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 aspiration 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 differentiate 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 40-45% 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 infections with
bacteria. Immature form is called a “band”
– Lymphocytes – involved in many types of infection, especially
viruses -Produce antibodies and “memory cells” - Are further
divided into T-cells and B-cells
– Eosinophils – involved in parasitic infections and allergies
– Basophils – involved in parasitic infections and allergies
– Monocytes – involved in bacterial and parasitic infections
 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 function is to aid in
blood clotting
– Lifetime in the blood is 7-10
days after which they are
destroyed in the spleen
– Their clotting function 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 - 46%
– Normal range for men: 41 - 53%

• Hemoglobin (HGB) measures the concentration of hemoglobin

expressed as grams of hemoglobin per deciliter (100 ml) of whole
blood.
– Normal range for women: 12 - 16 g/dL
– Normal range for men: 13.5 - 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 - 5.2 x106/mm3
– Normal range for men: 4.5 - 5.9 x106/mm3
 Red Blood Cell Indices
• Mean Corpuscular Volume (MCV) is the average size of red blood cells.
– Normal range: 80-100 fL
– Low = “microcytic” (“too small”) High = “macrocytic” (“too big”)
Normal = “normocytic” (“just right”)
• Red Cell Distribution Width (RDW) measures the variability in the size of red blood
cells.
– Normal range: 11.5-14.5%
– 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: 26-34 pg/cell
• Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration
of hemoglobin in an average RBC.
– Normal range: 31-37 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 testing
– If anemia is not present, MCV is of little value:
• Low MCV without anemia suggests thalassemia minor (trait)
• High MCV without anemia can be caused by certain medications
(Dilantin, oral contraceptives, methotrexate) and is a “soft” marker of
possible alcohol overuse

• Red Cell Distribution Width (RDW) measures the variability in

the size of red blood cells.
– Not useful in the absence of anemia
Classification of Anemias Using MCV
and RDW
 Descriptive Terms Used on Peripheral Smears

• Anisocytosis: marked variation 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 variation in the shape of
RBCs
 Reticulocyte Count
• Reticulocytes are “young” red blood cells that
were recently released from the bone marrow.
• Normally, reticulocytes comprise 0.5 - 2.5% of
all red blood cells.
• Increased reticulocytes (reticulocytosis) is a
normal response to blood loss or anemia. Since
reticulocytes are larger, the MCV (and RDW)
may be elevated.
• The combination of anemia with a low or
normal reticulocyte count indicates that the
bone marrow is unable to respond normally,
either due to lack of essential ingredients (iron
deficiency, vitamin B12 or folate deficiency),
bone marrow disease, or chronic disease.
 Types of White Blood Cells - 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
infection)
• 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
infections, inflammatory disorders, and
medications
• Cancer and myeloproliferative disorders can also
cause high, sometimes extremely high, WBC
counts
• Treatment is aimed at the underlying cause
• Death may result from the underlying cause such
as severe infection or cancer (leukemia)
 Neutropenia
• The relative 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 conditions
• Treatment is usually aimed at the underlying cause
• Some may require antibiotics to prevent infection or medications to
stimulate production of neutrophils
• Death may occur due to overwhelming infection

Chronic Benign Neutropenia:

• Overall risk of infection is low, usually asymptomatic
• Two forms – familial and non-familial
• Key features from underwriting perspective are the absence of significant
infections and stability over time
WBC Differential: Lymphocytes
WBC Differential: Monocytes
WBC Differential: Eosinophils
WBC Differential: 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 differential white blood count, especially if
the absolute counts are normal.
• The percentage of neutrophils, lymphocytes, etc.
often fluctuate in response to an infection; this is
not a big underwriting concern.
 Mean Platelet Volume (MPV)
• “Young” platelets, recently released from the
bone marrow, are typically slightly larger
• Often 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