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Hemo Labs

Hematology

QuestionAnswer
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