Hematologic System Reviewer PDF

PLASMA - the fluid portion of circulating blood. Plasma is 91% Water, 7% Plasma proteins, 2%Ions. - Plasma proteins (manufac...

PLASMA - the fluid portion of circulating blood. Plasma is 91% Water, 7% Plasma proteins, 2%Ions. - Plasma proteins (manufactured in the liver) 1. Albumin- the largest group; helps maintain blood pressure and circulating fluid volume. 2. Fibrinogen 3. Prothrombin Functions of the Hematologic System 4. Globulin 1. Transportation Serum 2. Regulation - plasma that has been allowed to clot in the 3. Protection laboratory in order to remove fibrinogen and other Transportation clotting factors that may interfere with some diagnostic tests. ✓ oxygen to body cells and carbon dioxide away Cellular components (Formed Elements)- from body cells RBC, WBC, Platelets ✓ water, nutrients, and other needed substances: 1. 2. RBC or erythrocytes- contains HEMOGLOBIN. salts (electrolytes) and vitamins, to body cell WBC or leukocytes- for defense ✓ hormones from sites of origin to organs they affect Granular leukocytes: (BEN) ✓ enzymes Basophils Regulation Eosinophils maintenance of acid–base balance Neutrophils maintenance of fluid–electrolyte balance Agranular leukocytes: Protection Monocytes Fights disease and infection (leukocytes) Lymphocytes Promotes clotting of blood (platelets and specialized factors) 3. Platelets or thrombocytes for blood clotting Provides immunity due to antibodies and antitoxins BLOOD TESTS (specialized cells) 1. ABO Blood Typing 2. CBC 3. Blood smear 4. Coagulation test 5. Crossmtaching 6. HgB Elecrtophoresis Mean cell volume (MCV)- average of hematocrit and RBC. I. ABO BLOOD TYPING Mean corpuscular hemoglobin (MCH)- average the classification of human blood based on the amount of hemoglobin in the average red cell. Average inherited properties of red blood cells as determined of hemoglobin and the red cell count. by the presence or absence of the antigens A and B Mean corpuscular hemoglobin concentration- is Antigenic properties of blood are analyzed to avoid the average concentration of hemoglobin in a given potentially lethal transfusion reaction. volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. III. BLOOD SMEAR Produced by spreading a drop of blood at peripheral blood on a slide and examining the slide microscopically Used to obtain a WBC count, differential count, estimate platelet count, and evaluate RBC morphology. II. COMPLETE BLOOD COUNT Consist of the ff: Hemoglobin Hematocrit RBC count WBC count The blood smear test is often done to diagnose conditions that are causing: mean cell volume (MCV) unexplained jaundice mean corpuscular hemoglobin (MCH) unexplained anemia (low levels of normal RBC) Mean corpuscular hemoglobin concentration (MCHC) abnormal bruising persistent flu-like symptoms sudden weight loss unexpected or severe infection skin rashes or cuts bone pain RBC disorders include: Hematocrit- ratio of the volume of RBC to the volume of whole blood iron-deficiency anemia  sickle cell anemia Evaluate the effect of heparin and thrombolytic drug therapy and coagulation abnormalities hemolytic uremic syndrome polycythemia rubra vera Disorders related to white blood cells include: acute or chronic leukemia HIV parasitic infections fungal infections lymphoproliferative diseases, (multiple myeloma) Disorders affecting platelets include: myeloproliferative disorders thrombocytopenia V. CROSSMATCHING IV. COAGULATION TESTS Determines compatibility between donor and recipient blood Bleeding time Agglutination between the donor’s RBC and the Bleeding time is a medical test done on someone to recipient’s serum indicates incompatibility assess their platelets function. VI. HEMOGLOBIN ELECTROPHORESIS Duration of bleeding after a standardized skin incision is made is recorded Uses electrophoretic separation and immunodiffusion to screen for the presence of Used to evaluate platelet quantity and function abnormalities such as multiple myeloma Activated Partial thromboplastin time (aPTT) Multiple myeloma causes cancer cells to Assess the intrinsic clotting pathway (aPTT tests all accumulate in the bone marrow, where they crowd out factors except VII) healthy blood cells. Time taken to form a clot after adding Kaolin, a BLOOD LAB TESTS BY CELL TYPE surface activating factor, and Cephalin, a substitute I. RED BLOOD CELLS for platelet factor to px's plasma CARBOXYHEMOGLOBIN (COHb) Used to monitor heparin therapy Carbon monoxide + Hemoglobin compound. Prothrombin time (PT) Displaces oxygen in RBCs. Assess extrinsic and common clotting pathway Normal COHb level for non-smokers is up to 3%. For (II,VII,IX,X and fibrinogen) smokers, 10-15% is normal. International standardized ratio (INR) is a ↑: Carbon monoxide or Methylene Chloride standardized expression of PT poisoning Thrombin time FOLATE Important in the production of RBC, WBC, platelets  ↓ serum folate levels: megaloblastic anemia ERYTHROCYTE SEDIMENTATION RATE Measures the rate at which RBCs settle out of mixed venous blood within an hour Used as a non-specific marker of inflammatory and malignant disease The normal range: HEMATOCRIT M: 0-22 mm/hr ↑ Vitamin B12 and folate deficiency (Pernicious and F: 0-29 mm/hr Megaloblastic anemia) ↑: anemia, rheumatoid arthritis and lupus, ↓ Iron deficiency anemia infections, lymphoma and multiple myeloma HEMOGLOBIN ↓: polycythemia, hyperviscosity, sickle cell anemia, leukemia, low plasma protein ↑ Polycythemia ↓ blood loss, IDA Assess patient response to replacement therapy and estimate arterial and venous oxygen content IRON METABOLISM A. Ferritin Useful indicator of tissue iron stores ↓ iron deficiency anemia B. Iron ↑ iron poisoning and hemolysis ↓Decreased in IDA, chronic infections, COOMB’S TEST (AGT or antiglobulin test) malignancies A. Direct Coomb’s test RED BLOOD CELL APPEARANCE (+) COOMB'S TEST: indicates that an immune mechanism is attacking the patient's own RBCs Acanthocytes (Spur Cells) Used to detect hemolytic anemia, SLE, hemolysis- RBCs with long, thin irregularly placed spikes on the inducing drugs such as Methyldopa, Penicillin, membrane Quinidine ↑Alcoholic cirrhosis and heparin therapy B. Indirect Coomb’s test Echinocytes (Burr Cells) For prenatal testing of pregnant women and in RBCs with evenly distributed spicules on the testing blood prior to a blood transfusion membrane; bu rr cells Crossmatching ↑Uremia, hyperlipidemia  Larger than normal Normochromia Normal RBC color Schistocytes Fragmented RBC Spherocytes Anisocytosis Small round RBCs Associated with IDA Stomatocytes unequal size of RBC RBCs with central slit-like areas of pallor Elliptocytes Target cells Rod-shaped RBCs; associated with sickle cell trait RBCs with dark centers surrounded by light rrings and thalassemia Hypochromia Decrease in the hemoglobin content of the RBCs Associated with Vitamin B12 and Folic acid deficiency anemias Ovalocytes Oval-shaped RBCs Associated with microcytic and megaloblastic anemia Microcytes Smaller-than normal Normocytes Macrocytes Normal-sized RBCs Macrocytes  May be increased by corticosteroids, exercise, and epinephrine ↓ some bacterial, viral and protozoal infection, marrow depressants, liver disease, and some collagen vascular disorders LYMPHOCYTES II. White Blood Cells Provide humoral, cell mediated, and cytotoxic immune responses and interact with antigens in the Three morphologically distinct types of WBC body Granulocytes ( basophils,eosinophils, neutrophils) T lymphocyte and B lymphocyte Lymphocytes Monocytes BASOPHILS: Produce heparin T lymphocytes: ↑ Chronic hypersensitivity states, derived from the thymus myeloproliferative diseases Responsible for cell-mediated immunity- immune EOSINOPHILS response that DOES NOT INVOLVE Contain numerous inflammatory mediators ANTIBODIES ↑ parasitic infections, allergic reaction Activates: May also increase in some neoplastic disease, skin ✓ phagocytes disorders, collagen vascular diseases ✓ antigen-specific cytotoxic T-lymphocytes NEUTROPHILS ✓ release of various cytokines in response to an AKA. polymophonuclear cells antigen Phagocytic cells that engulf and destroy bacteria CD4+ (Helper T cells) Precursors: myeloblasts, promyelocytes, Th1: defend against pathogens and play a role in myelocytes, metamyelocytes, and bands autoimmunity ↑ infections, tissue necrosis, inflammatory Th2: defend against parasites and play a role in disease, metabolic disorders, and some leukemias allergy and asthma  Th17: defend against bacteria and fungi and play a Peripheral platelet destruction role in autoimmunity Idiopathic thrombocytopenic purpura iTreg: involved in in immune tolerance, lymphocyte Disseminated intravascular coagulation homeostasis and regulation of immune system Hemolytic uremic syndrome CD8+ Increased in hepatitis B, acute mononucleosis, cytomegalo infection B lymphocytes: derived from the bone marrow Humoral immunity and produce antibodies ↑ viral disease, bacterial disease, metabolic disease and chronic inflammatory conditions ↓ immunodeficiency syndromes, severe illness, diseases associated with abnormalities of the lymphatic circulatory system Null lymphocytes: Neither T-cell nor B cell lymphocytes MONOCYTES Macrophage precursors ↑ infections, granulomatous, and collagen vascular disease III. PLATELETS Initiate hemostasis Normal value: 150-400 cells/mm3 Platelet function is impaired by: Aspirin, dipyridamole, NSAIDs Uremia, multiple myeloma, severe liver disease Conditions with thrombocytopenia: Bone marrow dysfunction Aplastic anemia Leukemia Viral infections