lab diagnostics exam #4

"shift to the left"

An increase in the number of immature neutrophils in the

circulation pool and is a sign of increased neutrophil demand seen with acute

infections.

other name for multiple myeloma

plasma cell myeloma

the gold standard method for SPEP testing

immunofixation

5 reasons when a peripheral blood smear would be obtained

- unexplained anemia

- leukopenia

- thrombocytopenia

- inherited hematologic disorders

- lymphoproliferative disorders

Philadelphia gene

- also known as BRC-ALB1

- abnormal fusion gene caused by the translocation of genetic material of chromosome 9 and 22

- creates a short chromosome 22

3 disease processes that dohl bodies can be seen on peripheral blood smears

- sepsis

- burns

- acute melogenic leukemia

WBC count <4500

leukopenia

WBC >11000

leukocytosis

terminal deoxynucleotidyl transferase stain positive

acute lymphocytic leukemia

increased number of immature cells, severe decrease in thrombocytes, auer rods in blood smear

acute myelogenous leukemia

smudge cells present in blood smear

chronic lymphocytic leukemia

monoclonal paraprotein (bence jones proteins) in blood smear

multiple myeloma

lymphoblasts with high nuclear to cytoplasmic ratio, bluish cytoplasm, absence of cytoplasmic granules in blood smear

acute lymphocytic leukemia

lymph node biopsy shows reed-sternberg cells

hodgkins lymphoma

monospot for heterophile antibody agglutination positive for EBV antibodies

hodgkins lymphoma

Diagnosis should not be based solely on serum protein electrophoresis so interpretation of likely cause will be in the context of other labs needed. true or false?

true

Which of the following has been used for years as part of the clinical evaluation of malignancies and noted to be a clinical biomarker in lymphoid malignancies and is the most useful serum biomarker for assessing metastatic melanoma?

serum LDH

the lab that measures the neutrophils specifically and obtained for the evaluation for a severe bacterial infection is

an absolute neutrophil count

which of the following cells are most commonly seen in chronic lymphocytic leukemia

b-cells (CD19)

Which of the following terms means: An increase in the number of immature neutrophils in the

circulation pool (circulating blood) and is a sign of increased neutrophil demand seen with acute

infections.

left shift

RBC count

The number of red blood cells in a sample of blood. Reflects the body's ability to carry oxygen.

hemoglobin

protein in RBCs that carry oxygen and carbon dioxide. It plays a critical role in oxygen transport.

hematocrit

- the percent of red blood cells in the body vs the total blood volume.

- Low levels can mean that there is an anemia of some sort.

- also known as packed cell volume

MCV

mean corpuscular volume. It is the average size of the body's RBCs. It can help differentiate types of anemia.

MCH

mean corpuscular hemoglobin. average amount of hemoglobin within a red blood cell. It can also help identify anemia or other conditions.

MCHC

mean corpuscular hemoglobin concentration. the average concentration of hemoglobin in a red blood cell. Low values can mean anemia or other conditions.

red cell distribution width

It indicates the amount of variation in the size of red blood cells in the body. A high RDW can be related to anemia and can differentiate other conditions.

reticulocyte count

the number of immature red blood cells in the blood. Low can mean anemia.

absolute reticulocyte count

the number of immature red blood cells per microliter of blood

reticulocyte index

more refined measure of reticulocytes. It adjusts for factors such as anemia and reticulocyte maturity time.

reticulocyte production index

- aka corrected reticulocyte count

- more refined measure of reticulocytes. It adjusts for factors such as anemia and reticulocyte maturity time.

reticulocyte mean cell volume

the average volume of reticulocytes in the blood

immature reticulocyte fraction

- aka reticulocyte maturity index

- percentage of reticulocytes that are in the blood.

reticulocyte mean cell hemoglobin content

the average amount of hemoglobin in the reticulocyte

anemia

when the body does not have enough healthy red blood cells to carry sufficient oxygen to the body's tissues

polycythemia

a high number of red blood cells in the body that causes thick blood

erythropoitetin

hormone that stimulates red blood cell production by the bone marrow

anisocytosis

when red blood cells are different sizes

poikilocytosis

when red blood cells are different shapes

hypochromia

red blood cells that have less color than normal (not enough hemoglobin)

hyperchromia

red blood cells that have more color than normal (too much hemoglobin)

polychromasia

more immature red blood cells that normal

hyperhomocysteinemia

the presence of high levels of homocysteine in the blood; associated with cardiovascular disease

typical lifespan of a RBC

120 days

typical lifespan of a platelet

10 days

The Hgb should increase by 1 g/dL within 2 to 4 weeks of treatment initiation of iron therapy. If the levels do not improve, which of the following should be your next step?

evaluate for alternate diagnosis or occult bleeding

The diagnosis of this heterogeneous group of disruptions in Hgb synthesis is made by a bone biopsy. If positive, the biopsy will show erythroblasts with iron-loaded mitochondria visualized by Prussian blue staining as a perinuclear ring of blue granules

sideroblastic anemia

which of the following has been used for years as part of the clinical evaluation of malignancies and noted to be a clinical biomarker in lymphoid malignancies and in the most useful serum biomarker for assessment of metastatic melanoma

serum LDH

A 45 yo male had presented to the clinic with complaints of fatigue, non-bloody diarrhea and crampy abdominal pain in the right lower quadrant of his abdomen. He underwent a colonoscopy that reveals that he has Crohn's disease in the terminal ileum. He continues to have fatigue. A peripheral blood smear was done and showed marked anisocytosis, poikilocytoses, and oval shaped macrocytes. The cells were normochromic.

Which of the following deficiencies is most likely due to Crohn's disease and is contributing to his complaint of fatigue?

vitamin B12

3 multiple choice options

the hallmark of aplastic anemia is pancytopenia. which of the following CBC results would be seen with it?

neutropenia, anemia, and thrombocytopenia

This test is a measure of the extrinsic pathway of coagulation and the time it takes for plasma to clot after the addition of tissue factor is given. It is also used to monitor Warfarin (Coumadin) therapy:

prothrombin time

The following tests are performance indicators that measure the efficacy of both the intrinsic and common coagulation pathway to form a clot. It is also used to monitor Heparin therapy:

partial thromboplastin time and activated partial thromboplastin time

This lab is obtained for a patient suspected of having a deep venous thrombosis (DVT) or pulmonary embolism (PE). A negative result will virtually rule out thromboembolism:

d-dimer test

which of the following cells seen on the peripheral smear would indicate the diagnosis of lymphoma

reed-sternberg cells

bence-jones proteins are also referred to as

M-proteins (myeloma proteins)

which of the following can be seen on the peripheral smear with lead poisoning

basophilic stippling aka punctate basophilia

hemophilia A is an inherited deficiency in

factor VIII

thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by a severe deficiency in

ADAMTS13

Antiphospholipid Antibody Syndrome (APS) is systemic autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPL) and is associated with thrombotic and obstetrical complications. Which of the following labs is specific for detecting Factor VL?

APC resistance test using the clotting time-based assay

Laboratory diagnosis involves specialized coagulation tests used primarily to detect lupus anticoagulants (LAs) which are a subset of antiphospholipid antibodies (aPLs) associated with antiphospholipid syndrome (APS).

One of the initial screen tests used to identify the prolonged clotting times associated with the LA's is:

dilute russell's viper venom time

the gold standard for identifying the cause of hyperhomocysteinemia is

High-performance liquid chromatography (HPLC)

Which of the following, is the most commonly used test that measures the activity of the coagulation factors (more commonly used for Factor VIII and Factor IX)?

one-stage clotting assay

Heparin-Induced Thrombocytopenia (HIT) is serious, immune-mediated adverse reaction to heparin characterized by platelet aggregation seen on peripheral smear and a significant drop in platelet count, typically more than 50% from baseline occurring:

5 to 10 days after starting heparin

EBV immunoassays

- tests used to detect and identify epstein barr virus

- can help diagnose hodgkins disease since it is present in half of cases

- IFA or ELISA detects antibodies

ferritin immunoassays

- measures antibodies to ferritin

- low levels signal iron deficiency

- laboratory test of choice to detect iron deficiency anemia

myeloid line blood cells

erythrocytes, platelets, granulocytes, monocyte

lymphoid line blood cells

lymphocytes, natural killer cells