Seeeeeeeeaeemueeasananen ineeteeneeeemeeeeenneeesaseeeseeeeeaiseeseeseseesiceeeeesseesaseeeseeeesesiaeeesss 2OL4LAB4 Name: y__lore taba: Juliana Week 4- PROBLEM SET (200 points) A3 | 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 (H1gB) yielded the equation y = 0.049x + 004 (with an r* value of 998 over the range of 0 - 50 g/dl HgB. Using the equation from this standard curve line equation, 18) Determine the HgB values for the patient samples to fill in the table below. (1S points total) Patient ‘Absorbance | HgB calculation HgB cone. | Het (340 nm) (g/d) (%) T Female) 0.383 338 a 372 (Female) 0.646 nubs uous i 3Ea 7 +3 (Male) 0.621 , , 4.7 v 4 (Maley 0.745 = | a24 5 (Pregnant) 0.586 : con 19 304 b) Is patient #1 anemic (“yes)/ no ) based on: low Het / low HgB>/ both normal Is patient #2 anemic ( yes / 0) based on: low Het / low HgB / both normal) Is patient #3 anemic (‘yes)/ no ) based on: low Het / ow HgB)/ both normal Is patient #4 anemic ( yes //no)) based on: low Het / lowHgB /( both normal Is patient #5 anemic (yes! / no ) based on:( low Hei / low HgB / both normal (2) Which of the statements is/are true concerning determination of Hct and HgB ? (2 pts) (@) the colorimetric assay for HgB uses alkaline potassium ferricyanide to oxidize hemoglobin * to methemoglobin b) Het is determined by dividing the total blood volume (or height) in the hematocrit tube by VY the packed red blood cell volume (height) ©) A blood sample with a large proportion of lysed (broken) cells will still give an accurate Het @) a and b only ©) 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 / ©) porphyrin defects @_allof the above e) @ and bonly2oL4LAB4 Name: Ziyino, Tov tab Ta: Juliana (4-6) Using the values provided below, calculate the MCV, MCH and MCHC values for each patient below, Calculate MCHC using Hgb and Het 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 Het) FigB (gia) RBCS 34.6 78 4.97 x 10” \ a 44.7 15.2 5.31x 10? - 36.7 13.0 4.54 x 10 a 48.4 81 471 x 10? . 33.7 68 5.02 x 10!? MCHC = MCHC=__34.09/d mcnce (85S Mcv'=_lo2.8fL apg wcuc=__Ib. Jf pees 02.16 VL. Patient Es = MCV=_b1.1f 1 Het decimal Cy 5 (PBC 1 A 0.3311 Boo!wravres Name:_Ziuiaa tabTa:__Juhiano, ¢ (7) Based on all data for each pati -d above (questions 4-6) fill in the table below (34 pts) ‘Anemia? (based on) Severity y Cell Morphology List 2 possible cause(s) Patient A (female) e eficiencie Fe Cah Patient B (male) NIA © Patient C (male) mul Mild Patient D| (female) | Ma | - Doeh ¥ Vinsic Many Patient E 1 (male) ophyyinn dete ck 5 - (8) A male patient has an MCV = 103.7 {L; RBC# of 4.82 x10"? and an MCH = 33.6 pg. (6 pis) cq, Based on these values, complete the questions below (show calculations and units) M\cl\~ ( 00% What is his Het value? What is his HgB value? atl) x Describe his RBC morphology Macioayt ~~ _ Based on what indicator(s) Sct, nov Ig8 value a 7 v Is he anemic? _ (9) A female patient has normal MCV and normal MCHC values. However, her RBC concentration is reduced and her Het value indicates a severe anemia (pss) In terms of RBCs, what is the fundamental problem that could account for this? The (met of RB suns ‘What type(s) of anemia (or conditions) present this way? Enc meng blood loss Siow=... 2014s Name:__Ziuing lar Lab TA: (10) Ann, a 21 year old female patient, presents with fatigue, edema of the fect and ankles, and has the following CBC values: Het = 34.8% RBCs= 4.23 x10? HgB = 12.3 g/dl ‘What are Ann's MCV and MCHC values? (Show calculations and units) (pss) v AX 7.23X107 X'PFY py = 82.2741 Is she anemic? _Yes. ri Based on what indicator(s) jou Hct 1€ — i= Describe (classify) her RBC morphology _Npiioayt'i > Nownarh Z Listideseribe some possible cause(s) for her condition + 3ve<< plac lose 5 plasner level increases» hemgl ed RBC: over ~ hy sly (U1) 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: Het = 37.7% RBCs =3.81x10" HgB = 12.4 g/dl What are Jack’s MCV and MCHC values? (Show eslculations and units) Opts) ogni, MCV=__ 9.08 MCHC = ag3dl_~ Mcy= O3TILy : f Met 5 ~ 33 1X ak a0 X37 ¥ 4/ al Ishe anemic? _\es po Based on what indicator(s) lo He4 vo lue HgB value v Describe his RBC morphology _Nowo a i Zz Possible cause(s) § : Hee cod_lhs RBC destinction; hemolusis lower tet (12) A patient has the following CBC results: MCV = 81.18 fL_ RBCs = 4.7310" MCH = 24.52pg Based on these values, which of the following is correct? 7 . (2 pts) a) Het=17.16% HgB=51.84g/al McV=[ Tet decwe b) Het=21.14% HgB=28.44 g/dl 2), J () Het=38.40% — HgB= 11.60 giat d) Het=21.14% e) Het=31.17%2oiiasa Name:___Ziyinos 5 Lab TA: (13) A patient has high MCV and high MCHC values. List their possible or likely RBC morphology ‘This could be indicative of what type(s) of anemia__De-{\ ier £ Based on only the data provided, is the patient anemic? | of on 00 Juliano, = we (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): Day 01 HgB = 3.2 gid Day 1S HgB= 13.1 g/dl Day30-HgB 25 gidl Day 45 HgB = 12.1 g/dl Day 60 HgB Ray 75 HgB Today HgB = 11.8 g/dl Given the data above, is she anemic? _\@s 2.0 g/dl 2.0 g/dl Het = 39.2% Het = 35.3% Het = 34.4% Het = 34.3% Het = 34.1% RBCs= 4.31 x10"? RBCs= 4.13 x10"? RBCs= 3.68 x10"? RBCs= 3.22 x10 RBCs= 2.91 x10" RBCs= 2.61 x10 RBCs= 2.60 x10"? Based on what/which indice(s)? Over-time (Day! to today), what has been the change in her MCV? inc \ aly (13 pis) inher MCH? In cvereet \é M = in her MCHC? _T. nye 7 Note: report change in indicator’s units and directionality of change (e.g. increased 2.0 AL or decreased 10 pg) What is her current RBC morphology? Mccous spe ‘ v _ ‘What type(s) of anemia is this indicative of? ces 0 (15) Two non-pregnant female patients have the following values: Jane - Het = 34.7%; Mary - HgB = 13.7 g/dl. Based on these values, which of the following is/are correct? if both have identical RBC # (4.27x10"), then only Mary is anemic if both have identical RBC # (as above), then only Jane has macrocytic cells if both have identical RBC # (as above), then Mary will exhibit microcytic cells if she a) ») °) 4 °) has a Het value <33.9% a and b only none of the above Vv pts)2014 484 Name: 4 Tar ab Ta (16) ‘Two males (Max and Bob), have identical numbers of RBCs (4.88x 10) and identical MCHC values (32.4g/dl). Based on these data, which of the follo 1g is/are correct? (2 pts) a) if Max has a Het = 39.7% and Bob has a Het = 41.5, then Bob has the lowest HgB value b) if Max and Bob have the Het values above, then only Max would have microcytic cells Yea if Max and Bob have the Het values above, then only Ma “da and b only ©) none of the above anemic (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 non- pregnant females who gave Anemic HgB values in a study conducted 6 weeks ago using @ different Cold”) 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 pis) Subjects: AA DD GG RR KK ww sTD New Assay 117/113 105/111 134/128 101/93 8.8/9.4 13.7143 15.0/14.8/15.5 Old Assay 10.2/9.4 9.6/8.1 10.0/11.4 8.1/6.9 7.8/6.2 — 10.5/9.1 13.0/13.8/14.5 Calculate the Mean HgB for each AA DD GG RR KK ww sTD New U5 tek ya iM Mo Jo Old 1s 3.4 od fc 1.€ 4. 38 Which assay is more precise based on the values for the standards (show work)! Vv Which assay is more accurate?__O 14 ‘Which (if any) diagnosis have changed as a result of the new vs old assay? Salyer’ GC - eee WIN i NOW dioanns non aneri aa Which assay (“old” or “new") would you use for the next, large-scale study and why would you use it?\ ros rss Name: wo To tab Ta:__Jiulinncy (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 fist} Géps) aes SAD: Het) HgBeul) RBC¥ MCV@1) sdpeMcv MCHie) MCHCiear) RDWeA DayOl 304 7.92 4.13x10" 73.61 12.38 19.18 26.05 16.82 Day07 29.8 7.86 4.10x10"" 72.68, 11.47 19.17 2638 15.92 (treatment started) — a Day14 29.5 7.73 4,09x10"" 23 13.58 Day28 30.2 7.88 4.10x10" 73.66 13.74 Day 56 31.7 8.21 4.12x10" 14 14.52 Day70 33.3 © 10.61 4.14x10"? 2 1553 Day84 34.2 11.25 4.t4x10” 82.61 1467 (Today) At the start of her treatment (day 14): Describe her cell morphology Was her RDW normal ? 3 Was she anemic? __\es_* Based on what indicator(s)_low SW x lo values ‘Today (day 84): Describe her cell morphology foo * Is her RDW normal? _)\c Is she anemic? ~ Based on what indicator(s) Het 2 Hag val Is the treatment working? ‘Ye ‘Are ALL the RBC indices within normal limits? _! Which (ifany) indices areNOT? Hoi, Hg®: RDY For any values that are NOT within normal limits, explain/discuss possible reasons why they are outside the normal range(s) HgB) Wet, RDW is not within “th | " ; : became ndimnalmuss Wome: _Ziuino, Tao tap ta:__Juliowio (19) Upon admission to the hospital, blood analysis on a 32 year old male patient provided the following data: Het (%) = 28.3 HgB (g/dL) = 9.1 RBCs (#) = 3.49 x x10" RDW (%) = 12.2 What are his MCV and MCHC values? (Show ealeulations and units) (24 points) v maiz( © MCHC = —— L Nov=( mich ( 61%, = TRIM Xo 7 S.0TF3 2 22.\69\dL Based on what indicator(s) ow Weand Het values Severity? _Aiedevare Describe his RBC morphology Nomocetic , Novmacn Further test results (ii1GH Blood Urea Nitrogen and HIGH Creatinine) revealed significant (60%) loss of renal function. Based on these'results and those above, briefly discuss iffhow this affects your interpretation of the patient's situation. : oe “al a 2 esponsible te limul ert “ Be. 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: Het (%)=29.8 HgB(@il)=9.6 RBCs ()=3.71xx10 — RDW(%) = 12.4 ‘What are his MCV and MCHC values now? (Show calculations and units) gtd : ag.) 9/dL Is he anemic? _‘e« Severity? Nid Describe his RBC morphology rmocatic s Nevmariontc + Should he continue receiving Procrit treatment - why or why not? Ys, even thoun’ Vesult Ltndicorte . he turns = out het neclevarte fn owl Also, ‘it ‘inexecte oa el p TI the Wt ond HoB pieduction There 2 Yeceivinn procit tyeritwerst2014104 Name: 400 Toe Lab TA: LO. (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? )) centrifuging the blood at too high a speed could artificially lead to a low Het value }) 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 Het compared to their values in a normal natremic (normal sodium) state 4) all of the above e) a and b only