Lecture 3 - CBC Coagulation Factor Tests and Smears

The larger the number, the smaller the needle

The smaller the number, the larger the needle

Gauge size and # relationship

21 G

Most common gauge size

the tests that are being ordered ex: purple - CBC

What do the colors of vacutainer tubes suggest?

blood cultures FIRST, then anything else

Specific order for drawing tubes of different colors

to prevent contamination

Why do you draw tubes in a specific color order?

a thin light colored layer of white blood cells and platelets than lie between a top layer of plasma and red blood cells

buffy coat

water, proteins, electrolytes, nutrients, waste products

components of plasma

Serum = Plasma - fibrinogen and other clotting factors

Serum equation

multiple tests that measure specific components of our blood cells

What is the CBC composed of?

RBC, WBC, Hgb, Hct, platelets

Components of the CBC

hemoglobin

Hgb

hematocrit

Hct

WBC differential

What test is almost always ordered concurrently with CBC?

MCV, MCH, MCHC, RDW

red blood cell indices

Mean Corpuscular Volume, which measures the average size or volume of your red blood cells.

What is an MCV?

Mean Corpuscular Hemoglobin - measures the average amount of hemoglobin inside a single red blood cel

What is an MCH?

Mean Corpuscular Hemoglobin Concentration

What is an MCHC?

Red Cell Distribution Width - variation in RBC size

What is an RDW?

total amount of white blood cells in a specified volume, thousands of cells per microliter

What does WBC measure?

total amount of red blood cells in a specified volume, millions of cells per microliter

What does RBC measure?

males > females

Which sex has a higher range of RBC count, HgB and HCT?

RBCs

when you look at a blood smear under a microscope, which cell SHOULD be the prominent cell?

binds with iroon and carries O2 in the blood

Hemoglobin function

the majority of the mass of the RBC is from HgbI

What does HgB contrubute to in the RBC?

the percentage of a blood volume that is made up of RBC's

what does hematocrit measure?

~ 3 x the amount of HgB

Hematocrit should be how much greater than the HgB?

index defining avg size of RBC

What does MCV measure?

MCV, MCHC, MCH

Infants and children have a wide variance in which CBC values?

mean corpuscular hemoglobin concentration - average weight of HgB per VOLUME of RBCs = index defining cell color concentration

What does MCHC measure?

mean corpuscular hemoglobin - average weight of HgB in RBCs

What does MCH measure?

acute hemorrhage and aplastic anemia - does not change what the RBCs are/look like

What two conditions / states do NOT change MCV and MCHC?

iron deficiencey anemia, thalassemia, anemia of chroninc disease

What conditions will cause hypochromic and microcytic RBC's?

Vitamin B12 deficiency, folate deficiency, alcohol abuse, liver disease

What conditions will cause hyperchromic and macrocytic RBC's?

hypochromic RBCs

what does this blood smear show?

RDW

RBC distribution width - the variance w/in the RBC size - expressed as a %

when the RBC population has cells that vary greatly in their size

When will RDW be high?

the platelet count per volume expressed in thousands per microliter

What do platelet counts measure?

Platelets on a blood smear

what does this image represent?

with bacterial infections, myelogenous leukemia, stress, inflammation, medications, and pregnancy?

when will WBC Differential for Neutrophils be elevated?

mediate immune response against infecious orgs - phagocytose and kill pathogens

What do neutrophils do?

neutrophils - 56% of total WBCs

What is the most abundent WBC?

Syphilis, TB, malaria, sarcoidosis, IBD, SLE, RA

when will WBC Differential for monocytes be elevated?

agranulocyte - differentiate into macrophages that kill pathogens and clean up cell debris at site of infection

What do monocytes do?

Viruses, Lymphocytic leukemias, autoimmune dz, and hypothyroidism

when will WBC Differential for lymphocytes be elevated?

T cells, B Cells, and NK cells

What are lymphocytes

allergic reactions, asthma, parasites

when will WBC Differential for eosinophils be elevated?

anaphylaxis

when will WBC Differential for basophils be elevated?

neutrophils and lymphocytes

if WBC count is elevated, which two WBC types will also most commonly be elevated?

Monocytes

What WBC is 4% of differential?

Lymphocytes

What WBC is 34% of differential?

Eosinophils and basophils

What WBC is <1% of differential?

12, 11, 9, 8

Clotting factors in intrinsic pathway

7 and 3

Clotting factors in extrinsic pathway

10, 5, 2, 1

Clotting factors in common pathway

Tests how many seconds it takes to clot, not including intrinsic pathway

Prothrombin Time (PT)

Factors 7, 10, 5, 2, and 1

Prothrombin time is prolonged in deficiencies of which factors?

Tests how many seconds it takes to clot, not including extrinsic pathway

Activated Partial Thromboplastin Time (aPTT)

Factors 12, 11, 9, 8, 10, 5, 2, 1

Activated Partial Thromboplastin Time will show prolongation in which factors?

Extrinsic pathway

Where is the deficiency is PT is high and aPTT is normal?

Intrinsic pathway

Where is the deficiency if PT is normal and aPTT is high?

Common pathway

Where is the deficiency if PT is high and aPTT is high?

Poikilocytosis

Abnormal variations in RBC shape

Anisocytosis

Abnormal variation in RBC size

Dacryocyte

Tear drop cells

Drepanocytes

Sickle cells

Codocytes

Target shaped cells

Schistocyte

Cell fragments