Experimental Diagnostics for CM 21 PDF

Experimental Diagnostics for CM 21 Chapter 2 Clinical hematological tests Qiang Ma, Associate Professor, M.D., Ph.D E-mail: [email protected] School of laboratory medicine, NSMC 1 Have you ever had a fever, cough, or diarr...

Experimental Diagnostics for CM 21 Chapter 2 Clinical hematological tests Qiang Ma, Associate Professor, M.D., Ph.D E-mail: [email protected] School of laboratory medicine, NSMC 1 Have you ever had a fever, cough, or diarrhea? If so, what was the most possible examination the doctors suggested you did? 2 Hematological X ray examination Stool analysis tests 3 Objective 4 Blood collection tubes Red: No anticoagulants, agglutinate, serum, Immunological testing Black: Sodium citrate, Coagulative function detection Gray: Blood glucose degradation inhibitor, Blood glucose testing Purple: EDTA, Blood routine testing Reddish orange: Coagulant, Immunological testing Green: Heperin, Routine and emergency plasma Biochemical testing Blood drawing for routine blood testing Median cubital vein 5 What is composed of human blood? Erythrocyte Blood Leukocyte cells Blood Thrombocyte Plasma: Proteins, Enzymes, Blood coagulation factors, Mineral salts, Hormones, Vitamines, etc. 6  What is composed of hematological tests? Red blood cell count, White blood cell count and hemoglobin measurement, classification, and RBC morphological analysis and WBC morphological analysis Hematological tests Platelet count and morphological analysis 7  Hematological analysis results White blood cell analysis Red blood cell analysis Platelet analysis 8  Department of clinical laboratory, Peking Union Hospital 1958 1965 1979 Manual analysis at all EEL blood cell counter Coulter-ZF blood cell counter Only for white blood cell count WBC, RBC, PLT 9  Department of clinical laboratory, Peking Union Hospital 1982 1993 2003 Backer-s810 semi-automatic platelet 18 parameters and leukocyte Five classification blood cell counter and BackER-8000 CBC 8 classfication function on a blood cell analyzer, XT-1800 parameter blood cell analyzer analyzer Fully automated analysis age Semi-automated age 10 Hematological analysis pipeline ~300 samples/hour 11  Content 1. Erythrocyte measurement 2. Leukocyte measurement 3. Thrombocyte measurement 12  1. Erythrocyte measurement Normal erythrocyte Size: 6-9 uM, average size: 7.5 uM Biconcave discs, the edge is orange and the middle area is light tinted Wrigt-Giemsa staining Reference interval Red blood cell count Adult male （4.0~5.5)×1012/L Adult female （3.5~5.0)×1012/L Newborn （6.0~7.0)×1012/L 13  1. Erythrocyte measurement The structure of Hb Ferrous ion 14  1. Erythrocyte measurement Physiological role of erythrocyte Carrier of oxygen Carrier of carbon dioxide Acid-base balance Base Acid 15  1. Erythrocyte measurement Reference interval of Hb in normal population Growth and development Newborn: 170～200 g/L Adult： Anoxic environment of uterus Male 120～160 g/L Female 110～150 g/L Children：120～140 g/L Infant：110～120 g/L Elder population： Male 94～122 g/L Oxygen sufficiency Female 87～112 g/L Hematopoietic decline 16  1. Erythrocyte measurement Newborn Hormone Cigarette Physiological increase of smoking RBC or Hb Plateau residents Sports 17  1. Erythrocyte measurement Depression of blood-forming organs Physiological decrease of RBC Insufficient or Hb nutrients for growth and development Plasma volume increased 18  1. Erythrocyte measurement Pathological increase Relative increase: Hemoconcentration, such as patients with vomiting, diarrhea, excessive sweating, diabetes, insipidus, burns. Absolute increase：Polycythemia （1）Polycythemia vera: A myeloproliferative disease characterized by an increase in erythrocytes. Its hematological manifestations are RBC increase，as well as WBC, PLT, and total blood volume. （2）Secondary erythrocytosis: Diseases of heart and lung (COPD, pulmonary heart disease)、Cancers (Renal cancer、 hepatocarcinoma、ovarian cancer）or kidney diseases, such as Hydronephrosis, polycystic kidney 19  1. Erythrocyte measurement Pathological decrease Results from different kinds of anemia Aplastic anemia Decreased production Iron deficiency anemia of red blood cells /Megaloblastic anemia Membrane proteins or Increased destruction of globin protein erythrocytes abnormal Hemolysis diseases of newborn Loss of erythrocytes Acute or chronic loss of blood 20  1. Erythrocyte measurement Case 1 A 3 years old children admitted to the hospital. The chief complaint from his father was pale skin and mucous membrane with poor mental state for 4 months. In the last 4 months, his father found that his skin was pale, prone to fatigue, lack of activity, poor appetite, early manifestations of fidgety and difficult to concentrate. Blood routine examination: RBC 2.68 ×1012 /L, Hb 52 g/L, WBC 5.5 ×109 /L, PLT 196×109 /L, the mean red blood cell volume (MCV) was 72 fL (reference 82-98 fL, femtoliter), the mean erythrocyte hemoglobin content (MCH) was 23 pg (reference 27-34 pg, picogram), and the mean erythrocyte hemoglobin concentration (MCHC) was 0.27 (reference 0.32-0.36). What are the main abnormal hematological parameters we can get from the blood routine examination? 21  1. Erythrocyte measurement Morphological abnormal of erythrocyte Abnormal size of RBC Abnormal shape of RBC Abnormal staining reaction 22  1. Erythrocyte measurement 1.1 Abnormal size of RBC Normal erythrocyte Microcyte Macrocyte Megalocyte Diameter less than Diameter more than Diameter more than 6 uM 10 uM 15 uM Iron deficiency anemia Hemolytic anemia Megaloblastic anemia Megaloblastic anemia Size: 6-9 uM, average size: 7.5 uM Biconcave discs, the edge is orange and the middle area is light tinted 23  1. Erythrocyte measurement 1.2 Abnormal shape of RBC Spherocyte Elliptocyte Stomatocyte Teardrop cell Hereditary spherocytosis Hereditary elliptocytosis Hereditary stomatocytosis Myelofibrosis Spinous RBC Target RBC Sickle cell RBC Fragments of RBC Thalassemia, Abnormal Sick-cell anemia DIC Acanthocytosis hemoglobinopathy 24  1. Erythrocyte measurement 1.3 Abnormal staining reaction Hypochromic RBC Hyperchromic RBC Polychromatic RBC Iron deficiency anemia, Megaloblastic anemia Basophilic substance in RBC Thalassemia, Sideroblastic anemia Hemolytic anemia 25  1. Erythrocyte measurement 1.3 Abnormal structure Basophilic stippling Howell-Jolly body Cabot ring Nucleated erythrocyte RBC Abnormal chromatin Severe anemia, Hemolytic anemia, Plumbism, Hemolytic anemia, Leukemia, Hemolytic anemia, Megaloblastic anemia Megaloblastic anemia, Myelofibrosis Megaloblastic anemia Plumbism 26  1. Erythrocyte measurement Case 2 A 42-years-old female patient was admitted due to "fatigue with low fever for 3 days". Moreover, patient complained that she suffered night sweats, with chest sulk after activity and relieved after a few minutes of rest. Laboratory tests Blood routine test: white blood cell: 1.67×109/L↓, red blood cell: 1.63 ×1012/L↓, hemoglobin: 58 g/L↓, mean corpuscular volume: 115.3 fL ↑, mean corpuscular hemoglobin: 35.8 pg↑, mean corpuscular hemoglobin concentration: 340 g/L ↑, red blood cell volume distribution width: 24.5%↑, platelet: 17×109/L↓, high-sensitivity CRP: 64.8 mg/L↑. Reticulocyte count: 62.3×109/L, reticulocyte ratio: 2.78%↑ 27  1. Erythrocyte measurement Anemia parameters detection: ferritin: 419.2 ug/L↑, folic acid 10.3 ug/L, vitamin B12