Hematology/oncology

what increases total number RBC

1. dehydration

2. cardiac dx

3. polycythemia

hemoglobin

Reflects the capacity to carry oxygen

hematocrit

Proportion of RBC volume vs plasm

MCV

mean corpuscular volume → average size of RBC

MCH

mean corpuscular hemoglobin → how much hemoglobin per cell

RDW

red cell distribution width → variance of RBC size

what is included in indices

1. MCV

2. MCH

3. MCH concentration

4. RDW

5. reticulocyte count

most predominant WBC

neutrophils → 40-60%

“partner” of neutrophils

monocytes → 2-8%

primary allergic response WBC

eosinophils → 1-4%

WBC in early infection and wound healing

basophils → 2-8%

purpose of peripheral smear and findings

1. differentiate viral from bacterial,

2. classify anemia,

3. malaria (can see parasites inside RBC),

4. jaundice,

5. sickle cell disease,

6. coagulopathies,

7. malignancies

8. Assess for nucleated RBCs, platelets, and RBC/WBC morphology

What type of smear cell and what conditions is it seen in

spherocytes - round, small, no nucleus

• hereditary spherocytosis

• autoimmune hemolytic anemia

What type of smear cell and what conditions is it seen in

ovalocyte

• megaloblastic anemias (vit B12 and folate deficiency)

What type of smear cell and what conditions is it seen in

heinz bodies “bite cells”

• G6PD

What type of smear cell and what conditions is it seen in

howell-jolly bodies - remnant purple DNA

• surgical/functionally asplenic persons

• autoimmune

• ETOH dependency

• congenital heart dx.

What type of smear cell and what conditions is it seen in

anisocytosis - non-uniform cell size

• anemia

• myelodysplasia

What type of smear cell and what conditions is it seen in

schistocyte

• hemolytic anemias

What type of smear cell and what conditions is it seen in

teardrop

• Splenic disorders,

• bone marrow disease,

• anemia,

• malignancy

What type of smear cell and what conditions is it seen in

poikilocytosis (abnormal shape in >10% cells)

• anemia

• renal dx

• hepatic dx

• Cancer

what is required to be seen on peripheral smear in order to call the smear poikilocytosis

abnormal cell shape of >10% of all cells on the smear

What type of smear cell and what conditions is it seen in

atypical lymphs

• Immunogenic reactions

• Transplant

• autoimmune,

• EBV and other viruses,

• malignancies

• drug therapies

What type of smear cell and what conditions is it seen in

acanthocyte

• Hepatic dx,

• malnutrition,

• hypothyroid,

• splenectomy

What type of smear cell and what conditions is it seen in

target cells

• Thalassemias

• hemoglobinopathy

• asplenia

What type of smear cell and what conditions is it seen in

rouleaux formation

• Infections,

• DM,

• CA,

• Inflammatory disorders

What type of smear cell and what conditions is it seen in

bands

• infection

which smear cells associated with infection

1. atypical lymphs (virus/EBV)

2. rouleaux formation

3. bands

which smear cells associated with malignancies

1. teardrop

2. poikilocytosis

3. atypical lymphs

4. rouleaux formation

which smear cells are associated with autoimmune confitions

1. howell jolly bodies

2. atypical lymphs

which smear cells are associated with splenic disorders

1. howell-jolly bodies

2. teardrop cell

3. acanthocyte

4. target cells

which smear cells are associated with hepatic disease

1. poikilocytosis

2. acanthosis

which peripheral smear cell would you see in vitamin B deficiency

ovalocytes

which peripheral smear cell would you see in myelodysplasia

anisocytes

which peripheral smear cell associated with malnutrition and hypothyroidism

acanthocytes

which peripheral smear cell would you see in thalassemia

target cells

what type of anemia

microcytic → small pale RBC

MCV in order to be considered microcytic anemia

<83

most common cause of microcytic anemia

iron deficiency

MCV in order to be macrocytic anemia

>99

define normocytsic anemia

normal MCV (80-100) but hemoglobin and hematocrit are low (normal size, just less RBC)

what would be seen in peripheral smear of hemolytic anemia

1. low HgB and HCT

2. spherocytes

3. schistocytes

4. heinz bodies

5. target cells

(SSHT the cell burst)

G6PD deficiency

deficiency of glucose-6-phosphate dehydrigenase makes RBC susceptible to hemolysis after exposure to certain drugs/chemicals, foods, infections, stress

• ASA, some NSAIDs

• sulfa antibiotics

• infection

• fava beans

how is G6PD treated

supportive and remove trigger

normal bleeding time

1-8 minutes

at what point does thrombocytopenia require therapy

once platelets are <50,000 (normal is 150,000-324,000)

causes of thrombocytopenia

1. inadequate production

2. abnormal destruction

3. medication

difference between PT and APTT

PT → assess extrinsic pathway; monitor warfarin; normal 11-13 sec

APTT → assess intrinsic pathway; monitor heparin; normal is 30-40 sec

sickle cell anemia aggravated by

1. temperature

2. altitude

3. stress

4. dehydration

which lab value is important for sickle cell anemia

reticulocyte (expected to be high bc marrow responding)

Direct vs indirect coombs test

direct → autoimmune hemolytic anemia

• detects antibodies/complement proteins bound to RBC

indirect → screen pregnant women and prior to blood transfusions

• detects free-floating antibodies that COULD bind to RBC

electrophoresis role

identify types of hemoglobins → F,S,C,E

alpha-fetoprotein (AFP)

1. pregnancy → part of triple or quad screen to assess defects

2. adults → elevated in liver, ovarian, and testicular cancer and hodgkin’s lymphoma

CA 19-9

pancreatic cancer

can also rise in

• cirrhosis

• cholelithiasis

• pancreatitis

• CF

CA 15-3 and CA 27-29

diagnose and monitor breast cancer

can also rise in

• Hepatitis

• cirrhosis

• TB

• PID

• endometriosis

• SLE

• lactation

CA 125

ovarian cancer

falsely elevated in

• IBS

• diverticulitis

• menses

• pregnancy

• ovarian cysts

calcitonin

1. medullary thyroid carcinoma

2. insuloma

3. lung cancer

4. bony metastasis

also elevated in goiter

Prostate Specific Antigen (PSA)

used as screening for prostate cancer

false elevation

• BPH

• prostatitis

• age

• ejaculation

• bike riding

• testosterone therapy.

normal hemoglobin lvl

M: 13.6-16.9

F: 11.9-14.8

normal MCV

80-100

normal platelet

M: 150-320

F: 150-360

normal WBC

3.8-10.4