a) Determine the HgB values for the patient samples to fill in the table below. (15 points total) (g/dl) (%) 1 (Female)

Transcription

1 Week 4 - PROBLEM SET ( 200 points ) INSTRUCTIONS: Report all numerical answers to 1 decimal place. Do not round values used for calculations. Must show calculations and units for full credit. (1) A standard curve for hemoglobin (HgB) yielded the equation y = 0.049x (with an r 2 value of.998 over the range of 0-50 g/dl HgB. Using the equation from this standard curve line equation, a) Determine the HgB values for the patient samples to fill in the table below. (15 points total) Patient Absorbance HgB calculation HgB conc. Hct (540 nm) (g/dl) (%) 1 (Female) (Female) (Male) (Male) (Pregnant) b) Is patient #1 anemic ( yes / no ) based on: low Hct / low HgB / both normal Is patient #2 anemic ( yes / no ) Is patient #3 anemic ( yes / no ) Is patient #4 anemic ( yes / no ) Is patient #5 anemic ( yes / no ) based on: low Hct / low HgB / both normal based on: low Hct / low HgB / both normal based on: low Hct / low HgB / both normal based on: low Hct / low HgB / both normal (2) Which of the statements is/are true concerning determination of Hct and HgB? (2 pts) a) the colorimetric assay for HgB uses alkaline potassium ferricyanide to oxidize hemoglobin to methemoglobin b) Hct is determined by dividing the total blood volume (or height) in the hematocrit tube by the packed red blood cell volume (height) c) A blood sample with a large proportion of lysed (broken) cells will still give an accurate Hct d) a and b only e) none of the above (3) Which of the following conditions can present with low MCV and low MCHC values? (2 pts) a) Thalassemia b) Iron deficiency c) porphyrin defects d) all of the above e) a and b only

2 (4-6) Using the values provided below, calculate the MCV, MCH and MCHC values for each patient below. Calculate MCHC using Hgb and Hct for Patients A, B and C and using MCV and MCH for patients D and E. Show your work and include units for full credit. (15 pts) Patient Hct (%) HgB (g/dl) RBCs A x B C D E x x x x Patient A: Patient B: Patient C: Patient D: Patient E:

3 (7) Based on all data for each patient provided above (questions 4-6) fill in the table below (34 pts) Patient A (female) Cell Morphology Anemia? (based on) Severity List 2 possible cause(s) Patient B (male) Patient C (male) Patient D (female) Patient E (male) (8) A male patient has an MCV = fl; RBC# of 4.82 x10 12 and an MCH = 33.6 pg. (6 pts) Based on these values, complete the questions below (show calculations and units) What is his Hct value? What is his HgB value? Describe his RBC morphology Is he anemic? Based on what indicator(s) (9) A female patient has normal MCV and normal MCHC values. However, her RBC concentration is reduced and her Hct value indicates a severe anemia (4 pts) In terms of RBCs, what is the fundamental problem that could account for this? What type(s) of anemia (or conditions) present this way?

4 (10) Ann, a 21 year old female patient, presents with fatigue, edema of the feet and ankles, and has the following CBC values: Hct = 34.8% RBCs= 4.23 x10 12 HgB = 12.3 g/dl What are Ann s MCV and MCHC values? (Show calculations and units) (8 pts) MCV = MCHC = Is she anemic? Based on what indicator(s) Describe (classify) her RBC morphology List/describe some possible cause(s) for her condition (11) Jack, a 43 year old male patient, is recovering from surgical removal of an aggressive, but benign, intestinal tumor 6 days ago. He has recently complained of light-headedness and extreme fatigue. His current CBC values are: Hct = 37.7% RBCs = 3.81x10 12 HgB = 12.4 g/dl What are Jack s MCV and MCHC values? (Show calculations and units) (9 pts) MCV = MCHC = Is he anemic? Based on what indicator(s) Describe his RBC morphology Possible cause(s) (12) A patient has the following CBC results: MCV = fl RBCs = 4.73x10 12 MCH = 24.52pg Based on these values, which of the following is correct? (2 pts) a) Hct = 17.16% HgB = g/dl b) Hct = 21.14% HgB = g/dl c) Hct = 38.40% HgB = g/dl d) Hct = 21.14% HgB = g/dl e) Hct = 31.17% HgB = g/dl

5 (13) A patient has high MCV and high MCHC values. (5 pts) List their possible or likely RBC morphology This could be indicative of what type(s) of anemia Based on only the data provided, is the patient anemic? (14) A non-pregnant 23 year old female patient had blood work done over a successive period of several months which yielded the following data (today = day 90): (13 pts) Day 01 HgB = 13.2 g/dl Hct = 39.2% RBCs= 4.31 x10 12 Day 15 HgB = 13.1 g/dl Hct = 38.4% RBCs= 4.13 x10 12 Day 30 HgB = 12.5 g/dl Hct = 36.3% RBCs= 3.68 x10 12 Day 45 HgB = 12.1 g/dl Hct = 35.3% RBCs= 3.22 x10 12 Day 60 HgB = 12.0 g/dl Hct = 34.4% RBCs= 2.91 x10 12 Day 75 HgB = 12.0 g/dl Hct = 34.3% RBCs= 2.61 x10 12 Today HgB = 11.8 g/dl Hct = 34.1% RBCs= 2.60 x10 12 Given the data above, is she anemic? Based on what/which indice(s)? Over-time (Day1 to today), what has been the change in her MCV? in her MCH? in her MCHC? Note: report change in indicator s units and directionality of change (e.g. increased 2.0 fl or decreased 10 pg) What is her current RBC morphology? What type(s) of anemia is this indicative of? (15) Two non-pregnant female patients have the following values: Jane - Hct = 34.7%; Mary HgB = 13.7 g/dl. Based on these values, which of the following is/are correct? a) if both have identical RBC # (4.27x10 12 ), then only Mary is anemic b) if both have identical RBC # (as above), then only Jane has macrocytic cells c) if both have identical RBC # (as above), then Mary will exhibit microcytic cells if she has a Hct value <33.9% d) a and b only e) none of the above (2 pts)

6 (16) Two males (Max and Bob), have identical numbers of RBCs (4.88x ) and identical MCHC values (32.4g/dl). Based on these data, which of the following is/are correct? (2 pts) a) if Max has a Hct = 39.7% and Bob has a Hct = 41.5, then Bob has the lowest HgB value b) if Max and Bob have the Hct values above, then only Max would have microcytic cells c) if Max and Bob have the Hct values above, then only Max is anemic d) a and b only e) none of the above (17) Having developed a new assay for HgB and established the new assays validity in lab settings, you will now be testing the assay under field conditions and will be confirming and following up on 6 nonpregnant females who gave Anemic HgB values in a study conducted 6 weeks ago using a different ( old ) assay. Given below, are data for the 6 Anemic subjects (replicate results), and triplicate results for an established HgB Standard [ 14.0 g/dl ]. Based on these data, answer the questions that follow. (21 pts) Subjects: AA DD GG RR KK WW STD New Assay 11.7/ / / / / / /14.8/15.5 Old Assay 10.2/ / / / / / /13.8/14.5 Calculate the Mean HgB for each AA DD GG RR KK WW STD New Old Which assay is more precise based on the values for the standards (show work)? Which assay is more accurate? Which (if any) diagnosis have changed as a result of the new vs old assay? Which assay ( old or new ) would you use for the next, large-scale study and why would you use it?

7 (18) A non-pregnant 26 year old female returned 13 weeks ago from a 10 month period as a Peace Corps worker in remote South America. Shortly after her return, she was diagnosed with anemia and began treatment. Since then, she has been monitored to assess the progress of her recovery. Evaluate her situation given the blood work data presented below [fill-in the missing data first]. (34 pts) Hct(%) HgB(g/dL) RBC # MCV(fL) Std DevMCV MCH(pg) MCHC(g/dL) RDW(%) Day x Day x (treatment started) Day x Day x Day x Day x Day x (Today) At the start of her treatment (day 14): Describe her cell morphology Was her RDW normal? Was she anemic? Based on what indicator(s) Today (day 84): Describe her cell morphology Is her RDW normal? Is she anemic? Based on what indicator(s) Is the treatment working? Are ALL the RBC indices within normal limits? Which (if any) indices are NOT? For any values that are NOT within normal limits, explain/discuss possible reasons why they are outside the normal range(s)

8 (19) Upon admission to the hospital, blood analysis on a 32 year old male patient provided the following data: Hct (%) = 28.3 HgB (g/dl) = 9.1 RBCs (#) = 3.49 x x10 12 RDW (%) = 12.2 What are his MCV and MCHC values? (Show calculations and units) (24 points) MCV = MCHC = Is he anemic? Based on what indicator(s) Severity? Describe his RBC morphology Further test results (HIGH Blood Urea Nitrogen and HIGH Creatinine) revealed significant (>60%) loss of renal function. Based on these results and those above, briefly discuss if/how this affects your interpretation of the patient s situation. Diet assessment revealed apparent sufficiency of all nutrients, and a synthetic form of Erythropoietin ( Procrit ) was administered. Now, 2 weeks after Procrit treatment, the following blood values were obtained: Hct (%) = 29.8 HgB (g/dl) = 9.6 RBCs (#) = 3.71 x x10 12 RDW (%) = 12.4 What are his MCV and MCHC values now? (Show calculations and units) MCV = MCHC = Is he anemic? Based on what indicator(s) Severity? Describe his RBC morphology Should he continue receiving Procrit treatment why or why not?

9 (20) 2 weeks after moving into the dormitories at the Colorado School of Mines (in the Rocky Mountains about 20 miles east of Denver), all students had blood taken and analysis performed as part of a study. Regarding the student blood samples, which of the following statements is/are true? a) centrifuging the blood at too high a speed could artificially lead to a low Hct value b) assuming similar ages, gender, diet and lifestyle, freshman coming from coastal communities of California would be expected to have HgB values comparable to California students who have lived in Denver area for the past 9-12 months c) a student with significant hypernatremia would likely have decreased HgB and a decreased Hct compared to their values in a normal natremic (normal sodium) state d) all of the above e) a and b only