Hematology/Oncology CM and CA

Percentage of RBCs in blood

41%

Percentage of WBCs in blood

4%

Percentage of plasma

55%

Ratio of myeloblasts to erythrocyte progenitor cells

2:1 up to 4:1

What progenitor cell develops into neutrophils, eosinophils, basophils, and mast cells

Granulocyte macrophage progenitor --> myeloblast

What is a reticulocyte?

immature RBC

what differentiates into platelets?

Megakaryocytes

What type of hemoglobin chains are found in fetal hemoglobin (HGB F)?

2 alpha, 2 gamma

What type of hemoglobin chains are found in adult hemoglobin?

2 alpha, 2 beta

At what age does hemoglobin turn from fetal to adult?

6 months

What does high Hgb/Hct indicate?

dehydration, polycythemia

What does low Hgb/Hct indicate?

anemia

What does MCV refer to?

Mean corpuscular volume - average size of RBC (Hct/RBC count)

What is the normal range of MCV?

81-100fL

What does high MCV indicate?

macrocytic; liver disease, chemo, alcoholism, B12, folate deficiency

What does low MCV indicate?

microcytic; iron deficiency, thalassemia, chronic illness

What does MCH indicate?

Mean corpuscular height; average amount of Hgb in RBCs

What does low MCH indicate?

Hypochromic; microcytic anemia

What is the normal range of MCH?

26-34pg

What does high MCH indicate?

Hyperchromasia; macrocytic anemia

what does MCHC indicate?

Mean corpuscular hemoglobin concentration

what is the normal value of MCHC?

31%-36%

what does high MCHC indicate?

hereditary spherocytosis, cold agglutinins, intravascular hemolysis

What does low MCHC indicate?

severe iron deficiency, thalassemia

What does RDW indicate?

Red cell distribution width, variation in size of RBC

What is the normal value for RDW?

11.5%-14.5%

What does high RDW indicate?

many different sized RBCs present due to large immature RBCs (reticulocytes); iron deficiency anemia, B12/folate deficiency, hemoglobinopathies, sickle cell anemia, hemolytic anemias, posthemorrhagic anemias

What is the normal range for RBC count, male and female

Male: 4.35-5.65 trillion cells/L

Female: 3.92-5.13 trillion cells/L

What is the normal range of hemoglobin for males and females?

Male: 13.2-16.6 g/mL

female: 11.6-15 g/mL

What is the normal range of hematocrit for males and females?

Male: 38.3%-48.6%

Female: 35.5%-44.9%

What does a low reticulocyte count indicate?

aplastic anemia, vitamin B12 or folate deficiency, depletion of iron stores, chronic infection, cirrhosis, cancer, radiation

What is the normal WBC count?

3.4-9.6 billion cells/L

What is the normal platelet range for males and females?

Male: 135-317 billion/L

Female: 157-371 billion/L

What is the normal range for serum iron levels for males and females?

Male: 80-180mcg/dL

Female: 60-160mcg/dL

what does high serum iron indicate?

hemochromatosis, hemosiderosis, hemolytic anemia, hepatitis, hepatic necrosis, lead toxicity, iron poisoning, massive transfusion

What does low serum iron indicate?

insufficient dietary iron or absorption of iron, chronic blood loss, late pregnancy, iron deficiency anemia, cancer, chronic GI/urinary blood loss

What is the normal range of ferritin in males and females?

Male: 12-300mcg/dL

Female: 10-150mcg/dL

What does high level ferritin indicate?

hemochromatosis, hemosiderosis, hemolytic anemia, megaloblastic anemia, liver disease (alcohol or inflammatory)

What does low ferritin levels indicate?

severe protein deficiency, iron deficiency anemia, hemodialysis

What is the normal range for transferrin saturation in males and females?

Male: 20-50%

Female: 15-50%

What does high transferrin saturation indicate?

iron overdose, hemolytic anemia, hemosiderosis, acute iron overload

What does low transferrin saturation indicate?

iron deficiency anemia, chronic illness

What is the normal range for total iron binding capacity?

250-460mcg/dL

What does high TIBC indicate?

oral contraceptives, late pregnancy, polycythemia vera, iron deficiency anemia

What does low TIBC indicate?

hypoproteinemia, inflammatory diseases, cirrhosis, hemolytic anemia, pernicious anemia, sickle cell anemia

What is the normal level of serum B12?

160-950pg/mL

What does high serum B12 indicate?

leukemia, polycythemia vera, severe liver dysfunction, myeloproliferative disease

What does low serum B12 levels indicate?

pernicious anemia, malabsorption, IBD, intestinal worms, achlohydria

What is the normal serum folate level?

5-25ng/mL

What is the normal RBC folate level?

360-14nMol/L

What does high folate levels indicate?

pernicious anemia, vegetarianism, recent blood transfusion

What does low folate levels indicate?

folic acid deficiency, hemolytic anemia, malnutrition, malabsorption, celiac disease, cancer, late pregnancy, alcoholism, anorexia, drugs

Anisocytosis

variation in RBC size

Poikilocytosis

variation in RBC shape

Rouleaux

RBCs arranged like "stacked coins"

Liver disease, lymphoma, multiple myeloma, chronic inflammatory disease

Agglutination

RBCs randomly clumped together

Howell-Jolly Bodies

Small, round remnants of nuclear material remaining in RBC

post-surgical splenectomy, functional asplenia, hemolytic anemia, megaloblastic anemia

Nucleated normoblasts

presence of immature RBCs

anemia, chronic hypoxemia, marrow-occupying neoplasm, fibrotic tissue

Basophilic stippling

bodies in cytoplasm of RBCs

lead poisoning, reticulocytosis

Siderocyte

RBC containing iron not bound by HGB

sideroblastic anemia, hemoglobinopathies, hemosiderosis, myelodysplastic syndrome, lead, ethanol

Eliptocyte/ovalocyte

severe iron deficiency, hereditary

Target cell/codocyte

thalassemia, liver disease, hemoglobinopathies, post-splenectomy

Tear drop

myelofibrosis, underlying marrow process

Schistocyte

fragmented RBCs

Hemolytic anemia, DIC, TTP, mechanical valve induced

What is leukocytosis? What are causes of it?

increased leukocytes

infections, leukemia, trauma, stress, tissue necrosis, inflammation

What is leukopenia? what are causes of it?

Decreased leukocytes

bone marrow suppression, infiltration, or failure

dietary deficiency, peripheral destruction, chemo, overwhelming infections, sequestration at site of infection, autoimmune disease

What is polycythemia? what causes it?

"thickening" of blood due to:

1. chronic hypoxia

2. dehydration, hemoconcentration

What is anemia? what causes it?

Decreased oxygen carrying capacity of blood

Hereditary hemoglobinopathies, hemorrhage, hemolysis, pregnancy, chemo, cancer, chronic illness, renal disease, inflammatory diseases, bone marrow failure, pernicious anemia, dietary deficiency, subacute endocarditis, prosthetic valves, overhydration

What is thrombocytosis? what causes it?

increased number of platelets

reactive: infection, cancer, blood loss, splenectomy

myeloproliferative disorders: polycythemia

Hemolysis, chronic myeloblastic leukemia, essential thrombocytosis

What is thrombocytopenia? what causes it?

Reduction of platelets

destruction from drugs (quinine, heparin), hypersplenism, DIC, autoimmune (ITP), thiazides, estrogen, etoh

What counts as low, very low, and critically low platelet levels?

Low: 10,000-50,000

Very low: 5,000-10,000

Critical: <5,000 ; WITHOLD SURGERY

What is lymphocytosis? what causes it?

Elevated levels of lymphocytes (B/T/NK)

chronic bacterial infection, viral infections (mumps, rubella, hepatitis, mono), ALL/CLL, multiple myeloma, radiation

What is lymphocytopenia? what causes it?

Reduction of lymphocytes (B/T/NK)

Leukemia, sepsis, infection, immunodeficiency (later stages of HIV, chemo, radiation), adrenocorticosteroids, Lupus

What is neutrophilia? What causes it?

Increased number of neutrophils

Physical/emotional stress, trauma, acute bacterial infection, AML/CML, cushing's, inflammatory disorder (RA, thyroiditis, rheumatic fever), metabolic disorders (ketoacidosis, gout)

What is neutropenia? What causes it?

Reduction of neutrophils

aplastic anemia, dietary deficiency, overwhelming bacterial infection (especially in elderly), viral infections (hepatitis, flu, measles), radiation therapy, chemo, addison's

What is monocytosis? what causes it?

Increased number of monocytes

chronic inflammatory disorders, viral infections (EBV/TB/UC), malaria

What is monocytopenia? what causes it?

Reduction of monocytes

aplastic anemia, hair-cell leukemia, prednisone

What is eosinophilia? What causes it?

increased number of eosinophils

parasitic infection, allergic reaction, eczema, leukemia, autoimmune disorders

What is eosinopenia? What causes it?

Decreased eosinophil count

increased adrenosteroid production

What is basophilia? what causes it?

increased number of basophils

myeloproliferative disease, leukemia, uremia

What is basopenia? What causes it?

Reduction of basophils

acute allergic reaction, hyperthyroidism, stress reaction

What is a tiger or gold top used for?

Gel substance to separate cells from liquid and clot activator -- chemistries

What is a red top used for?

serum on top without additives for anticoagulation; chemistries, drug levels, blood banking

What is a light blue top for?

plasma on top with sodium citrate anticoagulant

PT/INR, PTT, coagulation studies, hematology labs

What is a lavender top used for?

plasma on top with EDTA anticoagulant

CBC, hematology labs

What is a green top used for?

plasma on top, heparin anticoagulant to be analyzed quicker than red tube

chemistries, blood gases, ammonia

What is a yellow top used for?

Citrate dextrose to preserve RBC

blood grouping, typing, cultures

What is navy blue top used for?

EDTA, one without

Trace metals (arsenic etc)

What is a gray top used for?

sodium fluoride oxalate preventing glycolysis

glucose tolerance, lactose tolerance

What is a black top used for?

plasma on top, sodium citrate anticoagulant

ESR

Target Cell

What RBC morphology is this?

Acanthocyte

What RBC morphology is this?

Echinocyte (Burr cell)

What RBC morphology is this?

Sickle Cell (drepanocyte)

What RBC morphology is this?

Dacrocyte (Tear drop cell)

What RBC morphology is this?

Stomatocyte

What RBC morphology is this?

Spherocyte

What RBC morphology is this?

Schistocyte

What RBC morphology is this?

Elliptocyte

What RBC morphology is this?

Basophilic Stippling

What RBC morphology is this?