)(Heamatology Laboratory

.
:
)(Complete Blood Count CBC
) ( )(Differential Count
)(Reticulocyte Test
)(Erythrocytes Sedimentation Rate ESR
)(B.T
)(PT
)(PTT

.
.
.
.
.
.

:

. .
:
) (CBC .
) (PT ) (PTT ).(Coagulation
).(ESR

.
:
-1 ). (Anemia
-2 ). (Leukemia
-3 ). (Bleeding Diorders
-4 )(Inflammation
-5 ) (Bone Marrow

: ): (Complete Blood Count CBC

:
)( HB% RBC HCT MCV MCH MCHC- WBC PLT
.
-1
- ) :(1


) (

) (% .
: .

16

Drabkin Method
-
) (
) ( Spectrophotometer ) .(2

Spectrophotometer

540 )(Blank
.
.
:
-1 5 20 + )(Fresh Blood .
-2 5-3 .
-3 540 .
-4 ) (Standard :
= X 3.6 100 / = X 6.9 % HB
:

18 13 %
16.5 11.5 %

11 %

19.5 16.5%

17

) (


6 3
12 10

13.5 9.5 %
13.5 1.05 %
13.5 1.05 %
14 12 %
14.5 - 11.5 %

-2 R.B.Cs Counting
) Haemocytometer .( 3

-1 200:1 ) (%9 20 4
) 101 1 0.5
0.5 101 ( ). ( 4

RBCs
4

-2 .
-3 ) .( 5

-4 10 40
5 ) ( 6
) + (.

) (5 10000

: / = 3 X 10000
6
18

-
20 .
.
.
.
- :
20 . .
. . .

6.5 4.5 /

5.8 3.8 /

4.8 3.2 /
) 3 (
5.5 4.1 /
) 6 3 (
5.4 4 /
) 12 10 (
:
.
:
....
-3 ) Packed Cell Volume (PCV )Haematocrit (HCT
, .
. )(MCV / MCHC .% 48-39
.% 50 -42

- -
-.B12 - .


.
) ( 7 :

19

Blood Indices
- Mean Cellular Volume .. MCV

.
Microcyte : .Iron deficiency anaemia
.Thalassemia
Macrocyte Megaloblastic anaemia :
.Folate deficiency ..
.B12 deficiency.
) (MCV: 80 to 95 femtoliter :
- :Mean Corpuscular Haemoglobin .. MCH

MCH )(
. MCH .
) (MCH: 27 to 31 pg/cel :
-
:Mean Corpuscular Haemoglobin concentration ..MCHC

MCHC .
MCHC .
MCHC Hypochromia
.Iron deficiency anaemia
) ( MCHC: 32 to 36 gm/dL :
- Red Cell Distribution Width .. RDW
,
.
) ( : 11.5 14.5.
.
.

20

-4 Total Leucocytic Counting

Haemocytometer
.

-1 1 20 ) ( 20
380 ) 0.5
11 - 1 - 0.5 ) .11 ( 8

WBCs

-2 .
-3 ). (9

) : ( 7
10 ). ( 10

A+B+C+D 50

10
: / = 3

21

X 50

:
.
.

11.000 4000 / 3
/ 3
18.000 6000 / 3
) (
15.000 5000 / 3
( 7-4(
13.500 4.500 /3
) 12 8 (
:
) (
)
. . (.
:
. . .
:White Blood Cell Differential Count
:
) : ( 11
-1 :
% 75-40
- ) . (Neutrophils
% 6-1
- ) . (Eosinophils
%1
- ) . (Basophils
-2 :
- ) . (Lymphocytes .%45 20
- ) :. (Monocytes % 10-2
) 10 5 (

12

22

- :Neutrophils
) ( 13
* : Neutrophilia
) / / /). : ) / (.
. , . - . .* : Neutropenia
. / Typhoid fever .Brucellosis 13
. B12 . . ,. : / / / / /
) (14
- : Eosinophils
* :Eosinophila
, ,. . . . .* : Eosinopenia
/ Stress / Shock .Burns . 14
. - ) :Basophils (15
* : Basophilia
. . .* : Basopenia
. ..23

15

- ) :Lymphocytes (16
* : Lymphocytosis
- .
.Viral hepatitis . . 16
* Lymphocytopenia :
. . . . - ) Monocytes (17
* :Monocytosis
T.B . .Malaria . .* :Monocytopenia
B12 . .Leukemia Aplastic anaemia 17

-5 : Platelets
. .
) .(18

24


) Haemocytometer ( 19:

) (20
-1 20:1 ) ( ammonium oxalate
20 380 )
11 - 1 - 0.5 0.5
) ).11 (

Plateletes

20

-2 20 15.
-3 ) .(21

21
-4 10 40
5 ) (22
) + (.

) (5 10000

22

: / = 3 5 X 10000
25

150000 : 400000
* Thrombocytosis :
:
Iron Deficiency Anaemia ..
Haemolytic Anaemia ..
T.B... Mycobacterium Tuberculosis
- Polycythaemia ..
.
* Thrombocytopenia :
: Idiopathic thromcocytopenia Pupura I.T.P ... .
) // /
/ ..
) /
B12 Folic acid
MPV, mean platelet volume

.
7 : 11
MPV .
Platelet Distribution Width .. PWD

.
19 ) MCH MCV MCHC (23
- RBC: Red Blood Cell Count.
- HGB: Hemoglobin.
- HCT: Hematocrit.
- MCV: Mean Corpuscular Volume.
- MCH: Mean Corpuscular Hemoglobin.
- MCHC: Mean Corpuscular Hemoglobin Concentration.
- RDW: RBC Distribution Width .
23

- WBC: White Blood Cell Count.

- NEUT#: Neutrophil Count.
- LYMPH#: Lymphocyte Count.
- MONO#: Monocyte Count.
- EO#: Eosinophil Count.
- BASO#: Basophil Count.

- NEUT%: Neutrophil Ratio.

- LYMPH%: Lymphocyte Ratio.
- MONO%: Monocyte Ratio.
- EO%:
Eosinophil Ratio.
- BASO%: Basophil Ratio.

- PLT: Platelet Count.

- MPV: Mean Platelet Volume.
- PDW: Platelet Distribution Width.

26


Sysmex or coulter

Beckman coulter 890 , Coulter S880 , Coulter staker , Sysmex

, :
. RBC,WBC,Plt,Hb,Hct or PCV,MCH,MCHC,MCV,MPV,RDW
.
) ( 24
: : Electrical Impedance cell Counting
: poor conductor
, Electrolyte Solution
aperture or opening 100um
.

.
Impedance / interruption
Pulses
.
.
.
24
: : Light Scattering Cell Counting
: Laser beam or tungsten-halogen

photo detector .
.
Bayer ADVIA 120
. ABBOTT cell Dyn 3500
:
:
-1 Plt , RBCs .
-2 Hb , WBCs .
:
Plt , RBCs RBCs Plt
) ( aggregation collagen , Epinephrine or Ristocetin
.
:
: Hb , WBCs Drabkin Haemoglobincyanide
) (HICN Drabkin solution
potassium ferricyanide and potassium cyanide RBC
Oxidation ferricyanide methemoglobin
stable haemoglobincyanide HICN Cyanide
540nm
WBC parts 3 :
27

Lymphocyte , monocyte , granulocyte
: parts 5
Lymphocyte , monocyte , granulocyte , Eosinophil , Basophil

:
Shrink
fl ( famtoliter ) 35 99 . Size
200fl . Mononuclear cells ( mid ) fl 200-100 . Lymphocyte
. Granulocyte
:
, Histogram
. five part Differential counting

Comment Title
Anemia
Anemia
Anemia
Anemia
Aniso
Aniso
Aniso
Normoplast
Platelets
Platelets
Platelets
.Recom
.Recom
.Recom
.Retic
WBCs
WBCs
WBCs
WBCs
WBCs
WBCs

WBCs

28

Comment Text
Mild hypochromic normocytic anemia.
Mild macrocytic anemia.
Mild microcytic hypochromic anemia.
Mild normocytic normochromic anemia.
The Red cell show mild anisopoikilocytosis.
The Red cell show mild anisopoikilocytosis with moderate degree of targeting and
polychromasia and rouleaux formation seen in film.
The Red cell show mild microcytosis, anisocytosis and hypochromia.
Mild normoblastemia.
Mild thrombocytopenia.
Platelets show anisocytosis and platlets aggregates seen in film
Mild thrombocytosis
A case of pancytopenia .if it is not already diagnosed, recommended for bone
marrow examination.
Recommended for C.B.C follow up, bone marrow examination and RT-PCR for
bcr/abl chimeric gene product.
Recommended for serum Iron, TIBC, serum ferritin and Hb electrophoresis.
Mild reticulocytosis.
WBCs show absolute and relative Neutrophilia.
WBCs show leucocytosis with absolute & relative Neutrophilia and left shift to
(% Blasts.)
WBCs show marked leucopenia for which, differential count could not be
performed.
WBCs show mild easinophilia.
WBCs show mild leucocytosis with absolute and relative Neutrophilia
WBCs show mild leucocytosis with absolute and relative lymphocytosis and
many smudge cells seen in film. Lymphocytes small and mature-looking and
%prolymphoctes.A picture suggestive of C.L.L Recommended for bone marrow
examination and immunophenotyping.
WBCs show mild leucopenia with absolute and relative neutropenia

29


-6 ): (Reticulocyte Cells
) (25

30

:
) (Bone Marrow )
( ) (
.
: RBC ,
, 8.5 7.5 , RNA

:

% 2 0.2 .
% 6 2

:
)

(
(Reticulocytosis -: )(sickle cell anemia
)(thalassemia )(acute post-hemorrhagic anemia )(hemolytic anemia - )(Hereditary spherocytic anemia

( )
(Reticulocytopenia :
)( pernicious anemia
)(a plastic anemia
:



: :
1 : ,
.
2 )Plastic (anemia ).(Hereditary spherocyte
3 , .
) ( Megaloplastic anemia
.
:
) + ( ) ( NEW METHYLENE BLE
) (BRILLANT CRESYL BLUE
15 37 .
.
31


.
.FIELDS
:
= / 100

) . ( %..........

: ): (Erythrocyte Sedimentation Rate ESR

:
/
.
. ) (ESR

.
:
) ( 15 0 / .
) ( 20 0 / .
) ( 20 0 / .
) ( 30 0 /
) (13 0 /

) (T.B
.


) (.
A.S.O

.. rheumatoid factor
) )

:
congestive heart failure
.
Polycythemia
32

) : (26

. mm/hr
) (manual )
)300 ) (Westergreen
.

26

: ): (Coagulation Factor Test

) (1 ): (Bleeding Time B.T
:
)(
)
) . (B.T (27
:

.
27
) (2 ): (Prothrombin Time PT
photometric halogen
. . 405nm
cuvettes
.


.

Shaker
) . (28

28

33


:
.
). (Extrinsic Pathway
:
) (PT 16 11 .

) (3 ): (Partial Thromboplastin Time PTT

:
). (Intrinsic Pathway
:
) (PTT 35 25 .
Blood Group (A, B, AB ,O) :

) (Rh
) (A + ve A ...
) :29 50 +
2 (

29

.
34




)) . (Rh (30
30

Rhesus factor
1940 rhesus
monkeys .
) (+Rh % 85
) (-Rh % 15 .
.
):(RH



.
:
-1 ) (+Rh
-2 ) (-Rh .
-3 ) (-Rh ) (+Rh .
-4 ) (+Rh ) (-Rh
: )(Rh incompatibility
+ Rh - Rh ) (+Rh


" ".


" " " "
.
:

72 ) ( d: Anti - d Globulin
- ) (+Rh
.
35




6
72


)(Rh incompatibility
.
) (31
: 50 + 2
(
31
-Ve

Rh

+Ve

RH

: ): (Sickling Test
) (Anemia
((Hb S
.
)6 100 /(
) (%40-15 .
:


.
.
:

"".
: ): (Haemoglobin Electrophoresis
.
: ): (Direct Coombs Test
) (Antibody .
: ): (Indirect Coombs Test

.
: ): (Osmotic Fragility Test O.F.T

). Na Cl (Normal Saline
: Iron
)
( Haemoprotein
Respiratory Enzymes Mitochondria
4 %70 .
175-75 / ) 31.3-9 /
36



Total Iron Binding Capacity - TIBC
:


.
TIPC 410-250100 / ) 73-45 /(
.%25-%20
: Serum Iron )(
. ) (
Total Iron Binding Capicity: +
) = Transferrin Saturation / ( X100

: Ferittin
: ) + (++Fe ) (


.
.
.
:
) ) ( lymphocytic leukemia (
) (.
) ( myelogenous leukemia ) (


.

( acute lymphocytic leukemia ALL ) :

75 % 80
.
( acute myeloid leukemia AML ) :
20
% .
( Chronic myelogenous leukemia CML ) :
% 2

) ( Philadelphia chromosome % 90

.
( Chronic lymphocytic leukemia CLL ) :

37




4 : 1 .
: E GLOCUSE 6 PHOSPHATE DEHYDROGENAS
)( 6)GLOCUSE 6
( PHOSPHATE DEHYDROGENASE ) .(G6PD
.
.
.
) 100(
) ( .
.


.
.
Heamatology

38

.No

Test Name

Sample

Unit

Ref

.1

Blood Picture

EDTA Blood

See report

.2

RBC * WBC * HB

EDTA Blood

See report

.3

Hematocrit

EDTA Blood

% 47 37

.4

Platelets

EDTA Blood

cmm

450.000 150.000

.5

Reticulocytes

EDTA Blood

% 2 0.5

.6

Diff. Count

.7

Fresh film

See report

Blood Group ( ABO )

EDTA Blood

See report

.8

R H Group

EDTA Blood

See report

.9

Prothrombin Time &

Activity& INR
PTT

.10

.11 E.S.R

Plasma

See report

Plasma

sec

Up To 40

Citrated Blood

mm

.12

Iron

Serum

ug/dl

.13

TIBC

Serum

ng/ml

.14

Transferrin

Serum

mg/dl

.15

Ferritin

Serum

.16

G6PD Quantitative

EDTA Blood

.17

G6PD Qualitative

EDTA Blood

.18

Osmotic Fragility

.19

Sickling Test

5ml heparinized
blood
EDTA Blood

.No
.20
.21
.22
.23
.24

.25
.26

st

1 H. Up To 10
2nd H. UpTo 20

.27
.28
.29
.30
.31

u/g Hb

20.5 - 6.97

.32

Normal activity

.33

.34

Normal curve

.35

Negative

.36
.37
.38

39