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HAEMATOLOGICAL TESTS
Abel C. Mathew
PharmD fourth year
Roll no -1
• Cellular Components of blood derived from pluripotent
stem cells in bone marrow.
• Bone marrow is a hematopoietic and reticuloendothelial
organ, normally produces-
▫ 200 billions RBCs
▫ 1 billion granulocytes daily
As reticuloendothelial organ, involved in processing
antigens, cellular immune reactions, antibody synthesis,
recognition and removal of expired and abnormal cells.
Physiology of Blood Cells & Bone
Marrow
• Cell differentiation is differentiation of pluripotent stem
cells into any cell line (red blood cells [RBCs], white
blood cells [WBCs], and platelets) takes place in bone
marrow.
• Hence, hematopoietic system consists of three primary
cell components:
▫ Leukocytes, Platelets, and Erythrocytes.
• Leukocytes encompasses a functionally diverse group of
cells that includes
▫ Neutrophils,Eosinophils, Basophils,
Monocytes/Macrophages, Lymphocytes, and Plasma
cells.
• Platelets (thrombocytes) interact to facilitate blood
coagulation.
▫ provision of a specific receptor site for clotting factors, as
well as the necessary phospholipid surface for conversion
of prothrombin to thrombin, and protection of thrombin
from antithrombin.
▫ localization of the thrombus
• Reticulocyte is the final cell form that precedes
development of mature RBC or erythrocyte.
• During maturation, Hgb is produced and
incorporated into the cell.
• Present in the circulation for 1-2 days before
maturation
• Mature erythrocytes have a 120-day life span.
Introduction
Complete blood count (CBC) or Complete Blood
Examination (CBE) is routinely ordered test
Provides useful information on cellular and non-
cellular elements of blood
Helps in diagnosis of multiple haematological
disorders
Routine tests
RBC count
WBC count
Platelet count
Hemoglobin (Hgb)
Hematocrit (Hct)
RBC indices (specifically assess RBCs)
 Mean cell volume (MCV)
 Mean cell hemoglobin (MCH)
 Mean cell hemoglobin concentration (MCHC)
Reticulocyte Count
RDW
MPV
ESR
TOTAL RBC COUNT
• Actual count of red corpuscles in a given amount of blood
(cubic millimeter or liter).The RBC count is interpreted in
conjunction with red cell indices, haemoglobin and
haematocrit.
Normal Range-
Male: 4.6 to 6.2 x106 cells /mm3
Female: 4.2 to 5.4 x106 cells /mm3
• Increased in
Certain myeloproliferative neoplasms (example
polycythemia vera ),
severe dehydration ,RBC counts may be
appropriately decreased or increased in certain
physiological states.
• Decreased in
Various types of anemia
TOTAL LEUCOCYTE COUNT
• Number of leukocytes in a given amount of
blood. Describe and classify the white cell components
neutrophils, lymphocytes, monocytes, eosinophils,
basophils
• Normal Range
4.3-10.3 x 10³ cells/ mm³
Increased in
• Monocytes: If a person has high levels of monocytes, it may
indicate the presence of chronic infection, an autoimmune or
blood disorder, cancer, or other medical conditions.
• Lymphocytes: If there is an elevation in the level of
lymphocytes, the condition is known as lymphocytic
leukocytosis. This may occur as a result of a virus, or an
infection such as tuberculosis. It may also be linked to
specific lymphomas and leukemias.
• Neutrophils: If a person has heightened levels of neutrophils in
their body, the disorder is known as neutrophilic leukocytosis.
This condition is a normal physical response to an event, such as
infection, injury, inflammation, some medications, and certain
types of leukemia.
• Basophils: Increased levels of basophils may occur
in people with a history of underactive thyroid
disease, known as hypothyroidism, or in certain other
medical conditions.
• Eosinophils: If a person registers high levels of
eosinophils, the body may be reacting to a parasitic or
other infection, allergen, or asthma.
Decreased in
• Viral infections that temporarily disrupt the work of
bone marrow
• Certain disorders present at birth (congenital) that
involve diminished bone marrow function
• Canceror other diseases that damage bone marrow
• Autoimmune disorders that destroy white blood cells
or bone marrow cells
• Severe infections that use up white blood cells faster
than they can be produced
• Medications, such as antibiotics, that destroy white
blood cells
• Sarcoidosis (collections of inflammatory cells in the
body)
HEMOGLOBIN (Hb)
Hemoglobin is the respiratory protein of RBCs, consisting of
3.8 % heme and 96.2 % globin.
Hb amount in he given volume(100ml or 1 liter) of whole
blood. Provides a direct indication of the oxygen-transport
capacity of the blood.
Normal Range
Male: 14 to 18g/dl
Female: 12 to 16g/dl
Decreased in
Hb is educed in all anemias , in most cases as a
consequence of another underlying disease or a
deficiency (iron , folate, vitamin B12 )
Increased in
Hb is higher as a physiologic response to high altitude
due to low oxygen tension or in advanced lung or
cardiac disease
Certain meloproliferative neoplasms (example
polycythemia vera )
PLATELET COUNTS
• They are small discoid blood corpuscles, the primary link in
achieving hemostasis.
• Normal Range
150-450 x 1000 cells /mm³
Increased in
Clonal bone marrow disorders such as myeloproliferative
neoplasms
Reactive: after acute haemorrhage, in malignancies ( about
50 % of patients with ‘ unexpected’ thrombocytosis are
found to have a malignancy), after splenectomy, severe
trauma, infections, chronic inflammatory disorders, drug
reactions, and many miscellaneous conditions
Decreased in
Immune destruction such as in ITP, reaction to certain drugs,
aplastic anemia, leukemias, lymphoproliferative diseases,
hypersplenism,DIC, or TTP/HUS and with extracorporeal
circulation
Following chemotherapy, post-transfusion thrombocytopenia
Numerous congenital conditions which may be associated
with low platelet counts.
HEMATOCRIT (HCT) / PACKED CELL
VOLUME (PCV):
It is the percentage volume of blood that is composed of
erythrocytes.
Hct is usually about 3 times the value of Hgb.
Normal Range:
Male: 42 to 52 %
Female: 37 to 47%
Abnormalities in Hct levels parallel those for Hb.
Decreased in
Hb is educed in all anemias , in most cases as a
consequence of another underlying disease or a
deficiency (iron , folate, vitamin B12 )
Increased in
Hb is higher as a physiologic response to high altitude
due to low oxygen tension or in advanced lung or
cardiac disease
Certain meloproliferative neoplasms (example
polycythemia vera )
RBCs Indices
• They are part of the complete blood count (CBC) test that
provide information about the hemoglobin content and
size of red blood. They are used in diagnosis of anemia
and it’s causes.
Mean corpuscular volume (MCV): is the average size of
a red blood cell and is calculated by dividing the
hematocrit (Hct) by the red blood cell count.
• MCV = Hct / RBC
▫ Normal range: (78-98) fL (femto- is 10-15)
▫ Normal MCV = normocytic anemia
▫ Decreased MCV = microcytic anemia
▫ Increased MCV = macrocytic anemia
 Mean corpuscular hemoglobin (MCH): is the average amount of
hemoglobin (Hb) per red blood cell and is calculated by dividing the
hemoglobin by the red blood cell count.
• MCH = Hb / RBC
• Normal range: 27-32 pg/cell (pico- is 10-12)
• MCH levels over 34 pg are generally considered abnormally high.
The most common reason for high MCH is macrocytic anemia,
which is a blood disorder in which the body fails to produce enough
red blood cells
• MCH levels below 26 pg are considered abnormally low. Common
causes of Low MCH results include blood loss, iron deficiency and
microcytic anemia, which is a condition in which red blood cells are
abnormally small, carrying less hemoglobin
 Mean corpuscular hemoglobin concentration (MCHC): is the average concentration of hemoglobin
per Packed red blood cells and is calculated by dividing the hemoglobin by the hematocrit.
• MCHC = Hb / Hct
• Normal range: 30-35 g/dL (deci is 10-1)
• Generally, if the MCHC level is over 36%, this is considered to be too high. One reason that the
MCHC level would be too high is because of spherocytosis.
• Spherocytosis is the presence of spherocytes in the blood. Spherocytes are types of red blood
cells that contain an abnormally high amount of hemoglobin.
• If the hemoglobin is not stable, this can also cause the MCHC level to be too high.
• If the MCHC level is below 28%, this is considered too low. The MCHC level can be too low
because of blood loss over time, too little iron in the body, or hypochromic anemia.
• Hypochromic anemia is a condition in which the red blood cells have a decreased amount of
hemoglobin
RDW
• The red cell distribution width (RDW) blood test
measures the amount of red blood cell variat.
• A normal range for red cell distribution width is
11.9 to 15.5 percent in adult females and 11.8 to
15.6 percent in adult males. If you score outside
this range, you could have a nutrient deficiency,
infection, or other disorder. However, even at
normal RDW levels, you may still have a medical
condition.
MPV
• One of the tests run during a CBC is a mean platelet volume (MPV)
test. An MPV test measures the average size of your platelets. It's
closely related to a platelet count test, which measures the number
of platelets in your blood.
• The normal result for MPV for MPV is 7.5-11.5fL for Unisex gender
and for All age groups
• A high MPV means that your platelets are larger than average. This
is sometimes a sign that you're producing too many platelets.
• Platelets are produced in the bone marrow and released into the
bloodstream. Larger platelets are usually young and more recently
released from the bone marrow. Smaller platelets are more likely to
have been in circulation for a few days.
• low MPV means your platelets are smaller than average. Smaller
platelets tend to be older, so a low MPV could mean your bone
marrow isn't producing enough new ones. Again, a low MPV on its
own doesn't mean anything.ve been in circulation for a few days.
ESR
• Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the
degree of inflammation present in the body. The test actually measures the rate of fall
(sedimentation) of erythrocytes (red blood cells) in a sample of blood
• The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women
• There are multiple causes of a high ESR test result. Some common conditions
associated with high rates include:
• anemia
• kidney disease
• lymphoma
• multiple myeloma
• old age
• pregnancy
• A low ESR test result may be due to:
• congestive heart failure
• hypofibrinogenemia
• leukocytosis
• low plasma protein
• polycythemia
• sickle cell anemia
RETICULOCYTE
• Reticulocytes are immature red blood cells.,It’s also known as a retic count, corrected reticulocyte
count, or reticulocyte index
• A reticulocyte count can help if your bone marrow is producing enough red blood cells.
• . The reference range, or healthy range, of the reticulocyte percentage in adults is 0.5 percent to 1.5
percent.
• High reticulocyte levels could be a sign of:
acute bleeding,chronic blood loss,hemolytic anemia ,erythroblastosis fetalis, also called hemolytic
disease in a newborn, a potentially fatal blood disorder that affects some fetuses and newborns
• kidney disease
• Low reticulocyte levels could indicate:
• iron deficiency anemia
• aplastic anemia
• folic acid deficiency
• vitamin B-12 deficiency
• bone marrow failure caused by drug toxicity, infection, or cancer
• kidney disease
• cirrhosis
• side effects from radiation therapy
THANK YOU

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Hematological Tests Explained

  • 1. HAEMATOLOGICAL TESTS Abel C. Mathew PharmD fourth year Roll no -1
  • 2. • Cellular Components of blood derived from pluripotent stem cells in bone marrow. • Bone marrow is a hematopoietic and reticuloendothelial organ, normally produces- ▫ 200 billions RBCs ▫ 1 billion granulocytes daily As reticuloendothelial organ, involved in processing antigens, cellular immune reactions, antibody synthesis, recognition and removal of expired and abnormal cells. Physiology of Blood Cells & Bone Marrow
  • 3. • Cell differentiation is differentiation of pluripotent stem cells into any cell line (red blood cells [RBCs], white blood cells [WBCs], and platelets) takes place in bone marrow. • Hence, hematopoietic system consists of three primary cell components: ▫ Leukocytes, Platelets, and Erythrocytes.
  • 4. • Leukocytes encompasses a functionally diverse group of cells that includes ▫ Neutrophils,Eosinophils, Basophils, Monocytes/Macrophages, Lymphocytes, and Plasma cells. • Platelets (thrombocytes) interact to facilitate blood coagulation. ▫ provision of a specific receptor site for clotting factors, as well as the necessary phospholipid surface for conversion of prothrombin to thrombin, and protection of thrombin from antithrombin. ▫ localization of the thrombus
  • 5. • Reticulocyte is the final cell form that precedes development of mature RBC or erythrocyte. • During maturation, Hgb is produced and incorporated into the cell. • Present in the circulation for 1-2 days before maturation • Mature erythrocytes have a 120-day life span.
  • 6. Introduction Complete blood count (CBC) or Complete Blood Examination (CBE) is routinely ordered test Provides useful information on cellular and non- cellular elements of blood Helps in diagnosis of multiple haematological disorders
  • 7. Routine tests RBC count WBC count Platelet count Hemoglobin (Hgb) Hematocrit (Hct) RBC indices (specifically assess RBCs)  Mean cell volume (MCV)  Mean cell hemoglobin (MCH)  Mean cell hemoglobin concentration (MCHC) Reticulocyte Count RDW MPV ESR
  • 8. TOTAL RBC COUNT • Actual count of red corpuscles in a given amount of blood (cubic millimeter or liter).The RBC count is interpreted in conjunction with red cell indices, haemoglobin and haematocrit. Normal Range- Male: 4.6 to 6.2 x106 cells /mm3 Female: 4.2 to 5.4 x106 cells /mm3
  • 9. • Increased in Certain myeloproliferative neoplasms (example polycythemia vera ), severe dehydration ,RBC counts may be appropriately decreased or increased in certain physiological states. • Decreased in Various types of anemia
  • 10. TOTAL LEUCOCYTE COUNT • Number of leukocytes in a given amount of blood. Describe and classify the white cell components neutrophils, lymphocytes, monocytes, eosinophils, basophils • Normal Range 4.3-10.3 x 10³ cells/ mm³
  • 11. Increased in • Monocytes: If a person has high levels of monocytes, it may indicate the presence of chronic infection, an autoimmune or blood disorder, cancer, or other medical conditions. • Lymphocytes: If there is an elevation in the level of lymphocytes, the condition is known as lymphocytic leukocytosis. This may occur as a result of a virus, or an infection such as tuberculosis. It may also be linked to specific lymphomas and leukemias. • Neutrophils: If a person has heightened levels of neutrophils in their body, the disorder is known as neutrophilic leukocytosis. This condition is a normal physical response to an event, such as infection, injury, inflammation, some medications, and certain types of leukemia.
  • 12. • Basophils: Increased levels of basophils may occur in people with a history of underactive thyroid disease, known as hypothyroidism, or in certain other medical conditions. • Eosinophils: If a person registers high levels of eosinophils, the body may be reacting to a parasitic or other infection, allergen, or asthma.
  • 13. Decreased in • Viral infections that temporarily disrupt the work of bone marrow • Certain disorders present at birth (congenital) that involve diminished bone marrow function • Canceror other diseases that damage bone marrow • Autoimmune disorders that destroy white blood cells or bone marrow cells • Severe infections that use up white blood cells faster than they can be produced • Medications, such as antibiotics, that destroy white blood cells • Sarcoidosis (collections of inflammatory cells in the body)
  • 14. HEMOGLOBIN (Hb) Hemoglobin is the respiratory protein of RBCs, consisting of 3.8 % heme and 96.2 % globin. Hb amount in he given volume(100ml or 1 liter) of whole blood. Provides a direct indication of the oxygen-transport capacity of the blood. Normal Range Male: 14 to 18g/dl Female: 12 to 16g/dl
  • 15. Decreased in Hb is educed in all anemias , in most cases as a consequence of another underlying disease or a deficiency (iron , folate, vitamin B12 ) Increased in Hb is higher as a physiologic response to high altitude due to low oxygen tension or in advanced lung or cardiac disease Certain meloproliferative neoplasms (example polycythemia vera )
  • 16. PLATELET COUNTS • They are small discoid blood corpuscles, the primary link in achieving hemostasis. • Normal Range 150-450 x 1000 cells /mm³ Increased in Clonal bone marrow disorders such as myeloproliferative neoplasms Reactive: after acute haemorrhage, in malignancies ( about 50 % of patients with ‘ unexpected’ thrombocytosis are found to have a malignancy), after splenectomy, severe trauma, infections, chronic inflammatory disorders, drug reactions, and many miscellaneous conditions
  • 17. Decreased in Immune destruction such as in ITP, reaction to certain drugs, aplastic anemia, leukemias, lymphoproliferative diseases, hypersplenism,DIC, or TTP/HUS and with extracorporeal circulation Following chemotherapy, post-transfusion thrombocytopenia Numerous congenital conditions which may be associated with low platelet counts.
  • 18. HEMATOCRIT (HCT) / PACKED CELL VOLUME (PCV): It is the percentage volume of blood that is composed of erythrocytes. Hct is usually about 3 times the value of Hgb. Normal Range: Male: 42 to 52 % Female: 37 to 47% Abnormalities in Hct levels parallel those for Hb.
  • 19. Decreased in Hb is educed in all anemias , in most cases as a consequence of another underlying disease or a deficiency (iron , folate, vitamin B12 ) Increased in Hb is higher as a physiologic response to high altitude due to low oxygen tension or in advanced lung or cardiac disease Certain meloproliferative neoplasms (example polycythemia vera )
  • 20. RBCs Indices • They are part of the complete blood count (CBC) test that provide information about the hemoglobin content and size of red blood. They are used in diagnosis of anemia and it’s causes. Mean corpuscular volume (MCV): is the average size of a red blood cell and is calculated by dividing the hematocrit (Hct) by the red blood cell count. • MCV = Hct / RBC ▫ Normal range: (78-98) fL (femto- is 10-15) ▫ Normal MCV = normocytic anemia ▫ Decreased MCV = microcytic anemia ▫ Increased MCV = macrocytic anemia
  • 21.  Mean corpuscular hemoglobin (MCH): is the average amount of hemoglobin (Hb) per red blood cell and is calculated by dividing the hemoglobin by the red blood cell count. • MCH = Hb / RBC • Normal range: 27-32 pg/cell (pico- is 10-12) • MCH levels over 34 pg are generally considered abnormally high. The most common reason for high MCH is macrocytic anemia, which is a blood disorder in which the body fails to produce enough red blood cells • MCH levels below 26 pg are considered abnormally low. Common causes of Low MCH results include blood loss, iron deficiency and microcytic anemia, which is a condition in which red blood cells are abnormally small, carrying less hemoglobin
  • 22.  Mean corpuscular hemoglobin concentration (MCHC): is the average concentration of hemoglobin per Packed red blood cells and is calculated by dividing the hemoglobin by the hematocrit. • MCHC = Hb / Hct • Normal range: 30-35 g/dL (deci is 10-1) • Generally, if the MCHC level is over 36%, this is considered to be too high. One reason that the MCHC level would be too high is because of spherocytosis. • Spherocytosis is the presence of spherocytes in the blood. Spherocytes are types of red blood cells that contain an abnormally high amount of hemoglobin. • If the hemoglobin is not stable, this can also cause the MCHC level to be too high. • If the MCHC level is below 28%, this is considered too low. The MCHC level can be too low because of blood loss over time, too little iron in the body, or hypochromic anemia. • Hypochromic anemia is a condition in which the red blood cells have a decreased amount of hemoglobin
  • 23. RDW • The red cell distribution width (RDW) blood test measures the amount of red blood cell variat. • A normal range for red cell distribution width is 11.9 to 15.5 percent in adult females and 11.8 to 15.6 percent in adult males. If you score outside this range, you could have a nutrient deficiency, infection, or other disorder. However, even at normal RDW levels, you may still have a medical condition.
  • 24. MPV • One of the tests run during a CBC is a mean platelet volume (MPV) test. An MPV test measures the average size of your platelets. It's closely related to a platelet count test, which measures the number of platelets in your blood. • The normal result for MPV for MPV is 7.5-11.5fL for Unisex gender and for All age groups • A high MPV means that your platelets are larger than average. This is sometimes a sign that you're producing too many platelets. • Platelets are produced in the bone marrow and released into the bloodstream. Larger platelets are usually young and more recently released from the bone marrow. Smaller platelets are more likely to have been in circulation for a few days. • low MPV means your platelets are smaller than average. Smaller platelets tend to be older, so a low MPV could mean your bone marrow isn't producing enough new ones. Again, a low MPV on its own doesn't mean anything.ve been in circulation for a few days.
  • 25. ESR • Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body. The test actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a sample of blood • The normal range is 0-22 mm/hr for men and 0-29 mm/hr for women • There are multiple causes of a high ESR test result. Some common conditions associated with high rates include: • anemia • kidney disease • lymphoma • multiple myeloma • old age • pregnancy • A low ESR test result may be due to: • congestive heart failure • hypofibrinogenemia • leukocytosis • low plasma protein • polycythemia • sickle cell anemia
  • 26. RETICULOCYTE • Reticulocytes are immature red blood cells.,It’s also known as a retic count, corrected reticulocyte count, or reticulocyte index • A reticulocyte count can help if your bone marrow is producing enough red blood cells. • . The reference range, or healthy range, of the reticulocyte percentage in adults is 0.5 percent to 1.5 percent. • High reticulocyte levels could be a sign of: acute bleeding,chronic blood loss,hemolytic anemia ,erythroblastosis fetalis, also called hemolytic disease in a newborn, a potentially fatal blood disorder that affects some fetuses and newborns • kidney disease • Low reticulocyte levels could indicate: • iron deficiency anemia • aplastic anemia • folic acid deficiency • vitamin B-12 deficiency • bone marrow failure caused by drug toxicity, infection, or cancer • kidney disease • cirrhosis • side effects from radiation therapy