Lab med heme

RBC adult male

4.3-6.1

RBC adult female

4.2-5.4

MC of RBC loss is*

blood loss**

2 ways to get elevated RBCs

increase production

increase in concetration

increase in concentration of RBCs commonly caused by

dehydration (diarrhea, burns)*

2 ways to decrease RBCs

decrease production

loss and destruction

Normal MCV range

75-100

above that = macrocytic

below that = microcytic

2 examples of microcytic

iron def anemia, thalassemia

2 examples of macrocytic

vitamin B12, folate def

When is MCV not helpful

when they have a iron def & B12/folate def because it makes it normal bc cancels out*

MCH range

25-35

3 things that are microcytic, hypochromic

iron def

thal

lead poisoing

1 thing that is microcytic, normochromic

chronic renal disease

1 thing that is microcytic, hyperchromic**

heriditary spherocytosis*

MCHC normal range

30-35

MCHC is a measure of the

actual O2 carrying capacity of the RBC

when is MCHC increased?

spherocytosis

RDW measures

the variability in size of RBCs in a blood sample

Normal range RDW

11.5-14.5%

Increased RDW is the earliest heme mannifestation of ______

iron def

what usu have normal RDW (2 things)

B-thal & chronic disease anemia

Hb males

13.8 - 17.2

Hb femals

12.1 - 15.1

o2 carrying capcity of Hb

1.34 ml of O2 per gram of Hb

Left shift on Hb curve

Dec H+ (inc pH)

Dec temp

Dec 2,3 DPG

(increased affinity to O2)

*Not delivering to tissues

Right shift on Hb curve

Inc H+ (dec pH)

Inc Co2

Inc 2,3 DPG

Inc temp

(decreased affinity of O2)

*Delivering to tissues

Describe the Hb curve with mountain sickness

Decrease in O2 originally so curve shifts right and delivers O2

Increase ventilation so u blow off Co2 and Inc pH so curve shifts back left

Produce more RBCs

What is a common group that has high Hb to accomodate for hypoxia

Smokers

Male Hct

40.7 - 50.3 %

Female Hct

36.1 - 44.3 %

Hct would be elevated MC in

dehydration! burns

anemia with everything normal think...

acute blood loss (takes times for things to get affected

Iron def indices

Fe low

Ferratin low

RIBC high

***

WBC count

5,000-10,000

high WBCs indicates

infection

Elevated WBCs called a

left shift

(inc in bands)

What would indicate a right shift?

chronic infection

(neutrophils are low)

ANC formula

WBC (%neutrophils + %bands)

ANC concerning when

< 1000

Leukopenia without _____ can be chronic or normal

granulocytopenia (certain populations have low WBCs)

Adult lymphocytes

20-40%

absolute lymphocyte count can be used as a surrogate marker for

CD4 count

ALC <1000 predicts

a CD4 < 200 which can be a rough marker for HIV infection

Pregnancy does what to WBCs?

increases

WBCs are higher at what time of day

afternoon

Drug that increases WBCs*

steroids

Drug that decreases WBCs

NADIR from chemoRx

Plt range

150,000-400,000

Examples that have increased destruction of plts

ITP

HUS

HIT

CBC skeleton

Hemoglobin electrophoresis is uselful in

Sickle cell

Thal

Hb A1

95-98%

Hb A2

2-3%

Hg F

0.8 - 2%

HbS

0%

HbF pathologically is MC seen in

B-thal

Alpha thal

alpha protein is missing or mutated

Beta thal

gene defect with beta globulin

Mediterranean

B thal major aka

Cooley Anemia

immature RBCs

reticulocytes

high retic could indicate

more RBCs are being made by the bone marrow

Normal retic

0.5 - 2% or 25-75,000

First step to achieving hemostasis is

vessel constriction

The primary phase of hemostasis is**

platelet agregation

intrinsic pathway factors

8, 9, 11, 12

Extrinsic pathway factors

3, 7

Extrinisc test

PT

Intrinsic test

PTT

Normal PT

11-12.5

INR is used in conjuction with

PT

A lack of factor 8 would cause PT to be

prolonged

What factors are vitamin K dependent

2, 7, 9, 10

Warfarin inhibits

prothrombin (INR), works on 2,7,9,10

what drugs inhibit Xa?

Apixaban

Rivaroxaban

Edoxaban

Enoxaparin

What drug inhibits thrombin inhibitor II?

Dabigatran

Warfarin levels are measured with

INR

What else must you watch with warfarin?

foods with vitamin K

(warfarin inhibits vitK to work so dont wanna add more)

INR normal range

2-3

INR levels for a mechanical prosthetic valve

2.5-3.5

INR level for a patient with thrombosis and antiphosphoslipid syndrome

2-3

INR levels to prevent reccurent MI or DVT

2-2.5

Pt has an INR of 6.5....what is the concern

bleeding

What can prolong the PT and make INR high

alcohol

diarrhea/malabsoprtion

What can decerase the PT and INR

high fat or leafy veggies

Normal PTT

25-35 sec

PTT is mainly used to

monitor heparin therapy

Heparin interact with what to work?

antithrombin

Heparin is found to inactivate

prothrombin

The main affects of heparin are where in the coag cascade?

right before the common path X to Xa and as antithrombin (thrombin being the important enzyme to form fibrinogen to fibrin)**

test used to measure the lenght of time it takes for a fibrin clot to form in the plasma of a blood sample

Thrombin time

what can prolong TT

DIC, DOAC therapy

if you have a lot of clotting/clot turnover, what would be increased

Fibrin split products

Increased fibrinogen is one of the first signs of

inflammation

banked blood does not contain

fibrinogen (bc then it would clot)

decreased fbrinogen seen in

liver disease

DIC

Increased fibrinogen seen in

Exogenous estrogen (birth control)

Fibrin split products measures the fibrin degregation products, we most commonly use this to detect?**

DIC*

If to much fibrin split products are present, it will cause a

anticoagulation effect

(inhibitng fibrinofen conversion to fibrin and inability to advance the clot)

Increased fibrin split products seen in

DIC

therapuetic thrombolysis

Thrombotic thrombocytopenia (TTP)

Pt comes in on Warfarin with an INR of 7 and facial droop... what intervention do you take

Reverse warfarin with

-FFP, PCC (faster)

-Vit K (takes a little longer)

*this would be different if the patient was on a DOAC