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HematologyStudies

Test:TotalHemoglobin(HgborHb)
Atestusedtodeterminetheamountofhemoglobinintheblood.Hgbisthepigment
partoftheerythrocyte,andtheoxygencarryingpartoftheblood.
NormalValues:
males:1217grams/100ml
females:1115grams/100ml
ClinicalImplications:
ALowhemoglobinlevelindicatesanemia.EstimatesofHgbineachRBCare
moderatelyimportantwhendeterminingthetotalbloodHgb.However,hemoglobin
findingsareevenmoredependentuponthetotalnumberofRBC's.Inotherwords,for
thediagnosisofanemia,thenumberofRBC'sisasimportantasthehemoglobinlevel.
Bloodhemoglobinlevelhasbecomea"routine"labtestformostpatientsadmittedto
hospitalstoday.Hgbisobviouslyimportantforthediagnosisofanemiaand
hemorrhage.Itisequallyimportantfordiagnosingmanylesserknowndiseases.
Thetestcanbeperformeduponcapillaryblood,suchasdrawnfromthefingerstick.
Thetestisoftenperformedalongwithothertests,therebyrequiringalargerspecimen
ofblood,asfromvenipuncture.Hemoglobininthebodyisdependentuponamountsof
iron.Alackofavailableironcausesonetypeofanemia,duetothereducedproduction
ofhemoglobin.Rememberthatinthestrictestsense,anemiaisnotinitselfadiagnosis,
butratherasymptomthatthereissomethingelsewronginthebody.Forexample,
malnutrition(lowironlevels),wouldbethediagnosisofthepatient,notjusttheanemia.
Thesecondarydiagnosiswouldbeanemia,butmalnutritionmustbetreatedinorderto
"cure"theanemia.
*NoteFetalHemoglobin:
FetalHb(HbF),isanormalHbproductintheredbloodcellsofafetusandinsmaller
amountsininfants.Itconstitutes50%to90%ofHbinanewborntheremainingHb
consistsofHbA1andHbA2theHbinadults.
Undernormalconditions,thebodyceasestomanufacturefetalHbsometimeduringthe
firstyearoflife,andfromthatpointonmanufacturesadultHb.Ifthischangeoverdoes
notoccurandfetalHbcontinuestoconstitutemorethan5%oftheHbafteragesix
months,anabnormalityshouldbesuspected,particularlythalassemia.
VARIATIONSOFHEMOGLOBINTYPEANDDISTRIBUTION(inadults)
Percentageoftotal
Hemoglobin

hemoglobin

ClinicalImplications

HbA

95%to100%

Normal

HbA2

4%to5.8%

bthalassemiaminor

1.5%to3%

bthalassemiamajor

Under1.5%

bdthalassemiaminor

HbF

Under2%

Normal

2%to5%

bthalassemiaminor

10%to90%

bthalassemiamajor

5%to15%

bdthalassemiaminor

5%to35%

Heterozygoushereditary
PersistenceoffetalHb
(HPFH)

100%

HomozygousHPFH

15%

HomozygousHbS

HomozygousHbS

70%to98%

SickleCelldisease

HomozygousHbC

90%to98%

HbCdisease

HeterozygousHbC

24%to44%

HbCtrait

Test:HemoglobinElectrophoresis
Hemoglobinelectrophoresisisprobablythemostusefullaboratorymethodfor
separatingandmeasuringnormalandsomeabnormalHb.Throughelectrophoresis,
differenttypesofHbareseparatedtoformaseriesofdistinctlypigmentedbandsina
medium(celluloseacetateorstarchgel).Resultsarethencomparedwiththoseofa
normalsample.
HbA(sameasHbA1),HbA2,HbS,HbC,andHbFareroutinelychecked,butthe
laboratorymaychangethemediumoritspHtoexpandtherangeofthetest.Thistest,
bymeasuringthedifferenttypesofHb,isusedtodetectnormalandabnormaltypesof
hemoglobin,toaidinthediagnosisofthalassemia,andtoaidinthediagnosisofsickle
celldiseaseortrait.
**Fornormalorreferencevalues,seethechartabove.
Test:HematocritHct
Thehematocritmeasurespercentagebyvolumeofpackedredbloodcellsinawhole
bloodsample.Forexample,aHCTof40%indicatesthata100mlsampleofblood
contains40mlofbloodcells.Packingisachievedbycentrifuginganticoagulatedwhole
bloodinacapillarytubesothatthecellsaretightlypackedwithouthemolysis.
NormalValues:
males:40to50percent
females:37to47percent
ClinicalImplications:
Twosmallspecimensofbloodareobtainedandcompared.Theyarethesameamount
ofbloodexactly.Onespecimenisthencentrifugedandsubsequentlycomparedtothe
firstspecimen.Apercentageisthenobtainedfromthatcomparison.Thiscomparisonis
thehematocrit,Hct.Thevalueofthehematocritisdependentuponthenumberof
RBC's.IftheHctisabnormal,thentheRBCcountispossiblyabnormal.IftheRBC
countturnsouttobenormal,thentheaveragesizeoftheRBCisprobablytoosmall.
Shock,hemorrhage,dehydration,orexcessiveIVfluidadministrationcanreducethe
Hct.
Asyoucansee,therearemanyfactorswhichcaninfluencetheresultsofthe
hematocrittest.However,thisisstillagoodbaselinelabtestforthepatient.Ithelpsthe
physiciantodiagnoseandtotreatthepatientwithanydiseasewhichwilllowerorraise
theHctlevels.
Test:RedBloodCellCountRBCcount
Acountofactual(orestimated)numberofRBC'spercubicmmofwholeblood.
NormalValues:
males:4.5to6.0million/cummblood
females:4.0to5.5million/cummblood

ClinicalImplications:
TheRBCcountisusefulfordeterminingsuchproblemsasanemiaandhemorrhage.In
combinationwithotherhematologytests,itcanbequiteusefulfordiagnosis.Thistest
canalsogiveanindirectestimateofthehemoglobinlevelsintheblood.RBC'sare
actually"RedBloodCorpuscles,"(nonnucleatedcells).Thetermcorpuscleindicates
thatitisamatureRedBloodCell.Oncetheimmaturecellhasmatured,itisthen,and
onlythen,capableofcarryingoxygen.Itisthenalsonot"technically"acellanymore.
Onceithasmatured,itlosesitsnucleusandcannolongerbeproperlytermedacell.It
wouldbecalledacorpuscle.However,everyonestillreferstothemasRBC's(cells).
Thesourceofthespecimeniswholeblood,capillary,orvenousblood.
Test:RedCellIndices(WintrobeIndices)
AreportoftheindividualcharacteristicsoftheRBC.Thefollowingarethose
characteristicswhichareusedtoindicateanemia.Ifabnormalfindingsarepresent,the
anemiascanbedefinedasmacrocytic,microcytic,hypochromic,others.Whenthisis
discovered,theexactcauseoftheanemiacanbedeterminedmoreeasily.
Thefollowingareallpartofindices:
1. MCV
2. MCH
3. MCHC
1.MCVMeanCorpuscularVolume
ThevolumeoftheaverageRBC
calculatedby:
Hctx10=MCV
#ofRBC's
NormalValue:8094u3(cubicmicrons)
ClinicalImplications:
TheMCVindicatestherelativesizeoftheRBC's.Itdoesnotindicateanythingelse
aboutthecell.Severaldifferenttypesofanemiascanbeclassifiedasmicroor
macrocyticanemias.ThistestcandirecttheMDtowardthosetypesofanemiaswhich
altertheMCVresults.
a. microcyticanemia.......decreasedMCV(smallcells)
b. macrocyticanemia.......increasedMCV(largecells)
2.MCHMeanCorpuscularHemoglobin:(Weightofhemoglobinineachcell)
calculatedby:
Hgbx10=MCH
#ofRBC's
NormalValue:2731uuGrams(micromicroGrams)
3.MCHCMeanCorpuscularHemoglobinConcentration
ConcentrationofhemoglobinintheaverageRBC
calculatedby:
Hgbx10=MCHC
Hct
ClinicalImplications:

TheMCHCisdependentuponthesizeoftheRBCaswellastheamountofhemoglobin
ineachcell.CertaindiseasesandanemiaswillaltertheRBCcountand/ortheamount
ofhemoglobininthecell.TheMCHCisnotasdependentupontheRBCcountasthe
othertestsinthissection.Therefore,theMCHCcanbeusefulforthediagnosisofsuch
conditionswhicharenotdependentuponthenumberofRBC's.
Thenursingimplicationsforthesetestsarenumerous.Tothenurse,mostcasesof
anemiaarequiteapparent.Theyarecausedbyhemorrhage,malnutrition,etc.
However,theIndicescanbeusedtohelpdiagnosethelesscommontypesofanemias.
Nursingcarewillthenbedeterminedaccordingtotheneedsofthatparticularpatient.
Test:ReticulocyteCount(Reticcount)
Thisisatestfortheestimationoftheactualnumbersofreticulocytesintheblood.
ReticulocytesaretheimmatureRBC's.
NormalValues:approx1%ofnormalRBCcount(50,000)Resultsvaryrange0.5%to
1.5%
ClinicalImplications:
ThereticcountisanindicationoftheproductionofRBC'sbythebonemarrow.An
increasefromthenormal,usuallyindicatesthebodyisrespondingtosuchpathologies
ashemorrhage,anemia,hemolysis,orothersuchdiseaseprocess.Decreasedretic
countmaybeindicativeofaplasticanemiaoranyrelateddisease.
Thereticcountisalsoexaminedforthosepersonsworkingnearanytypeofradioactive
materials.Thenurseshouldrememberthatthebodytriestocompensateforsuch
conditionsasthehemolyticandmacrocyticconditionsmentionedabove.Alarge
numberofreticswillbeseenafterthetreatmenthasbegunforperniciousanemia,in
whichlargenumberswillbeproducedasanattempttobringtomaturity,largenumbers
ofRBC's.
Test:SickleCellTest
Thesicklecelltest,alsoknownastheHbStest,isusedtodetectsicklecells,whichare
severelydeformed,rigiderythrocytesthatmayslowbloodflow.Sicklecelltrait
(characterizedbyheterozygousHbS)isfoundalmostexclusivelyinpeopleofAfrican
ancestry.Itispresentinnearly8%ofAfricanAmericans.
Althoughthistestisusefulasarapidscreeningprocedure,itmayproduceerroneous
results.Hbelectrophoresisshouldbeperformedtoconfirmthediagnosisifsicklecell
diseaseisstronglysuspected.
**SeeHemoglobinelectrophoresistestearlierinthischapter.
Test:IronandTotalIronbindingCapacity
Ironisessentialtotheformationandfunctionofhemoglobin,aswellasmanyother
hemeandnonhemecompounds.Afterironisabsorbedbytheintestine,itisdistributed
tovariousbodycompartmentsforsynthesis,storage,andtransport.Serumiron
concentrationisnormallyhighestinthemorninganddeclinesprogressivelyduringthe
day.Thus,thesampleshouldbedrawninthemorning.
Anironassayisusedtomeasuretheamountofironboundtotransferrininblood
plasma.Totalironbindingcapacity(TIBC)measurestheamountofironthatwould
appearinplasmaifallthetransferrinweresaturatedwithiron.
SerumironandTIBCareofgreaterdiagnosticusefulnesswhenperformedwiththe
serumferritinassay,buttogether,thesetestsmaynotaccuratelyreflectthestateof
otherironcompartments,suchasmyoglobinironandthelabileironpool.Bonemarrow
orliverbiopsy,andironabsorptionorexcretionstudiesmayyieldmoreinformation.

NormalValues:
SerumIron:
males:50to150u/g/dl
females:35to145ug/dl
TIBC,TotalIronbindingcapacity:
malesandfemales:250to400ug/dl
Saturation:
malesandfemales:14%to50%
Test:Ferritin
Ferritinisamajorironstoringproteinfoundinreticuloendothelialcells.Itnormally
appearsinsmallquantitiesinserum.Inhealthyadults,serumferritinlevelsaredirectly
relatedtotheamountofavailableironstoredinthebodyandcanbemeasured
accuratelybyradioimmunoassay.
NormalValues:
Men:20to300NG/ml
Women:20to120NG/ml
6moto15yr

7to140NG/ml

2to5months

50to200NG/ml

1monthold

200to600NG/ml

Neonates

25to200NG/ml

NormalserumFerritinvalueswillvarywithage.Remembertocheckwithyourlab,as
normalvaluesmaybedifferentindifferentlabs.Thebloodiscollectedviavenipuncture
inastandard10mlredtoptube.Arandombloodspecimenisused.Nospecial
instructionsneedtobegiventothepatientexceptforexplainingtheprocedure.Recent
bloodtransfusionsmayelevateserumferritinlevels.
IncreasedSerumFerritinLevels:mayindicateacuteorchronichepaticdisease,iron
overload,leukemia,acuteorchronicinfectionorinflammation,Hodgkin'sDisease,or
chronichemolyticanemias.
Slightincrease,ornormalFerritinLevel:mayindicatechronicrenaldisease
DecreasedserumFerritinLevels:mayindicatechronicirondeficiency
Test:ESRErythrocyteSedimentationRate
TheESRmeasuresthetimerequiredforerythrocytesfromawholebloodsampleto
settletothebottomofaverticaltube.FactorsinfluencingtheESRincluderedcell
volume,surfacearea,density,aggregation,andsurfacecharge.Thesamplemustbe
examinedwithin2hoursofcollectionanditmustbehandledgently,noclottingof
samplemusttakeplace.
Normalvalues:020mm/hr(graduallyincreasewithage)
TheESRisasensitive,butnonspecifictestthatisfrequentlytheearliestindicatorof
disease.Itoftenrisessignificantlyinwidespreadinflammatorydisordersduetoinfection
orautoimmunemechanisms.Suchelevationsmaybeprolongedinlocalized
inflammationandmalignancies.
IncreasedESR:mayindicatepregnancy,acuteorchronicinflammation,tuberculosis,
rheumaticfever,paraproteinemias,rheumatoidarthritis,somemalignancies,oranemia.
DecreasedESR:mayindicatepolycythemia,sicklecellanemia,hyperviscosity,orlow

plasmaprotein.
Test:OsmoticFragility
Osmoticfragilitymeasuresredbloodcell(RBC)resistancetohemolysiswhenexposed
toaseriesofincreasinglydilutesalinesolutions.Thesoonerhemolysisoccurs,the
greatertheosmoticfragilityofthecells.
PurposeoftestThepurposeofthistestistohelpdiagnosehereditaryspherocytosis
andtosupplementastainedcellexaminationtodetectmorphologicRBCabnormalities.
Normalresults:Osmoticfragilityvalues(percentageofRBC'shemolyzed)are
determinedbythetonicityofthesaline.Referencevaluesforthedifferenttonicitiesare
asfollows:
0.5g/dlsodiumchloride(NaCl)solution(unincubated)
males:0.5%to24.7%hemolysis
females:0%to23.1%hemolysis
0.6g/dlsodiumchloridesolution(incubated)
males:18%to55.2%hemolysis
females:2.2%to59.3%hemolysis
0.65g/dlsodiumchloridesolution(incubated)
males:4%to24.8%hemolysis
females:0.5%to28.9%hemolysis
0.75g/dlsodiumchloridesolution(incubated)
males:0.5%to8.5%hemolysis
females:0.1%to9.3%hemolysis
Lowosmoticfragility(increasedresistancetohemolysis)ischaracteristicof
thalassemia,irondeficiencyanemia,andotherredbloodcelldisordersinwhich
codocytes(targetcells)andleptocytesarefound.Lowosmoticfragilityalsooccursafter
splenectomy.
Highosmoticfragility(increasedtendencytohemolysis)occursinhereditary
spherocytosis,inspherocytosisassociatedwithautoimmunehemolyticanemia,severe
burns,chemicalpoisoning,orinhemolyticdiseaseofthenewborn(erythroblastosis
fetalis).
Test:WBCcountWhiteBloodCellCount(Leukocytecount)
AlaboratorytestthatcountstheactualnumberofWBC'sintheblood.
NormalValues:totalWBC:4,500to10,500
BASICTYPESOFWBC'S:
neutrophils(granulocyte)
lymphocytes(nongranulocyte)
monocytes(nongranulocyte)
eosinophils(granulocyte)
basophils(granulocyte)
ClinicalImplications:
Asweallknow,WBC'sareourbody'sfirstlineofdefenseagainstinvadingbacteriaand
mostotherharmfulorganisms.Thistest(WBC),measuresthetotalnumberofalltypes
ofWBC's.Furtherexaminationofthedifferenttypesandnumbersofcellspresent,could
tellmuchaboutthestateofthebody'sdefensesystem.WBCcountwillnormallyvaryas
muchas2,000onanygivenday.

Test:DifferentialCellCountalsoknownas"diff"or"differential"
LaboratorytestthatcountsactualnumbersofdifferenttypesofWBC's.
ClinicalImplications:
ThefollowingchartgivesthenormalvaluesforeachtypeofWBC.Interpretationofthe
resultsofthedifferentialmustalwaysbedonewiththetotalnumberofWBC'sinmind.
TheWBCdifferentialevaluatesthedistributionandmorphologyofwhitebloodcells.
Therefore,itprovidesmorespecificinformationaboutapatient'simmunesystemthan
theWBCcountalone.Inthedifferentialtest,thelabclassifies100ormorewhitecellsin
astainedfilmofperipheralbloodaccordingtotwomajortypesofleukocytes.Theyare:
(1)Granulocytes(neutrophils,eosinophils,basophils)(2)nonGranulocytes
(lymphocytes,monocytes).Thepercentageofeachtypeisthendetermined.
Thedifferentialcountistherelativenumberofeachtypeofwhitecellintheblood.By
multiplyingthepercentagevalueofeachtype,bythetotalWBCcount,thelabobtains
theabsolutenumberofeachtypeofwhitecell.Althoughlittleisknownaboutthe
functionofeosinophilsintheblood,abnormallyhighlevelsofthemareassociatedwith
varioustypesofallergicdisordersandreactionstoparasites.Insuchcases,the
eosinophilcountissometimesorderedasafollowuptothewhitecelldifferential.This
testisalsoappropriateifthedifferentialWBCcountshowsadepressedeosinophil
level.

InterpretingtheDifferential
InordertointerprettheresultsoftheWBCandtheDifferential,thenursemustconsider
bothrelativeandabsolutevaluesofthedifferential.Consideredalone,relativeresults
maypointtoonediseasewhilemaskingthetruepathologythatwouldberevealedby
consideringtheresultsofthewhitecellcount.
Forexample,considerapatientwhosewhitebloodcell(WBC)countis6000/uland
whosedifferentialshows30%neutrophilsand70%lymphocytes.Hisrelative
lymphocytecountwouldseemtobequitehigh(lymphocytosis),butwhenthisfigureis
multipliedbyhiswhitecellcount(6000x70%=4,200lymphocytes/ul),itiswellwithin
normalrange.
Thepatient'sneutrophilcount,however,islow(30%),andwhenthisismultipliedbythe
whitecellcount(6,000x30%=1,800neutrophils/ul),theresultisalowabsolute
number.Thislowresultindicatesdecreasedneutrophilproduction,whichmaymean
depressedbonemarrow.
CELL

ADULT

ABSOLUTE

RELATIVEVALUE(618yearsold)

TYPE

VALUE

VALUE

BOYS

Neutrophils

47.6%to
76.8%

1,950to
8,400/ul

38.5%to71.5% 41.9%to76.5%

Lymphocytes

16.2%to43%

660to4,600/ul

19.4%to51.4% 16.3%to46.7%

Monocytes

0.6%to9.6%

24to960/ul

1.1%to11.6%

0.9%to9.9%

Eosinophils

0.3%to7%

12to760/ul

1%to8.1%

0.8%to8.3%

Basophils

0.3%to2%

12to200/ul

0.25%to1.3%

0.3%to1.4%

NEUTROPHILS:
Increasedby:

GIRLS

Infectiongonorrhea,osteomyelitis,otitismedia,chickenpox,herpes,others
IschemicnecrosisduetoMI,burns,carcinoma
MetabolicDisordersdiabeticacidosis,eclampsia,uremia,thyrotoxicosis
StressResponseduetoacutehemorrhage,surgery,emotionaldistress,others
Inflammatorydiseaserheumaticfever,acutegout,vasculitis,myositis
Decreasedby:
Bonemarrowdepressionduetoradiationorcytotoxicdrugs
Infectionssuchastyphoid,hepatitis,influenza,measles,mumps,rubella
hypersplenismhepaticdisease,storagedisease
Collagenvasculardiseasesystemiclupuserythematosus
DeficiencyoffolicacidorvitaminB12
EOSINOPHILS:
Increasedby:
Allergicdisordersasthma,hayfever,foodordrugsensitivity,others
Parasiticinfectionstrichinosis,hookworm,roundworm,amebiasis
SkinDiseaseseczema,psoriasis,dermatitis,herpes,pemphigus
NeoplasticdiseasesHodgkin'sdisease,chronicmyelocyticleukemia
Miscellaneouscollagenvasculardisease,ulcerativecolitis,perniciousanemia,
scarletfever,excessiveexercise,others
Decreasedby:
Stressresponseduetotrauma,shock,burns,surgery,mentaldistress,
Cushing'sSyndrome
BASOPHILS:
Increasedby:
MiscellaneousdisordersChronicmyelocyticleukemia,polycythemiavera,some
chronichemolyticanemias,Hodgkin'sdisease,myxedema,ulcerativecolitis,
chronichypersensitivitystates,
Decreasedby:
Miscellaneousdisordershyperthyroidism,ovulation,pregnancy,stress
LYMPHOCYTES:
Increasedby:
Infectionspertussis,syphilis,tuberculosis,hepatitis,mumps,others
Othersthyrotoxicosis,hypoadrenalism,ulcerativecolitis,immunediseases
Decreasedby:
Severedebilitatingillnesscongestiveheartfailure,renalfailure,advanced
tuberculosis
OthersDefectivelymphaticcirculation,highlevelsofadrenalCorticosteriods,
others
MONOCYTES:
Increasedby:
Infectionssubacutebacterialendocarditis,tuberculosis,hepatitis,malaria
Collagenvasculardiseasesystemiclupuserythematosis,rheumatoidarthritis
Carcinomasmonocyticleukemia,lymphomas

Decreasedby:(unknown)
HEMATOLOGY................InSummary
RBClabvalues,alongwiththeindices,areusedtodiagnoseanemiaandtodefinethe
typeofanemiapresent.Thelabvaluesarecalculatedandcomparedfortheindividual
characteristicsofthebloodcells.
Whentheindividualcharacteristicsofthecellsaredetermined,youcanthendecideif
theconditionishemorrhagicoranothertypeofanemia.
Oneshouldaskthefollowingquestionsinordertoisolatethetypeofanemia:
1. Arethereticulocytesincreased?
possiblehemorrhage
2. Isthehemoglobinabnormal?
possiblefactoranemia
possiblehemorrhage
3. IstheRBCnormal?
possiblemetastaticproblem
possiblehemorrhage

CoagulationStudies
Nursingimplicationsrelatedtoclottingstudiesarenumerous.Anincreaseinclottingof
bloodoradecreaseinclottingabilitywillbeconsideredthetwomainproblemsof
coagulationoftheblood.
Followingisasummaryoftheoverallphasesofbloodclotting.Circulatingblood
generallyhastwomaininactiveproteinsrelatingtoclotting.Theseareprothrombinand
fibrinogen.Itmustalsoberememberedthatplateletsstimulatetheclottingprocess.
BloodClottingProcess
PHASEI

InitiationPhase
plateletsplusinitiationfactor

PHASEII

ThromboplastinPhase
*plateletfactorsplusCalcium
*plusfactors8,9,10,11,12
.....yieldsthromboplastin

PHASEIII

ThrombinPhase
*prothrombinpluscalcium
*plusthromboplastin
*plusacceleratorfactors5,7,10
..........yieldsThrombin

PHASEIV

FibrinPhase
*fibrinogenplusfactor8
*plusThrombin
.........yieldsFibrinCLOT

Test:PlateletCount

Atestwhichisadirectcountofplatelets(thrombocytes)inwholeblood.
NormalValues:150,000to350,000permm3(cubicmm)
ClinicalImplications:
1. Plateletsarethesmallestformedelementsintheblood.Theyarevitaltothe
formationofthehemostaticpluginvascularinjury.Theypromotecoagulationby
supplyingphospholipidstotheintrinsicthromboplastinpathway.
Thrombocytopeniadecreasedplateletcount,belowapprox100,000
Spontaneousbleedingifplateletsdecreasedbelowapprox50,000
FatalGIbleedingorCNShemorrhageifplateletsbelowapprox5,000
2. Whentheplateletcountisabnormal,diagnosisusuallyrequiresfurtherstudies,
suchasCBC,bonemarrowbiopsy,directantiglobulintest(directCoomb'stest),
andserumproteinelectrophoresis.
3. Usea7mllavendertoptubeforcollection.Arandomspecimenisused.Mixthe
bloodGENTLYwiththeanticoagulantinthetube.Roughhandlingwillinterfere
withtheresults.
4. Hemolysisduetoroughhandlingortoexcessiveprobingatthevenipuncturesite
mayaltertestresults.
5. Manymedicationswilldecreaseplateletcounttheyincludeacetazolamide,
acetohexamide,antimony,antineoplasticdrugs,brompheniraminemaleate,
carbamazepine,chloramphenicol,furosemide,goldsalts,isoniazid,mephentoin,
methyldopa,sulfonamides,thiazide,andmanyothers.
Plateletsnormallyincreaseinpersonslivingathighaltitudesforextendedperiodsof
time.Theyalsoincreasewithpersistentcoldtemperatures,andduringstrenuous
exerciseandexcitement.Thecountdecreasesjustpriortomenstruation.
Test:ProthrombinTimePTorProTime
ThistestisameasureofphaseIIIoftheclottingprocess.ThePTmaygivefalse
readingsduetosomeotherclottingdefects.However,itisusuallyindicativeofaphase
IIIproblem.
Normalvalues:(childoradult):1115secondsor70%100%(dependsonmethodused)
ClinicalImplications:
ProthrombinisalsoknownasfactorIIofthecoagulationfactors.Itisproducedbythe
liverandrequiresvitaminKforitssynthesis.Inliverdisease,PTisusuallyprolonged.
Thetestrequires7to10mlofbloodwithananticoagulantinthebloodtube.Itcanbe
collectedinablacktoptube(sodiumoxalateinthetube),orbluetoptube(sodium
citrateinthetube).Themostcommonisthebluetoptube,thespecimenmustbetested
within4hoursofcollectionandisusuallypackediniceanddeliveredtothelabquickly.
Thisisaverycommonlabtestandisusuallyperformedasaroutinehospitaladmission
screeningtest.AhighfatdietmaycausedecreasedPT,andalcoholcancausean
increasedPTresult.
Test:PartialThromboplastinTimePTT
AtestsimilartothePT,thePTTisalsousedtodetectclottingabnormalities.APTT,
ActivatedPTT,similartoPTTbutismoresensitivethanPTTtestitwillhelptoidentify
thedefectivefactor,ifoneisdefective.
NormalValues:
PTT:6070seconds
APTT:3045seconds
*theseresultsmayvaryduetotestmethodsindifferenthospitals.
ClinicalImplications:

ThePTTisverysimilartothePT.ItisusedtodetectPhaseIIdefectsintheclotting
process.ItwillusuallydetectdeficienciesinallclottingfactorsexceptfactorsVIIand
XIII.ItisusuallyperformedformonitoringHeparintherapy.Heparindosesareusually
adjustedaccordingtothePTTtestresults.ThePTTisusuallymoresensitivethanthe
PTtest.
Test:BleedingTime
Arawmeasurementofthetimeneededforanartificiallyproducedskinpuncturetostop
bleeding.
NormalValues:
Ivymethod:16minutes
Dukemethod:13minutes
ClinicalImplications:
Hodgkin'sdiseaseissuspectedifthereisdecreasedbleedingtime.Prolongedratemay
indicate:thrombocytopenicpurpura,plateletabnormality,vascularabnormality,
leukemia,severeliverdisease,DICdisease,aplasticanemia,factordeficiencies(V,VII,
XI),Christmasdisease,hemophilia.Thefollowingdrugscanaffectbleedingtime:
aspirin,dextran,mithramycin,coumadin,streptokinasestreptodornase(fibrinolytic
agent).Aspirin,alcohol,andalsoanticoagulantsmayincreasebleedingtime.
Thistestisusuallyinconclusive.Itcanhowever,behelpfulfordiagnosingcapillary
abnormalitiesandotherdisorders.Fordetectingotherclottingproblems,thistestwill
usuallyshowanormalresult.Thistestisusuallyjustageneralscreeningtest.
Test:TGT,ThromboplastinGenerationTime
AtestforphaseIIclottingdefects.Itteststheabilityofthepatienttoproduce
thromboplastin.
ClinicalImplications:
Thistestisverycomplicatedandonlyafewlargelaboratorieswillperformthistest.The
TGThastheabilitytoexactlypinpointthedefectintheclottingprocess.Thisfactcan
maketheTGTaveryvaluabletestundercertaincircumstances.
Test:PlasmaFibrinogen
Atestforthelevelofcirculatingplasmafibrinogen.
ClinicalImplications:
Thistestcanbeveryvaluableforhelpingdiagnosedisorderswhichcancauselowered
levelsofthefibrinogen.Itisalsousefulfordetectingsubstanceswhichdestroy
fibrinogen(fibrinolysins).

DiscussionofCoagulationTests
Thetestsmentionedherearecommonlyusedinhospitalstoday.Therearemanyother
coagulationtestsavailable,mostofwhicharecomplicated,expensive,andusuallyonly
performedatlargemedicalcenters.Manyofthosespecializedtestsareusedonlyafter
simplerscreeningtestsareperformed.
Thenurseshouldalwaysremembertoobtainaverydetailedhistoryfromthepatient.
ThehistorycanbemostusefulinhelpingtheMDmakeanaccuratediagnosis.
Manytimesthepatientmaynotspeakfreelywiththephysicianormayhaveforgotten
someimportantdetailorsymptom.Anobservantnursecanpossiblyhelpwiththe

medicaldiagnosisandpossiblysavethepatientextrahospitalizationand/or
unnecessarytesting.
Asfarasthemechanicsofthetestsareconcerned,thereislittleforthenursetodoin
ordertopreparethepatients.Thenurseshouldalways"warn"thepatientthattheblood
willbedrawn,orthattheywillbeinjectedwithsomething,ifitispartofthetest.
However,mostcoagulationstudiesaredonewithaspecimenofblooddrawneither
randomlyorataspecialtimeoftheday.
Thespecimenofbloodwillprobablyhaveananticoagulantinitorinthecollectiontube
andmostspecimenswilleitherhavetobeicedorbroughttothelabquicklyforanalysis.