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CMWM633 WESTERN MEDICAL LABORATORY & IMAGING Credit hour: 3 Credits, 45 Hours Prerequisite: BS -525 Pathology PowerPoint Presentation
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CMWM633 WESTERN MEDICAL LABORATORY & IMAGING Credit hour: 3 Credits, 45 Hours Prerequisite: BS -525 Pathology Concurrent: BS-524 Microbiology Contents Composition of Blood Production of Blood cells Functions of Blood cells Hemostasis Hemogram(CBC) The lab test

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slide1

CMWM633

WESTERN MEDICAL

LABORATORY & IMAGING

Credit hour: 3 Credits, 45 Hours

Prerequisite: BS-525 Pathology

Concurrent: BS-524 Microbiology

contents
Contents
  • Composition of Blood
  • Production of Blood cells
  • Functions of Blood cells
  • Hemostasis
  • Hemogram(CBC)
composition of blood
Composition of Blood

Average person circulates about 5L of Blood , of which 3L is plasma and 2L is cells. Plasma Fluid derives from the intestines and lymphatic systems and provides a vehicle for cell movement.

slide7
Adult ♂ contains 5-6L
  • Adult ♀ contains 4-5L
  • T is about 100.4 F
    • Is this higher or lower than normal body T?
  • 5 times as viscous as water
    • Is it more or less resistant to flow than water?
    • What accounts for its viscosity?
  • pH ranges from 7.35 – 7.45 (slightly alkaline)
  • Color ranges from scarlet (oxygenated blood) to a deep red (deoxygenated blood).
slide8

BLOOD is composed of plasma (~55%), and the formed elements which are:

  • The erythrocytes (RBCs) (~45%)
    • Contain hemoglobin
    • Function in the transport of O2 and CO2
  • The Leukocytes (WBCs) and platlets (thrombocytes) (~1%)
    • Leukocytes are involved in the body’s defense against the invasion of foreign antigens.
    • Platlets are involved in hemostasis which forms a barrier to limit blood loss at an injured site.
components of blood
Components of Blood
  • 55% plasma
  • 45% cells
    • 99% RBCs
    • < 1% WBCs and platelets
plasma
Plasma
  • Liquid part of blood
    • Pale yellow made up of 91% water, 9% other
  • Colloid: Liquid containing suspended substances that don’t settle out
    • Albumin: Important in regulation of water movement between tissues and blood
    • Globulins: Immune system or transport molecules
    • Fibrinogen: Responsible for formation of blood clots
formed elements
Formed Elements
  • Red blood cells (erythrocytes)
  • White blood cells (leukocytes)
    • Granulocytes
      • Neutrophils
      • Eosinophils
      • Basophils
    • Agranulocytes
      • Lymphocytes
      • Monocytes
  • Platelets (thrombocytes)
formed elements of blood
Formed Elements of Blood
  • Red blood cells ( erythrocytes )
  • White blood cells ( leukocytes )
    • granular leukocytes
      • neutrophils
      • eosinophils
      • basophils
    • agranular leukocytes
      • lymphocytes = T cells, B cells, and natural killer cells
      • monocytes
  • Platelets (special cell fragments)
slide14

The cells are primarily produced by bone marrow and account for blood “solids”. Blood cells are classified as white cells (leukocytes),red cells(erythrocytes) and platelets(thrombocytes)

slide15

Hematopoiesis is a term describing the formation and development of blood cells.

    • Cells of the blood are constantly being lost or destroyed. Thus, to maintain homeostasis, the system must have the capacity for self renewal. This system involves:
      • Proliferation of progeny stem cells
      • Differentiation and maturation of the stem cells into the functional cellular elements.
      • In normal adults, the proliferation, differentiation, and maturation of the hematopoietic cells (RBCs, WBCs, and platlets) is limited to the bone marrow and the widespread lymphatic system and only mature cells are released into the peripheral blood.
slide17

Hematopoiesis begins as early as the 19th day after fertilization in the yolk sac of the embryo

    • Only erythrocytes are made
    • The RBCs contain unique fetal hemoglobins
  • At about 6 weeks of gestation, yolk sac production of erythrocytes decreases and production of RBCs in the human embryo itself begins.
slide18

The fetal liver becomes the chief site of blood cell production.

    • Erythrocytes are produced
    • The beginnings of leukocyte and thrombocyte production occurs
  • The spleen, kidney, thymus, and lymph nodes serve as minor sites of blood cell production.
  • The lymph nodes will continue as an important site of lymphopoiesis (production of lymphocytes) throughout life, but blood production in the other areas decreases and finally ceases as the bone marrow becomes the primary site of hematopoiesis at about 6 months of gestation and continues throughout life.
    • When the bone marrow becomes the chief site of hematopoiesis leukocyte and thrombocyte production become more prominent.
slide20

Hematopoiesis in the bone marrow is called medullary hematopoiesis

  • Hematopoiesis in areas other then the bone marrow is called extramedullary hematopoiesis
    • Extramedullary hematopoiesis may occur in fetal hematopoietic tissue (liver and spleen) of an adult when the bone marrow cannot meet the physiologic needs of the tissues. This can lead to hepatomegaly and/or splenomegaly (increase in size of the liver of spleen because of increased functions in the organs).

Hematopoietic tissue includes tissues involved in the proliferation, maturation, and destruction of blood cells

slide21

Bone marrow – is located inside spongy bone

  • In a normal adult, ½ of the bone marrow is hematopoietically active (red marrow) and ½ is inactive, fatty marrow (yellow marrow).
  • The marrow contains both Erythroid (RBC) and Myeloid (WBC) precursors as well as platlet precursors. The normal M:E ratio is 1.5:1 to 4:1.
  • Early in life most of the marrow is red marrow and it gradually decreases with age to the adult level of 50%.
slide22

Glassy hyaline cartilage

Compact+spongy

(remanent of plate-hyaline cartilage

Causes the lengthwise growth)

(red marrow)

(yellow marrow-fat)

Compact bone

Fibrous connective tissue

slide24

In certain pathologic states the bone marrow can increase its activity to 5-10X its normal rate.

    • When this happens, the bone marrow is said to be hyperplastic because it replaces the yellow marrow with red marrow.
    • This occurs in conditions where there is increased or ineffective hematopoiesis.
    • The degree to which the the bone marrow becomes hyperplastic is related to the severity and duration of the pathologic state.
    • Pathologic states that cause this include:
      • Acute blood loss in which there is a temporary replacement of the yellow marrow
      • Severe chronic anemia – erythropoiesis (RBC production) may increase to the extent that the marrow starts to erode the bone itself.
      • Malignant disease – both normal red marrow and fatty marrow may be replaced by proliferating abnormal cells.
slide25

The hematopoietic tissue may also become inactive or hypoplastic.

This may be due to:

  • Chemicals
  • Genetics
  • Myeloproliferative disease that replaces hematopoietic tissue with fiberous tissue
production of formed elements
Production of Formed Elements
  • Hematopoiesis or hemopoiesis: Process of blood cell production
  • Stem cells: All formed elements derived from single population
    • Proerythroblasts: Develop into red blood cells
    • Myeloblasts: Develop into basophils, neutrophils, eosinophils
    • Lymphoblasts: Develop into lymphocytes
    • Monoblasts: Develop into monocytes
    • Megakaryoblasts: Develop into platelets
blood cell differentiation28
Blood cell differentiation

Megakaryoblast

Magakaryocyte

Platelets

Lymphoblast

Bcells Tcells

plasma Active

cell Tcell

Myeloblast

Neutrophil Eosinophil Basophil

Promyelocyte

Myelocyte

Metamyelocyte

Stab Cell

Netrophil Eosinophil Basophil

Monoblasts

Monocyte

Proerytroblast

Reticulocyte

Erythrocyte

functions of blood
Functions of Blood
  • Transport of:
    • Gases, nutrients, waste products
    • Processed molecules
    • Regulatory molecules
  • Regulation of pH and osmosis
  • Maintenance of body temperature
  • Protection against foreign substances
  • Clot formation
red blood cells transport oxygen
Red blood cells transport oxygen
  • Red blood cells contain hemoglobin
    • Hemoglobin enables the transport of O2

Figure 23.14

white blood cells help defend the body
White blood cells help defend the body
  • White blood cells function both inside and outside the circulatory system
    • They fight infections and cancer

Basophil

Eosinophil

Monocyte

Neutrophil

Lymphocyte

thrombocytes
Thrombocytes
  • Cell fragments pinched off from megakaryocytes in red bone marrow
  • Important in preventing blood loss
    • Platelet plugs
    • Promoting formation and contraction of clots
hemostasis
Hemostasis
  • Arrest of bleeding
  • Events preventing excessive blood loss
    • Vascular spasm: Vasoconstriction of damaged blood vessels
    • Platelet plug formation
    • Coagulation or blood clotting
blood clots plug leaks when blood vessels are injured
Blood clots plug leaks when blood vessels are injured
  • When a blood vessel is damaged, platelets respond
    • They help trigger the formation of an insoluble fibrin clot that plugs the leak
slide39

1

Injury to lining of bloodvessel exposes connectivetissue; platelets adhere

2

Platelet plug forms

3

Fibrin clot trapsblood cells

Connectivetissue

Plateletplug

Platelet releases chemicalsthat make nearby platelets sticky

Clotting factors from:

Platelets

Calcium andother factorsin blood plasma

Damaged cells

Prothrombin

Thrombin

Fibrinogen

Fibrin

Figure 23.16A

platelet plug formation40
Platelet plug formation
  • Platelets store a lot of chemicals in granules needed for platelet plug formation
        • ADP, Ca+2, serotonin, fibrin-stabilizing factor, & enzymes that produce thromboxane A2
  • Steps in the process
    • (1) platelet adhesion (2) platelet release reaction (3) platelet aggregation
1 platelet adhesion
1. Platelet Adhesion
  • Platelets stick to exposed collagen underlying damaged endothelial cells in vessel wall
2 platelet release reaction
2. Platelet Release Reaction
  • Platelets activated by adhesion
  • Extend projections to make contact with each other
  • Release thromboxane A2, serotonin & ADP activating other platelets
  • Serotonin & thromboxane A2 are vasoconstrictors decreasing blood flow through the injured vessel. ADP causes stickiness
3 platelet aggregation
3. Platelet Aggregation
  • Activated platelets stick together and activate new platelets to form a mass called a platelet plug
  • Plug reinforced by fibrin threads formed during clotting process
coagulation
Coagulation
  • Stages
    • Activation of prothrombinase
    • Conversion of prothrombin to thrombin
    • Conversion of fibrinogen to fibrin
  • Pathways
    • Extrinsic
    • Intrinsic
blood clotting
Blood Clotting
  • Blood drawn from the body thickens into a gel
    • gel separates into liquid (serum) and a clot of insoluble fibers (fibrin) in which the cells are trapped
  • If clotting occurs in an unbroken vessel is called a thrombosis
  • Substances required for clotting are Ca+2, enzymes synthesized by liver cells(clotting factors) and substances released by platelets or damaged tissues
  • Clotting is a cascade of reactions in which each clotting factor activates the next in a fixed sequence resulting in the formation of fibrin threads
plasminogen plasmin
Plasminogen (plasmin)
  • Plasminogen is a glycoprotein, synthesized in the liver, present in plasma.Under normal conditions,plasminogen is part of any clot because of the tendency of fibrin to absorb plasminogen from plasma.When plasminogen activators perform their function plasmin is formed within the clot;this gradually dissolves the clot while leaving time for tissues repair,free plasmin is also released to the plasma;however,antiplasmins there immediately destroy any plasmin released from the clot.
slide49

FUNCTION:Determines plasminogen activity in persons with thrombosis or DIC, in these conditions excessive free plasmin is released to the plasma, In these situations antiplasmin is depleted and plasmin begins destroying components other than fibrin,including fibrinogen, factors V and VIII, and other factors

slide50

D-Dimer is an assay used to assess possible intravascular clotting. D-Dimer is a cleavage product of fibrin and is elevated in disseminated intravascular coagulation, in thromboembolic events and after surgery.

slide51
DIC
  • Activation of coagulation cascade leading to microthrombi and global consumption of platelets,fibrin,and coagulation factors.Causes: obstetric complications, gram-negative sepsis,transfusion,trauma,malignancy.Lab findings: ^PT^PTT, fibrin split products <platelet count.
bleeding time
Bleeding time
  • Measures the primary phase of hemostasis:
  • the interaction of platelets with the blood vessels wall and the formation of a hemostatic plug.
  • It is the best single screening test for platelets function disorders and is one of the primary screening tests for a coagulation disorder.
  • principal use of this test is in the diagnosis of Von Willebrands and inherited defective molecule of factor VIII
  • Normal 3-10minutes
hemogram
HEMOGRAM

Consists of a WBC count , RBC count,hemoglobin (Hb) ,Hemotocrit (Hct), red blood cells indices and a platelet count.

A complete blood cell count (CBC) consists of a hemogram plus a differential WBC.

diagnostic blood tests
Diagnostic Blood Tests
  • Type and crossmatch
  • Complete blood count
    • Red blood count
    • Hemoglobin measurement
    • Hematocrit measurement
  • White blood count
  • Differential white blood count
  • Clotting
slide55

Withdrawblood

Centrifuge

Place in tube

PLASMA 55%

CONSTITUENT

MAJOR FUNCTIONS

CELLULAR ELEMENTS 45%

Solvent forcarrying othersubstances

CELL TYPE

NUMBER(per mm3 of blood)

FUNCTIONS

Water

Erythrocytes(red blood cells)

Salts

5–6 million

Transport ofoxygen (and carbon dioxide)

Sodium

Potassium

Calcium

Magnesium

Chloride

Bicarbonate

Osmotic balance,pH buffering, andregulation ofmembranepermeability

Leukocytes(white blood cells)

Defense andimmunity

5,000–10,000

Plasma proteins

Albumin

Fibrinogen

Immunoglobins(antibodies)

Osmotic balance,pH buffering

Clotting

Immunity

Lymphocyte

Basophil

Eosinophil

Substances transported by blood

Monocyte

Nutrients (e.g., glucose, fatty acids, vitamins)

Waste products of metabolism

Respiratory gases (O2 and CO2)

Hormones

Neutrophil

Platelets

250,000–400,000

Blood clotting

Figure 23.13

slide56
CBC
  • CONSISTS OF A SERIES OF TESTS THAT DETERMINE NUMBER ,VARIETY, PERCENTAGE, CONCENTRATIONS,AND QUALITY OF BLOOD CELLS;WBC, RBC, Hct, Hb, MCV, MCH, MCHC, MPV
slide59

Tests of White Blood CellsWhite Blood Cell Count (CBC)LeukocytesAre divided into two main groups :Granulocytes ; neutrophils,basophils,eosinophils also called PMNsAgranulocytes; lymphocytes and monocytes also called mononuclears

  • Normal values:Adult 3.200 – 10,000 cells/mm3
leukocytes
Leukocytes
  • Protect body against microorganisms and remove dead cells and debris
  • Movements
    • Ameboid
    • Diapedesis
    • Chemotaxis
    • Passive Immunity
    • Active Immunity
    • Antigen – Antibody
  • Types
    • Neutrophils: Most common; phagocytic cells destroy bacteria (60%)
    • Eosinophils: Detoxify chemicals; reduce inflammation (4%)
    • Basophils: Alergic reactions; Release histamine, heparin increase inflam. response (1%)
    • Lymphocytes: Immunity 2 types; b & t Cell types. IgG-infection, IgM-microbes, IgA-Resp & GI, IgE- Alergy, IgD-immune response
    • Monocytes: Become macrophages
slide63

diagrams the entire process of extravasation from leukocyte rolling to migration into the tissues.

slide64

Neutrophils extravasate from blood vessels to the site of tissue injury or infection during the innate immune response

slide66

fight infections and defend the body by a process called phagocytosis, also produce, transport and distribute antibodies as part of the immune response to a foreign susbstance (antibody)

slide67

Leukocytosisoccurs in acute infections, in which the degree of increase of leukocytes depends on the severity of the infection. In certain disease (measles,pertussis,sepsis) the increase of leukocytes is so great that the blood pictures suggests leukemia ( in leukemia the leukocytosis is permanent and progressive)Other causes:Trauma or tissue injuryMalignant neoplasm's (bronchogenic carcinoma)Drugs (ether,epinephrine)Acute hemolysis

slide68

Leukopenia: WBC < 4000 mm3CAUSESViral infections, some bacterial infections, overwhelming bacterial infectionsHypersplenismBone Marrow depression caused by intoxication'sPrimary bone disorders: leukemia, pernicious anemia

slide69

Clinical ImplicationsLeukocytosis: WBC > 11,000mm3 It is usually caused by the increase of only one type of leukocyte, and it is given the name of the type of cell that shows the main increase.Neutrophilic leukocytosisLymphocytic leukocytosisMonocytic leukocytosisBasophilic leukocytosisEosinophilic leukocytosis

slide72

NEUTROPHILSNeutrophils, or neutrophil polymorphonuclear leucocytes, Acute Inflamatory response cell .40-70% WBC’c Phagocyitic . Multilobed.Large,sperical, azurophilic 1 granules(called lysosomes) contain hydrolytic enzymes,lysozyme,meyloperoxidase)

slide74

LYMPHOCYTESLymphocytes are produced within bone marrow (a primary lymphoid organ). If they achieve immune-competence within the bone marrow, they are known as B cells, or if in the thymus (also a primary lymphoid organ), they are known as T cells. Organized lymphoid tissue elsewhere is known as secondary lymphoid tissue, and includes lymph nodes, adenoids, tonsils and mucosa associated tissue (MALT). Small amount of pale cytoplasm,small ,round , densely staining nucleus. B lymphocytes produce antibodies. T lymphocytes manifest in the cellular immune response as well as regulate B lymphocytes and macrophages.

Lymphocytes are only slightly larger than red blood cells (small lymphocytes) and they have a relatively large nucleus:cytoplasm ratio. 

slide76

B Lymphocyte: Part of the humoral immune response.Arises from stem cells in bone marrow.Matures in marrow.Migrates to the peripheral tissue (follicles of lymph nodes,white pulp of spleen,unencapsulated lymphoid tissue.When an Antigen is encountered, B cells differentiate into plasma cells and produce antibodies.Has a memory, Functions as antigen presenting cell via MHCmajor histocompatibility complex

slide77

Plasma cells (fully differentiated B cells) are similar in appearance to lymphocytes, even though they are not normally present in this blood test measures the number of lymphocytes in the peripheral blood.Off-center nucleus, clock face chromatin distribution, abundant RER and well developed Golgi apparatus.Multiple Myeloma is a plasma cell neoplasm

slide78

The T cells the master immune cells include CD4+ helpers T cells CD8+ suppressor T cellsMediates cellular immune response,Originates from stem cells in the bone marrow but matures in the thymus.T cells differentiate in:1- cytotoxic T cells (MHC I,CD8) 2-helper T cells,delayed hypersensitivity Tcell.MHC=Mayor histocompability complex

slide79

Clinical Implications:1-Inmmunosuppressive drugs therapy usually decreases lymphocyte total2-Patients with an absolute helper T lymphocyte count <200mm3 are at greatest risk for developing clinical AIDS3-Decrease T cells occur in congenital immunodeficincy(DiGeorge syndrome,thymic hypoplasia)4-A marked increase in B cells occurs in lymphoproliferative disorders (chronic lymphocyitc leukemia)

slide80
Lymphocytosis > 4000/mm3 in adultsLymphatic leukemiaInfectious mononucleosisCytomegalovirusMeasles,mumps,chickenpoxHepatitis
slide81

Lymphopenia < 1000cells/mm3ChemotherapyAfter administration of ATCHIncrease loss of G-I tract owing to obstruction of lymphatic drainageAplastic anemia

slide82

BASOPHILSBasophils are non-phagocytic cells which, when activated, release numerous compounds from the basophilic granules within their cytoplasm. They play a major role in allergic responses, particularly type I hypersensitive reactions.

slide84

MONOCYTESMonocytes circulate in the peripheral blood prior to emigration into the tissues. Within certain organs they have special names, e.g. in liver they are known as Kupfer cells, in brain as microglia, in kidney as mesangial cells, and in bone as osteoclasts. Elsewhere they are referred to as tissue macrophages. Phagocytosis is mediated by macrophages and polymorphonuclear leucocytes

slide86

EOSINOPHILSThese cells have the purpose of giving large parasites such as helminths, a hard time. The eosinophils release various substances from their eosinophilic granules. The granule contents are capable of damaging the parasite membrane.

allergic processes asthma

EOSINOPHIL

Allergic Processes, asthma

Parasites

Tumors, Collagen vascular disease

lymphocyte neutrophils
Lymphocyte Neutrophils

70%

30%

Bacterial disorders

Viral disorders

slide90
WBCs in order of abundance:

Never(neutrophils

Let(lymphocytes)

Monkeys(monocytes)

Eat(eosinophils)

Bananas(basophils)

How do I remember the

relative percentages?

60 + 30 + 6 + 3 +1

(i.e., 60% neutrophils, 30% lymphocytes, 6% monocytes, 3% eosinophils & 1% basophils)

leukemias leukocytes bone marrow
Leukemias^leukocytesbone marrow

Acute Leukemias Chronic Leukemias

Blast predominante

children-elderly

short and drastic courses

More mature cells

midlife age range

longer,less devastating course

CLL CML

ALL AML

Children more

responsive to therapy

Auer rods

adults

Older adults

PAS

SBB

TDT

slide93

SBB STAINS (Sudan Black B)The SBB stain aids in differentiation of the immature cells of acute leukemias, specially acute myeloblastic leukemias (AML). The SBB stains a variety of fats and lipids that are present in myeloid leukemias but not present in the lymphoid leukemias.

slide94

Periodic Acid-Schiff (PAS) Stain.The PASS stian aid in the diagnosis of acute lymphoblastic leukemias (ALL) Early myeloid precursors and erythrocyte precursors are negative. As granulocytes mature,they increase in PAS positivity, whereas mature RBC’s stay negative. The PAS stain cannot be used to distinguish between ALL and AML or between benign and malignant lymphocytic disorders.

slide95

Terminal Deoxynucleotidyl Transferase (TDT)The thyme is the primary site of TDT-positive cells, and TDT is found in the nucleus of the more primitive T cells. TDT is increase in >90% of cases of ALL of childhoodTDT positive blasts are predominant in some cases of chronic myelogenous leukemia (CML) , relating to the development of an acute blast phase.

erythrocytes
Erythrocytes
  • Structure
    • Biconcave, anucleate
  • Components
    • Hemoglobin
    • Lipids, ATP, carbonic anhydrase
  • Function
    • Transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs
red blood cells or erythrocytes
Red Blood Cells or Erythrocytes
  • Contain oxygen-carrying protein hemoglobin that gives blood its red color
    • 1/3 of cell’s weight is hemoglobin
  • Biconcave disk
    • increased surface area/volume ratio
    • flexible shape for narrow passages
    • no nucleus or other organelles
    • no mitochondrial ATP formation
  • Normal RBC count
    • male 5.4 million/drop ---- female 4.8 million/drop
    • new RBCs enter circulation at 2-3 million/second
rbc life cycle
RBC Life Cycle
  • RBCs live only 120 days
    • wear out from bending to fit through capillaries
    • no repair possible due to lack of organelles
  • Worn out cells removed by fixed macrophages in spleen & liver
  • Breakdown products are recycled
slide101

RED BLOOD CELL COUNT(RBC,Erythrocyte count)Many test look at the red blood cells:their number and size,amount of Hb , rate of production and percent composition of the blood.The red blood cell count(RBC), hemotocrit(Hct) and hemoglobin(Hb) are closely related ,the same conditions cause an increase (or decrease) in each of these indicators

slide102

The main function of the RBC is to carry oxygen from the lungs to the body tissues and to transfer dioxide from the tissues to the lungs , by the Hb in the RBC which combines easily with oxygen and carbon dioxide. This test is an important measurement in the evaluation of anemia or polycytemia,determines the total number of erythrocytes in a microliter of blood.

O2

CO2

erythropoiesis
Erythropoiesis
  • Production of red blood cells
    • Stem cells proerythroblasts early erythroblasts intermediate late reticulocytes
  • Erythropoietin: Hormone to stimulate RBC production
slide105
Erythrocytosisa-primary (polycythemia vera, Erythemic Erythrocytosis)b-secundary(renal disease, high altitud etc..)
slide106

Hematocrit (Hct)The word means separate blood , the mechanism of the test separates by centrifugation the plasma and the blood cells.Indirectly measures the RBC mass, important for determination of anemia or polycythemia.NormalWomen; 36%-48%Men 42%-52%

hematocrit hct
Hematocrit (Hct)
  • Packed cell volume diagram
hemoglobin
Hemoglobin
  • Consists of:
    • 4 globin molecules: Transport carbon dioxide (carbonic anhydrase involved), nitric oxide
    • 4 heme molecules: Transport oxygen
      • Iron is required for oxygen transport
slide110

Hemoglobin (Hb)Hb the main component of erythrocytes , serves as the vehicle for the transportation of O2 and C02. It is composed of amino acids that form a single protein called globulin and a compound called heme, which contains iron atoms and the red pigment porphyrin. It is the Iron pigment that combines with oxygen and gives blood its characteristic red color

slide111

The Hb determination is part of the CBC. It is used to screen for disease associated with anemia, to determine the severity of anemia, to monitor the response to treatment for anemia and to evaluate polycytemia.

normal women 12 0 16 0g dl
NormalWomen:12.0-16.0g/dl

Men:14.0-17.4g/dl

slide113

Decreased Hb levels are found in anemic states, the Hb must be evaluated with the Htc and the RBCIron deficiencyliver diseasehemorrhagehemolytic anemias

slide114
Increased Hb levelsPolycitemia veraCongestive heart failureCOPDVariations in Hb occurs after transfusions….
red blood cells indices
RED BLOOD CELLS INDICES
  • The red blood cell indices define the size and Hb content of the RBC and consist of:

MCV : the mean corpuscular volume

MCHC: the mean corpuscular concentration

MCH: the mean corpuscular hemoglobin

slide116

The RBC indices are used in differentiating anemias. When they are used together with an examination of the erythrocytes on the stained smear, a clear picture of the RBC morphology may be ascertained.In deficient states anemias can be classified by cell size as macrocytic,normocytic,microcytic, or by cells size and color , as microcytic hypochromic.

slide117

MCVIndicates the red blood cell sizenormal: small<82um3 or larger >100um3MCV= Hct% x 10 / RBCMacrocytic: (MCV>100) Megaloblastic (B12-Folic acid) Microcytic: (MCV<80) Iron Deficiency Thalasemias, lead poisoningNormocytic,normochromic: enzyme defects(G6PD def-) , RBC membrane defects, bone marrow disorders, Autoinmmune hemolytic anemias, anemias of chronic disease.

slide118

MCHC (Mean Corpuscular Hemoglobin Concentration)Measures the average concentration of Hb in RBC’s , used for monitoring therapy for anemias.Normal: 32-36g/dLMCHC=Hb x 100/Hct%

slide119

MCH (Mean Corpuscular Hemoglobin)Is a measure of the average weight of Hb per RBC , this index is of value in Dx severly anemic patients.Normal:26-34pg/cell

rbc disorders anemias
RBC disorders (Anemias) :

“Anemia is decreased red cell mass affecting tissue oxygenation”

* Low Hb <13.5 (males), <11.5 (females)

  • Onset, chronicity, presentation & pattern.
  • Congenital disorders:
    • Membrane, Hb & enzyme disorders.
  • Acquired disorders:
    • Decreased production
    • Increased loss
congenital rbc disorders
Congenital RBC Disorders:

1

2

3

(Hemolysis)

  • Membrane Disorders:
    • Spherocytosis, Elliptocytosis
  • Hemoglobin Disorders:
    • Hemoglobinopathies - Sickle cell, HbC etc.
    • Thalassemia Syndromes - , , 
  • Enzyme disorders:
    • G6PD, PK deficiency
acquired rbc disorders
Acquired RBC disorders :

(Deficiency, Marrow disorder, Blood loss & Hemolytic)

  • Decreased Production:
    • Deficiency anemias Iron, B12, Folate etc.
    • Aplastic, Hypoplastic anemias
    • Marrow disease, malignancy, radiation
  • Increased loss/destruction:
    • Blood loss anemias - parasites, bleeding
    • Hemolytic anemias - Autoimmune (cold & warm antibody) mechanical, drugs & toxins.
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AnemiasMicrocytic MCV<80Iron deficiencyThalassemiasLead poisoningMacrocytic MCV>100Megaloblastic:B12/folate def.Drugs that block DNA: Methotrexate-MTXNormocytic-normochromic:Enzyme defects,RBC membrane defects,bone marrow disorders, hemolytic,chronic disease.

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= B12

MEGALO B LASTIC

= IRON

M I CROCYTIC

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Reticulocyte Count.Young immature nonnucleated RBC , normally a small number of these cells are found in the circulating blood , it is used to differentiate anemias caused by bone marrow failure from those caused by hemorrhage or hemolysis , to check the effectiveness of treatment in pernicious anemia and folate and iron deficiency, to asses the recovery of bone marrow function in aplastic anemia, and to determine the effects of radioactive substances on exposed workers.

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Normal: 0.5%-1.5% of total erythrocytes.Increased : means that increase production RBC is occurring as the bone marrow replaces cells lost or prematurely destroyed. Identification of reticulocytosis may lead to the recognition of an otherwise occult disease , such as hidden chronic hemorrhage or unrecognized hemolysis(eg sickle cell anemia, thalassemia).

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Fetal Hemoglobin (hbF)Is a normal Hb manufactured in the RBCs of the fetus and infant; it makes up to 50% to 90% of the Hb in newborn.The portion of the Hb in the newborn is made up to of HbA1 and HbA2. In adult types under normal conditions the manufacture of fetal Hb is replaced by the adults types during the first year of life, but if the FHb persists and constitutes more than 5% of the Hb after 6 moths an abnormality should be expected.

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Hemoglobin A2HbA2 levels have special application in the diagnosis of beta thalassemias trait,which may be present even though the peripheral blood smear is normal. This measurements is used in the investigation of hemolytic anemias for hemoglobinopathies especially thalassemia (beta thalassemia)

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Hemoglobin S (sickle cell test)Sickle cell disease is a term for a group of hereditary blood disorders,caused by an abnormality of the Hb,the red protein in the red blood cell that carries oxygen from the lungs to the tissues. People with sickle cell disease make abnormal Hb, hemoglobin S , this cells do not last as long as normal red blood cells, they become rigid and take a sickle or crescent shape, they are not flexible enough to squeeze through the vessels, resulting in blood vessels being blocked damaging tissues and organs.Normal:not present.

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MyoglobinIs the oxygen binding protein of striated muscles.It resembles Hb but is unable to release oxygen except in extremely low tension, injury of the muscle results in the release of the oxygen, Myoglobin is not tightly bound to protein and is rapidly excreted in urine, It is used as an early marker of muscle damage in myocardial infarction and to detect injury of the skeletal muscle

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Platelet CountMean Platelet Volume(MPV)Platelets are the smallest of the formed elements in the blood ,they are nonnucleated round or oval ,dish-shaped structures, Platelet activity is necessary for the blood clotting,vascular integrity and vasoconstriction,and the adhesion and aggregation activity .Thorombocyte development takes place in the bone marrow life is about 7.5 days

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PANIC VALUES , a decrease in platelets to <20X10 3/mm3/L is associated with a tendency for spontaneous bleeding prolonged bleeding time, pethechie and ecchymosis.Platelets count >50x10 3/mm3 are not generally associated with spontaneous bleeding.

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MPVIs valuable in assessing bleeding disorders that occur in thrombocytopenia,uremia,liver disease or malignancies and for monitoring the course of disease associated by the bone marrow failure.The mean platelet volume is sometimes ordered in conjunction with a platelet count it indicates the uniformity of size of platelets population.It is used for differential diagnosis of thrombocytopenia.ValuesNormal: adults:140-400x 10 3/mm3

coagulation cascade
Coagulation Cascade

Intrinsic pathway Extrinsic Pathway

endothelial disruption

XI XI a tissue factor

IX IX a VII VII a

VIII(pro-ag)

X X a

II II a

FIBRINOGEN FIBRIN fibrin products

V

Procoagulant-antigenic portions VIII

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Platelet AggregationIt is used to evaluate congenital qualitative functional disorders of adhesion,release ,or aggregation. It is rarely used to evaluate acquired bleeding disorders.

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Prothrombin time(PT) is used to assess the extrinsic pathway Prolongation the PT is seen with warfarin use,vitamin K deficiency and liver disease.Monitors Warfarin Tx

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Partial Thromboplastin time (PTT) is used to assess the intrinsic system.It is prolonged during heparin use, in hemophilia A,B and von Willebrand’s disease.Monitors Heparin Tx

hemorragic disorders
Hemorragic Disorders

Platelet count bleeding time PT PTT

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Thrombocytopenia

hemophilia A (factor VIII)

hemophilia B (factor IX)

Von Willebrands (VIII)

DIC,vitamin

Vitamin K def(1972)

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blood grouping
Blood Grouping
  • Determined by antigens (agglutinogens) on surface of RBCs
  • Antibodies (agglutinins) can bind to RBC antigens, resulting in agglutination (clumping) or hemolysis (rupture) of RBCs
  • Groups
    • ABO and Rh