hypothermia, convulsions and extensive exertions
False negatives of hematuria include what? failure to mix or large doses of vitamin C
a leukocyte esterase false positive can be because of what? trichomonas organisms
Nitrites in urine tests for what? gram-negative bacteria (bacteriuria) caused by nitrate reducing bacteria
Urine must be incubated in the bladder for how long to produce a positive nitrite test? 4 hours
Appearance of urinary bilirubin can be a sign of what? liver disease or extrahepatic or intrahepatic biliary obstruction
What tyep of bilirubin is found in the urine? conjugated water soluble bilirubin
Reference range of RBC's, WBC's and casts under a microscopic exam of a urinary sediment? 0-2 RBC, 0-5 WBC and an occasional cast per high power field
Best specimen for a microscopic exam of urine? first-morning, mid-stream
Clinical significant hematuria under a microscope? >3 RBC per hpf
Clinical significant pyuria under a microscope? >5 WBC per hpf
Etiology of RBC's in urine under a microscope include? benign hematuria or a vaginal contaminant
WBC's in urine? pyuria
Pyuria of renal origin is usually accompanied by what? significant proteinuria
UTI's tend to be accompanied by what? bacteriuria
Suspicion of contamination of epithelial cells? >10 squamous epi cells per lpf
Hyaline casts indicate what? Casts seen in exercisers
Waxy casts indicate what? advanced kidney failure
RBC casts indicate what? AGN
WBC casts indicate what? Acute pyelonephritis and WBC's uriginate in the kidney
Fatty casts inidcate what? nephrotic syndrome
Fatty, RBC and WBC casts are always what? significant
A few hyaline and granular casts have what? no importance
To make blood? Hematopoiesis
RBC's in bone marrow called? medullary hematopoiesis
RBC's our of the bone marrow called? Extramedullary hematopoiesis
To make RBC's Erythropoiesis
Specific hormone which responds to hypoxia? Originating where? Erythropoietin; kidney
Erthyrocyte stage where the RBC has a nucleus, nucleus has no function and the cytoplasm is orange/red in color orthochromatic normoblast
Erthryocyte stage where there is no nucleus, cytoplasm is slight blute and is larger than the mature rbc? AKA what? polychromatic erythrocyte; reticulocyte
Diameter of a mature erythrocyte? 7.2 micra
5 hemoglobin types? gower 1, gower 2, Hb F, Hb A, Hb A2
Majority of the Hb when you are a fetus? Hb F
Majority of the Hb when you are an adult? Hb A
Aged RBC's are phatocytized by the macrophages of the RE syste and broken down into iron, globin and protoporphyrin, majority of the Hb breakdown. Extravasclar hemolysis
RBC's lyse within the circulation and is the minority of the Hb breakdown Intravascular hemolysis
CBC includes what? Hb, total RBC count, Hct, RBC indices, WBC count, Platelet count
Hb is great at detecting what? anemias or erythrocytosis (Opposites)
Hb is (Increased/Decreased) in all anemias? Decreased
Improper what will give you a false increase in Hb? venipuncture technique, which may introduce hemoconcentration
RR for Hb? 14g/dl +/- 2 g/dl in women; 16g/dl +/- 2 g/dl in men
Anemia exists when the Hb level is what? <13 in males and <11 in females
What will increase the Hb levels? Heavy smokers, exercise, living at high altitudes, higher in the morning
Fake anemia is called what and seen in who? dilutional pseudoanemia seen in pregnancy and athletes
RR for RBC count? 3.5-5.5 mill for women, 4.3-5.9 mill for men
Decrease in RBC's? Various anemias
Increased in RBC's? myelopoliferative neoplasms
Ratios of spun RBC's to plasma reflecting the volume of packed RBC's Hematocrit
Equation for Hct Hb x 3
Falsely elevated Hct prlonged stasis
Falsely decreased Hct EDTA keeps blood from clotting
RR for Hct 37-47% females, 40-54% males
What is used to determine the morphologic type of anemia? RBC indicies
Average measurement of RBC volume Mean Corpuscular(Cell) Volume (MCV)
RR of MCV 80-100 femtoliters(fl)
Causes of increased MCV? macrocytic anemias, myelodysplastic syndromes, alcoholism, liver disease, hypothyroidism, infants and newborns
Causes of decreased MCV? iron deficiency anemias, Thalassemias, Hereditary sideroblasic anemia, lead poisening, chronic disease anemia
Etiology of macrocytosis Folate or B12 deficiency, Chronic liver disease, chronic alcoholism, reticulocytosis, myxedema
Etiology of microcytosis Chronic iron deficiency, alpha or beta thalassemia, anemia of chronic disease, sideroblastic anemia
Quantity(weight) of hemoglobin in the average RBC? Mean Cell Hemoglobin(MCH)
RR of MCH 27-33 picograms(pg)
Increased MCH macrocytic anemias and infants
Decreased MCH microcytic and normocytic anemias
Color or the average concentration of hemoglobin in the average RBC? Mean Cell Hb Concentration(MCHC)
Decreased MCHC Microcytic and normocytic anemias, pale
Increased MCHC Macrocytic anemias, hereditary spherocytosis and infants
Better test for identifing hypochromasia? MCHC
RR of MCHC 32-36 g/dL
Index of RBC size differences and useful in drawing attention to anisocytosis, a marker for various anemias RBC Distribution Width(RDW)
T/F: RDW is never decreased True
First thing that changes in anemias? RDW
RR of RDW 11-15%
RR for WBC count 4,500-11,000/microliter
Decreased WBC count? Leukopenia
Increased WBC count? Leukocytosis
Causes of leukopenia? Viral infections
Causes of leukocytosis? Bacterial infections
Platelets Small discoid blood corpuscles, the primary link in achieving hemostasis
RR of platelets 150,000-400,000/cu mm
Too many platelets called what? What causes this? Thrombocythemia; Malignancy
Decreased platelet count? Thrombocytopenia
<70,000 platelets is clinically evident for what? Bleeding tendency
What two tests will give 90% of all the diagnostic info obtainable by the hematologic examinations? PBS and Hb value
Peripheral blood smear tests for what? To obtain differential counts of WBC and to study blood cell morphology
PBS are most helpful for the rapid identification of what? anemias, leukemias and platelet abnormalities
Variation in RBC sizes and by what? anisocytosis; by RDW
Variation of the shape of RBC poikilocytosis
Bluish discoloration of RBC reflecting reticulocytes polychromasia
What are the 2 anisocytosis sizes named and how are they tested? microcytes and macrocytes; MCV
RBC fragmentation syndromes Schistocytes
Spiky RBC's? and what causes them? Acanthocytes; severe liver disease, anorexia nervosa
Causes of echinocytes? artifact, liver disease, renal disease, hyperlipidemia
Causes of bite cells(degmacytes) hemolytic anemia due to an oxidizing agent(Heinz body anemia)
Shaped cell seen in thalassemia? Target cells
Causes of teardrop cells? myeloid metaplasia, CML
Stacked up coins and what causes them? Rouleaux; multiple myeloma
RBC type caused by lead poisoning? Basophilic stippling
RBC type caused by magaloblastic anemias and thalassemia? Howell-Jolly bodies
RBC type caused by an increased iron load? Pappenheimer bodies
Pale RBC's caused by what? hypochromic; iron deficiency anemia, thalassemia
Spherocytes are what color? Hyperchromic
Reticulocytes are what color? polychromatophilic
Shift to left means what? infection
Neutrophils with > than 5 nuclear lobes is called what and seen in what? hypersegmentation; pernicious anemia, b12 or folic acid deficiency
Reactive lymphocytes are seen in what and look like what? viral infections like mono; too much blue cytoplasm
Presence of both immature WBCs and nucleated RBCs in the PBS is what? Caused by what? leukoerythroblastosis; leukemia
Normal range of neutrophils and increased in what? 50-70%; bacterial infections
Increased neutrophils is called what? neutrophilic leukocytosis
Decreased neutrophils is called what? neutrophilic leukopenia
Normal range for eosinophils? 1-5%
Increased eosinophils is called what and what causes these to increase? eosinophilia; parasites and acute allergic reactions
Normal range for basophils? 0-1%
Increased basophils is called what? When is it increase? basophilia; bad to be increased, seen in myeloproliferative disorders
Normal range of lymphocytes? 20-40%
Increased lymphocytes is called what and what causes them to increase? lymphocytosis; viral infections
Decreased lymphocytes is called what and what causes them to decrease? lymphocytopenia; immunodeficiency syndromes (AIDS)
Normal range of monocytes? 2-10%
Increased monocytes is called what and what does it mean to be increased? monocytosis; good to have AFTER an infection, helps the recovery
Hematological test of inflammation? erythrocyte sedimentation rate (ESR)
ESR Test Filling a tube with anticoagulated whole blood and measuring the rate of RBC sedimentation during 1 hour. Most changes in sed rate are caused by alterations in plasma proteins, mainly fibrinogen
RR for ESR children: 3-13mm/hr post-adolescent man: 1-15mm/hr post-adolescent woman: 1-20mm/hr
Formaula for ESR? males = age/2 females = age + 10/2
Bad nodes? hard, non-movable, non-tender, hard to get finger around them
Basic neoplastic cell of Hodgkins is what and some of these cells take on a binucleated form called what? malignant reticulum cell; Reed-Sternberg Cells
Male:female ratio? 1.4:1
Bimodal age distributions? 15-34 than another after 54
Clinical findings of Hodgkins? localized, progressive, painless lymphadenopathy; unilater nodes at neck; intense pruritus; night sweats, Pel-Ebstein Fever, weight loss, anorexia; immediate pain after alcohol
Lab findings of Hodgkins? Lymphocytopenia, anemia(33-50%)(hypochromic and microcytic), Eosinophilia (20%), elevated serum alkaline phosphatase (Bone Marrow or liver involvement)
Hodgkins Triad? fever of unknown origin, pruritus and lymphadenopathy
Diagnosis of hodgkins from what? lymph node biopsy
Disease which means many cells in the blood, also called what? polycythemia vera; stem cell CA
Myeloproliferative clonal disorder marked by increased RBC(erythrocytosis) with excessive erythroid, myeloid and megakaryocytic elements in the BM. Increased RBC, WBC and Platelets. Polycythemia vera
Hx of PV? asymptomatic or present with nonspecific complaints, erythromelalgia (burning pain of feets/hands), pruritus
Physical exam of PV? Organomegaly(liver and spleen), facial plethora(Redness of face)
Lab findings of PV? Inc. RBC, Inc. Hct, Dec. EPO, Thrombocytosis, Leukocytosis, hyperuricemia, hypercholesterolemia
Management of PV? phlebotomy
Secondary erythrocytosis Hypoxia, high altitude, chronic lung disease, hormonal
Relative erythrocytosis Falsely increased RBC's due to decrease in plasma volume. Etiology dehydration(cloudy urine)
Overview of leukemia? Diminished production of normal RBC's, WBC's and platelets
Leukemia that the predominant cell is usually the blast WBC(young WBC) Acute Leukemia
Leukemia that the predominant cell is the more mature WBC's Chronic Leukemia
Leukemia in which the total peripheral blood WBC count is within the RR but a significant number of immature cells are present as well Subleukemic Leukemia
Leukemia in which the PBS of WBC count is normal and no abnormal cells are found in the peripheral blood. Aleukemic Leukemia
Etiology of Leukemia? virus's, ionizing radiation, chemical leukemogens and genetic defects
Clinical findings of Leukemia? splenomegaly, lymphadenopathy, fever, anemia, hemorrhage, infection
Pediatric Leukemia Acute Lymphoblastic Leukemia (ALL)
History of ALL? Bleeding, bone/jt pain, limp, refusal to bear weight, anemia, respiratory distress, renal failure, headache
Lab findings of ALL? WBC elevated, Anemia, leukemic lymphoblasts in the peripheral blood smear(PBS)
Adult Leukemia Acute Myeloid Leukemia(AML)
2nd most common type of leukemia in adults? AML
M:F Ratio of AML Men>Females
History of AML? Fatigue, bleeding, difficulty clearing infections
Lab findings of AML? Leukocytosis, myeloblasts with auer rods
Most common form of leukemia in adults in the US? Chronic Lymphocytic Leukemia(CLL)
Predominant age for CLL elderly, 70 years old
History of CLL Insidious onset normally discovered incidentally. Asymptomatic at the time of diagnosis. Enlarged nodes, early satiety, enlarged spleen, mucocutaneous bleeding and/or petechiae due to thrombocytopenia, fevers and night sweats.
Lab findings of CLL Absolute lymphocytosis, ruptured lymphocytes(smudge cells) and mature-appearing small lymphocytes
Leukemia with the proliferation of myeloid precursors? Chronic Myelogenous Leukemia (CML)
Hallmark of CML is what? Philadelphia chromosome
History of CML? Splenomegaly is usually moderate but may be extreme
Lab findings of CML? WBC markedly increased, granulocytes in all stages of development, basophilia, eosinophila, platelets can be normal, elevated or low on occasion
Created by: 1277880004
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