Cardio/Renal - Complete Blood Count: RBC Indices

What is contained in the plasma (supernatant)

water, proteins, nutrients, hormones, etc.

What is located in the buffy coat?

white blood cells, platelets

What is the hematocrit?

red blood cells

What are 2 complete blood count indications?

- detect a variety of disorders

- monitoring the response and/or effects of treatment

What is unique about white blood cells?

they are the only blood cells that form neoplastic cells/undergo malignant transformation

Which white blood cells are granulocytes? (3)

neutrophils, eosinophils, basophils

- they are "philled" with granules

which white blood cells are agranulocytes? (2)

lymphocytes and monocytes

what is hematopoeisis?

the process where mature blood cells are produced from hematopoietic stem cells

where does fetal hematopoiesis originate? where do they mature?

in the yolk sac

mature in the fetal liver and spleen

what is the major site of hematopoiesis in children and adults?

bone marrow

- other sites include liver, spleen, lymph nodes and thymus

Erythropoietin (EPO) is produced by?

kidneys

what are functions of Erythropoietin (EPO)?

- convert Pro-erythroblasts to erythrocytes

- stimulates the production of RBCs when O2 saturation is low (COPD)

The following is information gathered from what?

• Hgb (hemoglobin)

• Hct. (hematocrit)

• MCV. (mean corpuscular volume)

• MCH. (mean corpuscular hemoglobin)

• MCHC (mean corpuscular hemoglobin concentration)

• RDW (red cell distribution width)

RBC count

What is anemia?

lowered RBC count

What is polycythemia?

elevated RBC

normal female RBC count?

4.2-5.9 million/L

normal male RBC count?

4.6-6.2 million/L

What is the average lifespan of the RBC?

120 days

What are the two common cases of decreased blood cell count?

blood loss

decreased production from bone marrow

What are the 4 causes of decreased production of RBCs from the bone marrow?

• e.g., bone marrow failure (pancytopenia), leukemias, myeloproliferative disorders

• Increased destruction (hemolysis)

• sickle cell anemia

• thalassemia

• autoimmune

What causes primary polycythemia vera?

chronic O2 deficiency

- this leads to stimulation of erythropoietin

What causes secondary polycythemia vera?

dehydration, steroid use, smoking

Hematocrit & Mean Corpuscular Volume are _______ correlated.

directly

Male hemoglobin normal value

13.0 to 17.5 gm/dL

female hemoglobin normal value?

11.5 to 15.5 gm/dL

In fetus -> Hb ___

Hb F

Following birth -> Hb ____

Hb A

Hb A is a quaternary protein featuring:

• 2 alpha chains

• 2 beta chains

• 4 ferrous molecules

What is the hematocrit?

The % by volume of RBCs in blood

The hematocrit reflects?

RBC mass divided by total blood volume

The Mean corpuscular volume (MCV) represents?

Size of a mature RBC

How is Mean Corpuscular Volume (MCV) calculated?

Hematocrit/RBC count

normal Mean Corpuscular Volume (MCV) =

normocytic: 80-100 fL

less than normal

greater than normal

What do it mean for a value to be

• microcytic =

• macrocytic =

less than normal Mean Corpuscular Volume (MCV)

greater than normal Mean Corpuscular Volume (MCV)

Mean corpuscular hemoglobin (MCH) represents?

Amount of Hb per RBC

Normal Mean Corpuscular Hemoglobin (MCH)

27-34 pg*

How is Normal Mean Corpuscular Hemoglobin (MCH) calculated?

Hb/RBC count

What do it mean for a value to be

• hypochromic

• hyperchromic

lower than Normal Mean Corpuscular Hemoglobin (MCH)

higher than Normal Mean Corpuscular Hemoglobin (MCH)

What does the Mean corpuscular hemoglobin concentration (MCHC) represent?

Hb concentration in a given volume of packed RBCs

How is the Mean corpuscular hemoglobin concentration (MCHC) calculated?

MCHC = Hb (gm/dl x 100) / HCT (ml per 100ml)

normal Mean corpuscular hemoglobin concentration (MCHC)?

32- 36 gm/dl

What is the Red blood cell distribution width (RDW)?

Degree of variation in size (width) = anisocytosis

normal Red blood cell distribution width (RDW)?

Normal range 10-15%

What helps distinguish between anemia types?

reticulocyte count

What does the reticulocyte count measure?

erythropoietic activity & bone marrow response to anemia

- Immature nucleated RBCs is increased

What is the normal reticulocyte count?

0.5-1.5%

What does the following describe?

Retic count is low: BM is not making enough RBCs

aplastic anemia

Retic. count is high: RBCs are destroyed prematurely & BM works overtime

hemolytic anemia

Retic count is low: the body does not have enough iron to make RBCs

Iron deficiency anemia:

Retic Count is low: the body does not get enough vitamin B12

Pernicious anemia

What are 3 reasons for why reticular count may be low? What type of anemia belongs to each reason?

- the body does not get enough vitamin B12: pernicious anemia

- the body does not have enough iron to make RBCs iron deficiency anemia

- BM is not making enough RBCs: aplastic anemia

What is a reason reticulocyte count may be high? What type of anemia is this associated with?

RBCs are destroyed prematurely & BM works overtime: hemolytic anemia

What is the normal circulating WBC count for adults?

Circulating WBCs → 4400 to 11,000/μL in adults

What is the normal Absolute Neutrophil Count (ANC)?

1,500-7,200 cells/mm3

What does it means if the Absolute Neutrophil Count (ANC) > 1,500/mm3?

patient can adequately fight infection

What does it means if the Absolute Neutrophil Count (ANC) < 1,500/mm3?

risk of infection increases

What does it means if the Absolute Neutrophil Count (ANC) < 500/mm3?

severe neutropenia. NO DENTAL TREATMENT CAN BE PERFORMED

What is the ANC Calculation Formula?

WBC count x (%Neutrophils + %Bands*)/100

*Bands: the percentage of immature neutrophils

What are the 2 broad categories of leukemias?

Myeloproliferative disorders• Acute myeloid leukemia: immature malignant myeloid cells• Chronic myeloid leukemia: mature malignant myeloid cells

Lymphoproliferative disorders• Acute lymphoblastic leukemia: immature malignant lymphoid cells• Chronic lymphocytic leukemia: mature malignant lymphoid cells

What are the Myeloproliferative disorders?

• Acute myeloid leukemia: immature malignant myeloid cells

• Chronic myeloid leukemia: mature malignant myeloid cells

What are the Lymphoproliferative disorders

• Acute lymphoblastic leukemia: immature malignant lymphoid cells

• Chronic lymphocytic leukemia: mature malignant lymphoid cells

What is Hodgkin's lymphoma?

malignant B lymphocytes, primarily in lymph nodes

What is non-Hodgkin's lymphoma?

malignant B- or T-cells, many types/locations; mostly B-cells

What is Burkitt lymphoma?

non-Hodgkin's B-cell lymphoma involving bone & lymph nodes

What is multiple myeloma?

cancer of plasma cells

Describe the start, development and presentation of hodgkin's lymphoma

- starts as a painless group of firm, nontender, enlarged lymph nodes (single focus of tumor)

- Enlarged LN often the mediastinal or the neck nodes (>50% of cases). Underarm or groin are also common

- Fever, fatigue, weight loss, & night sweats occur in 1/3rd of patients & may precede the enlargement of LN

Describe the start, development and presentation of non-hodgkin's lymphoma

• Starts as a multifocal enlarged painless lymph nodes (LN)

• Only 20%-40% of NHL develop outside of LN (i.e., extranodal lymphomas)

• Fever, weight loss, malaise, sweating, tender lymphadenopathy, abdominal or chest pain aremore common

what is the most common lymphoma of childhood?

Burkitt lymphoma

- Tumors can double in size every 3 days --> obstruction of the airway, alimentary canal, &vasculature

What are the 3 types of Burkitt lymphoma?

endemic, sporadic, and immunodeficiency associated

in which lymphoma is Jaw involvement is more common in patients younger than 5 years of age?

Burkitt lymphoma

How does Endemic Burkitt lymphoma often present?

as a rapidly expanding tumorous mass in the posterior region of the maxilla or mandible with 50%-70% of the cases with jaw lesions

• Rapid growth displaces adjacent teeth, resulting in mobile & abnormally positioned teeth

• Pain and paresthesia accompany the condition.

• Radiographically, the tumor produces an osteolytic lesion with poorly demarcated margins,erosion of the cortical plate, and soft tissue involvement.

Burkitt's lymphoma typically arises where?

extranodal sites