LAB DIAGNOSIS EXAM 3 REVIEW - Logan Class of December …



LAB DIAGNOSIS EXAM 3 REVIEW

NORMAL VALUES

- glucose/FBS (80-115mg/dl WBC(5-10K/dl

- bilirubin (.2-1.2mg/dl RBC(4.2-6K

-BUN (7-27mg/dl Hgb(12-15.5(F) 12.5-17.5(M)

-creatinine (.5-1.5mg/dl Hct(37-45 (F) 40-50(M)

-uric acid (2.5-7.7mg/dl MCV(80-100

- hemoglobin ((F)12-15.5 (M)12.5-17.5 MCH(26-32

- magnesium (1.3-2.2meq/l MCHC(31-36

- sodium (135-148meq/l LDL( 11,000/mm3

- usually caused by an increase of only 1 type of leukocyte

*leukocytosis of a temporary nature must be distinguished from leukemia

- most commonly occurs in acute infections

- leukopenia: WBC< 4000/mm3

- occurs during viral infections, some bacterial infections

- hypersplenism

- bone marrow depression

- primary bone marrow disorders

- pernicious anemia

WBC Differential (51-64)

- a total count of circulating WBCs is differentiated according to the 5 types of leukocytes

- expressed as a percentage of the total number of WBCs

-Segmented Neutrophils: most numerous and important type of leukocytes in inflammation and microbial invasions

- immature neutrophils( bands

- neutrophilia( increased levels in response to invading organisms and tumor cells

- neutropenia( too few produced in marrow, stored, or used up

- Eosinophils: become activated in later stages of inflammation

- responds to allergic and parasitic diseases (granules contain histamine)

- eosinophilia( allergies, hay fever, asthma, parasitic disease

- eosinopenia( usually caused by an increased adrenal steroid production

- eosinophilic myelocytes( only found in leukemia or leukemoid blood pictures

-Basophils: basophil counts are used to study chronic inflammation

- basophilia: granulocytic leukemia, acute basophilic leukemia, Hodgkin’s

- basopenia: acute phase of infections, stress reactions, prolonged steroid/chemotherapy

-Monocytes: the largest cells of normal blood and second line of defense against infection

- these phagocytic cells remove injured and dead cells, microorganisms, and insoluble particles from the circulating blood

- provide the antiviral agent called interferon

- monocytosis: increased monocyte usually due to bacterial infection, TB, syphilis, subacute bacterial endocarditis

- decreased monocyte count: HIV/AIDS, overwhelming infection

-Lymphocytes: small cells that migrate to areas of inflammation

- source of serum immunoglobulins

- all are produced in bone marrow; B lym. Mature in bone marrow; T Lym. Mature in thymus

- plasma cells are fully differentiated B cells and are not normally present

- increased in: plasma cell leukemia, multiple myeloma, SLE, etc

- Lymphocytosis: lymphatic leukemia, infectious mononucleosis/lymphocytosis, other viral diseases

- Lymphopenia: chemo/radiation therapy, AIDS

-Lymphocyte Immunophenotyping

- T-Cells: life span is months to years; thymus derived; cellular immunity

- B-Cells: life span is days; bone marrow dependent; humoral immunity

- important in clinical evaluating of 2 major disease stages:

1) lymphoproliferative states: i.e. leukemia

2) immunodeficient states: i.e. HIV, organ transplants

RBC (69-90)

-Red Blood Cell Count: has a biconcave disk shape to enable use of maximal amount of Hb

- important in evaluating of anemia or polycythemia

- decreased in: anemia, lymphomas, SLE, Addison’s…

- Erythrocytosis: pulmonary, cardiovascular diseases, polycythemia

- Hematocrit (Hct): means “to separate blood”

- indirectly measures RBC mass

- decreased Hct: anemia, leukemias, lymphomas, Hodgkin’s

- increased Hct: erythrocytosis, polycythemia vera, shock

- Hemoglobin (Hb): composed of protein globin and an iron containing compound heme

- serves as an important extracellular buffer

- decreased: anemia, iron deficiency, liver disease, hemorrhage

- increased: polycythemia vera, CHF, COPD

-RBC Indices:defines the size and Hb content of the RBC

- consists of MCV, MCHC, MCH

- useful for differentiating anemias

- Mean Corpuscular Volume(MCV): expresses the volume occupies by a single erythrocyte

* basis for classifying anemias by size

- Mean Corpuscular Hemoglobin Concentration (MCHC): measures the average concentration of Hb in the RBCs

* most valuable in monitoring therapy for anemia

-Red Cell Distribution Width (RDW): an indication of the degree of anisocytosis (abnormal variation in size of RBCs)

*helpful in the investigation of some hematologic disorders and in monitoring response to therapy

- Stained Red Cell Examination: determines variations and abnormalities in erythrocytes size, shape, structure, HB content, and staining properties

* useful in diagnosis of various blood disorders

- Reticulocyte Count: count of young, immature, nonnucleated RBC

- in order to be valuable, it must be viewed in relation to the total number of erythrocytes

* used to differentiate anemias caused by bone marrow failure from those casued by hemorrhage or hemolysis

- Sedimentation Rate/ Erythrocyte Sed. Rate: sedimentation occurs when erythrocytes clump/aggregate together

- due to alterations in the plasma proteins

* based on the fact that inflammatory and necrotic processes cause an alteration in blood proteins, resulting in aggregation of RBCs, making them heavier( falls rapidly

LECTURE TOPICS

Urine Analysis-Dipstick

- used to reveal diseases that have gone unnoticed b/c they don’t produce striking signs or symptoms

- the most cost-effective device used to screen urine is the dipstick( allows quantitative and qualitative analysis within 1 minute

- 1st part of urinalysis is direct visual observation: normal fresh urine is pale to dark yellow with little smell

- excess turbidity results from the presence of suspended particles in the urine

- pH is affected by a variety of factors: acid/base balance, dietary factors, specimen age, contaminants/pathogenic bacteria

- herbivores( alkaline urine; carnivores( acidic urine

- pH effects sedimentation rates

* urine pH is not a reliable indicator of total body acid/base status

- specific gravity is influenced by the number, weight, and size of molecules in urine

- no one can eat their blood glucose above 200

**** all this info can be found in reading assignment section of this review***

Urine Analysis-Microscopic

- under normal conditions, urine of healthy people contains a number of erythrocytes, leukocytes, and hyaline casts

- no precise info as to the upper limit of the normal cell range counts in urine excreted daily

- morphology of the blood red cells found in urinary sediment is extremely variable

- urinary red cell morphology can be assessed best by Phase-contrast microscopy

- Morphological classifications:

1) biconcave red cells similar to those in the blood

2) irregularly shaped cells showing fractured membranes, extrusion of cytoplasm, or fragmentation (typical in hematuria in glomerulonephritis, vascular nephropathies)

- RBCs found in urinary sediment of healthy people are very rarely normal

- Elements that may be mistaken for RBCs: fungi, calcium carbonate crystals, small air bubbles, fat droplets, small leukocytes

- renal tubular epithelial cells are found in varying numbers in 90% of glomerular diseases

- morphology can indicate what part of urinary tract it is from

- casts are made up of protein material that has been precipitated into the tubular lumen

- Tamm-Horsfall urinary protein: from ascending limb of loop of Henle

- can be classified as: hyaline (CHF, hyperthermia, nephropathies), cellular, granular (cellular debris, progressively more homogeneous, large=pathologic), waxy( final transformation of all kinds of casts), mixed, with inclusions

- Crystals: usually due to uric acid buildup

- calcium oxalate: may be observed in healthy people, especially after eating sinach or cocoa

- phosphate crystals: only the presence of magnesium ammonium phosphate in freshly voided urine is now regarded as significant ( infection with urease- producing bacteria

- cystine crystals: always very important feature as they are a definite sign of urolithiasis

Complete Blood Count

Stem cell ( lymphocytic

( monocytic

( myelocytic (granulocytic) ( eosinophilic

( basophilic

( neutrophilic

* most common and important causes of leukocytosis is inflammation and infection

***see reading assignment info above***

Anemia Hand-out

* Know Bolded and Italicized words

* Also the first lines of paragraphs

….. this coming from Dr. Sanders…. And there will be a good number of questions from this packet

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