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Ph111-1

Cbc

QuestionAnswer
Lab tests are used for: 1. To diagnose a patient, 2. To screen individuals, 3. To assess progress.
Progress: how the patient is doing now.
Prognosis: how a patient will be a week from now.
Patients lab value: actual found value
The reference interval: interval that covers 95% of the population "normal"
Outside of the interval: would be considered abnormal,even the other 5% of the population.
​Accuracy correctness. how close to a true value.
​ Precision deals with reproducibility.
Specificity ability to determine a true postive(affected when actually affected)
Sensitivity abilty to determine a false negative(not healthy when actually affected)
​Hematology is the study of blood as well as the blood forming tissues.
​Hematopoiesis is the formation and the development of all types of blood.
CFU( colony forming unit) ​The minimum number of stem cells to produce blood cells, is known as colony forming unit.
Where are WBC's and  RBC's produced and matured? in the bone marrow
Erythrocytes RBC
Erythropoiesis red blood cell production
Hematopoiesis production of all blood cells.
Erythropoietin hormone made in kidneys, stimulate RBC prod. in the bone marrow under low O2.
CBC gives you number of RBC, also hemoglobin, hematocrit, reticulocyte count, mean corpuscular volume, concentration, White blood cell count, and Platelet
RBC from pluripotent stem cells, mature in circulation, de-nucleated, biconcave disks, size ~ 8 microns, very flexible(squeeze in kidneys and spleen for O2 exchange) buffer by CO2 bind; E.g. sickle cell anemia, can have micro infarcts in kidneys or spleen,
Hypoxic E.g. low RBC = low O2 levels
Low RBC count anemia but does not say type, from anemia perspective you can either stop decreasing RBC, or  bleeding internally or external.
Increased number of RBC It is known as erythrocytosis.
Real erythrocytosis increase number of RBC. Mostly cancer, require chemotherapy. Apparent erythrocytosis
Early RBC no nucleus slightly red colored or bluish, known as a reticulocyte and it is functional 1% of all your RBC’s are reticulocytes.
Reticulocyte in anemia count increases in early anemia, From a pharmacist’s perspective, if you are initiating therapy and reticulocyte count does not increase, you are initiating the wrong therapy.
​Corrected reticulocyte count due to anemia changing the bottom line. Corrected reticulocyte count is the observed times the patient’s hematocrit divided by the mean normal hematocrit (45%)
Hemoglobin gives red blood cell a red color, carries oxygen, helps measure the ability to carry oxygen. If HMG is low, you can’t carry normal amount of oxygen.
HMG’s is made of? four peptide chains, two alpha and two beta subunits in normal adult HMG, Abnormal HMG is known as hemoglobinopathy. E.g. Sickle cell anemia (hemoglobin S) and Alpha and beta thalassemia
​Hematocrit packed cell volume (PCV). It is the percentage of RBC in the whole blood. Proportional to RBC's. Helps indicate size of RBC and amount of HMG/cell
Mean Corpuscular Volume (MCV) volume and size of the red cell.
Normocytic normal range MCV
Microcytic low MCV
Macrocytic High MCV
Mean Corpuscular Hemoglobin (MCH) weight / color of RBC. If weight is high then a lot of HMG, therefore red color.
Normochromic cells normal color
Hypochromic cells lower than normal MCH
Hyperchromic cells higher than normal MCH
Mean Corpuscular Hemoglobin Concentration (MCHC) MCH and MCHC relate the color of RBC. Sometimes the cells can have variation in sizes, they are not uniform.
Anisocytosis is a medical term for variation in cell size.
Poikilocytosis means variation in shape
Iron 1 ml of blood = ½ mg of iron, bleeding =  loss of iron
1. Functional iron 90% found in hemoglobin and 10% in myoglobin, which is inside the muscle. 2. Stored iron
a. Ferritin (stored iron in liver, spleen, bone marrow). Serum ferritin is a description of what is stored,  “normal”  = high.
b. Hemosiderin another storage product for iron
Iron is found in 2 ways ferrous (Fe+2) and ferric (Fe+3). Most of the food has ferric, difficult to absorb so it is aided by HCl in the stomach. If you don’t have enough gastric acid you are at risk of iron deficiency anemia.
How much is consumed and absorbed? 10 – 20 mg/day. only 10% is absorbed ~1mg/day to replenish the 1mg/day lost, women need 1.5mg/day due to menstruation. A flag is raised when low in males.
Iron when cell dies RBC removed by reticuloendothelial system. The hemoglobin is reused or discarded. The iron will be reused to make more RBC. The iron is moved to bone marrow by transferrin, which carries iron through the body.
Normal plasma has enough transferrin to bind about 250 – 400 micrograms/deciliter, and iron is 50 – 150. If you do a ratio of iron to total iron binding capacity,  total transferrin is about 1/3 saturated. 25 – 33% Fe : TIBC is normal.
​ A Fe : TIBC of 16% or less is diagnostic of iron deficiency anemia. A person who has levels of 16 – 25% we are not sure.
hypochromic microcytic anemia, should you think it is late stage iron deficiency anemia? no. You must look at the Fe : TIBC, ferritin levels if normal then is not
Cobalamin is the functional unit of vitamin B12, needed for mitochondrial reactions. In the stomach it binds with intrinsic factor, secreted by the gastric parietal cells. so low HCl =low intrinsic factor. This patient has 2 problems.
The carrier for cobalamin can either be transcobalamin 1 or transcobalamin 2
B12 deficiency is known as pernicious anemia. This is when you are not producing enough intrinsic factor.
Do all patients with B12 deficiency have pernicious anemia? no but all pernicious anemia do have a B12 deficiency. Pernicious anemia and B12 deficiency are not the same!
B12 deficiency will cause significant neurological abnormalities. it is easy to treat.
Reference intervals for B12 is 200 – 900 pg/ml
Shilling Test used to understand B12
Folic acid is not active; active once reduced to tetrahydrofolic acid or folate, If folic acid doesn’t get to the cell, the cell will die. Therefore, dihydrofolate reductase inhibitor is a good anti-cancer drug because growing cells need folic acid
WBC known as leukocyte, nucleated, It’s the largest cells and presents in the fewest number on a CBC.
​What are 2 types of WBC's: granulocytes and neutrophils
Granulocytes dark staining granules found in cytoplasm, these are Neutrophils, Eosinophils, Basophils
Agranulocytes also known as mononuclear – one nucleus.
white blood cell differential to look at all the different types of WBC. This is considered in 1000/mm3.
Leukocytosis Rise in number of WBC, caused by an infection, malignancies, normal body response to inflammation, etc.. In myocardial infarction, there is leukocytosis, this is normal. But temporary; An elevated WBC count does not mean there is for sure an infection.
Neutrophil Most common, immature WBC it is fast and the first defense against bacteria(eat it) after skin. Enter circulation, lifespan is 7 – 10 hours. divided nucleus, a segmented neutrophil(SEGS). Also polymorphonuclear leukocytes(POLY). Immature = bands or stabs
Neutrophilia – an increase in number and percent of neutrophils.
Neutropenia – a decrease in number and percent of neutrophils may occur during a viral infection, or a patient with a bone marrow problem à this is a big problem.
Shift to the left: More cells on left side of lab slip (line two – larger values on the left), This implies that WBC kills and eats things (bacterial infection). $
Shift to the right: The right side is larger than the left$
Lymphocytes second most common. They play an important role in the immune system – fighting off chronic infections.$
The two types of lymphocytes T–cells and B–cells.$
Lymphocytosis an increase in number of lymphocytes; seen in viral diseases (hepatitis).$
Lymphocytopenia a decrease in number of lymphocytes, e.g. immune suppression (AIDS)$
Monocytes are phagocytes that engulf bacteria in our body. They are important in bacterial chronic infections.$
Monocytosis an increase in number of monocytes. E.g. Tuberculosis, malaria, subacute endocarditis (infection of heart valves)$
Eosinophils respond to antigen/antibody, fight parasites and have a 2 lob nuclei.$
Eosinophelia is usually due to an allergic attack, asthma and parasites.$
Basophils found in skin and respiratory tract. known as mast cells and are important in allergic reactions. They have IgE receptors. E.g. a viral infection like chickenpox there is an increase in basophils.$
Platelets also called thrombocytes. They are needed for normal coagulation for external or internal cuts. If a patient has a decrease in platelets there is prolonged bleeding time.$
Thrombocytopenia bone marrow does not produce or is destroying platelets.$
Thrombocytosis malignancy$
Is the lab slip the platelet count accurate? it isn’t accurate, and is commonly repeated.$
Erythrocyte Sedimentation Rate (ESR) non specific lat test. It's a special ordered test. It is the rate at which the RBC sinks to the bottom of a test tube. The ESR will increase with any inflammation. Ex. Infection, rheumatoid arthritis.$
Blood Chemistry Test It allows us to measure blood levels of chemicals. In the lab they have instruments to measure 6, 7, 18 tests at a time. The instrument that does this is called sequential multiple analyzer or SMA or SMAC.$
SMA 12 measures 12 tests at a time$
CHEM 12 measures 12 tests at a time$
SMAC 12 measures 12 tests at a time$
SMA 6,7,12 universal$
SMA 18 is the most common$
SMA 6 always has the exact same test (Na+, K+, Cl, CO2, glucose and BUN)$
SMA 7 same as SMA 6, but also measures serum creatine$
SMA 12 varies$
Cations vs anions cations carry a positive charge, while anions carry a negative charge. Anions travel toward anode while cations travel toward the cathode in an electrical field.$
WATER Universal and body solvent. Water has many responsibilities, Transporting nutrients, removing waste, aids in cooling the body (perspiration) determines the size of cells. Found  in ICF and ECF(plasma and interstitial fluid).
SODIUM controls the water movenment by concentration and osmolality (mmol/kg) of water.
hypothalamus when osmolality of blood increases: you get thirsty as a result to reverse the increased osmolality to get your osmolality back to normal.
vasopressin (ADH): is secreted by your posterior pituitary. So if there is increased osmolality, it causes retention of water in your kidneys to reduce the osmolality.
Created by: studypharm