Basic Hematologic Tests – Flashcards
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CBC
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determine number, variety, percentage, concentration and quality of blood cells
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Red Blood Cell Count
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the number of RBCs per cubic millimeter of blood
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Purpose of RBC count
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evaluate bleeding, anemia, RBC production
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RBC count indirectly measures ...
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oxygen carrying capacity of blood
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normal mens RBC count
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4.2 - 5.4 x 10^6/microl (ave 4.8)
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normal womens RBC count
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3.6 - 5.0 10^6/microl (ave 4.3)
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How does posture change RBC count?
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count in recumbant person will be decreased
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How does dehydration change RBC count?
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results in elevated count
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How does altitude and smoking change RBC count?
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results in elevated count
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How does pregnancy change RBC count?
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results in decreased count
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decreased RBC count indicates ...
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anemia
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elevated RBC count indicates ...
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polycythemia
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What is the purpose of the hemoglobin count in a CBC?
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used to check and monitor anemia
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What two factors affect hemoglobin levels?
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number of RBCs and amount of Hb in each RBC
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HbA1
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major adult form of hemoglobin
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HbA2
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1.5 to 3% of normal form of hemoglobin
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HbF
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major fetal form of hemoglobin
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HbS
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sickle cell hemoglobin
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HbC
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mild hemolytic anemic hemoglobin
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normal amount of hemoglobin in men
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14 - 18 g/100 ml
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normal amount of hemoglobin in women
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12 - 16 g/100 ml
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normal amount of hemoglobin in newborns
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18.5 - 19.5 g/100 ml
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normal amount of hemoglobin in 2 -3 month old infant
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10 - 11 gm/100 ml
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hematocrit (Hct)
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the red cell volume expressed as a percentage of the whole blood volume
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What factors determine the hematocrit?
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number of RBCs and their size
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normal hematocrit values in men
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42 - 52%
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normal hematocrit values in women
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36 - 48%
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How will venous stasis effect hematocrit?
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it will elevate values
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How will dehydration effect hematocrit?
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it will elevate values
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How will fluid retention effect hematocrit?
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it will decrease values
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How will altitude effect hematocrit?
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it will elevate values
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What does decreased hematocrit indicate?
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anemia
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What does increased hematocrit indicate?
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polycythemia
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MCV
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mean corpuscular volume
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MCH
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mean corpuscular hemoglobin
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MCHC
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mean corpuscular hemoglobin concentration
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RDW
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red cell distribution width
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Which CBC value is best for classifying anemias?
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MCV
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Which factors increase MCV?
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B12 deficiency, folate deficiency, alcohol abuse, liver cirrhosis
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What effect does B12 and folate deficiency have on MCV?
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MCV increases
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Which factors decrease MCV?
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iron deficiency, thalassemia
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How does chronic disease effect the MCV?
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MCV is normal
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What factor increases MCH?
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macrocytosis
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What factors decrease MCH?
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microcytosis or hypochromia
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What is the most valuable test in monitoring anemia therapy?
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MCHC
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What is the MCHC test best for?
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monitoring anemia therapy
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What is the RDW test useful for?
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following patients with anemia
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Reticulocyte count
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count of young, immature, nonnucleated RBCs
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What is reticulocyte count used for?
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differentiate anemias to those caused by bone marrow failure and those caused by hemorrhage or hemolysis
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What is a normal reticulocyte index?
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normal is >1%
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What does a <1 reticulocyte index indicate?
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decreased bone marrow response
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normal reticulocyte count in men
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0.5 - 1.5% of total erythrocytes
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normal reticulocyte count in women
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0.5 - 2.5% of total erythrocytes
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normal reticulocyte count in children
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0.5 - 4% of total erythrocytes
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normal reticulocyte count in infants
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2 - 5% of total erythrocytes
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What does a low reticulocyte count with anemia indicate?
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bone marrow failure, iron deficiency, aplastic anemia, chronic infection, B12 and folate deficiency
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What does a high reticulocyte count with anemia indicate?
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hemolytic anemia, 3 - 4days following hemorrhage, treatment of anemia
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Erythrocyte Sedimentation Rate (ESR)
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rate of fall of RBCs in plasma in one hour in a tube of standard diameter
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What factors increase ESR?
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inflammatory and necrotic processes cause aggregation of RBCs, making them heavier, resulting in an increased ESR
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normal ESR values in men
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1 - 10 mm/hr
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normal ESR values in women
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0 - 20 mm/hr
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What are interfering factors in ESR?
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blood older than 24 hours and refrigerated blood
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An increased ESR is seen in ...
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children, pregnancy, menstruation, oral birth control
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A decreased ESR is seen in ...
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high blood sugar, aspirin use, steroid use
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What is ESR used for?
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not diagnostic, but an indication that a disease process is ongoing
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What conditions increase ESR?
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acute and chronic disease, malignancy, rheumatoid and collagen disease, macrocytic anemia, anemia with rouleaux, MI
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What conditions decrease ESR?
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sickle cell anemia, spherocytosis, policythemia, microcytosis
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What information is gained from a peripheral blood smear?
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allows visual estimation of the amount of hemoglobin in RBCs and the overall size of RBCs
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What information about platelets can be gained from a peripheral blood smear?
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a good estimation of platelet count can be made
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In what conditions are spherocytes found?
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hemolytic anemia, autoimmune disease, and hereditary spherocytosis
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How do cells appear in spherocytosis?
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Hb volume and content is normal, cells appear microcytic and hyperchromic
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stomatocytes
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rectangular or slit like central pallor configuration
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Where are stomatocytes seen?
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spherocytosis, hemolytic anemia, alcohol cirrhosis
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echinocytes
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appear normal except for unifor small triangular projections
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Where are echinocyes seen?
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liver disease, renal disease, hyperlipidemia
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rouleaux formation
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stacked coin appearance due to the RBCs sticking to each other
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What is basophilic stippling associated with?
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lead poisoning
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Howell-Jolley Bodies
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small, round, blue-black inclusions that are smaller than basophilic stippling and ordinarily occur one to an RBC
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When are Howell-Jolley Bodies present?
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severe anemia
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codocytes
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(target cells) consists of a peripheral ring and central disc of hemoglobin
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Where are codocytes seen?
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thalassemia and chronic liver disease
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dacrocytes
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(tear drop cells) look like RBCs in which one side has been pulled out to a point
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Where are dacrocytes seen?
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TB and chronic myelocytic leukemia
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drepanocytes
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(sickle cells) crescent shaped RBCs
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Where are drepanocytes seen?
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sickle cell anemia
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Where are bite cells seen?
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hemolytic anemia and G6PD
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Where are schistocytes (broken cells) seen?
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DIC, thrombocytopenia, alcohol abuse, septicemia, renal failure, cirrhosis, hypothyroidism
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Where are macrocytes seen?
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hemolytic anemia, bleeding, hyperthyroidism, B12/folate deficiency
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Where is normocytic, normochromic anemia seen?
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chronic disease, chronic infection, cancer, autoimmune
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Where is microcytic, hypochromic anemia seen?
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iron deficinecy, thalacemia
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Where is macrocytic, hyperchromic anemia seen?
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B12/folate deficiency, alcohol liver disease
