Hematology & Coagulation Exam 3 SG CLM PDF

 Hematologya coagulation red blood cell "corpusce" Red Blood Cell Indices > 02 transport Men : 47 6.1 x 104 - women:...

 Hematologya coagulation red blood cell "corpusce" Red Blood Cell Indices > 02 transport Men : 47 6.1 x 104 - women: 42 - 5 4x104 MCV corpuscular volume... mean >estimate of average vol Of RBCs. Hemoglobin * Pirons 80-94f((cell >carries 02 * made in > divide hematocrit by RBC count *anemia bone marrow men : 13.00 17 2 -. women: 12 1-15 1.. mean corpuscular hemoglobin hgb dividedby hot anemiacowng fatigue sob coagulation >weakness, , Reticulocyte count > immature RBC's · ↑ in hemolysis ↓ in iron, folate, vit B12 deficiency ·.5-2 5 % RBCS 8. aPTT or PT >measures intrinsic pathway Look at MCV surrogate marker to monitor heparing certain direct thrombin inhibitors ↳iron deficiency > measured in seconds >96 = macrocytic anemia ~ 30 sees normal ↳ folate B12 or deficiency on IV heparin 45-15 sees · further eval. · obtain at baseline and burs after initiation or ↳ iron studies 6 hrs after rate change/discontinuation ↳ BK or folate panels  D-Dimer unfractionated heparin >breakdown product in cot form. > conformational change when bound · factor Xa-no wrap around,not permanent > 05. mcgImL · 18 sacc , long to wrap a become irreversible >used for suspected blood clots (thrombin) > highly sensitive low molecular weight heparin >use antixatest Prothrombin Time (PT) · same as thrombin but less than 18 sacc. (only fXa) 'Protime' · inhibit fXa > measures factor 2 ,5,7, 10 > cannot be measured by aPTT ~ 12sees · assessing& adjusting ther. Of Warfarin 0 5-1 (BID). 1-2 (QD) · draw levels 4 his after dosing INR risk of *Warfarin # clot ISI 7 = > INR= PT measured PT control > Isl= international sensitivityindex risk of 1 bleeding normal = 1234 common 2-3  Gea Rheumatology improve symptoms a prevent damage streamofwateryhumokaras antibodies to tissues wi body 'Autoimmune Disease " * requires hi risk drugs # tests to determine AUTOANTIBODIES complement &tests Acute Phase Reactants · assist humoral immunity Plasma proteins > that Mor ↓ prod of itis (ACPA) · complement proteins attach to pathologic INCREASE acute Anticitrullinated Protein Antibodies targets to identify them for destruction 4 CRP , fibrinogen prealbumin , Phase DECREASE response ↳ transferrin albumin > target amino acid citrulline in joints (THC) , total hemolytic complement * rheumatoid arthritis > ability of pt serum to lyse (ESR) (RF) erythrocyte sedimentation rate Rheumatoid factor C3 & C4 > elevated presence of itis > decrease a > target fo portion of IgG * Observing ↑ levels improvement = (CRP) > low levels in can be used * rheumatoid arthritis pts w/ lupus or C-reactive protein to monitor severe infection response to (ANA) > activation of complement therapy in Antinuclear Antibodies (1000X ↑ in severe cases) rheumatologic (should ↓) sattack nuchic acids/proteins w/nucleus or cytoplasm Rheumatoid Arthritis * detects presence of > negative = arthritis antibodies > autoimmune disease of multiple joints joints systemicLupus Erythematosus · > presence of inflammatory markers (ANCA) > worsens over time Antineutrophil Cytoplasmic Antibodies simmune system attacks multiple ACPA & RE organs in body &attack neutrophil cytoplasmic antigens >best for diagnosis > women between 15445 * vasculitis > common = renal transplant HLA-B2T Juvenile Idiopathic Arthritis · ANA Of 11:00 · 10 or more on clinical criteria > on surface of RBC > begins before * butterfly rash age 16 a lasts /6 weeks) + for autoimmune diseases > clinical diagnosis - no test is definitive Synovial Joint fluid Analysis >joint fluid removed a tested for color/viscosity , etc. Methotrexate · ↑WBC = yellow color ↳ CRP &ESR improve w/ treatment ↳ monitor CBCd liver fu  2nd Cancer leading cause of death in US tumor markers : found in blood/body fluid ↳ malignancy Genes *Help predict aggresiveness response targets , , ↳regulate normalEx * mutations give rise to... Biological Markers ↳ genetic mutations > proto-oncogenes > tumor suppressor genes Molecular Markers less damaging than chemo. > DNA repair genes ↳ proteins from abnormal genes Diagnosis TUMOR MARKERS > at routine screening · proteins produced by Humor cells (CA 19-9) > Symptoms receptors on cancer cells themselves (HER2) > labs , biopsy , imagingI staging genes for particular trait (BRCA) of substances (HCG) mass quantities Markers for Diagnosis ↳PSA ↳ CEA Immunotherapy Markers ↳ turn on immune system to fight cancer 4 hCG ↳Cancers ↳ CA 15-3 27 , 29 w/ high level of genetic instability (targets. ↳ CA19-9 Biologic Markers ↳ BRCA- += + chance of recurrence ↳ ER/PR-> t = favorable response (hormonal therapy) 4 HER2 > higher - rate of recurrence  Pulmonary Labs ABG Regulation of Homeostasis most common sample arterial Blood Gas Lungs PH : 7 35-7 45 (7 4) ↳ via respirate · ·... · PaCO2 : 35-45 mmHg (40) V Determining Respiratory/metabolic > 7 45 = alkalosis Kidneys. · HCO3 22-26 mealL (24) : direction -> metabolic ) 7 35 = acidosis <. > values in same ↳ via HCOz absorption/reabsorption ↳ elevated in metabolic alkalosis eX : TPH & ↑HCO3 ↳ reduced in metabolic acidosis < values in opposite direction -> respiratory 4 Renal-slow process ↓PH ↑ PaCO2 eX : & (hours) Anion Gap Metab Acidosis Respiratory systemadjusts rapilya. (normal AG : 10-12 mEgIL or less compensation process > AG?20 = primary metab acidosis. process : Resp Acidosis. Metab Acidosis. Other labs Pulmonary Ex test Pharmacists Role > Copplasthma compensation : Metab Alkalosis. Resp Alkalosis. > fVC : · clinical mgmt. ) vol Of air ↳. forcefully I rapidly awareness of med Toxicity. in one breath leading to acid/base imbalance > SVC : Of · mgmt. COPD/Asthma ↳ slower inhalationa exhalation > FEVl : ↳in I second > FEVI/FUC : ↳estimates amount of obstruction fairflow rate during forced exp. Nutrition,fluid electrolytes PH a k are inverse ↓ Na (extracell ) specialized nutrition support. PORT > oval intake limited inhibited & follows H2O K(intracell) Mg ++ or 2 7-4.. 5 mg/dL enteral 135-145 meal) 3 5-5mea. 1 8-2 8. mgld hypo 5. hyper > 2 8 · · ·. ·. * mortality in stable Pts ·... other labs · hypo 10 2. ↳renal clearance · MgSO4 pharmacists role ionized ca additives Sor · kphos snotbound to albumin · lassess & mgmt Of SNS ↳ venal clearance ca gluconate regularinsuiin the. · > nutrition support team ~ most accurate ca reading · liver fX test 1 12-1 3 mmol/L. trace elements. > compound/delivery of parenteral coag tests hypo < 1 12 ·. ↳ aPPT hyper > 1 3 ·. · Hz antagonists · TG , BG · thiamine Patient Assessment · Zinc * Albumin/Pre-Albumin indicator of monitoring TPN · ascorbic acid > basic lab panels prior nutritional status electrolytes (CMP BMP) < > BMP (r/Mg/Phos /Ca daily T > ,. ↳indicate renallliver failure > prealbumin. TG (weekly check daily or QOD