Basic Hematology

Boule Diagnostics AB
Basic Hematology
Mariel Selin, Product Manager
2017-08-29 – BOULE DIAGNOSTICS– Basic Hematology (PT19932) (1) Copyright © 2017, Boule Diagnostics AB
Agenda
• Hematopoesis
• Example of blood morphology
• Parameters of interest and interpretation
• Sampling and artefacts
• Quality control
What is blood?
• Specialized body fluid
• Red colored
• Blood cells suspended in liquid (plasma)
• All cellular blood components are derived from
hematopoietic stem cells
• Deliver necessary substances to the body's cells
• Volume human adult:
5 - 6 liters or about 8 % of the body weight
The function of blood
Blood is the ”spirit” that gives life to the body
Main functions:
– Transportation of oxygen, nutrients, hormones to
the cells
– Removing carbon dioxide and other waste
products
– Sealing after damages
– Involved in the defence against infections
– Help the body to maintain the normal temperature
– Control the liquid and the acid base balance
Blood components
RBC HGB
Formed PLT Neutrophils

Elements
Eosinophils
WBC Basophils
Blood
Monocytes
Water Lymphocytes
Plasma Electrolytes
~ 55 % of Albumin
the total
volume of Proteins Immunoglobulin
normal
blood Fibrinogen
Others
The blood cells
The white blood cell:
– size: 35 - 420 fL
– ref. value: 3.5 - 10.0 x 109/L
The red blood cell:

– size: 75 - 100 fL
– ref. value: Females: 3.5 - 5.2 x 1012 /L
Males: 4.2 - 5.5 x 1012 /L
The platelet:
– size: 8 - 11 fL
– ref. value: 100 - 400 x 109/L
The blood cells
The red blood cell
The white blood cell
The platelet
Normal blood smear
Normal blood smear
Production of blood
Hematopoiesis
Hematopoiesis
Erythropoiesis
The process by which red blood cells are
produced
– 7 days process
– Produced in the bone marrow
– About 2 million RBC are produced per
second
– Erythropoietin (EPO) stimulates the
production
– Released from the bone marrow as
reticulocytes
Erythrocytes
Morphology: Contain no nucleus
Biconcave and elastic
Size: 7 μm
Lifetime: 120 days
Function: Transports oxygen to the
different cells and removes
carbon dioxide
Normal range: Females: 3.5 - 5.2 x 1012/L
Males: 4.2 - 5.5 x 1012/L
Hemoglobin
• Iron-containing oxygen-transport protein in the
red blood cells
• Color the blood red
• HGB: ”The blood value”/ hemoglobin
concentration
• HGB can be given in g/dL, mmol/L or g/L
• Normal ranges:
– Females: 11.5 – 15.3 g/dL
– Males: 13.4 – 16.5 g/dL
Hematocrit (HCT) or EVF
• Total packed Red Cell mass in respect to
whole blood given in % or L/L.
• Definition Hematocrit: HCT = RBC x MCV
• Used to monitor changes in the liquid
balance
• Hematocrit allows quick testing for anemia
• Normal range:
– Males: 0.40 – 0.55
– Females: 0.35 – 0.47
– Children: 0.37 – 0.45
RBC parameters
MCV: Mean cell volume of the red blood cells
– Classify the type of anemia
– Normal range: 75 - 100 fl
MCHC: Mean HGB concentration of the RBC

– The best parameter for quality control
– Useful in evaluating the clinical response of an
anemic patient to therapy
– Most common reason for high MCHC is cold agglutinins
– MCHC = HGB/HCT
– Normal range 31 - 38 g/dL
MCH: Mean Cell Hemoglobin

– Classify the type of anemia
– MCH = HGB/RBC
– Normal range 25 - 35 pg
RBC parameters cont.
RDW: Red cell distribution width
– Measure variation of red blood cell width
– Elevated RDW is known as anisocytosis
– RDW is calculated from the RBC Histogram
– Normal range: 11.0 – 16.0 %
Platelets/Thrombocytes
Morphology: Contain no nucleus
Small fragments of cytoplasm (P)
from the megakaryocyte (M)
Lifetime 8 – 10 days
Size 3 μm
Function Coagulate the blood, wound

healing in interacting with other
cells, Inflammation
Normal range 100 – 400 x 109/L
Platelet parameters
PLT: Platelet concentration
– Normal range: 100 – 400 x 109/L
MPV: Mean Platelet Volume
– Normal range: 8 – 11 fL
PDW: Platelet Distribution Width
– Calculated from the platelet histogram distribution curve
– SD/MPV x 100
PCT: Platocrit
– Calculated according to the formula: PLT x MPV
LPCR: Large Platelet Concentration Ratio
– Platelets that are larger than 12 fl
Leukocytes/White blood cells
• Cells of the immune system
• Defending the body against both

infectious diseases and foreign materials
• Five different and diverse types, all

produced and derived in the bone marrow
• Leukocytes are found throughout the

body, including the blood and lymphatic
system
Leukocytes/White blood cells
Type Diagram Approx. % Diameter (?m ) Main targets Nucleus Granules Lifetime
Inflammatory infections 6 hours –few

Neutrophil 54 –62% 10–12 Bacteria Infections M ultilobed Fine, faintly pink days
(H&E Stain)
Fungi
Larger parasites 8–12 days

Bi-lobed or Pink-orange
Eosinophil 1–6% 10–12 Allergic inflammatory (circulate for 4 –5
tri-lobed (H&E Stain)
hours)
responses
Release histamine for Bi-lobed A few hours to

Basophil <1% 12–15 Large blue
inflammato ry responses a few days
Defense troops of the body.

Clean ing up of damages or Deeply staining, Weeks to
Lymphocyte 25 –33% 7–8
destroyed cells and tissues. eccentric years
Inflammatory reactions.
Important in the coordination of

the immune defense .
Monocyte 2–10% 14–17 Kidney shaped None Hours to days
Tuberculosis
Hair cells leukemia
Neutrophils
Morphology Segmented nuclei, 2 – 5 lobes
Size 12 – 15 µm
Lifetime 1 – 2 days
10 hours in the blood stream
Function Bacterial infections,

inflammatory processes
Eosinophils
Morphology Usually 2 – 3 lobes, brick-red,
shiny granules
Size 12 – 15 µm
Lifetime 12 hours in blood stream
Function Indicate infection or inflammatory

process
Antiparasitic and bactericidal
activity
Allergic reactions, asthma
Basophils
Morphology Dark to black granules,
2-lobed nucleus
Size 12 – 15 µm
Lifetime Hours to a few days
Function Prevent blood from clotting - heparin

Promotes blood flow to tissues
Active participant in allergic and
parasitic infections.
Monocytes
Morphology Often kidney shaped nuclei,
Blue-gray cytoplasm
Size 12 – 20 µm
Lifetime Hours to days
Function Defence troop of the body.

Cleaning up of damage or
destroyed cells and tissue.
Inflammatory reaction
Lymphocytes
Morphology Round nucleus and basophilic
cytoplasm
Size 7 – 8 µm
Lifetime Weeks to years
Function Important to coordination of the

immune defence.
Viral infections.
White Blood Cell Parameters
WBC:
White Blood cell Concentration
Normal range: 3.5 – 10.0 x 109/L
NEUT and NEUT %:

Number and proportion of neutrophils of all WBC
Normal range: 55 - 65 %
EOS and EOS%:

Number and proportion of eosinophils of all WBC
Normal range: 1 – 5 %
MONO and MONO%:

Number and proportion of monocytes of all WBC
LYM and LYM%:

Number and proportion of lymphocytes of all WBC
BASO and BASO%:

Number and proportion of basophils of all WBC
Normal range: 0 – 2 % (separate scattergram)
WBC: White Blood cell Concentration 3.5 – 10.0 x 109 / l
LYM and LYM%: Number and proportion of

lymphocytes of all WBC, 20 - 48%
MID and MID%: Number and proportion of midcells, mostly

monocytes, of all WBC, 2 - 10%
GRAN and GRAN%: Number and proportion of

Neutrophil, Eosinophil and Basophil Granulocytes
of all WBC, 42 - 80%
Sample Result Screen, Medonic
WBC: White Blood cell Concentration 3.5 – 10.0 x 109 / l
LYM and LYM%: Number and proportion of

lymphocytes of all WBC, 20 - 48%
MID and MID%: Number and proportion of midcells, mostly

monocytes, of all WBC, 2 - 10%
GRAN and GRAN%: Number and proportion of

Neutrophil, Eosinophil and Basophil Granulocytes
of all WBC, 42 - 80%
Sample Result Screen, Swelab
Review of parameters
Review of parameters
MCH, MCHC
RBC HGB
RBC, MCV, HCT, RDW, RDW% HGB
Formed PLT Neutrophils

Elements PLT, MPV, PCT,
PDW, PDW%
Eosinophils GRAN, GRAN%
WBC Basophils
WBC
MID, MID%
Blood
Monocytes
Water Lymphocytes LYM, LYM%
Plasma Electrolytes
~ 55 % of Albumin
the total
volume of Proteins Immunoglobulin
normal
blood Fibrinogen
Others
Examples of
blood cell morphology
A normal RBC show minimal anisocytosis and
poikilocytosis.
Only mild variations in hemoglobinization.
Larger than average RBCs are

macrocytic (left).
Smaller than average are microcytic (right)
Normal RBCs are normochromic normocytic
Cells without central pallor are called

hyperchromic (left)
Pale cells are referred to as

hypochromic (right).
Parameters of interest and interpretation
Parameters of interest
HGB: WBC
– Anemia – Increased LYM indicates viral
infection
MCV – Increased NEUT indicates
– For investigation of anemia bacterial infection
together with RDW
Eosinophilia/Basophilia
RBC: – Asthma
– Anemia
– Allergy
– TBC
PLT
– Reduced number due to
leukemia, infection, chemo
therapy or other drugs
Interpretation
Type of ce ll Increase Decrease
Red Blo o d Cells (RC B) Erytro c ytho sis o r Anem ia o r erythro b lastp enia
p o lyc ytem ia
W hite Blo o d Cells (W BC ): Leuko c yto sis Leuko p e nia
− Lym p ho c yte s − Lym p ho c yto sis − Lym p ho c yto p enia

−
− Granulo c yte s − Granulo c yto sis − Granulao c yto p enia o r
ag ranulo c yto sis
− Neutro p hils − Neutro p hilia − Neutro p e nia

−
− Eo sino p hils − Eo sino p hilia − Eo sino p e nia
−
Plate lets Thro m b o c yto sis Thro m b o c yto p enia
All c ell lines Panc yto p enia
Sampling and artifacts
Handling of samples and tubes
– K2 or K3 EDTA shall be used
anticoagulant
– 15 minutes ”rest” after drawing.

After that, gentle mixing before analysing
– Sample storage at maximum 6 hours

if stored in room temperature
Most crucial artifacts
Low RBC and high MCHC
– Hemolysis. The red blood cells are destroyed
Low PLT count
– Platelet aggregation due to EDTA
High PLT
– Micro bubbles
– Dust particles and/or bacteria in reagents
High MCHC
– Cold agglutinins
– Instrumental malfunction
And finally…
Quality control
It is of utmost importance to perform
daily quality checks
Boule therefore provides the necessary
control material for all instruments
Thank you!

Basic Hematology

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Boule Diagnostics AB

Mariel Selin, Product Manager

Formed PLT Neutrophils

The red blood cell:

The red blood cell

The white blood cell

MCHC: Mean HGB concentration of the RBC

MCH: Mean Cell Hemoglobin

Function Coagulate the blood, wound

Normal range 100 – 400 x 109/L

• Defending the body against both

• Five different and diverse types, all

• Leukocytes are found throughout the

Inflammatory infections 6 hours –few

Larger parasites 8–12 days

Release histamine for Bi-lobed A few hours to

Defense troops of the body.

Important in the coordination of

Function Bacterial infections,

Lifetime 12 hours in blood stream

Function Indicate infection or inflammatory

Lifetime Hours to a few days

Function Prevent blood from clotting - heparin

Lifetime Hours to days

Function Defence troop of the body.

Lifetime Weeks to years

Function Important to coordination of the

NEUT and NEUT %:

EOS and EOS%:

MONO and MONO%:

LYM and LYM%:

BASO and BASO%:

WBC: White Blood cell Concentration 3.5 – 10.0 x 109 / l

LYM and LYM%: Number and proportion of

MID and MID%: Number and proportion of midcells, mostly

GRAN and GRAN%: Number and proportion of

WBC: White Blood cell Concentration 3.5 – 10.0 x 109 / l

LYM and LYM%: Number and proportion of

MID and MID%: Number and proportion of midcells, mostly

GRAN and GRAN%: Number and proportion of

Formed PLT Neutrophils

Larger than average RBCs are

Smaller than average are microcytic (right)

Cells without central pallor are called

Pale cells are referred to as

− Lym p ho c yte s − Lym p ho c yto sis − Lym p ho c yto p enia

− Neutro p hils − Neutro p hilia − Neutro p e nia

All c ell lines Panc yto p enia

– 15 minutes ”rest” after drawing.

– Sample storage at maximum 6 hours

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