IPDM 1 WK 3 Lecture Summary

alchemist04's version from 2016-05-02 23:14


Question Answer
What is Quantitative Test?Numeric range e.g. Blood sugar, Blood count, CrCl
What is Qualitative Test?Non numeric, Positive (+) or Negative (-) e.g. Pregnancy Test
What does RBC indices mean?the size and shape of the RBC
What is the most abunddant circulating WBC?Neutrophils
What could cause an increase of Neutrophils?Bacterial Infections and Fugal infections
Absolute Neutrophil Count (ANC) formula isWBC x (% Segs + % Bands) in cells/mm^3
Which one is more Hgb or Hct and by how much?Hct is more, 3x more than Hgb


Question Answer
Segs% of mature neutrophils/PMN
Bands% of immature neutrophils or % of immature granulocytes / stab
Unit for ANCcells/mm3
ANC normal range1,500-8000 cells/mm3
NeutropeniaANC < 1,500 cells/mm3
AgranuclocytosisANC < 500 cells/mm3


Question Answer
What is "absolute neutropenia"?Agranulocytosis
What is ANC used for?To monitor patients undergoing chemotherapy and Patient taking medications such as clozapine
"Left Shift" Neutrophilia(1) Increase in neutrophils and bands (2) production of large number of new and immature white blood cells (bands) trying to fight off an infection.
"Right Shift" Neutrophiliamean bone marrow suppression. There is an increase in Matured Neutrophil
What is the difference between BMP and CBC?BMP is Basic Metabolic Count like Na+, Cl-, Glucose, HCO3, K+ while CBC is blood count of RBC (Hgt, Crt, Platelet, ESR) and WBC


Question Answer
Platelets is also known asThrombocytes
Normal range of Platelets150,000-450,000/uL
Platelet count of <150,000/uL meanslow platelet count (Thrombocytepenia)
Platelet count that is >800,00/uL meanshigh platelet count (Thrombocythemia or Thrombocytosis)
Unit for Platelets countuL
Average life span for platelet8-10 days
Function of Plateletconverts liquid blood into gel (clot)
Platelet aggregation can causethrombus formation


Question Answer
Thrombocytopenia< 150,000 uL, low thrombocytes or deficiency of platelets in the blood resulting in low blood clot.
Common signs and symptoms of Thrombocytopenia(1) Ecchymosis (2) Petechiae (3) Hematura (4) Melena (5) Menorrhagia (6) Epistaxis (7) Bleeding gums (8) Prolonged bleeding from cuts
Thrombocytosis>800,000 uL, increase production of platelets
Common signs and symptoms of Thrombocytosis(1) increase risk of thrombosis (blood clot), (2) Posthemorrhagic anemia (3) splenectomy (4) infection (5) Stress


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ESRErythrocyte Sedimentation Rate
ESR Unitmm/hr
ESR Normal RangeMales 1-15 mm/hr Female 1-20 mm/hr
ESR Useto monitor activity of inflammatory conditions
High ESR meansdisease is active
Low ESR meansintensity of disease is decreased


Question Answer
SCrSerum Creatinine
Normal range0.6-1.2 mg/dL
SCr Unitmg/dL
SCr Useprimary marker for renal function
True of False? SCr can be sole assessment for renal functionFalse. Avoid using SCr as the sole Assessment of renal function
SCr > 1.2 mg/dL meansWorsening renal function
What are the factors that could affect SCr?(1) Age (2) Muscle mass (3) Sex (4) Race (5) Diet


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BUNBlood Urea Nitrogen
BUN Normal Range8-20 mg/dL
BUN Unitmg/dL
BUN > 20 mg/dL means(1) their is a reduced renal blood flow (2) GI bleeding (3) Dehydration (4) blood loss (5) high protein consumption
BUN < 20 mg/dL means(1) Liver damage (2) Malnutrition
BUN Usemeasure liver damage and dehydration/malnutrition


Question Answer
BUN:CrBUN-to-Creatinine Ratio. It is the ration of BUN and SCr
BUN:Cr useto determine dehydration and Acute Kidney Injury (AKI) i.e. kidney function
BUN:Cr Normal Range10:1 - 20:1
BUN:Cr < 10:1 meansAcute Kidney Injury (Renal damage)
BUN:Cr > 20:1 meansDehydration


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CrClCreatine Clearance
CrCl Normal Range75-140 mL/min
CrCl UnitmL/min
CrCl Useto calculate a good approximation of GFR, Kidney function for medications that are renally cleared
CrCl that is below or above desirable therapeutic threshold will result in ?adjustment of dose avoidance of medication
CrCl < 75 mL/min means(1) severe dehydration (2) Kidney damage (3) heart failure
CrCl > 140 mL/min means(1) high diet protein (2) pregnancy
What is the Formula for calculating CrCl called?Cockcroft-Gault Equation


Question Answer
Sulfamethoxazole/Trimethoprim (Bactrim) with CrCl > 30 mL/min will result in what dosage adjustmentNo dosage adjustment required
Sulfamethoxazole/Trimethoprim (Bactrim) with CrCl 15-30 mL/min will result in what dosage adjustmentdecrease dose by 50%
Nitrofurantoin (Macrobid) with CrCl < 60 mL/min will result inContraindication


Question Answer
When do you consider Adjusted Body Weight rather than Ideal Body Weight?When the patient is 30% over IBW
IBW Females45.5 + (2.3 kg x inches over 5')
IBW Male50 + (2.3 Kg x inches over 5')
Adjusted Body Weight0.4 (Actual Body Weight - Ideal Body Weight) + Ideal Body Weight
Identify the limitations of Cockcroft-Gault equations(1) A stable Kidney function is required (2) Developed for adult only (3) May be affected by decreased muscle mass as in elderly (4) Obesity with less muscle mass will result in overestimation of kidney function
For overweight person, what would you need to do to get accurate Cockcroft-Gault EquationMay need Adjusted Body weight (ABW) or Ideal Body Weight (IBW) or Lean Body Weight (LBW)
If patient is 30% above IBW, use ................ to calculate Cockcroft-Gault EquationUse Adjusted body weight


Question Answer
How do you directly measure GFR estimateby MDRD and CKD-Epi
MDRDModification of diet in Renal Disease
CKD-EpiChronic Kidney Disease Epidemiology Collaboration
Could one use both MRDR and CKD-Epi in patient with AKIBoth equation are not appropriate in AKI patient
What is the limitation of MDRD & CKD-Epi in using it DIRECTLY estimate GFR?Both equations cannot be used in Acute Kidney Failure


Question Answer
AKIAcute Kidney Injury
An SCr >/= 0.5 mg/dL and a decrease in GFR that is >/= 2.5% meansAKI
True or False? Estimating kidney functions in AKI is difficult because commonly used SCr-base equation are NOT appropriateTrue
What are possible causes of AKI?(1) Nephrotoxic drugs (2) Obstructions (3) Volume depletion


Question Answer
CDKChronic Kidney Disease
KDOQIKidney Disease Outcome Quality Initiative
According to KDOQI, Kidney damage for more than ------- months and +/- --------- GFR?3 months, decrease GFR
According to KDOQI, Kidney damage has GFR less than ----------- for 3 monthsGFR 60 mL/min/1.73 m^2 for 3 months


Question Answer
Unit for Urine Albuminmcg/mg
Albuminuria/proteinuraabnormally high amount of albumin/protein found in urine
Nephropathykidney damage due to disease
Normal Urine Albumin<30mcg/mg
Urine Albumin > 30mcg/mg means?Increased urinary albumin excretion


Question Answer
Normal Liver Albumin3.5 - 5 g/dL
Liver Albumin Serum half-life20 days
What happens to Serum Albumin measurement after the onset of hepatic dysfunctionSerum albumin fall slowly
What happens to Serum Albumin measurement in patient with acute liver disease?The Serum Albumin remain normal


Question Answer
HypoalbuminemiaAlbumin < 3.5 g/dL, low concentration of Serum Albumin
What % of Serum Ca2+ bound to Plasma protein40%
What % of Ca2+ form complexes with phosphate and citrate?~5-15%
What % of Ca2+ are Ionized and unbound?~ 45-55%
Formula for "Corrected Ca2+", see slide 650.8 (Alb - serum Alb) + Ca2+
What are the causes of Hypoalbuminemia?(1) Chronic liver disease (2) Malabsorption (3) Malnutrition (4) Severe burn (5) Trauma (6) Alcohol use (7) ascites
How does Hypoalbuminemia affect drug like Phenytoin?It affects the interpretation of serum calcium and the concentration of drugs that are highly protein bound like Phenytoin
What laboratory information do you need to interprete Serum Calcium report or calculate Adjusted Serum Calcium? Albumin result and TOTAL Serum Calcium.


Question Answer
Prealbumin Normal Range16-40 mg/dL
Prealbumin half life2 days ( shorter than Albumin half-life of 20 days)
True or False? Prealbumin is more affected by liver diseaseFalse, it is less affected by liver disease
True or false? Prealbumin is less sensitive to protein nutritionFalse, it is more sensitive to protein nutrition
True or false? Prealbumin is has smaller body poolTrue, it has smaller body pool
True or false? Prealbumin is involved in osmoregulationFalse, it is not involved in osmoregulation
True of false? when malnourished patient are fed, prealbumin concentration rise before albuminTrue, prealbumin concentrations rise before albumin
What is the use of Prealbumin?Use to monitor patients receiving parenteral and enteral nutrition


Question Answer
TPTotal Protein
TP equationTP = albumin + globulin
TP normal range5.5 -8.3 g/dL
Calc. Globulin using TP =globulin = TP - albumin
Albumin is made inside or outside the liver?Inside the liver
Globulin is made inside or outside the liver?Outside the liver


Question Answer
PTProthrombin Time
Normal Range10-13 sec
What is PT used for?To monitor Wafarin therapy.
Vit K is a co factor for activation of which clotting factors?II, VII, IX, X
Liver synthesize six co factors what are they?I, II, V, VII, IX, X


Question Answer
True or False? Vit K deficiency causes elevated PTTrue
True or False? Vit K malabsorption (e.g. Tetracycline effect on Warfarin) does not elevate PTFalse, It does cause elevated PT
Vit K antagonist like Warfarin does not cause elevated PT ?False, it does cause elevated PT
True of false, elevated systemic lupus erythematosus cause elevated PTTrue, it causes elevated PT
True or False? Disseminated Intravascular Coagulation causes elevated PTTrue, it causes elevated PT
True or false? Substantial Hepatic Impairment DOES not cause elevated PTFalse, Substantial Hepatic Impairment causes elevated PT.


Question Answer
INRInternational Normalized Ration
True of False? PT has been replaced by INRTrue
What is the use to calculate INR?ISI
What is ISI?International Sensitivity Index
What is INR used for?to measure how long it takes blood to form a clot


Question Answer
Microcytic anemia value< 75 uM^3
Macrocytic anemia value> 100 uM^3
Normochronic meansHgt is normal
Hypochronic meansCrt is normal
Granulocytescells having granules, Leukocytes ending with -phils, Neutrophils, Eosinophil & Basophil
AgranulocytesCell w/o granules (no grain in site), Leukocytes with cytes, Lymphocytes & Monocytes
Why is there Neutrophil and not Neutrocytes?Bc Neutrophil has granules and it belongs to granulocytes.


Question Answer
What does Reticulocytes count meansAmount of Immature Red Blood Cells (Erythrocytes)
What will be the value of Reticulocytes in a patient with drug induced bone marrow suppression?The Reticulocyte will be near Zero
What will be the value of Reticulocytes in a patient undergoing therapy for Anemia?There will be an increase in Reticulocytes w/n 5-7 days
What is PMN?Polymorphonuclear Neutrophil

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