Hematology Lec M1-4 Canvas and PPT 2 PDF

CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO MODULE 1: OUTLINE OVERVIEW OF HEMATOLOGY I. INTRODUCTION...

CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO MODULE 1: OUTLINE OVERVIEW OF HEMATOLOGY I. INTRODUCTION Hematology is defined as the study of blood, its II. OVERVIEW development, and diseases associated with it III. FUNCTIONS OF THE BLOOD It includes the study of RBCs (erythrocytes), WBCs IV. COMMON HEMATOLOGICAL TESTS (leukocytes), platelets (thrombocytes), and hemostatic V. PHYSICAL CHARACTERISTICS OF BLOOD elements in plasma in order to provide a di erential VI. COMPOSITION OF BLOOD diagnosis. VII. DIFFERENTIATION BETWEEN PLASMA AND SERUM VIII. COMMON PREFIXES AND SUFFIXES USED IN FUNCTIONS OF THE BLOOD HEMATOLOGY VOCABULARY 1. Respiratory IX. HEMATOLOGICAL TERMINOLOGIES - refers to the delivery of gases to and from the tissues X. SPECIMEN COLLECTION AND CONSIDERATIONS ON - Oxygen attach to hemoglobin in RBCs for delivery from the HEMATOLOGY XI. ORDER OF DRAW lungs to the peripheral tissues. XII. OTHER BLOOD COLLECTION TUBES - Carbon dioxide is also transported by the blood from the tissues for elimination by the lungs 2. Homeostasis INTRODUCTION - refers to the regulation of certain balances in the body. Hematology is the study of the blood and diseases - The blood is involved in a number of certain homeostatic mechanisms such as pH homeostasis and temperature associated with the blood. Clinical Hematology deals with regulation the study and analysis of blood constituents - primarily 3. Nutritive the red blood cells (erythrocytes), white blood cells - refers to the delivery of nutrients to the tissues. These nutrients (leukocytes), and platelets (thrombocytes) - in order to are dissolved in the plasma. aid in diagnosing diseases of the blood or other systemic 4. Excretory diseases that a ect the blood. Hematology results are - refers to the delivery of waste products from the tissues to the used by physicians in selecting and monitoring therapy of excretory organs for elimination from the body. patients with such disorders. A Complete Blood Count is Ex. Non-protein nitrogenous wastes (NPNs) such as urea and usually among the tests ordered by physicians for creatinine are dissolved in plasma and filtered by the patients coming in for consultations or admitted to the kidneys. hospital. 5. Immunity The field of Clinical Hematology deals with the study of - refers to the body’s defense against infectious organisms the cellular components (red blood cells, white blood cells, (Bacteria, Fungi, Parasites, or Viruses) and platelets) and the hemostatic elements (proclotting - White blood cells populations in the blood are play a protective factors and inhibitors of coagulation) in order to aid in the role against a group of microorganisms diagnosis and monitoring of diseases of the blood or - Neutrophils protect against most bacterial agents by engulfing these bacteria, and releasing its granular contents, which other conditions that a ect these di erent components. have anti-bacterial action Hematological tests, primarily the Complete Blood Count, - Monocytes protect against a wide range of infectious agents o ers a wealth of information to the clinician regarding by performing phagocytosis various physiological processes. - Eosinophils protect against helminthic infections - Lymphocytes are active against most viruses and its RED BLOOD CELLS subpopulation of B-lymphocytes di erentiate into plasma Red blood cells circulate in the blood for 120 days cells to produce antibodies performing their function of oxygen delivery from the 6. Water Regulation lungs to the peripheral tissues. Essential to this function of - the blood is involved in maintaining the water levels in the oxygen delivery is normal RBC morphology. When Red body. Water is excreted or reabsorbed into the blood as a Blood Cells have abnormal morphology or become function of plasma osmolality, which is the measure of senescent (old), they are marked for elimination from the solute concentration of the blood. Increased plasma circulation. In this module, students will be given a more osmolality promotes water reabsorption in the kidneys. detailed study into normal and abnormal red blood cell Decreased plasma osmolality promotes water excretion. morphology, as well as the processes that are essential to 7. Transportation of Hormones normal RBC function. Red blood cells with abnormal - Hormones are secreted by endocrine glands. The targets of morphology will be discussed together with endocrine hormones are distant from its source. Thus, the corresponding clinical correlations of each abnormal hormones need to be dissolved in the plasma to reach its morphology. target tissue/organ Disease like meningitis and multiple sclerosis causes 8. Hemostasis disruption of the BBB. - refers to the mechanism by which blood flow to an injured blood vessel is arrested in order to prevent excessive blood loss. 1  CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO - This occurs as a function of platelets (forming a platelet plug) - abnormal morphologic characteristics may indicate the and hemostatic elements in plasma (responsible for clot presence of disease processes formation and dissolution). - Example: the presence of agranular platelets may be associated with Gray Platelet Syndrome, which also a ects COMMON HEMATOLOGICAL TESTS platelet function 1. Complete Blood Count (CBC) 3. Bleeding Time and Coagulation Tests - these are tests used - Composed of a panel of tests to evaluate the formed elements to evaluate hemostatic functions of the blood: in the blood A. Bleeding Time: general screening test for hemostatic - the CBC results o er a wealth of information regarding the abnormalities health status of an individual B. Prothrombin Time: coagulation test used to evaluate - each component of CBC is associated with di erent conditions the extrinsic pathway (similar to the components of urinalysis) C. (Activated) Partial Thromboplastin Time: coagulation test used to evaluate the intrinsic pathway COMPONENTS OF CBC D. Thrombin Time and Reptilase Time: coagulation tests used to evaluate the Fibrinogen function Cell counts (RBC count, WBC count, Platelet count) E. Stypven Time / Dilute Russel Viper Venom Time: determines the quantities of circulating blood cells coagulation test used to evaluate the common increases or decreases in each of the cell counts may pathway reveal the presence of a disease process 4. Reticulocyte Count - Reticulocytes are immature red blood Hemoglobin determination cells. These are normally found in the blood in small numbers quantitative measure of hemoglobin, the protein in - Evaluation of its count reveals the bone marrow’s response to RBCs responsible for binding oxygen. Low levels of hypoxia hemoglobin impair oxygen delivery to the tissues and are most often associated with anemia 5. Erythrocyte Sedimentation Rate (ESR) - This test is a measure of the rate of fall of red blood cells within a packed Hematocrit testing column determination of the amount of red blood cells in whole - Traditionally, this test was used as a screening test for the blood (expressed as a relative quantity; ratio of red presence of inflammatory processes blood cells to whole blood in a sample) PHYSICAL CHARACTERISTICS OF BLOOD WBC di erential count 1. Fluid in vivo (due to balance between proclotting factors details the relative counts of each white blood cell and anticoagulants) population (Neutrophils, Lymphocytes, Monocytes, 2. Volume: 4-6 L (normal adult volume) or 75-85 mL per Eosinophils, and Basophils) kilogram of body weight each WBC population is expressed as the percentage of 3. Viscosity: Viscous (3.5-4.5 times thicker than water) white blood cells COMPOSITION OF BLOOD RBC indices values of these indices aid in making a specific diagnosis of anemia 1. Cellular Components (Formed Elements): a. Mean Cell/Corpuscular Volume (MCV) – average A. Red Blood Cells (Erythrocytes) volume of red blood cells in a sample B. White Blood Cells (Leukocytes) b. Mean Cell/Corpuscular Hemoglobin (MCH) – average C. Platelets (Thrombocytes) amount of hemoglobin in each red blood cell in a sample c. Mean Cell/Corpuscular Hemoglobin Concentration (MCHC) 2. Liquid Component (called Plasma or Serum) - composed - average hemoglobin content for a specified volume of red mostly of water - dissolved elements include carbohydrates, blood cells proteins, lipids, non-protein nitrogenous compounds (NPNs), d. Reticulocyte Distribution Width (RDW) – quantitates vitamins, electrolytes, trace elements, hormones, and gases the spread of RBC sizes in a sample. The greater the RDW, the greater is the di erence in RBC sizes in the 4. Reaction: slightly alkaline sample – Arterial blood pH: 7.35 - 7.45 – Venous blood pH: 7.38 - 7.48 2. Peripheral Blood Smear (PBS) Examination - performed to analyze the morphologic characteristics of 5. Osmolality: 280-295 mOsm/kg RBCs, WBCs, and Platelets 6. Average specific gravity: 1.055 2  CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO ante- before crena- wrinkled cyst- cell dys- Abnormal, di cult erythro- red ferr- iron Hemo- Pertaining to the blood (hemato-) hypo- Beneath, under, deficient, decreased hyper- Above, beyond, extreme iso- Equal, alike, same leuk(o) white macro- Large, long mega- Large, giant meta- (1) After, next; (2) change DIFFERENTIATION BETWEEN PLASMA AND SERUM micro- small PLASMA SERUM myel(o)- (1) from bone marrow; (2) spinal cord Liquid part of Liquid part of clotted blood anticoagulated and pan- all, overall, all-inclusive unclotted blood phleb- vein Hazy Clearer phago- Eat, ingest All Coagulation Factors are Clotting Factors that are present (Fresh Plasma): consumed in Coagulation: poikilo- Varied, irregular FI, FII, FV, FVII, FVIII:c, FI / I (Fibrinogen) FIX, FX, FXI, FXII, FXIII, FV / V (Proaccelerin) Poly- Many PK, HMWK FVIII:c / VIII:c (Anti-Hemophilic Factor A) Pre- (pro-) Before FXIII / XIII (Fibrin Stabilizing Factor) pykino- Dense Only residual amount (less reticulo- Netlike than 20%) of FII / II (Prothtrombin) is present schis- Split scler- Hard Common Prefixes Used in Hematology Vocabulary sidero- Iron PREFIX MEANING spleen- Spleen a- / an- lack, without, absent, decreased thrombo- Clot, thrombus aniso- unequal, dissimilar xanth- Yellow 3  CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO S; ex vivo, substances that are added to a blood sample that inhibit clot formation either by binding Common Su xesUsed in Hematology Vocabulary with calcium, precipitation of calcium, inhibition of thrombin, or removal of fibrin Su x Meaning Apoptosis – programmed cell death; process of ordered removal of organelles and cells -algia Pain along a nerve Arterial tap – process of blood collection by accessing an artery -ase An enzyme Basophil – white blood cell morphologically characterized by coarse blue-black granules that -cide The killer of obscure the view of the nucleus; involved mainly in mediating allergic response -crit To separate Blast – early stage of di erentiation of a blood cell as it transitions from stem cell to a mature cell. It is -cyte Cell normally confined to the bone marrow and is the earliest recognizable stage of a blood cell using Light -ectomy Incision and remova Microscopy. Blood Film – aka Peripheral Blood Smear; a stained -emia Blood smear of a drop of blood that, when viewed through a -itis Inflammation microscope, produces additional morphologic information about the blood cells -lysis Destruction or dissolving Bone Marrow – soft tissue found inside hollow bones responsible for production of blood cells. -oma Swelling or tumor Cellularity – expression of the amount of blood cells within the bone marrow -opathy Disease Chemotaxis – movement of white blood cells toward or away from the source of a chemical gradient -osis (1) Abnormal increase; (2) Clotting factors – aka Proclotting Factors or disease Procoagulants; specialized proteins that, when activated, form an interplay that e ects coagulation -penia Deficiency, decreased Coagulation – aka clot formation or clotting; process of clot formation through the interaction of -phil(ic) Attracted to, a nity for specialized proteins in plasma culminating in the conversion of fibrinogen to fibrin -plasia (-plastic) Cell production or repair Coagulopathy – hereditary or acquired abnormality of blood coagulation -poiesis Cell production, formation, and Complete Blood Count (CBC) – test performed in the development hematology laboratory that determines red blood cell count, white blood cell count and di erential count, -poietin Stimulates production platelet count, hemoglobin concentration and hematocrit of a patient Cytopenia – a reduction in number of one or more cell types in the blood HEMATOLOGICAL TERMINOLOGIES Deoxyhemoglobin – aka reduced hemoglobin; hemoglobin that is not carrying oxygen Hematology (Haematology) – the study of blood. It Dyserythropoiesis – abnormal red blood cell involves the study of blood cells and coagulation. It development includes the study of diseases associated with the Ecchymosis – (pl: ecchymoses); bruising caused by blood, as well as the reaction of the formed elements leakage of blood from blood vessels to the presence of disease. EDTA – ethylenediaminetetraacetate / -tetraacetic Agglutination – clumping of cells acid; most common anticaoagulant used for Aggregation – in blood coagulation, it is the clumping hematological studies, especially for CBC of platelets together in the formation of a platelet Embolus – a blood clot that migrates through the plug blood stream and lodges into another vessel, causing Anisochromia – variation in hemoglobin content of blockage of blood flow red blood cells Eosinophil – white blood cells morphologically Anisocytosis – increased variation in size of red blood characterized by bilobed nuclei and coarse orange cells granules; involved mainly in anti-helminthic immune Anticoagulant – substance that prevents clot response and regulating allergic response formation; in vivo, includes natural anticoagulants such as Heparin, Antithrombin III, and Proteins C and 4  CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO Erythrocytes – aka red blood cells; cells that contains Serum - liquid portion of clotted blood hemoglobin and carries oxygen through the blood Supravital stain – dyes employed in staining cellular Erythropoietin – glycoprotein hormone produced by elements while the cell is inits living state (eg. New the kidneys in response to tissue hypoxia; targets red Methylene Blue, Brilliant Cresyl Blue) blood cell precursors in the bone marrow to stimulate Thrombocytes – aka platelets; cellular elements that proliferation and maturation are involved in promoting hemostasis Fibrinolysis – process of dissolution of the clot Thrombosis – inappropriate or pathological e ected by the action of plasmin (fibrinolysin) formation of a clot in an artery or vein Hematoma – accumulation of blood in the tissues or Thrombus – blood clot that usually develops in a cavities of the body deep vein of the body Hematocrit – relative expression of the amount of red Venipuncture – process of blood collection via blood cells in relation to the amount of whole blood in intravenous access a sample (in vitro) or total body fluids (in vivo) Wright stain – a type of Romanowsky stain; most Hematopoiesis / Hemopoiesis – involves the common stain used for studying blood cell production, development, di erentiation, and morphology maturation of blood cells in a blood-forming organ or tissue Hemoglobin – oxygen-binding protein found within LESSON 2: SPECIMEN COLLECTION AND red blood cells CONSIDERATIONS ON HEMATOLOGY Hemolysis – inappropriate destruction of red blood cells 1. Patient Identification Hemorrhage – Excessive bleeding leading to leakage of blood from the vessels to the surrounding tissues considered as the most critical step in Specimen and brought about by a breakdown of hemostasis collection Hemostasis – process of arresting blood flow to a site Identify the patient by asking the patient to state of vessel injury; also, the system that keeps the blood his/her full name (including middle name); if the in a fluid state under normal conditions patient cannot speak, verify the patient’s identity Hypoxia – lack of oxygen experienced by the tissues; from the relative, attending physician, or nurse physiologic stimulus for production of red blood cells Whenever possible, verify a 2nd patient identifier Leukocytes – aka white blood cells; blood cells that (eg. Date of Birth / Social Security Number) for a are involved in the body’s immune response positive patient identification. Lymphocytes – smallest of the white blood cells; morphologically characterized by a round nucleus 2. Physiologic factors a ecting test results: and scanty sky blue cytoplasm; involved in anti-viral immune response and antibody production Macrophages – Phagocytes found in tissues Factor E ect/s Monocytes – white blood cells morphologically characterized by a round or irregularly-shaped Posture Shift in posture from supine to erect may cause an increase in the levels of Lipids, nucleus and agranular light blue cytoplasm; Enzymes, and Proteins considered as professional phagocytes of the blood; develop into macrophages in the tissues Diurnal Rhythm In the afternoon, decreased levels of Neutrophils – white blood cells morphologically ACTH and cortisol and increased levels of characterized by multilobed nuclei and neutral (lilac eosinophils may be seen or purple) staining of the cytoplasm; involved mainly in anti-bacterial immune response and inflammatory Stress Causes an increase in WBC counts, FI, FV, response FVIII:c, and FXIII Oxyhemoglobin – hemoglobin with oxygen bound to it Exercise Causes an increase in WBC and Platelet Peripheral blood – blood that is contained within the counts, Creatine Kinase (CK), and Lactate circulatory system Dehydrogenase (LD) Peripheral puncture – aka capillary puncture; process of blood collection via skin puncture Diet After a fatty meal, increased Alkaline Petechiae – red pinpoint-sized hemorrhages of small phosphatase (ALP) may be seen, false capillaries in the skin or mucus membranes increase in hemoglobin using the Phagocytosis – process of engulfment and cyanmethemoglobin method destruction of foreign and unwanted material (such as bacteria or senescent red blood cells) Smoking Increases cortisol and WBC Phlebotomy – process of blood collection counts; Chronic smoking may increase RBC count, hemoglobin, and Plasma – liquid portion of unclotted blood or hematocrit anticoagulated blood 5  CENTRO ESCOLAR UNIVERSITY PRML141 : HEMATOLOGY 1 (LECTURE) SANCON, KATRIEL M. | 1ST SEMESTER | A.Y. 2024 – 2025 |DEAN CHARITO BERMIDO Order of Draw for Skin Puncture: 3. Sources of blood for Hematology testing: Tube for blood gas analysis Slides Skin Puncture / Peripheral Puncture – source of EDTA microcollection tubes (must be filled before peripheral blood (contains a mixture of capillary blood other microcollection tubes to ensure adequate from the capillaries, venous blood from the venules, blood volume for testing) arterial blood from the arteries, and interstitial and Other microcollection tubes with anticoagulants Serum microcollection tubes intercellular fluids) used when only small quantities of blood sample are Venipuncture – source of venous blood; preferred when required large volumes of blood are required for testing. preferred sites of puncture are the veins in the antecubital Indications of Skin Puncture: area: median cubital vein (vein of choice), cephalic vein, and Infants/neonates/pediatric patients the basilic vein Geriatric patients Adults who are/have: Important considerations when performing venipuncture: a. extremely obese; Angle between the skin and the needle: 15 degrees b. a history of thromboembolism, stroke, Tourniquet application: Disseminated Intravascular ○ Distance from the venipuncture site should Coagulation/Coagulopathy (DIC), or be 3-4inches (7.5-10cm) Transient Ischemic Attack (TIA); or ○ Length of time should be at 1 minute c. extensive burns (maximum) d. If the examination requested necessitates Prolonged tourniquet application causes skin puncture (bleeding time, micro hemoconcentration, hemolysis, and shortened methods of clotting time) coagulation time. Release the tourniquet once blood enters the hub. Recommended sites for skin puncture: ○ A phlebotomist must never puncture the Distal portion on the palmar surface of the 3rd or 4th patient more than twice. After the second digits of the non-dominant hand attempt, the phlebotomist must endorse to ○ the middle and ring fingers are usually the a more senior or more experienced sta. least used and are less calloused compared ○ Standard needle for phlebotomy: 21G to the thumb and index fingers. ○ Most common needle lengths: 1.0 and 1.5 For infants, the plantar surface of the foot/sole (heel inches portion). (see shaded portion on the right) ○ Common causes of hemolysis: Prolonged tourniquet application Moisture or contamination on blood collection tubes Using needles with too small bores Excessive agitation during mixing of samples Introduction of bubbles (frothing) during blood collection. Traditionally, the free margin of the earlobe was 4. Additives used since there was less tissue juice and there were Additive Color Notes less nerve endings causing less pain. This is no Code longer recommended due to less capillary access. Antiglycolytic Agents (MOA: inhibits glycolysis) Important considerations when performing skin puncture: Depth of puncture should be 2-3mm for adults; Sodium Gray Top Preserves glucose for up to 3 days For