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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