Pediatric Hematology Oncology Labwork Interpretation Linda Ballard, CPNP, APRN

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<ul><li> Slide 1 </li> <li> Pediatric Hematology Oncology Labwork Interpretation Linda Ballard, CPNP, APRN </li> <li> Slide 2 </li> <li> Aflac Cancer and Blood Disorders Center Heme/Onc Lab Interpretation Im freaking out- the platelet count is 20 k!! 2 </li> <li> Slide 3 </li> <li> Aflac Cancer and Blood Disorders Center Okay, so a low platelet count by itself isnt always leukemia! 3 </li> <li> Slide 4 </li> <li> Aflac Cancer and Blood Disorders Center Components of the CBC White blood cells (WBC) Red blood cells (RBC) Platelets (PLT) </li> <li> Slide 5 </li> <li> BONE MARROW PROGENITORS Bone marrow precursors produce WBC RBC Platelets </li> <li> Slide 6 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells Normal lifespan is hours to days Primary responsibility..fight infection Normal range~4-15,000 Race variation Age variation </li> <li> Slide 7 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells Differential Neutrophils Lymphocytes Monocytes Eosinophils Basophils </li> <li> Slide 8 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells Neutrophils; also called Segs Most numerous ~31-75% Shortest lifespan Band=immature form Left shift Myelocytes/Metamyelocytes </li> <li> Slide 9 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells--Neutrophils Increased by Infections, stress response, inflammatory disease, childbirth, ischemic necrosis Decreased by Infection, hypersplenism, SLE, chemotherapy, radiation therapy Autoimmune process </li> <li> Slide 10 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells-Lymphocytes Lymphocytes Normal range 35-61% Produced in lymph nodes and thymus Increased by: infection, mononucleosis, thyrotoxicosis, ulcerative colitis, leukemia Decreased by: steroids, immunosuppressants, renal failure </li> <li> Slide 11 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells-Monocytes 2nd line of defense after neutrophils Phagocytosis..think Pac-man Normal range 4-7% Increased by: infection, leukemia, TB, RMSF, malaria, ulcerative colitis, mono Decreased by: infection, bone marrow failure/leukemia </li> <li> Slide 12 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells--Eosinophils Normal range 2-4% Most commonly produced in response to parasitic infections allergic disorders Other stimulants: leukemia, Hodgkin, ulcerative colitis, scarlet fever Decreased production: stress, Cushings </li> <li> Slide 13 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cells---Basophils Normal range 0-1% Increased by: chronic inflammation, hypersensitivity reactions Decreased by: Steroids, hyperthyroidism </li> <li> Slide 14 </li> <li> Aflac Cancer and Blood Disorders Center White Blood Cell--ANC Absolute Neutrophil Count= ANC ANC=WBC x (neutrophils/segs +bands) Important predictor of immune function/reserve Bodys ability to fight bacterial infections </li> <li> Slide 15 </li> <li> Aflac Cancer and Blood Disorders Center Red Blood Cells Normal lifespan is 120 days Primary role is to carry hemoglobin 2 primary regulatory factors Tissue oxygenation Renal production of erythropoietin </li> <li> Slide 16 </li> <li> Aflac Cancer and Blood Disorders Center Red Blood Cells-Indices Mean cellular volume(MCV) Mean cellular hemoglobin(MCH) Mean cellular hemoglobin concentration(MCHC) Red cell distribution width(RDW) </li> <li> Slide 17 </li> <li> Aflac Cancer and Blood Disorders Center Indices--MCV Average size of the red cell Normal range~75-94 Morphology Microcytic Normocytic Macrocytic </li> <li> Slide 18 </li> <li> Aflac Cancer and Blood Disorders Center Microcytic RBC ( Low MCV) Small size Common causes: Fe Deficiency Lead poisoning Thalassemia Inflammation </li> <li> Slide 19 </li> <li> Aflac Cancer and Blood Disorders Center Normocytic RBCs Normal MCV=normal size Normocytic anemia: Early aplastic anemia TEC Leukemia/solid tumors IBD/JRA Sickle cell/hemolytic anemias Renal disease </li> <li> Slide 20 </li> <li> Aflac Cancer and Blood Disorders Center Macrocytic RBCs (High MCV) Large size=macrocytic Common causes: Nutritional Liver disease, cyanotic heart disease Hypothyroidism Downs Syndrome Bone marrow failure </li> <li> Slide 21 </li> <li> Aflac Cancer and Blood Disorders Center RBC indices--MCH Mean cellular hemoglobin (MCH) average weight of Hgb per RBC generally rises and falls with MCV </li> <li> Slide 22 </li> <li> Aflac Cancer and Blood Disorders Center Red Cell Indices-MCHC Mean cellular hemoglobin concentration measures the concentration of hemoblobin in the RBC Hypochromic; pale appearing Normochromic Hyperchromic </li> <li> Slide 23 </li> <li> Aflac Cancer and Blood Disorders Center Red Cell Distribution Width RDW Measures the uniformity of cell size Range~11.5-14.5 Increased in Fe deficiency B12/Folate deficiency Sickle cell Anisocytosis.variablity in the RBC size </li> <li> Slide 24 </li> <li> Aflac Cancer and Blood Disorders Center Reticulocyte Count Immature RBC Measures hematopoesis from the bone marrow 0.5-1.5% normal range </li> <li> Slide 25 </li> <li> Aflac Cancer and Blood Disorders Center Reticulocytosis (High retic) Indicates an overactive bone marrow Hemolytic anemias Sickle cell, AIHA, Hereditary spherocytosis Acute blood loss </li> <li> Slide 26 </li> <li> Aflac Cancer and Blood Disorders Center Reticulocytopenia (Low retic) Indicates lack of RBC production in the bone marrow Infection Bone marrow failure syndromes Folate/Fe deficiency/B12 anemias </li> <li> Slide 27 </li> <li> Aflac Cancer and Blood Disorders Center Hemoglobin--Hgb Part of RBC that binds oxygen and delivers to tissues in the body Normal ranges based on age and gender Physiologic nadir ~2mos. Of age </li> <li> Slide 28 </li> <li> Aflac Cancer and Blood Disorders Center Hemoglobin--Hgb Increased with: Congenital heart disease Chronic hypoxia High altitudes Polycythemia vera Dehydration </li> <li> Slide 29 </li> <li> Aflac Cancer and Blood Disorders Center Hemoglobin-Hgb 3 major reasons for decreased hgb Decreased production of RBC Increased destruction of RBC Blood loss </li> <li> Slide 30 </li> <li> Aflac Cancer and Blood Disorders Center Hematocrit Percentage of RBC to whole blood In relation to Hemoglobin usually 3 times the hemoglobin value Affected by: Dehydration Stress Vasocclusion </li> <li> Slide 31 </li> <li> Aflac Cancer and Blood Disorders Center Platelets Form a plug at the site of injury Lifespan is 8-10 days Normal range is 150-450k 2/3 in circulating blood volume; 1/3 in spleen </li> <li> Slide 32 </li> <li> Aflac Cancer and Blood Disorders Center Platelets Thrombocytopenia Decreased platelet count </li> <li> Aflac Cancer and Blood Disorders Center Platelets Thrombocytosis Increased platelet count&gt;600,000 Causes: Myeloproliferative disease Acute blood loss Polycythemia vera </li> <li> Slide 34 </li> <li> Aflac Cancer and Blood Disorders Center Platelets--MPV MPV=Mean platelet volume Measures uniformity of platelet size Increased: ITP, leukemia, splenectomy, vasculitis Decreased: Wiskott Aldrich </li> <li> Slide 35 </li> <li> Aflac Cancer and Blood Disorders Center Abnormal labs Production vs Destruction Quality vs Quantity Acquired vs Congenital 35 </li> <li> Slide 36 </li> <li> Aflac Cancer and Blood Disorders Center Clinical Assessment 36 History Activity level, appetite Recent infections, fevers Pain Weight loss Family medical hx </li> <li> Slide 37 </li> <li> Aflac Cancer and Blood Disorders Center Clinical Assessment Physical Skin color Bruising, bleeding Rashes Lymph nodes Spleen, liver Lung sounds 37 </li> <li> Slide 38 </li> <li> Aflac Cancer and Blood Disorders Center Other Labs Chemistries Bone Marrow CSF 38 </li> <li> Slide 39 </li> <li> Aflac Cancer and Blood Disorders Center Case # 1 Annie is a 2 year old referred for anemia. Screening hgb at well check was 9.4. Clinical sx to review? Pt started on oral iron supplement 2 mg/kg/day Recheck 2 mths later- CBC: WBC 6.8, Hgb 9.9, Hct 29, MCV 62, plt 224 k. 39 </li> <li> Slide 40 </li> <li> Aflac Cancer and Blood Disorders Center Case # 2 Henry is 3 years old, brought to PCP for 4 days of worsening fever, lethargy, pallor. Alert, VSS. PE: enlarged spleen, scleral icterus, jaundice CBC: WBC 9.4, Hgb 7.5, MCV 78, plt 257 k retic 10.8 40 </li> <li> Slide 41 </li> <li> Aflac Cancer and Blood Disorders Center Case # 3 Lucy is a 10 year old brought to PCP for a rash noted on chest, back and abdomen for a few days. Other sx include fatigue, c/o leg pains. Low grade fever CBC: WBC 35 K, Hgb 11, plt 34 K. 41 </li> <li> Slide 42 </li> <li> Aflac Cancer and Blood Disorders Center Summary Its not just about the numbers History Patient Family Physical findings Full system exam If the labs dont match the clinical picture, repeat the lab! </li> </ul>