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