1. 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 FROM HEME II BOOK OR LOOK UP PLATE FROM FAVORITES-WEBPATH
TODAY WILL COVER BASIC COCEPTS AND BLOOD MAKE-UP, NAME THOSE ELEMENTS OF BLOOD BUT CONCENTRATE ON THE RBC’S AND THE TESTS CONCERNING RBC’S
Jane Finley, BS MT (ASCP)
Nov 1, 2004 1

2. HEMATOLOGY AND LAB LANGUAGE
Blood
Serum
Plasma
Erythrocytes (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?

3. 55% Fluid; 44% Red blood cells; 1 % white blood cells and Platelets

4. Dissolved 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,

5. Lab Language: Hematology Testing
Complete Blood Count (CBC)
Erythrocyte Sedimentation Rate (ESR)
Sickle Cell Screening
Hemoglobin Electrophoresis
Ferritin
Iron
Total Iron Binding Capacity (TIBC)
Transferrin
Most basic of tests done in lab for heme

6. Lab Language : CBC Hemoglobin Hematocrit RBC WBC Plt ct RDW MCV MCH
MCHC
Segmented Neutrophil
Lymphocyte
Monocyte
Eosinophil
Basophil
Reticulocyte
Reticulcyte Production Index (RPI)
Individual parts of CBC; cells listed are counted individually and reported as % of whole WBC

7. Complete 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 RBC
Can be done without the differential but must indicate that you want a CBC no diff; most instruments give a diff automatically

8. CBC Differential -WBC Segs Lymphs/Atypical Mono’s Eo’s Baso’s Bands
Metamyelocyte
Myelocyte
Promyelocyte
Blast
Enumerating individual blood cells; commenting on abnormal structures that may be clinically significant

10. CBC Differential-RBC Anisocytosis Microcytes Macrocytes Nucleated RBC
Howell Jolly Bodies
Basophilic Stippling
Hypochromia
Riticulocytes
Poikilocytosis
Teardrop
Ovalocytes
Helmet cells
Sickle Cells
Don’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.

13. Cell Counts: Number of cells per liter of whole blood
Terms
Leukocytosis
Erythrocytosis
Erythropenia
Thrombocytosis
Thrombopenia
WBC
x 109/L
RBC
Males: x1012/L
Females: “
Plt
x109/L
Leukocytosis: Increase in WBC count
Erythrocytosis: Increased RBC =>6.0 ; Erythropenia: <3.8
Thrombocytosis: increase in platelets; Thrombopenia: decrease in plt
We will move on the the RBC portion of our learning unit and do WBC next week.

14. Hemoglobin Heme + protein (globulin) Main purpose is to carry O2
Three main types
Variants result in identifiable disorders
Normal ranges are age and gender related
Prinicipal 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 CO2
Carboxyhemoglobin: 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%
Caroxyhemogl
Hemoglobin disorders: Sickle Cell(S,C), Thalassemias(A2)

15. Hematocrit Packed Cell Volume
Measures what percentage of whole blood is represented by RBC
Compares RBC and hemoglobin
Normal ranges are age and gender related
Small 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.

16. Lab Language: Red Cell Indices
MCV- Mean Corpuscular Volume
MCH-Mean Corpuscular Hemoglobin
MCHC-Mean Corpuscular Hemoglobin
Concentration
RDW-Red Cell Distribution Width
Starting 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 cells
MCH
MCHC
RDW: variation in The size of the red cells; INDICATES THE DEGREE OF ANISOCYTOSIS

17. Mean Corpuscular Volume (MCV)
The average size (volume) of an RBC.
MCV (in fL) = (hematocrit x 10)
(rbc count [in millions/µL])
Normal values: fL
The MCV is a useful tool in the differential
diagnosis of anemia
Used to determine anisocytosis, size of rbc: microcytosis= < 80 fL; macrocytosis= >100 fL
1 femtoliter(fL) L

18. Mean Corpuscular hemoglobin (MCH)
The average hemoglobin content of a RBC.
Normal values: pg.
MCH (in pg) = hemoglobin x 10
rbc count
(a picogram [pg] = gram) MCH=15x10/5.0=30 pg=WNL

19. Mean Corpuscular Hemoglobin Concentration (MCHC)
The percentage of a RBC's volume which
contains hemoglobin.
Normal values: Usually between 31-37%.
MCHC may be decreased with severe iron
deficiency 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

20. RED CELL DISTRIBUTION WIDTH (RDW)
Degree of Red Cell size variability in a blood sample
Coefficient of variation of the size of the RBCs
Expressed as %
Derived from automated instruments that can directly measure the MVC
Normal: %
RDW =SD of MCV x 100
Mean of MCV
How do we use these measurements to reveal the state of the blood system?
If RDW normal = homogenous population of cells
RDW >14.5% = heterogeneous population of cells

21. Using the RBC Indices MCV reveals the average size of the RBCs
RDW reveals a variation in size among the RBCs
MCHC reveals how much of the cell is being taken up by hemoglobin
Together can reveal anemia or physiologic disorders that affect quality of life
Decreased MCV = small Rbc, microcytosis
Increased MCV=Macrocytosis
Increased RDW mean more diffrerent sized RBC; could mean younger rbc

22. Lab Language: Indices Anemia Microcytic Macrocytic Hypochromic
normochromic
Using the indices to classify anemia’s: decrease in hemoglobin affecting capability of carrying O2. Results from decresed RBC, decreased Hgb conc, abnormal Hgb
Micro: smaller than 8o fL
Macro: larger than 100 fL
Hypo: less normal hemoglobin measurement
Normo: within normal ranges

23. ERYTHROCYTOSIS Polycythemia vera Secondary Polycythemia -COPD
-Inappropriate stimulation of
erythropoietin, such as tumors
Relative Polycythemia
-dehydration,
-severe burns
RBC > upper limits of normal

24. ERYTHROPENIA (ANEMIA)
Anemias - may result from:
chronic or acute blood loss
decreased synthesis
increased destruction or decreased survival
dilutional effect:
postural (lower in recumbent position)
overhydration
A 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

25. Anemia Classifications
Microcytic, hypochromic
Microcytic, normochromic
Normocytic, normochromic
Macrocytic, normochromic

26. NORMOCYTIC, NORMOCHROMIC ANEMIA
MCV normal
MCHC normal
Examples:
acute blood loss
aplastic anemia
most leukemia's
bone marrow infiltration
Normal looking RBC, Normal indices, decreased number of RBC circulating.
Hemolytic anemia’s
Increased plasma volume will result in NC/NC anemia (pregnancy)

27. MICROCYTIC, HYPOCHROMIC ANEMIA
MCV decreased
MCHC decreased
Examples:
iron deficiency
thalassemia
lead poisoning
anemia of chronic disease

28. MICROCYTIC, NORMOCHROMIC ANEMIA
MCV decreased
MCHC normal
Examples:
mid-stage iron deficiency
thalassemia
Most 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.

29. MACROCYTIC, NORMOCHROMIC ANEMIA
MCV increased
MCHC normal
Examples:
folate deficiency
vitamin B12 deficiency
pernicious anemia
Primarily megaloblastic anemias, Vit B12 or folic acid def; Larger, more immature RBC produce MCV values of fL
Floic acid def more common than B12 def. Osberved when requirement is increased, pregnanc;y, infancy, hemolytic anemias, hyperthyroidisms

30. Hemoglobin & Hematocrit Normal Ranges
Cord blood:
- Hb ± 3 g/dl
- Hct ± 9 %
0.5-2 years:
- Hb: 12.0 ± 1.5g /dl
- Hct ± 3 %
12-16 yrs:
Female:
-Hb ± 2 g/dl
-Hct 41 ± 4%
Male:
-Hb ± 1 g/dl Hct 43 ± 6%

31. Hemoglobin & Hematocrit Adult Normal Ranges
Male: Hb ± 2 g/dl Hct 47 ± 6%
Female: Hb ± 2 g/dl Hct 41 ± 5%

32. Used for quality control Hb X 3 = Hct ± 3% RBC X 3 = Hb
RULES OF THREE
Used for quality control
Hb X 3 = Hct ± 3%
RBC X 3 = Hb
Hct X 100,000 = RBC
Review the CBC to make sure the results reflect a good test.
The technologt will do this on every cbc that is done.

33. Complete 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 RBC
Can be done without the differential but must indicate that you want a CBC no diff; most instruments give a diff automatically

34. CBC 1 RBC 5.25 x 10[12]/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

35. CBC 1 RBC 5.25 x 10[12]/L HGB 15.4 g/dL HCT 46.1 % MCV 87.9 fL
MCH pg
MCHC g/dL
RDW

36. CBC 1

37. CBC 2 RBC 3.71 x 10[12]/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

38. CBC 2 RBC 3.71 x 10[12]/L HGB 5.9 g/dL HCT 20.9 % MCV 56.2 fL
MCH pg
MCHC g/dL
RDW

39. CBC 2

40. CBC 3 RBC 3.36 x 10[12]/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

41. CBC 3 RBC 3.36 x 10[12]/L HGB 10.9 g/dL HCT 31.2 % MCV 92.8 fL
MCH pg
MCHC g/dL

42. CBC 3

43. CBC 4 RBC 1.26 x 10[12]/L HGB 5.7 g/dL HCT 16.3 % 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

44. CBC 4 RBC 1.26 x 10[12]/L HGB 5.7 g/dL HCT 16.3 % MCV 130 fL
MCH pg
MCHC g/dL

45. CBC 4
MACROCYTOSIS