1 / 42

Pediatric Hematology Oncology Labwork Interpretation

Pediatric Hematology Oncology Labwork Interpretation. Linda Ballard, CPNP, APRN. Heme/Onc Lab Interpretation. I’m freaking out- the platelet count is 20 k!!. Okay, so a low platelet count by itself isn’t always leukemia!. Components of the CBC. White blood cells (WBC) Red blood cells (RBC)

dutch
Download Presentation

Pediatric Hematology Oncology Labwork Interpretation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pediatric Hematology Oncology Labwork Interpretation Linda Ballard, CPNP, APRN

  2. Heme/Onc Lab Interpretation • I’m freaking out- the platelet count is 20 k!!

  3. Okay, so a low platelet count by itself isn’t always leukemia!

  4. Components of the CBC • White blood cells (WBC) • Red blood cells (RBC) • Platelets (PLT)

  5. BONE MARROW PROGENITORS • Bone marrow precursors produce • WBC • RBC • Platelets

  6. White Blood Cells • Normal lifespan is hours to days • Primary responsibility…..fight infection • Normal range~4-15,000 • Race variation • Age variation

  7. White Blood Cells • Differential • Neutrophils • Lymphocytes • Monocytes • Eosinophils • Basophils

  8. White Blood Cells • Neutrophils; also called Segs • Most numerous ~31-75% • Shortest lifespan • Band=immature form • “Left shift” • Myelocytes/Metamyelocytes

  9. White Blood Cells--Neutrophils • Increased by • Infections, stress response, inflammatory disease, childbirth, ischemic necrosis • Decreased by • Infection, hypersplenism, SLE, chemotherapy, radiation therapy • Autoimmune process

  10. 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

  11. 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

  12. 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

  13. White Blood Cells---Basophils • Normal range 0-1% • Increased by: chronic inflammation, hypersensitivity reactions • Decreased by: Steroids, hyperthyroidism

  14. White Blood Cell--ANC • Absolute Neutrophil Count= ANC • ANC=WBC x (neutrophils/segs +bands) • Important predictor of immune function/reserve • Body’s ability to fight bacterial infections

  15. Red Blood Cells • Normal lifespan is 120 days • Primary role is to carry hemoglobin • 2 primary regulatory factors • Tissue oxygenation • Renal production of erythropoietin

  16. Red Blood Cells-Indices • Mean cellular volume(MCV) • Mean cellular hemoglobin(MCH) • Mean cellular hemoglobin concentration(MCHC) • Red cell distribution width(RDW)

  17. Indices--MCV • Average size of the red cell • Normal range~75-94 • Morphology • Microcytic • Normocytic • Macrocytic

  18. Microcytic RBC ( Low MCV) • Small size • Common causes: • Fe Deficiency • Lead poisoning • Thalassemia • Inflammation

  19. Normocytic RBCs • Normal MCV=normal size • Normocytic anemia: • Early aplastic anemia • TEC • Leukemia/solid tumors • IBD/JRA • Sickle cell/hemolytic anemias • Renal disease

  20. Macrocytic RBC’s (High MCV) • Large size=macrocytic • Common causes: • Nutritional • Liver disease, cyanotic heart disease • Hypothyroidism • Down’s Syndrome • Bone marrow failure

  21. RBC indices--MCH • Mean cellular hemoglobin (MCH) • average weight of Hgb per RBC • generally rises and falls with MCV

  22. Red Cell Indices-MCHC • Mean cellular hemoglobin concentration • measures the concentration of hemoblobin in the RBC • Hypochromic; pale appearing • Normochromic • Hyperchromic

  23. 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

  24. Reticulocyte Count • Immature RBC • Measures hematopoesis from the bone marrow • 0.5-1.5% normal range

  25. Reticulocytosis (High retic) • Indicates an overactive bone marrow • Hemolytic anemias • Sickle cell, AIHA, Hereditary spherocytosis • Acute blood loss

  26. Reticulocytopenia (Low retic) • Indicates lack of RBC production in the bone marrow • Infection • Bone marrow failure syndromes • Folate/Fe deficiency/B12 anemias

  27. 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

  28. Hemoglobin--Hgb • Increased with: • Congenital heart disease • Chronic hypoxia • High altitudes • Polycythemia vera • Dehydration

  29. Hemoglobin-Hgb • 3 major reasons for decreased hgb • Decreased production of RBC • Increased destruction of RBC • Blood loss

  30. Hematocrit • Percentage of RBC to whole blood • In relation to Hemoglobin • usually 3 times the hemoglobin value • Affected by: • Dehydration • Stress • Vasocclusion

  31. 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

  32. Platelets • Thrombocytopenia • Decreased platelet count <150,000 • Causes: • Decreased production • Abnormal destruction • Abnormal pooling

  33. Platelets • Thrombocytosis • Increased platelet count>600,000 • Causes: • Myeloproliferative disease • Acute blood loss • Polycythemia vera

  34. Platelets--MPV • MPV=Mean platelet volume • Measures uniformity of platelet size • Increased: ITP, leukemia, splenectomy , vasculitis • Decreased: Wiskott Aldrich

  35. Abnormal labs • Production vs Destruction • Quality vs Quantity • Acquired vs Congenital

  36. Clinical Assessment • History • Activity level, appetite • Recent infections, fevers • Pain • Weight loss • Family medical hx

  37. Clinical Assessment • Physical • Skin color • Bruising, bleeding • Rashes • Lymph nodes • Spleen, liver • Lung sounds

  38. Other Labs • Chemistries • Bone Marrow • CSF

  39. 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.

  40. 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

  41. 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.

  42. Summary • It’s not just about the numbers • History • Patient • Family • Physical findings • Full system exam • If the labs don’t match the clinical picture, repeat the lab!

More Related