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RMT2022-KLUBSYBEAR
RMT2022-KLUBSYBEAR
RMT2022-KLUBSYBEAR
RMT2022-KLUBSYBEAR
RODAK’S 6TH EDITION
PTT REFERENCE RANGE 26 to 38 seconds
PTT THEURAPEUTIC RANGE 60 to 100 seconds
Experts once recommended a PTT therapeutic range of 1.5 to 2.5
times the mean of the reference interval
PT TYPICAL REFERENCE RANGE 12.6 to 14.6 seconds
TCT THROMBIN CLOTTING TIME 15 to 20 seconds
REFERENCE RANGE
REPTILASE TIME 10-15seconds
DUCKERT’S TEST /5 M UREA Stabilized clot is insoluble to urea for 24 hours
SOLUBILITY TEST
EUGLOBULIN LYSIS TIME Normal fibrinolysis = Lysis time is more than 1 or 2 hours
RELATIVE RETICULOCYTE COUNT 0.5 to 2.5 % Adults (Rodak’s)
0.5 to 1.5% Adults (Other Books)
ABSOLUTE RETICULOCYTE COUNT 20 to 115 x 109/L
CORRECTED RETICULOCYTE COUNT *Patients with a hematocrit of 35% should have an elevated
(CRC) corrected reticulocyte count of 2% to 3% to compensate for the mild
anemia
*Patients with a hematocrit of less than 25%, the count should
increase to 3% to 5% to compensate for the moderate anemia
RETICULOCYTE PRODUCTION INDEX >3 = Adequate bone marrow response
(RPI) <2= Inadequate erythropoietic response
RETICS COUNT USING MILLER DISK The disc is composed of two squares, the area of smaller square(B)
measuring 1/9 of the larger square
RMT2022-KLUBSYBEAR
METHEMOGLOBIN LEVEL
Using 40x HPO Average number of WBC per field x 2000 2-5 WBC/ Hpf = 4000-7000 WBC/ul
using 50x OIO) Average number of WBC per field x 3000 4-6 WBC/ Hpf = 7000-10000 WBC/ul
6-10 WBC/ Hpf = 10000-13000 WBC/ul
10-20 WBC/ Hpf = 13000-18000 WBC/ul
RMT2022-KLUBSYBEAR
NEWBORNS/NEONATES/INFANTS
RBC COUNT Increases during the first 24 hours of life, remains at this plateau for about 2 weeks,
“polycythemia”
of the newborn and then slowly declines
WBC COUNT Leukocytosis is typical at birth for full-term and preterm infants.
Fluctuations in the number of WBCs are common at all ages but are greatest in infants
At birth, preterm infants exhibit a left shift, with promyelocytes and myelocytes commonly
observed
HEMOGLOBIN Reference interval for a full-term infant at birth is 16.5 to 21.5 g/dL
Abnormal value= less than 14 g/dl
Minimum /Lower limit= 14g/dl
At birth Hb F constitutes 53% to 95% of the total hemoglobin. Hb F declines from 90% to 95%
at 30 weeks’ gestation to approximately 7% at 12 weeks after birth and stabilizes at 2% to 3%
by6 months of age
LYMPHOCYTES Lymphocytes constitute about 30% of the leukocytes at birth and increase to 60% at 4 to 6
months. They decrease to 50% by 4 years, to 40% by 6 years, and to 30% by 8 years
MONOCYTES The mean monocyte count of neonates is higher than adult values. At birth the average
proportion of monocytes is 6%.
EOSINOPHIL The percentages of eosinophils and basophils remain consistent throughout infancy and
childhood.
NEUTROPHIL Full-term and premature infants have a greater absolute neutrophil count than that found in
older children.
RMT2022-KLUBSYBEAR
Newborn girls have absolute neutrophil counts averaging 2000 cells/ml higher than those of
boys;
Neonates whose mothers have undergone labor have higher counts than neonates delivered by
cesarean section with no preceding maternal labor
BAND CELLS Band forms are also higher for the first 3 to 4 days after birth
Vitamin K At birth, the vitamin K-dependent coagulation factors (factors II, VII, IX, and X) are about
dependent 30% of adult values; they reach adult values after 2 to 6 months.
clotting factors
Contact Levels of factor XI, factor XII, prekallikrein, and highmolecular- weight kininogen are between
Factors 35% and 55% of adult values at birth, reaching adult values after 4 to 6 months
Fibrinogen, the levels of fibrinogen, factor VIII, and von Willebrand factor (VWF) are similar to adult
Factor VIII, values throughout childhood
and vwF
Physiologic The physiologic anticoagulants and inhibitors of coagulation (protein C, protein S, and
anticoagulants antithrombin) and a disintegrin and metalloprotease with a thrombospondin type 1
motif, member 13 (ADAMTS13) are reduced at about 30% to 40% at birth
Plasminogen Lower levels and decreased activity in neonates compared with adults
Plasminogen Tissue plasminogen activator (TPA) and plasminogen activator inhibitor-1 (PAI-1) levels are
activators increased
However, 5 times the amount of TPA is required to activate plasminogen compared with
activation of plasminogen in adults
RMT2022-KLUBSYBEAR
GERIATRIC/ELDERLY
AGE CATEGORIES Elderly adults can be roughly divided into three age categories:
CATEGORY AGE
Young-old 65 to 74
Old-old 74 to 84
Very old 85 and above
MARROW CELLULARITY Marrow cellularity begins at 80% to
100% in infancy and decreases to about 50% after 30 years, followed
by a decline to 30% after age 65.
RBC PARAMETERS Most RBC parameters (e.g., RBC count, indices, and RDW) for healthy elderly adults
do not show significant deviations from those for younger adults
HEMOGLOBIN There is a gradual decline in hemoglobin starting at middle age, with the mean level
decreasing by about 1 g/dL during the sixth through eighth decades
Men older than 60 years have average hemoglobin levels of 12.4 to 15.3 g/dL.
Elderly women have hemoglobin concentrations ranging from 11.7 to 13.8 g/dL.
Typically, the lowest hemoglobin levels are found in the oldest patients
WBC In the absence of any underlying pathologic condition, there are no statistically
significant differences between the total leukocyte count and WBC
differential for the young-old and old-old and those for middle-aged adults
LYMPHOCYTES Some investigators have reported a lower leukocyte count in elderly adults, owing
primarily to a decrease in the lymphocyte count
The number of naive T cells decreases in elderly adults
WBC FUNCTION Many neutrophil functions are decreased in elderly adults, including chemotaxis,
phagocytosis of microorganisms, and generation of superoxide
MONOCYTE The aging process does not significantly affect the number of monocytes
PLATELET COUNT The platelet count does not significantly change with age.
PLATELET ACTIVITY Platelets increase in activity with age
Decrease in bleeding time in elderly adults
Increase in markers of platelet activation such as b-thromboglobulin and
platelet factor 4 in the a-granules of platelets
Increased platelet phospholipid content
RMT2022-KLUBSYBEAR
HEMOSTASIS Age-related changes occur in the vascular and hemostatic systems, including
alterations in platelets, coagulation, and fibrinolytic factors. These changes contribute
to the increased incidence of thrombosis in elderly adults.
Overall, elderly adults demonstrate a shift of the hemostatic balance toward
increased coagulation and decreased fibrinolysis.
Elderly people are at risk to thrombosis
Clotting factors Fibrinogen, factors V, VII, VIII, IX, and XIII, VWF, highmolecular- weight kininogen,
and pre-kallikrein increase in healthy individuals as they age
Fibrinogen Fibrinogen, which has been implicated as a primary risk factor for thrombotic disorders,
including ischemic heart disease, increases approximately 10 mg/dL per decade
in elderly adults (65 to 79 years), from 280 mg/dL to more than 300 mg/dL
Fibrinolytic system Fibrinolysis is impaired in elderly adults, especially as a result of an increase in PAI-1
D-dimer D-dimer levels trend upward in adults 50 years and older.
Numerical Description
Scale
0 Normal appearance or slight variation in erythrocytes.
1+ Only a small population of erythrocytes displays a particular abnormality; the terms slightly
increased or few would be comparable.
2+ More than occasional numbers of abnormal erythrocytes can be seen in a microscopic field; an
equivalent descriptive term is moderately increased.
3+ Severe increase in abnormal erythrocytes in each microscopic field; an equivalent descriptive term
is many.
4+ The most severe state of erythrocytic abnormality, with the abnormality prevalent throughout each
microscopic field; comparable terms are marked or marked increase
HEMOGLOBINOPATHIES
HB S HB C Hb A1 Hb A2 Hb F
Sickle cell disease 80% - - variable 20%
Sickle cell trait 40% - 60% normal Normal
HB SC disease 50% 50% - - -
HB CC/disease - 90% 2% 7%
Hb C Trait - 40% 60% - -
RMT2022-KLUBSYBEAR
THOMAS PLOT INTERPRETATION
True IDA sTfR will rise and the ferritin will drop so that the sTfR/log
ferritin will be high and the hemoglobin content of
reticulocytes will be low
Plot: Lower right quadrant
Functional IDA Ferritin may be falsely elevated by inflammation, the
sTfR/log ferritin will be normal despite reduced availability
of iron for hemoglobin production resulting in a low
hemoglobin content in reticulocytes
Plot: Lower left quadrant
Latent IDA As iron deficiency develops, other cells are starved for iron
before erythrocytes; production of hemoglobin in
reticulocytes remains at a normal level for as long as
possible. However, the body’s other iron-starved cells will
increase sTfR production and systemic iron stores of ferritin
will be depleted, thus elevating the sTfR/log ferritin value.
Plot: Upper right quadrant
3+ Multiple petechiae over the whole arm and back of the hand 20-50
4+ Confluent petechiae on the arm and back of the hand 50 and above
RMT2022-KLUBSYBEAR
PLATELET ESTIMATION FACTOR
1 platelet per 10-40 RBCs
3-10 platelets per 100 RBCs (or in 1 OIF)
5-20 platelets per 200 RBCs
A normal blood smear should demonstrate approximately 8 to 20 platelets per field
MANUAL CELL COUNTS WITH MOST COMMON DILUTIONS, AND COUNTING AREA
Cells counted Diluting fluid Dilution Objective Area Counted
WBC 1% ammonium oxalate 1:20 (standard) 10x (LPO) 4mm2
3% acetic acid 1:100 10x (LPO) 9mm2
1%HCL
RBC Isotonic saline / NSS 1:100 40x(HPO) 0.2mm2
(5small squares of center square)
Platelets 1% ammonium oxalate 1:100 40x (HPO) 1mm2
BLEEDING TIME
Method Reference value
RMT2022-KLUBSYBEAR
PT INR VALUES
INR CONDITIONS
2.0-4.5 Recurrent DVT and pulmonary embolism, myocardial infarction, arterial disease
RMT2022-KLUBSYBEAR
FORMULA IN HEMATOLOGY
CELL COUNT
CORRECTED WBC
if nRBC is ≥5
ABSOLUTE COUNT
RULE OF THREE
%RETIC COUNT
(RELATIVE Retics (%) = __number of Retics x 100_
COUNT) 1000 RBCs observed
RETIC COUNT
USING MILLER
DISK
ABSOLUTE RETIC
COUNT
CORRECTED RETIC
COUNT
RPI
RMT2022-KLUBSYBEAR
HEMATOCRIT MATURATION OF RETICS IN BLOOD
40-45 % 1.0 Day
35-39 % 1.5 Days
25-34% 2.0 Days
15-24% 2.5 Days
<15% 3 Days
INR
Sodium Citrate
Blood Collection 100-Hct x ml of Whole blood
Anticoagulant 595-Hct
Adjustment for
Hematocrit >55%
RDW Computed by dividing the SD by the mean of the RBC size distribution
Color coded needle ♥ (18gauge: Pink), (21gauge: green), (22gauge: black), (23gauge: blue/torquise)
♥ The larger the gauge the smaller the internal bore diameter (vice versa)
RMT2022-KLUBSYBEAR
♥ Range =15 to 30-degree angle
Position of the patient ♥ Lying down – hemodilution: ↓ Packed cell Volume by 8 %, ↓ WBC
KLIEHAUER BETKE
TEST (ACID ELUTION Positive Fetal RBC (with Hb F)
Result =RBCs are deeply stained red and resist acid denaturation
TEST)
Negative Maternal RBC (Hb A)
result =RBC appear as pale pink ghost cells and susceptible to acid denaturation
RMT2022-KLUBSYBEAR
KAPLOW COUNT /LAP SCORE (TURGEON)
CELL RATING AMOUNT (%) SIZE OF GRANULES STAIN INTENSITY
0 none - None
1+ 50 small Faint to moderate
2+ 50 t0 80 small Moderate to strong
3+ 80 to 100 Medium to large Strong
4+ 100 Medium to large Brilliant
RMT2022-KLUBSYBEAR
RAI AND BINET STAGING FOR CLL
RAI BINET
Low Risk (formerly Stage 0) Stage A
Hemoglobin ≥ 10 g/dL
Lymphocytosis >5 x 109/L platelets ≥ 100 x 109/L
<3 enlarged nodal areas
Intermediate Risk Stage B
(Formerly Stages I and II) Hemoglobin ≥ 10 g/dL
platelets ≥ 100 x 109/L
Lymphocytosis >5 x 109/L ≥3 enlarged nodal areas
(lymphadenopathy + splenomegaly) or hepatomegaly, or both
High Risk (formerly Stages III and IV) Stage C
Hemoglobin <10 g/dL
Lymphocytosis >5 x 109/L Platelets <100 x 109/L
hemoglobin <11 g/dL Any number of enlarged nodal areas
Don’t worry about anything; instead, pray about everything. Tell God what you need, and thank him for all
he has done. Then you will experience God’s peace, which exceeds anything we can understand. –
PHILIPPIANS 4:6
RMT2022-KLUBSYBEAR