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Hematology Studies

Hematology Studies

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Published by Shin Shin

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Published by: Shin Shin on Jan 25, 2012
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Hematology Studies
Test: Total Hemoglobin (Hgb or Hb)
  A test used to determine the amount of hemoglobin in the blood. Hgb is the pigment part of theerythrocyte, and the oxygen-carrying part of the blood.Normal Values:males: 12-17 grams/100mlfemales: 11-15 grams/100mlClinical Implications: A Low hemoglobin level indicates anemia. Estimates of Hgb in each RBC are moderately important whendetermining the total blood Hgb. However, hemoglobin findings are even more dependent upon the totalnumber of RBC's. In other words, for the diagnosis of anemia, the number of RBC's is as important as thehemoglobin level.Blood hemoglobin level has become a "routine" lab test for most patients admitted to hospitals today. Hgbis obviously important for the diagnosis of anemia and hemorrhage. It is equally important for diagnosingmany lesser known diseases.The test can be performed upon capillary blood, such as drawn from the finger stick. The test is oftenperformed along with other tests, thereby requiring a larger specimen of blood, as from venipuncture.Hemoglobin in the body is dependent upon amounts of iron. A lack of available iron causes one type of anemia, due to the reduced production of hemoglobin. Remember that in the strictest sense, anemia isnot in itself a diagnosis, but rather a symptom that there is something else wrong in the body. For example, malnutrition (low iron levels), would be the diagnosis of the patient, not just the anemia. Thesecondary diagnosis would be anemia, but malnutrition must be treated in order to "cure" the anemia.*Note--Fetal Hemoglobin:Fetal Hb (Hb F), is a normal Hb product in the red blood cells of a fetus and in smaller amounts in infants.It constitutes 50% to 90% of Hb in a newborn; the remaining Hb consists of Hb A1 and Hb A2 the Hb inadults.Under normal conditions, the body ceases to manufacture fetal Hb sometime during the first year of life,and from that point on manufactures adult Hb. If this changeover does not occur and fetal Hb continues toconstitute more than 5% of the Hb after age six months, an abnormality should be suspected, particularlythalassemia.VARIATIONS OF HEMOGLOBIN TYPE AND DISTRIBUTION (in adults)Percentage of totalHemoglobinhemoglobin Clinical ImplicationsHb A 95% to 100% NormalHb A2 4% to 5.8% b-thalassemia minor 
 
1.5% to 3% b-thalassemia major Under 1.5% b-d-thalassemia minor Hb F Under 2% Normal2% to 5% b-thalassemia minor 10% to 90% b-thalassemia major 5% to 15% b-d-thalassemia minor 5% to 35%Heterozygous hereditary Persistence of fetal Hb (HPFH)100% Homozygous HPFH15% Homozygous Hb SHomozygous Hb S 70% to 98% Sickle Cell diseaseHomozygous Hb C 90% to 98% Hb C diseaseHeterozygous Hb C 24% to 44% Hb C trait
Test: Hemoglobin Electrophoresis
 Hemoglobin electrophoresis is probably the most useful laboratory method for separating and measuringnormal and some abnormal Hb. Through electrophoresis, different types of Hb are separated to form aseries of distinctly pigmented bands in a medium (cellulose acetate or starch gel). Results are thencompared with those of a normal sample.Hb A (same as Hb A1), Hb A2, Hb S, Hb C, and Hb F are routinely checked, but the laboratory maychange the medium or its pH to expand the range of the test. This test, by measuring the different typesof Hb, is used to detect normal and abnormal types of hemoglobin, to aid in the diagnosis of thalassemia,and to aid in the diagnosis of sickle cell disease or trait.**For normal or reference values, see the chart above.
Test: Hematocrit Hct
 The hematocrit measures percentage by volume of packed red blood cells in a whole blood sample. For example, a HCT of 40% indicates that a 100-ml sample of blood contains 40 ml of blood cells. Packing isachieved by centrifuging anticoagulated whole blood in a capillary tube so that the cells are tightly packedwithout hemolysis.Normal Values:males: 40 to 50 percentfemales: 37 to 47 percentClinical Implications:Two small specimens of blood are obtained and compared. They are the same amount of blood exactly.One specimen is then centrifuged and subsequently compared to the first specimen. A percentage is thenobtained from that comparison. This comparison is the hematocrit, Hct. The value of the hematocrit isdependent upon the number of RBC's. If the Hct is abnormal, then the RBC count is possibly abnormal. If the RBC count turns out to be normal, then the average size of the RBC is probably too small. Shock,hemorrhage, dehydration, or excessive IV fluid administration can reduce the Hct.
 
 As you can see, there are many factors which can influence the results of the hematocrit test. However,this is still a good baseline lab test for the patient. It helps the physician to diagnose and to treat thepatient with any disease which will lower or raise the Hct levels.
Test: Red Blood Cell Count RBC count
  A count of actual (or estimated) number of RBC's per cubic mm of whole blood.Normal Values:males: 4.5 to 6.0 million/cu mm bloodfemales: 4.0 to 5.5 million/cu mm bloodClinical Implications:The RBC count is useful for determining such problems as anemia and hemorrhage. In combination withother hematology tests, it can be quite useful for diagnosis. This test can also give an indirect estimate of the hemoglobin levels in the blood. RBC's are actually "Red Blood Corpuscles," (non-nucleated cells).The term corpuscle indicates that it is a mature Red Blood Cell. Once the immature cell has matured, it isthen, and only then, capable of carrying oxygen. It is then also not "technically" a cell anymore. Once ithas matured, it loses its nucleus and can no longer be properly termed a cell. It would be called acorpuscle. However, everyone still refers to them as RBC's (cells). The source of the specimen is wholeblood, capillary, or venous blood.
Test: Red Cell Indices (Wintrobe Indices)
  A report of the individual characteristics of the RBC. The following are those characteristics which areused to indicate anemia. If abnormal findings are present, the anemias can be defined as macrocytic,microcytic, hypochromic, others. When this is discovered, the exact cause of the anemia can bedetermined more easily.The following are all part of indices:1. MCV2. MCH3. MCHC
1.
MCV - Mean Corpuscular VolumeThe volume of the average RBCcalculated by:Hct x 10 = MCV# of RBC'sNormal Value: 80-94 u3 (cubic microns)Clinical Implications:The MCV indicates the relative size of the RBC's. It does not indicate anything else about the cell.Several different types of anemias can be classified as micro- or macrocytic anemias. This test can directthe MD toward those types of anemias which alter the MCV results.

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