Introduction to Hematology PDF

Hematology Kevin Telles, MT(AMT) Introduction to Hematology  Hematology Study of formed cellular blood elements: the white blood cells, red blood cells and platelets Hemostasis Arrest of bleeding by the formation of a barrier...

Hematology Kevin Telles, MT(AMT) Introduction to Hematology  Hematology Study of formed cellular blood elements: the white blood cells, red blood cells and platelets Hemostasis Arrest of bleeding by the formation of a barrier to blood loss Terms Maintenance of an adequate number of cells to carry out the functions of the organism Hematopoiesis Dynamic formation and development of blood cells, normally in the bone marrow Process responsible for the replacement of circulating blood cells  Confirm Confirm a physician’s clinical impression of a possible hematological disorder Establish Establish a diagnosis or rule out a diagnosis Functions of the Hematology Detect Detect an unsuspected disorder lab Monitor Monitor the effects of radiation or chemotherapy Blood Composition Plasma: 55% ○ Constituents of Plasma Water (92%) Solutes(8%) ○ Albumins ○ Globulins ○ Fibrinogen ○ Others ( electrolytes, hormones, vitamins, lipids, salts, enzymes and carbohydrates)  Transport medium for nutrients & metabolites Functions Immune Defense of Plasma Coagulation  Cellular Elements ○ Leukocytes: 1% White Blood Cell= WBC ○ Granulocytes- fight infection ○ Lymphocytes- cellular and humoral immunity ○ Monocytes- phagocytosis of foreign substances and dead or dying cells ○ Platelets: 1% Thrombocytes ○ Help to maintain hemostasis by plugging capillaries and forming clots ○ Actually a fragment of cytoplasm from megakaryocyte ○ Erythrocytes: 43% Red Blood Cell= RBC ○ Transports oxygen (O2) to tissues and excrete carbon dioxide (CO2) from tissues Blood Composition RBC’s do not have a nucleus  A Erythrocytes (RBCs) B&H Lymphocytes C&E Segmented neutrophil D Eosinophil F Monocyte G Platelets I Neutrophilic band J Basophil  proteins, albumins, globulins, fibrinogen, electrolytes, hormones, nutrients, and 55% respiratory gases 45% Blood Composition Plasma: liquid Serum: liquid portion portion of blood of blood from a from an clotted specimen anticoagulated tubes (Without fibrinogen) Reference ranges DIFFER ACCORDING TO AGE, ESTABLISHED BY INDIVIDUAL REFER TO INSIDE COVERS RACE, SEX AND FACILITIES IN ORDER TO OF TEXTBOOK TO REVIEW GEOGRAPHIC LOCATION ACCOUNT FOR PATIENT VARIOUS REFERENCE POPULATION RANGES  Complete Blood Count= CBC ○ Indications: fatigue, weakness, infection, inflammation, bruising, Overview: ○ bleeding Quantifies the white blood cells Laboratory (WBC), red blood cells (RBC) , hemoglobin, hematocrit and platelets. Testing ○ ○ Calculates the RBC indices WBC Differential: enumeration of the types of WBC’s, RBC morphology, platelets  Sample ○ Whole blood, non-hemolized ○ Avoid clots Anticoagulant of choice ○ K2 or K3 EDTA (ethylene diamine tetracetate) Sample & ○ Purpose of the anticoagulant is to Storage prevent clotting of specimen Storage Requirements ○ Room temperature- up to 1 day ○ 4oC- to preserve sample longer, but may induce cold agglutination  Erythrocyte Changes Neutrophil Changes Hypochromic Smudge/basket cells Schistocytes Cytoplasm rupture Elliptocytes Pyknotic nuclei Spherocytes Loss of granulation Crenated Cytoplasmic vacuoles Loss of nuclear shape, chromatin Changes in Aging EDTA Samples Observations from Aged EDTA  PARAMETER AFFECT WBC Probably unaffected RBC Falsely low due to RBC lysis and/or RBC fragments not be counted as RBCs HGB Reportable- accurate measurement relies on RBCs being completely lysed Affect of HCT Falsely low- calculated with an invalid MCV and falsely low RBC Hemolysis on MCV Invalid falsely low or high depending on the degree of hemolysis. May be falsely low if RBC fragments cause smaller pulses to be produced in the RBC aperature or falsely CBC Parameters MCH high if fragmented RBCs fall below the RBC threshold and are not counted. Invalid- calculated with a falsely low RBC MCHC Invalid- calculated with a falsely low HCT RDW Falsely high due to RBC fragments increasing the CV of the RBC histogram PLT Falsely high due to RBC fragments being incorrectly counted as platelets  McKenzie, Shirlyn B., and J. Lynne. Williams. "Chapter 21." Introduction. Clinical Laboratory Hematology. Boston: Pearson, 2010. Print Rodak, Bernadette F., Fritsma, George, References and Elaine Keohane. "Chapter 35." Myelodysplastic Syndrome. Hematology Clinical Principles and Applications. St. Louis: Elsevier, 2012. Print Teshima, D. Y. (2017, July). EDTA in transit: Degenerative changes in blood cell morphology. MLO, 49(7), 12-14.