Presentation on theme: "HEMATOLOGY WHAT IT IS : Study & measurement of individual elements of Blood. WHAT IT’S COMPOSED OF. SHOW SLIDES FROM PERIPHERAL BLOOD TUTOR CD OR USE PLATE."— Presentation transcript:
1HEMATOLOGYWHAT IT IS : Study & measurement of individual elements of Blood.WHAT IT’S COMPOSED OF.SHOW SLIDES FROM PERIPHERAL BLOOD TUTOR CD OR USE PLATE FROM HEME II BOOK OR LOOK UP PLATE FROM FAVORITES-WEBPATHTODAY WILL COVER BASIC COCEPTS AND BLOOD MAKE-UP, NAME THOSE ELEMENTS OF BLOOD BUT CONCENTRATE ON THE RBC’S AND THE TESTS CONCERNING RBC’SJane Finley, BS MT (ASCP)Nov 1, 20041
2HEMATOLOGY AND LAB LANGUAGE BloodSerumPlasmaErythrocytes (RBC)Granulocytes (WBC)Platelets (Plt)As with any new learning experience it’s best to understand that most of the battle of learning is understanding the language used. Hematology has a very definite language must be recognized by anyone who orders tests and who needs to interpret findings in light of signs and symptoms already obtained.I’m going to introduce the terms that are used as we go through the areas of hematology we’ll be studying. We’ll begin with the most basic and move up to the most detailed.What is blood? What’s it’s main purpose?
355% Fluid; 44% Red blood cells; 1 % white blood cells and Platelets
4Dissolved in the fluid part of blood, serum or plasma, are a variety of elements: analytes involved in metabolism, Na, K+, Cl--, Glucose, Nitrogen,Factors involved in clotting, fibringen, thromboplastin, clotting factors (F VIII)Factors involved in immune system: antibodies,
5Lab Language: Hematology Testing Complete Blood Count (CBC)Erythrocyte Sedimentation Rate (ESR)Sickle Cell ScreeningHemoglobin ElectrophoresisFerritinIronTotal Iron Binding Capacity (TIBC)TransferrinMost basic of tests done in lab for heme
6Lab Language : CBC Hemoglobin Hematocrit RBC WBC Plt ct RDW MCV MCH MCHCSegmented NeutrophilLymphocyteMonocyteEosinophilBasophilReticulocyteReticulcyte Production Index (RPI)Individual parts of CBC; cells listed are counted individually and reported as % of whole WBC
7Complete Blood Count White Blood Count (WBC) Red Blood Cell Count (RBC)Platelet Count (Plt)Hemoglobin (Hb or Hgb)Hematocrit (Hct)Red Cell Indices (MCV,MCHC,MCH)Red Cell Distribution Width (RDW)Differential Count (Diff)Most common test done; basic to health of individual; consists of very specific counts of formed elements of the blood. EVALUATION OF SIZE AND SHAPE of RBCCan be done without the differential but must indicate that you want a CBC no diff; most instruments give a diff automatically
8CBC Differential -WBC Segs Lymphs/Atypical Mono’s Eo’s Baso’s Bands MetamyelocyteMyelocytePromyelocyteBlastEnumerating individual blood cells; commenting on abnormal structures that may be clinically significant
10CBC Differential-RBC Anisocytosis Microcytes Macrocytes Nucleated RBC Howell Jolly BodiesBasophilic StipplingHypochromiaRiticulocytesPoikilocytosisTeardropOvalocytesHelmet cellsSickle CellsDon’t actually count; compare RBC against normal and report degrees of abnomality seen( 1+,2+,3+….)Abnormality of RBC caused by conditions from various disorders; Microcytosis from malnutrition, FE def anemia; Sickle cell from abnormal hemoglobin S; Ovalocytes from abnormal Heme structure.
13Cell Counts: Number of cells per liter of whole blood TermsLeukocytosisErythrocytosisErythropeniaThrombocytosisThrombopeniaWBCx 109/LRBCMales: x1012/LFemales: “Pltx109/LLeukocytosis: Increase in WBC countErythrocytosis: Increased RBC =>6.0 ; Erythropenia: <3.8Thrombocytosis: increase in platelets; Thrombopenia: decrease in pltWe will move on the the RBC portion of our learning unit and do WBC next week.
14Hemoglobin Heme + protein (globulin) Main purpose is to carry O2 Three main typesVariants result in identifiable disordersNormal ranges are age and gender relatedPrinicipal adult Hbg: A1, A2; normally make-up 95%, Hgb F 5%: Genetic varients interfer with O2 carrying capability: S,C, D, E inherited abnormality.Oxyhemoglobin: Heme + O2 from lungs to tissue. O2 exchanged at tissues for CO2Carboxyhemoglobin: Hemoglobin has greater affinity for CO than O2. (200X’s). Can’t carry O2 if combined with CO causing carbon monoxide poisoning. Skin will turn bright cherry red, high levels causes axphyxiation. Reversible condition; Smokers blood can show as high as 10% of hemoglobin. Small amount normal, <1%CaroxyhemoglHemoglobin disorders: Sickle Cell(S,C), Thalassemias(A2)
15Hematocrit Packed Cell Volume Measures what percentage of whole blood is represented by RBCCompares RBC and hemoglobinNormal ranges are age and gender relatedSmall amount of blood collected in a capillary tube, spun down for specified amount of time, measured to ascertain what % of the whole is RBC.Results are effected by size of RBC,amount of Hgb in cell, hydration of patient, condition of samples(hemolysis), technique of collection and procedure.
16Lab Language: Red Cell Indices MCV- Mean Corpuscular VolumeMCH-Mean Corpuscular HemoglobinMCHC-Mean Corpuscular HemoglobinConcentrationRDW-Red Cell Distribution WidthStarting with the RBC : We look at the relationship of the amount of hemoglobin to the size of the cell using mathematical comparisons we call Indices. There are 4 that are listed on a CBC.MCV measures the average size of the red cellsMCHMCHCRDW: variation in The size of the red cells; INDICATES THE DEGREE OF ANISOCYTOSIS
17Mean Corpuscular Volume (MCV) The average size (volume) of an RBC.MCV (in fL) = (hematocrit x 10)(rbc count [in millions/µL])Normal values: fLThe MCV is a useful tool in the differentialdiagnosis of anemiaUsed to determine anisocytosis, size of rbc: microcytosis= < 80 fL; macrocytosis= >100 fL1 femtoliter(fL) L
18Mean Corpuscular hemoglobin (MCH) The average hemoglobin content of a RBC.Normal values: pg.MCH (in pg) = hemoglobin x 10rbc count(a picogram [pg] = gram) MCH=15x10/5.0=30 pg=WNL
19Mean Corpuscular Hemoglobin Concentration (MCHC) The percentage of a RBC's volume whichcontains hemoglobin.Normal values: Usually between 31-37%.MCHC may be decreased with severe irondeficiency anemia.MCHC [in g/dL] = hemoglobin [in g/dL]hematocrit [in L/L]CALCULATED AS: MCHC=MCH/MCV ( MCH FORMULA USES HGB; MCV FORMULAS USES HCT)WHAT % OF THE TOTAL AREA OF THE RED CELL IS OCCUPIED BY HEMOGLOBIN; How big is the central pallor?NORMAL VALUES MAY VARY DEPENDENT ON INSTITUTION; MORE LIKELY TO BE 33-36
20RED CELL DISTRIBUTION WIDTH (RDW) Degree of Red Cell size variability in a blood sampleCoefficient of variation of the size of the RBCsExpressed as %Derived from automated instruments that can directly measure the MVCNormal: %RDW =SD of MCV x 100Mean of MCVHow do we use these measurements to reveal the state of the blood system?If RDW normal = homogenous population of cellsRDW >14.5% = heterogeneous population of cells
21Using the RBC Indices MCV reveals the average size of the RBCs RDW reveals a variation in size among the RBCsMCHC reveals how much of the cell is being taken up by hemoglobinTogether can reveal anemia or physiologic disorders that affect quality of lifeDecreased MCV = small Rbc, microcytosisIncreased MCV=MacrocytosisIncreased RDW mean more diffrerent sized RBC; could mean younger rbc
22Lab Language: Indices Anemia Microcytic Macrocytic Hypochromic normochromicUsing the indices to classify anemia’s: decrease in hemoglobin affecting capability of carrying O2. Results from decresed RBC, decreased Hgb conc, abnormal HgbMicro: smaller than 8o fLMacro: larger than 100 fLHypo: less normal hemoglobin measurementNormo: within normal ranges
23ERYTHROCYTOSIS Polycythemia vera Secondary Polycythemia -COPD -Inappropriate stimulation oferythropoietin, such as tumorsRelative Polycythemia-dehydration,-severe burnsRBC > upper limits of normal
24ERYTHROPENIA (ANEMIA) Anemias - may result from:chronic or acute blood lossdecreased synthesisincreased destruction or decreased survivaldilutional effect:postural (lower in recumbent position)overhydrationA condition in which there is a decrease in hemoglobin in the blood and therefore in the amount of O2 reaching the tissues and organs. May be the result of a drcrease in the number of RBC (decreased cell mass), decreased hgb conc, or abnormal hgb
26NORMOCYTIC, NORMOCHROMIC ANEMIA MCV normalMCHC normalExamples:acute blood lossaplastic anemiamost leukemia'sbone marrow infiltrationNormal looking RBC, Normal indices, decreased number of RBC circulating.Hemolytic anemia’sIncreased plasma volume will result in NC/NC anemia (pregnancy)
28MICROCYTIC, NORMOCHROMIC ANEMIA MCV decreasedMCHC normalExamples:mid-stage iron deficiencythalassemiaMost common type; Fe def has several possible causes: decreased Fe intake( diet or malabsorption), increased Fe loss(chronic bleed), increased Fe requirement(pregnancy,etc).Must determine cause so as to treat properly to correct.
29MACROCYTIC, NORMOCHROMIC ANEMIA MCV increasedMCHC normalExamples:folate deficiencyvitamin B12 deficiencypernicious anemiaPrimarily megaloblastic anemias, Vit B12 or folic acid def; Larger, more immature RBC produce MCV values of fLFloic acid def more common than B12 def. Osberved when requirement is increased, pregnanc;y, infancy, hemolytic anemias, hyperthyroidisms
32Used for quality control Hb X 3 = Hct ± 3% RBC X 3 = Hb RULES OF THREEUsed for quality controlHb X 3 = Hct ± 3%RBC X 3 = HbHct X 100,000 = RBCReview the CBC to make sure the results reflect a good test.The technologt will do this on every cbc that is done.
33Complete Blood Count White Blood Count (WBC) Red Blood Cell Count (RBC)Platelet Count (Plt)Hemoglobin (Hb or Hgb)Hematocrit (Hct)Red Cell Indices (MCV,MCHC,MCH)Red Cell Distribution Width (RDW)Differential Count (Diff)Most common test done; basic to health of individual; consists of very specific counts of formed elements of the blood. EVALUATION OF SIZE AND SHAPE of RBCCan be done without the differential but must indicate that you want a CBC no diff; most instruments give a diff automatically
34CBC 1 RBC 5.25 x 10/L HGB 15.4 g/dL HCT 46.1 % MCV ______ MCH _____MCHC ______RDW _____Lets take what we learned today and apply it to a situation.Do the rules of three apply?Calculate the indices.What can you say about these patient’s CBC?Make these calculations and let’s see what it tells us
37CBC 2 RBC 3.71 x 10/L HGB 5.9 g/dL HCT 20.9 % MCV ______ MCH ______MCHC ______RDW ______Do the rules of three apply?Calculate the indices.What can you say about these patient’s CBC?Make these calculations and let’s see what it tells us
40CBC 3 RBC 3.36 x 10/L HGB 10.9 g/dL HCT 31.2 % MCV _______ MCH ________MCHC ________Do the rules of three apply?Calculate the indices.What can you say about these patient’s CBC?Make these calculations and let’s see what it tells us
43CBC 4 RBC 1.26 x 10/L HGB 5.7 g/dL HCT 16.3 % MCV ________ MCH ________MCHC ________RDWDo the rules of three apply?Calculate the indices.What can you say about these patient’s CBC?Make these calculations and let’s see what it tells us