Introduction to Hematology PPT Notes April 28, 2009 Clinical problems in Hematology Anemia (cytopenia), Leukocytosis (Cytosis) and Bleeding
Hematology Lab Tests The most important lab test used in the diagnoses and working-up a clinical problem o CBC and differential leukocyte count o Bone marrow biopsy and aspiration o Reticulocyte count o Serum iron, vit B12, folate levels o Hemoglobin electrophoresis o Prothrombin time (PT) and activated partial thromboplastin time (aPTT) o Clotting factor assays Blood cells – terminology o Erythroctyes (RBCs) o Leukocytes (WBCs) Granulocytes (recognizable granules) • Neutrophils, eosinophils, basophils Monocytes (a type of mononuclear cell) Lymphocutes (a type of mononuclear cell) o Platelets Clinical evaluation – Blood tests quantitative and qualitative o CBC count provides information about the absolute and relative numbers of blood cells in a specimen of blood (quantitative d/o) CBC Sample report
Component WBC Count Red Blood Cell Count Hemoglobin Hematocrit Mean Cell Volume (MCV) (rbc size) Platelet Count WBC Differential Count Patient Values 6500 /mm3 4.5 x 10 6/mm3 16 g/dL 48% 85 fL 225,000/mm3 Reference Range 4000 -10000/mm3 3.9 – 5.20 x 10 6/mm3 14 – 17 g/dL 41 – 51 % 81-89 fL
150,000 350,000/mm3 60% Neutrophils, 5 % Bands, 50 - 70% Neutrophils 2% Eosinophils, 1% Basophils, 2 - 6% Bands 25 % Lymphocytes, 7% 20 - 40% Lymphs Monocytes 2 - 8% Monocytes 0 - 1% Basophils 1 - 3% Eosinophils Patient Values 6500 /mm3 4.5 x 10 6/mm3 225,000/mm3 60% Neutrophils, 5 % Bands, 2% Eosinophils, 1% Basophils, 25 % Lymphocytes, 7% Monocytes Reference Range 4000 -10000/mm3 3.9 – 5.20 x 10 6/mm3 150,000 350,000/mm3 50 - 70% Neutrophils 2 - 6% Bands 20 - 40% Lymphs 2 - 8% Monocytes 0 - 1% Basophils 1 - 3% Eosinophils Reference Range 3.9 – 5.20 x 10 6/mm3 14 – 17 g/dL
Cells and Counts Sample report
Component WBC Count Red Blood Cell Count Platelet Count WBC Differential Count
All about the RBC
Component Red Blood Cell Count Hemoglobin Patient Values 4.5 x 10 6/mm3 16 g/dL
erythrocytosis o Cytopenia – a deficiency or lack of celluar elements in the circulating blood Anemia – low RBC Leucopenia – low WBC count Neutropenia – low neutrophil count Lymphocytopenia – low lymphocyte count Pancytopenia – all low Leukocytes – Granulocytes Estimated Values o Granulocytes Neutrophils 40-75% Bands 0-8% Eosinophils 0-4% Basophils 0-2% o Monocytes 0-12% o Lymphocytes 15-45% Granulopoiesis Terminology – Leukocyte Maturation o Myeloblast o Promyelocyte (azurophilic. nonspecific granules) o Myelocyte (specific for type of granulocyte) o Metamyelocyte o Band cell o Mature granulocyte (neutrophil. neutrophilia. and Red Cell Distribution Width (RDW)
.o Blood smear gives information about the various structural and functional
characteristics of cells (qualitative d/o) Morphology and relative concentrations of erythrocytes. eosinophil or basophil) o Granulopoeisis stages – know these stages and note the primary and secondary granules o
Hematocrit 48% 41 – 51 % Mean Cell Volume (MCV) 85 fL 81-89 fL (rbc size) Others: Mean Cell Hemoglobin (MCH). lymphocytosis. monocytes and abnormal cells o Platelet count Cell count Terminology (CBC count) o Cytosis – a condition in which there is grater than normal number of cells in a tissue or organ Leukocytosis. leukocytes and platelets (ran with CBC) Recognize peripheral blood cells based on the description of the peripheral blood smear Use knowledge of histology to make a mental visualization based on the description of the peripheral blood smear o Red blood cell indices – give red cell count. Mean Cell Hemoglobin Concentration (MCHC). and hemoglobin content o White blood cell count and differential (“diff”) – divides WBCs into granulocytic cells. lymphocytes. size.
cytoplasm (relative amount of RNA and hemoglobin content) and nucleus
Hematocrit: the %age of whole blood made up of erythrocytes Red cell size/indices Mean corpuscular volume (MCV).WBC Count and Diff o Total WBC count is measured. mean corpuscular hemoglobin (MCH) define the size Mean corpuscular hemoglobin concentration (MCHC) and hemoglobin content (MCH) or RBCs define hemoglobin content These values are useful in elucidating the etiology of anemias Red cell shape and cytoplasmic inclusions
Anemia Work-up CBC count and peripheral blood smear o Hematocrit and RBC count o
. reference range varies: 5000-10.000 cells/mm3 o Diff count is the relative concentration of the various leukocytes 60% Seg neutrophils 30% lymphocytes 7% monocytes o Think about this: what is the absolute count multiply the number of cells x the % Erythropoiesis and Anemia o Red cell maturation – learn and recognize the changes in size.
Since different etiologic factors result in characteristically different red cell morphology. as being Normocytic (normal MCV) Macroctic (increased MCV) Microcytic (decreased MCV) Leukocytosis Increased WBC count above reference range (TOO many WBCs) Specific types o Neutrophilia – pt with severe bacterial infection o Eosinophilia – prominent at sites of allergic rxns with parasitic larvae infections (helminthes) The eosinophil specific granules contain rhomboid crystals by EM. various with age and activity (yellow marrow) o Marrow sinuses and capillary network o Hemosiderin: iron stores o Simple Diagram of Hematopoiesis:
. Malignant: Leukemia and Lymphoma Hematology Bone marrow o Hematopoietic active marrow with stem cells.Physiology – Classifications of Anemia o Classify anemia (a cytopenia) based on underlying physiology . This core contains major basic protein (MBP). can migrate into tissue: macrophages o Basophilia – contain heparin and large amounts of histamine. mature nucleus is segmented into 2-3 lobes. and developing erythroblasts. necrosis. microfilariae. the management of a pt with an anemia depends upon the interpretation fo the blood counts and peripheral blood smear well. Few d/o have basophilia Types: Reactive: Infections. schistomiasis) o Lymphocytosis – first consideration is a viral infection or any chronic infection o Monocytosis – phagocyte and frequently contain vacuoles. either Increased urilization Increased premature destruction (hemolysis) Impaired production o Red cell indices are valuable in the morphologic classification of anemias. myeloblasts and megakaryoblasts (red marrow) o Adipose cells. known to be toxic to several parasites (helminthes. inflammation. o Classified according to the size of the red cell. progenitor cells. these are active participants in hypersentivity reactions.
clot free in normal vessels and inducing rapid and localized hemostatic plug at sites of vascular injury. Hemostasis o Physiologic blood clotting to maintain the blood in an appropriate fluid state. has boney trabeculae and marrow space o Marrow is taken from the posterior iliac crest. platelet d/o or coagulation d/o Platelets Small fragments of megakaryocytes (MK) released into the blood. which are derived from fragmentation of precursor MK. 2-4 micrometers in diameter. irregularly shaped anuclear cells. Aka Thrombocytes – are small. Number o Thrombocytopenia – increased destruction and utilization with impaired production Will see skin changes due to this: pupura (large purple bruises that are sometimes raised) or petechiae (small red or purple dots that look like a rash)
. o Stages Vasoconstriction (neurogenic) Hemostatic plug formation (primary hemostasis) Fibrin clot formation (secondary hemostasis) Thrombolysis (limits the clotting) o Hemostasis and thrombosis have three components Vascular (endothelium) Platelets (peripheral blood) Clotting factors (coagulation cascade) Bleeding d/o – causes o Bleeding d/o cab be divided into vascular abnormalities. Closer inspection of MKs show a network of platelet forming zones forming fissures throughout the MK cytoplasm. average life span of a platelet is 8-12 days.o
Clinical evaluation – tests of bone marrow function o Small amounts of tissue are removed from bone cavity and examined under the microscope Bone marrow aspiration Bone marrow biopsy – a core of bone is taken out. The membranes of this demarcation system eventually form cytoplasmic platelet membranes.
Cytoplasmic components o Granules o Tubular system Function: hemostasis