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Hemo Labs
Hematology
| Question | Answer |
|---|---|
| Schilling test | 2-step test using radiolabeled B12 to test for pernicious anemia |
| Schistocytes; MAHA; high LDH; low platelets; ADAMTS13-auto antibodies; neg Coombs = | TTP |
| TTP labs | Normal PT, PTT, fibrinogen. Platelets <20,000. High LDH. MAHA (schistocytes, helmet cells, NRBCs). ADAMTS13-auto antibodies. Neg Coombs |
| Glanzmann labs | normal ristocetin (von W or B-S abnormal); abnl ADP, collagen, thrombin (opp von W or B-S) |
| DIC labs | +D dimer, +FSP; low fibrinogen; PTT prolonged more often than PT, but PT goes out 1st (FVII short half life) |
| Fe def anemia labs | low H&H/MCV, aniso & poikilocytosis, TIBC increases; ferritin <30, serum Fe <30, transferrin saturation <15%; high plts in severe |
| thalassemia labs | Hgb H: lower Hct. Hgb H & beta thal: increased retic (alpha: normal); Normal Fe/ferritin. Basophilic stippling & NRBCs |
| thalassemia: blood smears | alpha: target/acanth; Hgb H: target/poik; beta: target, poik (NRBCs in major) |
| sideroblastic anemia labs | Hct 20-30, high serum Fe, low MCV, hypochromic; BM eval to est dx (sideroblasts); HSM; baso stippling in Pb tox |
| N/N anemia labs | nml-high BM iron stores/ serum Fe/ferritin, nml-low TIBC |
| macro anemia 2/2 folate def: labs | serum folate <150 ng/mL (daily diet req 50-100 mg/dL); macro-ovalocytes, H-J bodies, nml B12 |
| macro anemia 2/2 B12 def: labs | high MCV, aniso, poik, macro-ovalocytes, hypersegs; high LDH & indirect bili; low B12, low retic, high methylmalonic acid |
| G6PD def | inc retic & ind bili; bite cells & Heinz bodies |
| CRAG = | cryptococcal Ag assay |
| Hemolytic anemia lab findings | Low haptoglobin; high LDH (microangiopathic hemolysis), high indirect bili (not >4-5mg/dL unless underlying liver dz); high retic with low-normal H&H; hemoglobinuria; stable or falling Hgb |
| Absolute Neutrophil count formula | WBC x (% segs + % bands) = ANC |
| Neg Coombs | hereditary spherocytosis |
| Pos Coombs | AIHA, cold agglutinin |
| HIT labs | Plt drop 4-10 d post heparin; 50% of plt baseline; coags normal; confirm w/Serotonin Release Assay |
| PT measures: | extrinsic (FVII) & common pathways (Factor 1,2,5,10) (exogenous TF is added to initiate clotting) |
| aPTT measures: | intrinsic (factors 12,11,9,8) & common pathways (1,2,5,10) |
| Cause of prolonged PT: | Def. in FVII and Common Pathway Factors (FX, FV, FII, Fibrinogen); Liver Dz; Warfarin tx; Vit K Def; Inhibitor to FVIIa (rare) |
| Common pathway deficiencies will prolong: | PT & aPTT |
| von W Disease usually presents with PT and aPTT that are: | Normal |
| Anti-Phospholipid Syndrome: Labs | prolonged aPTT (b/c in vitro fx of the Ab on aPTT); mixing study fails to normalize; confirmatory tests required to make the diagnosis |
| Confirm HIT with: | Serotonin Release Assay |
| Unlike PTT, PT tests for | factor 7 |
| PT monitors: | Coumadin; common pathway (1,2, 5, 10); F7 |
| PT/PTT ref ranges | PT = 11-13; PTT = 26-36 |
| PTT monitors: | Heparin; intrinsic (12, 11, 9, 8); common pathway (1,2, 5, 10) |
| Formula: corrected retic | % retic x HCT/45% = absolute % retics |
| Hallmark of Waldenstrom: | Monoclonal IgM spike in SPEP |
| Waldenstrom is differentiated from MGUS by: | Presence of bone marrow infiltration |
| Pancytopenia seen in: | ALL, AML, hairy cell |
| Giant plts & teardrop poik | Myelofibrosis |
| Dohle bodies | blue patch near edge; PMN; infxn |
| Toxic gran | purple/blue-black; PMN; severe infxn/toxic |
| Hyperseg: | 6 or more; PMN; megaloblastic anemia, B12-folate def |
| Causes of prolonged aPTT: | Def of intrinsic (FXI, FVIII, FIX ) & common pathway factors; Heparin & DTI tx; Inhibitors to coag factors |
| Prolonged aPTT; doesn't correct w/mixing study | FVIII inhibitor |
| PT is sensitive to (1) & normal range is (2) | (1) FVII ; (2) 9.5-13.1 |
| aPTT measures: | intrinsic (factors 12,11,9,8) & common pathways (1,2,5,10) |
| aPTT normal range | 24.1-32.3 sec (uses neg charged particles to initiate) |
| Very rare causes of prolonged PT | FVII def; FVIIa inhib |
| DIC labs: | 1st PT prolonged 1st (2/2 short FVII half-life), then long aPTT. Low factor II, V, VII, VIII, IX, X) & fibrinogen & AT & platelets. Anemia High D-Dimer (more specific than FSP). Schistocytes; likely toxic granulation. |
| Normal bleeding time is | < 8 min |
| Single best indication of functional platelet deficiency | Bleeding time |
| When is bleeding time is prolonged? | Platelets <100,000. Abnormal platelet function. Drugs (eg, clopidogrel) |
| Heparin tx PTT range | 50-70 seconds |
| Negative Coombs | hereditary spherocytosis |
| Positive Coombs | AIHA, cold agglutinin |
| Heinz bodies | Hemolytic anemias (G6PD) |
| Low retic is found in: | hypoproliferative anemia; B12; PRCA; aplastic anemia |
| Defintion of neutropenia | PMN <1500 (AA may have 1200 normal) |
| Absolute Neutrophil count formula | WBC x (% segs + % bands) = ANC |
| Reticulocytosis may reflect: | Hemolytic anemias. Elevated retic indicates increased RBC production |
| PNH labs | Flow cytometry: absence of CD59 Ab. Normocytic; hemoglobinuria |
| Sickle cell labs | Very low Hgb (7-10). sickled cells: 5-50% of RBCs. Reticulocytosis. NRBCs. Leukocytosis, thrombocytosis, high indirect bilirubin |
| H&H normal ranges | RBC: M 4.4-5.9, F 3.8-5.2. Hgb: M 13.3-17.7, F 11.7-15.7. Hct: M 40-52%, F 35-47% |
| Gold standard test to measure Hct | RBC mass: nuclear med test measuring mL RBCs per kg body wt (usually reserved to evaluate polycythemia |
| Normal retic range | 0.5-1.5% |
| Lead poisoning labs | Micro/hypo, basophilic stippling. ringed sideroblasts. Increased Fe, normal TIBC, increased transferring & ferritin. Lead lines in xrays of long bones. Blood lead level >10 in kids |
| Pernicious anemia labs | Serum IF (intrinsic factor) antibodies, parietal cell antibodies, high serum gastrin levels, high MMA and homocysteine. pos Schilling test |
| Anemia of chronic disease labs | N/N (possibly mildly micro/hypo). Normal-high ferritin. Low Fe and TIBC. |
| Transferrin saturation calculation | Serum iron / TIBC |
| ITP labs | Isolated thrombocytopenia +/- megakaryocytes in BM. Acute form <20,000. Chronic form 30,000-80,000. Coags normal. Platelet clumping on smear suggests pseudothrombocytopenia |
| Hemophilia A & B labs | Decreased level of FVIII or FIX. Increased PTT; normal PT, bleeding time, & fibrinogen. |
| Hemophilia A & B: mixing study results | Mixing normal plasma with Hemophilia pt plasma -> normal PTT |
| von Willebrand labs | BT >8 min. Low factor VIII level. High PTT. Platelet aggregation abnormal with ristocetin. Low vW antigen (VWF:Ag); Low levels of vW Activity (VWF:RCo). Multimers are decreased |
| Liver dz coagulopathy labs | Prolonged PT>PTT. Long PTT in advanced dz. Mixing study corrects. No response to Vitamin K. low fibrinogen. Target cells & macrocytes on PBS. |
| Lupus anticoagulant labs | Immunoglobulin in pts with / without SLE. Increases risk of VTE & spontaneous abortion. High PTT. Mixing study does not completely correct. |
| Beta thalassemia labs | Beta major: Hgb A2 and Hgb F. Beta minor: Hgb A2 |
Created by:
Abarnard
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