Lab Procedures Chapter 47: Venipuncture and Blood Collection Chapter 48: Hematology Part 1 Professor Fowler

Hematology: the study of blood and the tissues that produce it Blood and its components are studied to detect pathological conditions and to determine the appropriate course of treatment Introduction

Collect the specimen Label correctly Properly stored Medical Assistant’s Role

Hematopoiesis: formation of blood Occurs primarily in bone marrow of adult Lymphocytes are produced in the lymph nodes Blood Formation and Components

Red blood cells Contain hemoglobin (transports oxygen) Oxyhemoglobin: carrying oxygen Carboxyhemoglobin: carrying carbon dioxide Erythropoietin: hormone that controls RBC production and is secreted by the kidneys in an adult and by the liver in a fetus Decreased erythropoietin = RBCs will not be formed in proper amounts resulting in certain types of anemia RBCs last 4 months and continually reproduced by body Blood Formation and Components

RBC Count Normal count is adult male is million per mm3 and million per mm3 in females Increase = polycythemia Low = anemia Erythrocyte sedimentation rate (ESR) - also called sed rate – is the rate at which RBCs settle at the bottom of a tube (procedure 48-3 (47-9 black WB) – video) Phenylketonuria (PKU) is a congenital disease caused by a defect in the metabolism of the amino acid phenylalanine (procedure 48-6 (47-10 black WB) – video) Mono Testing – also known as mononucleosis spot test Used to help determine whether a pt has infectious mononucleosis (Procedure 48-7 (47-11 black WB) – video) Mono is commonly referred to as the “kissing disease” and is a contagious viral infection frequently passed through oral contact RBC Tests

Microhematocrit Procedure Hematocrit performed on an extremely small quantity of blood by use of capillary tube Provides MD info about pts RBC volume Low = anemia or hemorrhage High = dehydration or polycythemia Normal is 40-50% is males and 35-45% in females Procedure 48-2 (47-6 black WB) (video) Hemoglobin (Hgb) Determination Provides MD info regarding the amount of hemoglobin present in the sample Low = iron-deficiency anemia High = polycythemia and extreme burns Normal for adult male is g/dL and for adult females g/dL Procedure 48-1 (47-7 black WB) (video) RBC Tests

Anemias Aplastic: loss of functioning red bone marrow Hemolytic: destruction of RBCs Hypochromic: insufficient Hbg Iron-deficiency Pernicious: insufficient absorption of vitamin B12 Sickle cell: RBC abnormally shaped Anemias

White blood cells (leukocytes) Defend against infection Neutrophils: combat infection by phagocytosis (surround, swallow and digest) Eosinophils: presence of large number indicates parasitic infection or presence of certain allergic conditions Basophils: produce heparin (substance that prevents clotting) – increased amounts may be found in those with their spleen removed or excessive exposure to radiation – may have a connection to severe allergic reactions Lymphocytes: produces antibodies against foreign substances Monocytes: assist in phagocytosis (substances that neutrophils can not ingest), assist in cleaning up after infection – increase may mean TB, typhoid, or Rocky Mountain spotted fever Blood Formation and Components

WBC Count Normal count in adults range from 4500 to per mm3 Elevated = infection or if grossly elevated = possible leukemia Low = viral infection or autoimmune deficiency Differential Count Determines the percentages of each type of WBC, RBC morphology and platelet estimation WBC Tests

Platelets (thrombocytes): smallest formed cells – assist with clotting process Clotting process: injured area, platelets and tissue release thromboplastin, this combines with other elements in blood to produce thrombin, thrombin acts on a protein in the blood called fibrinogen resulting in the formation of fibrin, fibrin is tiny threads that create a mesh that catches RBCs and other cells to form clot Blood Formation and Components

Platelet Count PT/INR PTT Platelet Tests

Liquid blood formation and components Liquid portion of blood is plasma 55% of the composition of blood Carries cellular elements and other substances Transports 90% of plasma is water and other 10% is solid substances called solutes (plasma proteins, electrolytes (NA+, K+, CL-), glucose, amino acids, lipids and carbohydrates, metabolic waste products (urea, lactic acid, uric acid), creatnine, oxygen and carbon dioxide, hormones, antibodies, enzymes, vitamins and mineral salts Blood Formation and Components

Profiles (Panels or Groups) table 48-1 Liver Lipid OB Electrolyte CMP Common lab tests with normal values – table 48-2 Common Blood Chemistry Tests – table 48-3 Comprehensive Metabolic Panel: screening to evaluate organ function, check for common disorders and/or to monitor progress of current conditions and response to medications Glucose, BUN, creatinine, Ca+, Na+, K+, CO2, Cl-, albumin, total protein, bilirubin, ALP, AST, ALT Diabetic tests Blood sugar (procedure 47-5 black WB) HbgA1C – Procedure 48-5 Glucose tolerance test (in lab) CBC Other Blood Tests