Introduction to Hematology PPT Notes April 28, 2009 Clinical problems in Hematology Anemia (cytopenia), Leukocytosis (Cytosis) and

Bleeding Hematology Lab Tests The most important lab test used in the diagnoses and working-up a clinical problem o CBC and differential leukocyte count o Bone marrow biopsy and aspiration o Reticulocyte count o Serum iron, vit B12, folate levels o Hemoglobin electrophoresis o Prothrombin time (PT) and activated partial thromboplastin time (aPTT) o Clotting factor assays Blood cells terminology o Erythroctyes (RBCs) o Leukocytes (WBCs) Granulocytes (recognizable granules) Neutrophils, eosinophils, basophils Monocytes (a type of mononuclear cell) Lymphocutes (a type of mononuclear cell) o Platelets Clinical evaluation Blood tests quantitative and qualitative o CBC count provides information about the absolute and relative numbers of blood cells in a specimen of blood (quantitative d/o) CBC Sample report
Component WBC Count Red Blood Cell Count Hemoglobin Hematocrit Mean Cell Volume (MCV) (rbc size) Platelet Count WBC Differential Count Patient Values 6500 /mm3 4.5 x 10 6/mm3 16 g/dL 48% 85 fL 225,000/mm3 Reference Range 4000 -10000/mm3 3.9 5.20 x 10 6/mm3 14 17 g/dL 41 51 % 81-89 fL

150,000 350,000/mm3 60% Neutrophils, 5 % Bands, 50 - 70% Neutrophils 2% Eosinophils, 1% Basophils, 2 - 6% Bands 25 % Lymphocytes, 7% 20 - 40% Lymphs Monocytes 2 - 8% Monocytes 0 - 1% Basophils 1 - 3% Eosinophils Patient Values 6500 /mm3 4.5 x 10 6/mm3 225,000/mm3 60% Neutrophils, 5 % Bands, 2% Eosinophils, 1% Basophils, 25 % Lymphocytes, 7% Monocytes Reference Range 4000 -10000/mm3 3.9 5.20 x 10 6/mm3 150,000 350,000/mm3 50 - 70% Neutrophils 2 - 6% Bands 20 - 40% Lymphs 2 - 8% Monocytes 0 - 1% Basophils 1 - 3% Eosinophils Reference Range 3.9 5.20 x 10 6/mm3 14 17 g/dL

Cells and Counts Sample report

Component WBC Count Red Blood Cell Count Platelet Count WBC Differential Count

All about the RBC

Component Red Blood Cell Count Hemoglobin Patient Values 4.5 x 10 6/mm3 16 g/dL

o Blood smear gives information about the various structural and functional
characteristics of cells (qualitative d/o) Morphology and relative concentrations of erythrocytes, leukocytes and platelets (ran with CBC) Recognize peripheral blood cells based on the description of the peripheral blood smear Use knowledge of histology to make a mental visualization based on the description of the peripheral blood smear o Red blood cell indices give red cell count, size, and hemoglobin content o White blood cell count and differential (diff) divides WBCs into granulocytic cells, lymphocytes, monocytes and abnormal cells o Platelet count Cell count Terminology (CBC count) o Cytosis a condition in which there is grater than normal number of cells in a tissue or organ Leukocytosis, neutrophilia, lymphocytosis, erythrocytosis o Cytopenia a deficiency or lack of celluar elements in the circulating blood Anemia low RBC Leucopenia low WBC count Neutropenia low neutrophil count Lymphocytopenia low lymphocyte count Pancytopenia all low Leukocytes Granulocytes Estimated Values o Granulocytes Neutrophils 40-75% Bands 0-8% Eosinophils 0-4% Basophils 0-2% o Monocytes 0-12% o Lymphocytes 15-45% Granulopoiesis Terminology Leukocyte Maturation o Myeloblast o Promyelocyte (azurophilic, nonspecific granules) o Myelocyte (specific for type of granulocyte) o Metamyelocyte o Band cell o Mature granulocyte (neutrophil, eosinophil or basophil) o Granulopoeisis stages know these stages and note the primary and secondary granules o

Hematocrit 48% 41 51 % Mean Cell Volume (MCV) 85 fL 81-89 fL (rbc size) Others: Mean Cell Hemoglobin (MCH); Mean Cell Hemoglobin Concentration (MCHC), and Red Cell Distribution Width (RDW)

WBC Count and Diff o Total WBC count is measured, reference range varies: 5000-10,000 cells/mm3 o Diff count is the relative concentration of the various leukocytes 60% Seg neutrophils 30% lymphocytes 7% monocytes o Think about this: what is the absolute count multiply the number of cells x the % Erythropoiesis and Anemia o Red cell maturation learn and recognize the changes in size, cytoplasm (relative amount of RNA and hemoglobin content) and nucleus

Erythroid Matu
Hematocrit: the %age of whole blood made up of erythrocytes Red cell size/indices Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) define the size Mean corpuscular hemoglobin concentration (MCHC) and hemoglobin content (MCH) or RBCs define hemoglobin content These values are useful in elucidating the etiology of anemias Red cell shape and cytoplasmic inclusions
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Anemia Work-up CBC count and peripheral blood smear o Hematocrit and RBC count o

Early Inter

Physiology Classifications of Anemia o Classify anemia (a cytopenia) based on underlying physiology , either Increased urilization Increased premature destruction (hemolysis) Impaired production o Red cell indices are valuable in the morphologic classification of anemias. Since different etiologic factors result in characteristically different red cell morphology, the management of a pt with an anemia depends upon the interpretation fo the blood counts and peripheral blood smear well. o Classified according to the size of the red cell, as being Normocytic (normal MCV) Macroctic (increased MCV) Microcytic (decreased MCV) Leukocytosis Increased WBC count above reference range (TOO many WBCs) Specific types o Neutrophilia pt with severe bacterial infection o Eosinophilia prominent at sites of allergic rxns with parasitic larvae infections (helminthes) The eosinophil specific granules contain rhomboid crystals by EM. This core contains major basic protein (MBP), known to be toxic to several parasites (helminthes, microfilariae, schistomiasis) o Lymphocytosis first consideration is a viral infection or any chronic infection o Monocytosis phagocyte and frequently contain vacuoles; can migrate into tissue: macrophages o Basophilia contain heparin and large amounts of histamine, these are active participants in hypersentivity reactions, mature nucleus is segmented into 2-3 lobes. Few d/o have basophilia Types: Reactive: Infections, inflammation, necrosis; Malignant: Leukemia and Lymphoma Hematology Bone marrow o Hematopoietic active marrow with stem cells, progenitor cells, and developing erythroblasts, myeloblasts and megakaryoblasts (red marrow) o Adipose cells, various with age and activity (yellow marrow) o Marrow sinuses and capillary network o Hemosiderin: iron stores o Simple Diagram of Hematopoiesis:

Clinical evaluation tests of bone marrow function o Small amounts of tissue are removed from bone cavity and examined under the microscope Bone marrow aspiration Bone marrow biopsy a core of bone is taken out; has boney trabeculae and marrow space o Marrow is taken from the posterior iliac crest. Hemostasis o Physiologic blood clotting to maintain the blood in an appropriate fluid state, clot free in normal vessels and inducing rapid and localized hemostatic plug at sites of vascular injury. o Stages Vasoconstriction (neurogenic) Hemostatic plug formation (primary hemostasis) Fibrin clot formation (secondary hemostasis) Thrombolysis (limits the clotting) o Hemostasis and thrombosis have three components Vascular (endothelium) Platelets (peripheral blood) Clotting factors (coagulation cascade) Bleeding d/o causes o Bleeding d/o cab be divided into vascular abnormalities, platelet d/o or coagulation d/o Platelets Small fragments of megakaryocytes (MK) released into the blood. Closer inspection of MKs show a network of platelet forming zones forming fissures throughout the MK cytoplasm. The membranes of this demarcation system eventually form cytoplasmic platelet membranes. Aka Thrombocytes are small, irregularly shaped anuclear cells, 2-4 micrometers in diameter, which are derived from fragmentation of precursor MK; average life span of a platelet is 8-12 days. Number o Thrombocytopenia increased destruction and utilization with impaired production Will see skin changes due to this: pupura (large purple bruises that are sometimes raised) or petechiae (small red or purple dots that look like a rash)

Cytoplasmic components o Granules o Tubular system Function: hemostasis