PEMERIKSAAN*

PROFIL*DARAH*
What%Are%the%Major%Components%of%Blood?%
•  Red%Blood%Cells%%
(also%called%erythrocytes)%
•  White%Blood%Cells%
%(also%called%leukocytes)%%
•  Platelets%%
(also%called%thrombocytes)%
•  Plasma%
 Cell Type Too High Too Low
Erythrocytosis or
Red Blood Cells (Erythrocytes) Anemia
Polycythemia
Thrombocytosis or
Platelets (Thrombocytes) Thrombocytopenia
Thrombocythemia

White Blood Cells (Leukocytes) Leukocytosis Leukopenia

Neutrophils Neutrophilia Neutropenia

Lymphocytes Lymphocytosis Lymphopenia

Eosinophils Eosinophilia ---

Monocytes Monocytosis ---

Basophils Basophilia ---

Hematology%Tests%%
• Specialized%tests%
–  Bone%Marrow%aspiraEon%and%biopsy%
• All%of%the%formed%elements%of%the%blood%
are%produced%primarily%in%the%bone%
marrow%%
• They%are%produced%by%progenitor%cells%–%
cells%which%grow%and%differenEate%into%
mature%formed%elements%
• This%test%can%detect%the%lack%or%
overabundance%of%these%progenitor%cells,%
and%can%find%other%problems%such%as%
cancer%
 Red%Blood%Cells%(RBCs)%
•  Largest%cellular%component%of%
blood,%about%40P45%%of%blood%
volume%
•  Comprised%mostly%of%
hemoglobin%%
•  Transport%oxygen%
•  Red%blood%cells%normally%last%
about%120%days%before%they%
are%removed%by%the%spleen%
 Hemoglobin%
•  Red%pigment%molecule%
which%gives%RBCs%(and%
blood)%its%color%
•  Contains%4%molecules%of%
heme%and%4%of%globin%(2%
alpha%chains%and%2%beta%
chains)%
•  Each%molecule%of%heme%
contains%one%iron%ion%%
 White%Blood%Cells%%
• There%are%several%types%of%White%Blood%Cells%
• They%are%all%involved%in%immunity%but%in%somewhat%different%ways%
–  Granulocytes%(neutrophils,%PMNs,%polymorphonuclear%
leukocytes,%or% polys )%–%involved%in%acute%infecEons%with%
bacteria.%Immature%form%is%called%a% band %
–  Lymphocytes%–%involved%in%many%types%of%infecEon,%especially%
viruses%PProduce%anEbodies%and% memory%cells %%P%Are%further%
divided%into%TPcells%and%BPcells%
–  Eosinophils%–%involved%in%parasiEc%infecEons%and%allergies%
–  Basophils%–%involved%in%parasiEc%infecEons%and%allergies%
–  Monocytes%–%involved%in%bacterial%and%parasiEc%infecEons%
 White%Blood%Cells%(WBCs)%
•  Neutrophils%–%also%called%a%
variety%of%other%names%on%
CBC%reports,%including:%
–  polys%
–  PMNs%
–  segs%
–  grans%
•  Lymphocytes%%
•  Monocytes%
•  Eosinophils%
•  Basophils%
 Platelets%
• Really%more%of%a%fragment%of%a%
cell%
–  They%are%broken%off%from%a%
very%large%cell%in%the%bone%
marrow%called%a%
megakaryocyte%
–  Primary%funcEon%is%to%aid%in%
blood%clo\ng%
–  LifeEme%in%the%blood%is%7P10%
days%a^er%which%they%are%
destroyed%in%the%spleen%
–  Their%clo\ng%funcEon%is%
permanently%inhibited%by%
aspirin%
 Plasma%
•  Plasma%is%the%liquid%component%of%
blood%
•  Comprised%mostly%of%water,%but%
also%includes:% ►  57%%Plasma%
–  Protein%(albumin,%globulin,% %
fibrinogen)% ►  1%%Buffy%coat%%
–  Lipids%(cholesterol,% %–%WBC%
triglycerides)%
–  Dissolved%salts%and%minerals%
►  42%%Hct%(PCV)%
(sodium,%calcium,%potassium)%
–  Glucose%
 Measuring%RBCs%(and%the% Rule%of%Threes )%
• Hematocrit*(HCT)%is%the%percent%of%a%volume%of%whole%blood%
occupied%by%intact%red%blood%cells.%Measured%in%percent.%
–  Normal%range%for%women:%36%P%46%%
–  Normal%range%for%men:%41%P%53%%

• Hemoglobin*(HGB)%measures%the%concentraEon%of%hemoglobin%
expressed%as%grams%of%hemoglobin%per%deciliter%(100%ml)%of%whole%
blood.%
–  Normal%range%for%women:%12%P%16%g/dL%
–  Normal%range%for%men:%13.5%P%17.5%g/dL%

• RBC*count%is%the%number%of%red%blood%cells%per%microliter%of%whole%
blood.%Measured%in%millions%of%RBCs%per%microliter%of%whole%blood.%
–  Normal%range%for%women:%4.0%P%5.2%x106/mm3%
–  Normal%range%for%men:%4.5%P%5.9%x106/mm3%
 Red%Blood%Cell%Indices%
• Mean*Corpuscular*Volume*(MCV)%is%the%average%size%of%red%blood%cells.%
–  Normal%range:%80P100%fL%
–  Low%=% microcyEc %( too%small )%% %High%=% macrocyEc %( too%big )%
% % % %Normal%=% normocyEc %( just%right )%%
• Red*Cell*DistribuGon*Width*(RDW)%measures%the%variability%in%the%size%of%red%blood%
cells.%%
–  Normal%range:%11.5P14.5%%
–  On%a%peripheral%blood%smear,%high%RDW%is%described%as% anisocytosis *
• Mean*Corpuscular*Hemoglobin*(MCH)%is%the%amount%of%hemoglobin%in%an%average%
red%blood%cell.%
–  Normal%range:%26P34%pg/cell%
• Mean*Corpuscular*Hemoglobin*ConcentraGon*(MCHC)%is%the%average%concentraEon%
of%hemoglobin%in%an%average%RBC.%
–  Normal%range:%31P37%g/dL%
–  Hypochromic %=% too%pale % Normochromic %=% just%right %
 Red%Blood%Cell%Indices%
• Mean*Corpuscular*Volume*(MCV)%is%the%average%size%of%red%
blood%cells.%
–  If%anemia%is%present,%MCV%is%a%useful%tool%to%guide%further%tesEng%
–  If%anemia%is%not%present,%MCV%is%of%liile%value:%
• Low%MCV%without%anemia%suggests%thalassemia%minor%(trait)%
• High%MCV%without%anemia%can%be%caused%by%certain%medicaEons%
(DilanEn,%oral%contracepEves,%methotrexate)%and%is%a% so^ %marker%of%
possible%alcohol%overuse%

• Red*Cell*DistribuGon*Width*(RDW)%measures%the%variability%in%
the%size%of%red%blood%cells.%%
–  Not%useful%in%the%absence%of%anemia*
ClassificaEon%of%Anemias%Using%MCV%
and%RDW%
 DescripEve%Terms%Used%on%Peripheral%Smears%

•  Anisocytosis:%marked%variaEon%in%RBC%sizes%
(visual%counterpart%of%increased%RDW)%
•  Hypochromia*or*hypochromasia:%RBCs%are%paler%
than%normal%because%they%contain%less%
hemoglobin%(visual%counterpart%of%decreased%
MCH)%
•  Macrocytosis:%increased%number%of%large%RBCs%
(visual%counterpart%of%increased%MCV)%
•  Microcytosis:%increased%number%of%small%RBCs%
(visual%counterpart%of%decreased%MCV)%
•  Poikilocytosis:%marked%variaEon%in%the%shape%of%
RBCs%
 ReEculocyte%Count%
•  ReEculocytes%are% young %red%blood%cells%that%
were%recently%released%from%the%bone%marrow.%
•  Normally,%reEculocytes%comprise%0.5%P%2.5%%of%
all%red%blood%cells.%
•  Increased%reEculocytes%(reEculocytosis)%is%a%
normal%response%to%blood%loss%or%anemia.%Since%
reEculocytes%are%larger,%the%MCV%(and%RDW)%
may%be%elevated.%
•  The%combinaEon%of%anemia%with%a%low%or%
normal%reEculocyte%count%indicates%that%the%
bone%marrow%is%unable%to%respond%normally,%
either%due%to%lack%of%essenEal%ingredients%(iron%
deficiency,%vitamin%B12%or%folate%deficiency),%
bone%marrow%disease,%or%chronic%disease.%
 Types%of%White%Blood%Cells%P%What s%the%Diff?%

•  Neutrophils%–%also%called%a%
variety%of%other%names%on%CBC%
reports,%including:%
–  polys%
–  PMNs%
–  segs%
–  bands%or%stabs%(immature%
neutrophils%indicate%acute%
infecEon)%
•  Lymphocytes%%
•  Monocytes%
•  Eosinophils%
•  Basophils%
 Leukocytosis%
•  An%elevated%WBC%count%is%termed% leukocytosis %
•  Normal%level%is%4,400%to%10,000%WBC%per%mm3%
•  This%can%result%from%many%causes,%principally%
infecEons,%inflammatory%disorders,%and%
medicaEons%
•  Cancer%and%myeloproliferaEve%disorders%can%also%
cause%high,%someEmes%extremely%high,%WBC%
counts%
•  Treatment%is%aimed%at%the%underlying%cause%
•  Death%may%result%from%the%underlying%cause%such%
as%severe%infecEon%or%cancer%(leukemia)%
 Neutropenia%
•  The%relaEve%lack%of%neutrophils%(the%most%common%type%of%WBC,%also%
called%granulocytes)%
•  Normally%humans%have%at%least%1500%neutrophils/mm3%
•  Severe%neutropenia%(almost%no%neutrophils)%is% agranulocytosis %%
•  May%be%cause%by%gene%defects,%various%drugs,%or%medical%condiEons%
•  Treatment%is%usually%aimed%at%the%underlying%cause%
•  Some%may%require%anEbioEcs%to%prevent%infecEon%or%medicaEons%to%
sEmulate%producEon%of%neutrophils%
•  Death%may%occur%due%to%overwhelming%infecEon%
%
Chronic*Benign*Neutropenia:*
•  Overall%risk%of%infecEon%is%low,%usually%asymptomaEc%
•  Two%forms%–%familial%and%nonPfamilial%
•  Key%features%from%underwriEng%perspecEve%are%the%absence%of%significant%
infecEons%and%stability%over%Eme%
WBC%DifferenEal:%Lymphocytes%
WBC%DifferenEal:%Monocytes%
WBC%DifferenEal:%Eosinophils%
WBC%DifferenEal:%Basophils%
•  If%the%total%white%blood%count%(WBC)%is%normal,%
the%red%cells%and%platelets%are%normal,%and%your%
applicant%is%otherwise%healthy,%don t%worry%
about%the%differenEal%white%blood%count,%
especially%if%the%absolute%counts%are%normal.%
•  The%percentage%of%neutrophils,%lymphocytes,%etc.%
o^en%fluctuate%in%response%to%an%infecEon;%this%is%
not%a%big%underwriEng%concern.%
 Mean%Platelet%Volume%(MPV)%
•  Young %platelets,%recently%released%from%the%
bone%marrow,%are%typically%slightly%larger%
•  O^en%elevated%in%immune%or%idiopathic%
thrombocytopenic%purpura%(ITP)%
•  In%an%individual%with%low%platelet%count%
(thrombocytopenia):%
–  Increased%MPV%indicates%normal%bone%marrow%
response%
–  Decreased%or%low%normal%MPV%may%indicate%impaired%
bone%marrow%response%
Selected%Causes%of%Abnormal%Platelet%Counts%
TERIMA%KASIH%