2What is laboratory diagnosis? Laboratory diagnosis is such a diagnostic process in which the samples coming from patients’ blood , body fluid , secretion , excretion , tissues and cells are examined by using various laboratory methods to get useful data which may reflects body` s functional status , pathological changes and etiological hints.
3Why to study laboratory diagnosis? Laboratory diagnosis is a very important part in diagnostics. After we have finished the study of physical diagnosis and instrument examination , we might be able to judge what kind of disease this patient probably suffer from . For further diagnosis , it is still not enough if we only master physical examination . We have to depend upon some laboratory data to ensure our diagnosis .
4How to learn laboratory diagnosis? First, the methods used in laboratory diagnosis are more automatic and computerized.Second , the aim is to train for clinical application .For each test, referential values and clinical significance always should be known very well.
5Chapter 1 Blood Test Blood routine test (BRT) 1. content (items) of BRTred blood cell count (RBC)hemoglobin(HB)concentration determinationtotal white blood cell count (WBC)leukocyte differential count (DC)platelet count (PC)[ˈpletlɪt]
6Referential values of BRT Table 1. Referential values for blood routine test in different age and sex___________________________________male female newbornRBC (x1012/L)HB (g/L)WBC (x109/L)PLT (x109/L )
9Changes of nucleusnucleus shift to left:mild shift to left: Nst > 6% onlymedium shift to left: Nst > 10% withmetamyelocyte[metə'maɪəloʊsaɪt]晚幼粒细胞severe shift to left : Nst > 25% with moreimmuture cell (leukemiod reaction = is similar to leukemia)nucleus shift to left can be seen in acute infection,acute poisoning, acute hemolysis
10Nucleus shift to right: multi-segmented Nse >3% 3-lobed Nse is normal segmented neutrophil in WBCnucleus shift to right can be seen:megaloblastic anemia(folates deficiency,VitB12 deficiency)administration of anti-metabolic drugs
11Morphology of blood cells Red blood cell: normocyte: 6-9um（micron）, discocyte- shape, no nucleus[ˈnju:kliəs]white blood cell divided in five types: 1.neutrophilic granulocyte : neutrophil stab cell (Nst), neutrophil segmented cell (Nse), 2.lymphocyte, 3.basophil granulocyte, 4.eosinophil granulocyte ,5.monocytePlatelet: smallest cell in peripheral[pəˈrɪfərəl] blood
12In automatic blood cell analyzer, 25 items are included together : WBC : 4.0~10.0x109/LLYM : 0.8~ 4.0 x109 /L (20~40%)MID( middle cells) : monocyte, eosinocyte, basocyte , immature cells(rare be seen)GRAN(granulocyte):2.0~7.8x109/L(50~70%)RBC:4.0~5.5x1012/L(male),3.5~5.0x1012/L (female)HGB: 120~160 g/L (male), 110~150 g /L (female)
13- HCT(hematocrit):0.4~0.5L/L(male),0.37~0.48L/L(female) MCV ( mean corpuscular volume): 82~95 flMCH(mean corpuscular hemoglubin): 27~31 pgMCHC ( mean corpuscular hemoglubin concentration): 320~360 g/LPLT( platelet): 100~300x109 /LMPV ( mean platelet volume): 8.7~16.5 flPDW ( platelet distribution width): 15.8~21.4%serumMCH = Hb/RBCRBC can be separated by centrifugationthickness
14Clinical significance Anomalies of RBC and HB1. decrease of RBC and HBAnemia: When RBC and HB of individual is lower than the referential values of the people in same age , same sex and same area. Usually, if Hb of adult male and female is lower than 120g/L or 110g/L respectively, they are considered as anemia.
15According to the level of Hb, anemia is divided into four degrees in clinic mild anemia: Hb < 120g/L(male) or < g/L(female)medium anemia : Hb <90 g/Lsevere anemia : Hb <60g/Lextreme severe anemia: Hb <30g/L
16Physiological anemiainfant and children aged between 3 months to 15 years,pregnant women in middle or terminal periods of pregnancy,elderly people.
17Pathological anemia.decrease in synthesis[ˈsɪnθɪsɪs] of red blood cell in bone marrowincreased destroy of red blood cell in peripheral bloodblood loss
18Decrease in synthesis of red blood cell in bone marrow disorder of hemopoiesis[ˌhiməpɔɪˈisɪs] in bone marrow: aplastic anemiainfiltration of bone marrow by tumorous cell: leukemia, multiple myeloma , lymphoma , metastatic tumor转移瘤deficiency of hemopoietic materials or factors: iron deficiency anemia(IDA), megaloblastic anemia (folic acid deficiency)
19Destroy of RBC in peripheral blood -- hemolytic anemia Hereditory disease :G-6PD deficiency, thalassmia（地中海贫血） , Hb diseaseAcquired[əˈkwaɪrd] anomalies : hemolysis by immunological , physical, chemical , biological and mechanical factors
21[.frægmən‘teiʃən] smear:涂片 ['mʌltipl]Causes red blood cells to rupture
22Blood loss -- hemorrhagic anemia acute blood loss : acute upper digestive tract bleeding , splenic rupturechronic blood loss : hemorrhoid痔[ˈhɛməˌrɔɪd] , hookworm disease, hypermenorrhea[haɪpəmenɒ‘ri:ə] 月经过多, GI (gastrointestinal) tumor
23Increase of RBC and HbComparative increase of RBC and Hb: due to the decrease of volume of plasma--severe dehydration: severe vomoting, diarrhea, severe burnAbsolute increase of RBC and Hb—ery-throcytosis: polycythemia vera真红(PV), chronic cardiopulmonary diseases: cor pulmonale肺心病, obstructive emphysema, scarcity of oxygen.
24Leukocytosis: WBC is higher than 10 x109 /L Anomalies of WBC and DCIn most cases, increase and decrease of WBC is chiefly depend on the numbers of neutrophil granuiocyte in the blood.Leukocytosis: WBC is higher than 10 x109 /LLeukopenia: WBC is lower than 4 x109 /L
251. Neutrophil granulocyte A. granulocytosis: 5 causes leading to granulocytosisacute infection or inflammation: acute pyogenic[ˌpaɪə'dʒenɪk]tonsilitis, acute appendicitis, hematosepsis[hi:mətoʊ‘sepsɪs]败血症damage or necrosis of tissue: severe burn, acute myocardiac infarction
443. Regulation of blood cell development Cytobody: from large to small,Mega is an exceptionCytoplasma: from less to more,color from blue to pink or orange red,granules from invisible to visible,granules from non-specific to specific
45Nucleus:from large to small, Mega is an exception,shape of nucleus from round to irregular,chromatin patten of nucleus from fine tocoarse.nucleolus from existance to nonexistanceRation of nucleus to cytoplasma:from bigger to smaller
516. Normal myelogram and hemogram Normal cellularity: erythrocyte: nucleated cellM:E=2-4:1Granulocytic series is 40-60% in all nucleated cellsErythrocytic series is 20% in all nucleated cellsLymphocyte is 20% , monocyte is <4% in all nucleated cellsMeg count is 7-35, platelet is normalOther cell: plasmacyte and histiocyte are rareNo specific cells and parasite
825. Idiopathic Thrombocytopenic Purpura(ITP) Hemogram:normal Hb, RBCnormal WBC and DCPC decreas with abnormal morphology
83Myelogram:Significant hypercellulerity or normal cellularityNormal myeloid, erythroid lineSignificant hyperplasia of Meg.Impaired maturation of Meg:Granular Meg or promeg increasePlatelet producting Meg absentPlatelet rarely be seen