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Hematology review '04

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Hematology review '04

  1. 1. Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi
  2. 2. Introduction <ul><li>Hematology: the study of blood and blood forming tissues. </li></ul><ul><li>Blood consists of 55% plasma and 45% formed elements. </li></ul><ul><li>Formed elements include erythrocytes, leukocytes, and thrombocytes. </li></ul>
  3. 3. Erythrocytes <ul><li>Normal range 4.2-5.5 million per mm 3 in adults. </li></ul><ul><li>Biconcave shape. </li></ul><ul><li>Diameter 7 microns. </li></ul><ul><li>Cells for transport of O 2 and CO 2 . </li></ul><ul><li>Life span 120 days. </li></ul>
  4. 4. Leukocytes <ul><li>Normal range 4 - 11 thousand per mm 3 in adults. </li></ul><ul><li>Five types. </li></ul><ul><li>Size 8-20 microns. </li></ul><ul><li>Involved in fighting infection, combatting allergic reactions, and immune responses. </li></ul>
  5. 5. Thrombocytes <ul><li>Smallest cells in the blood. </li></ul><ul><li>Normal range 130,000-400,000. </li></ul><ul><li>Active role in coagulation and hemostasis. </li></ul>
  6. 6. Routine Hematology <ul><li>Anticoagulant of choice: EDTA </li></ul><ul><li>Complete Blood Counts (CBCs) </li></ul><ul><li>Manual WBC Differentials </li></ul><ul><li>Erythrocyte Sedimentation Rates (ESRs) </li></ul><ul><li>Sickle Screens </li></ul><ul><li>Reticulocyte Counts </li></ul>
  7. 7. Automated Counting <ul><li>Coulter Principle </li></ul><ul><li>Electrical impedance: resistance or change in current when cell passes between two electrodes in NaCl solution. </li></ul>
  8. 8. Automated Counting <ul><li>Flow Cytometry </li></ul><ul><li>Uses lasers to measure both forward and side scatter. </li></ul><ul><li>Forward scatter measures size. </li></ul><ul><li>Side scatter measures granularity. </li></ul>
  9. 9. Sources of Error <ul><li>Inadequate mixing of specimen . </li></ul><ul><li>Hemolyzed specimens. </li></ul><ul><li>Lipemic specimens. </li></ul><ul><li>Cold agglutinins. </li></ul><ul><li>Clotted specimens. </li></ul><ul><li>Platelet clumps or platelet satellitosis. </li></ul><ul><li>Diluted specimens. </li></ul>
  10. 10. Know Normal Ranges!!! <ul><li>WBC </li></ul><ul><li>RBC </li></ul><ul><li>HGB </li></ul><ul><li>HCT </li></ul><ul><li>MCV </li></ul><ul><li>MCH </li></ul><ul><li>MCHC </li></ul><ul><li>PLT </li></ul><ul><li>MPV </li></ul><ul><li>SEGS </li></ul><ul><li>LYMPHS </li></ul><ul><li>MONOCYTES </li></ul><ul><li>EOSINOPHILS </li></ul><ul><li>BASOPHILS </li></ul>
  11. 11. Erythrocytic Maturation Series <ul><li>Rubriblast </li></ul><ul><li>Prorubricyte </li></ul><ul><li>Rubricyte </li></ul><ul><li>Metarubricyte </li></ul><ul><li>Reticulocyte </li></ul><ul><li>Erythrocyte </li></ul>
  12. 12. RBC Morphology
  13. 13. Elliptocytes Target Cells
  14. 14. Tear Drops Stomatocytes
  15. 15. Sickle Cells Schistocytes
  16. 16. RBC Inclusions
  17. 17. Howell-Jolly Bodies <ul><li>Round, purple inclusions in RBCs . </li></ul><ul><li>Composed of DNA. </li></ul><ul><li>Commonly seen in in patients with hypofunctioning spleens. </li></ul><ul><li>Splenectomy. </li></ul>
  18. 18. Basophilic Stippling <ul><li>Numerous, small purple inclusions in RBCs . </li></ul><ul><li>Aggregates of ribosomal RNA. </li></ul><ul><li>Most commonly seen in lead poisoning. </li></ul>
  19. 19. Pappenheimer Bodies <ul><li>Clusters of dark blue granules, irregular in size and shape. </li></ul><ul><li>Composed of iron and ribosomal RNA. </li></ul><ul><li>Seen in sideroblastic and hemolytic anemias. </li></ul>
  20. 20. Classifications of Anemias <ul><li>Microcytic, Hypochromic </li></ul><ul><ul><li>Iron deficiency </li></ul></ul><ul><ul><li>Sideroblastic </li></ul></ul><ul><ul><li>Chronic disease, Inflammation </li></ul></ul><ul><ul><li>Lead poisoning </li></ul></ul><ul><ul><li>Thalassemia trait </li></ul></ul>
  21. 21. Microcytic, Hypochromic <ul><li>Many RBCs smaller than </li></ul><ul><li>nucleus of normal </li></ul><ul><li>lymphocytes, increased central pallor. </li></ul><ul><li>Iron deficiency, thalassemias, anemia of chronic disease. </li></ul>
  22. 22. Classifications of Anemias <ul><li>Normochromic </li></ul><ul><ul><li>Hereditary Spherocytosis </li></ul></ul><ul><ul><li>Hereditary Elliptocytosis </li></ul></ul><ul><ul><li>PNH </li></ul></ul><ul><ul><li>G6PD deficiency </li></ul></ul><ul><ul><li>Aplastic anemia </li></ul></ul><ul><ul><li>Acute blood loss </li></ul></ul>
  23. 23. Classifications of Anemias <ul><li>Macrocytic </li></ul><ul><ul><li>Vitamin B12 deficiency </li></ul></ul><ul><ul><li>Folate deficiency </li></ul></ul><ul><ul><li>Liver disease </li></ul></ul>
  24. 24. Macrocytic RBCs <ul><li>Most RBCs larger than nucleus of normal </li></ul><ul><li>lymphocytes, increased MCV. </li></ul><ul><li>Folate or Vitamin B12 deficiencies, alcoholism, and liver disease. </li></ul>
  25. 25. Reticulocytes <ul><li>Immature RBCs. </li></ul><ul><li>Contain residual </li></ul><ul><li>ribosomal RNA. </li></ul><ul><li>Reticulum stains blue using a supravital stain (new methylene blue). </li></ul><ul><li>Counted and expressed as % of total red cells. </li></ul>
  26. 26. Reticulocyte Count <ul><li>Uses supravital stain which stains cells in the living state. </li></ul><ul><li>Retic % = # retics per 1000 RBCs </li></ul><ul><li> 10 </li></ul><ul><li>Corrected retic= % retics x pt. HCT </li></ul><ul><li>45 </li></ul>
  27. 27. Hemoglobinopathies <ul><li>Beta Chain Substitutions </li></ul><ul><li>Hgb S: Valine for glutamic acid </li></ul><ul><li>(6th position, beta chain) </li></ul><ul><li>Hgb C: Lysine for glutamic acid </li></ul><ul><li>(6th position, beta chain) </li></ul>
  28. 28. Hemoglobinopathies <ul><li>Alkaline Electrophoresis </li></ul><ul><li>- C S F A + </li></ul><ul><li>A 2 D </li></ul><ul><li>E G O </li></ul>
  29. 29. WBC Evaluation
  30. 30. Myelocytic Maturation Series <ul><li>Myeloblast </li></ul><ul><li>Promyelocyte </li></ul><ul><li>Myelocyte </li></ul><ul><li>Metamyelocyte </li></ul><ul><li>Band Neutrophil </li></ul><ul><li>Segmented Neutrophil </li></ul>
  31. 31. Toxic Granulation <ul><li>Increased basophilic granules </li></ul><ul><li>in neutrophils. </li></ul><ul><li>Seen in severe infections, burns, malignancies, and pregnancy. </li></ul><ul><li>Distinguish from basophils. </li></ul>
  32. 32. Dohle Bodies <ul><li>Sky blue inclusions in cytoplasm of neutrophils. </li></ul><ul><li>Seen in infections, burns, myleproliferative disorders, and pregnancy. </li></ul><ul><li>Composed of RER and glycogen granules. </li></ul>
  33. 33. Pelger-Huet Anomaly
  34. 34. Special Stains <ul><li>PAS: ALL, Erytrholeukemia </li></ul><ul><li>LAP: CML v. Leukomoid Reaction </li></ul><ul><li>Myeloperoxidase: AML, AMMoL (weak+) </li></ul><ul><li>Sudan Black: AML, AMMoL (weak+) </li></ul><ul><li>Specific Esterase: AML, AMMoL </li></ul><ul><li>Non-specific Esterase: AMML, AMoL </li></ul><ul><li>TRAP: Hairy Cell Leukemia </li></ul><ul><li>TDT: ALL </li></ul><ul><li>Prussian Blue: Sideroblastic Anemia </li></ul>
  35. 35. CML versus Leukomoid Reaction <ul><li>Characteristic CML Leukomoid </li></ul><ul><li>LAP score Decreased Increased </li></ul><ul><li>Toxic gran. Decreased Increased </li></ul><ul><li>Dohle bodies Absent Present </li></ul><ul><li>Philadelphia May be present Absent </li></ul><ul><li>chromosome </li></ul>
  36. 36. WBC Disorders <ul><li>Alder-Reilly : Large azurophilic granules, increased mucopolysaccharides </li></ul><ul><li>Chediak-Higashi : Membrane defect of lysosomes, large primary granules in segs </li></ul><ul><li>May-Hegglin : Familial disorder with large platelets and Dohle bodies </li></ul><ul><li>Pelger-Huet : Hyposegmented neutrophils </li></ul>
  37. 37. FAB Classifications <ul><li>M1: Myeloblastic without maturation </li></ul><ul><li>M2: Myeloblastic with maturation </li></ul><ul><li>M3: Promyelocytic </li></ul><ul><li>M4: Myelomonocytic </li></ul><ul><li>M5a: Monocytic, poorly differentiated </li></ul><ul><li>M5b: Monocytic, well differentiated </li></ul><ul><li>M6: Erythroleukemia, DiGuglielmo’s </li></ul><ul><li>M7: Megakaryoblastic </li></ul>
  38. 38. Acute Myeblastic Leukemia (M1)
  39. 39. Chronic Myelogenous Leukemia
  40. 40. FAB Classifications <ul><li>L1: Small, uniform lymphoblasts </li></ul><ul><li>L2: Large, pleomorhphic lymphoblasts </li></ul><ul><li>L3: Burkitt’s type (vacuolated and </li></ul><ul><li> deeply basophilic cytoplasm) </li></ul>
  41. 41. Acute Lymphoblastic Leukemia
  42. 42. Chronic Lymphocytic Leukemia
  43. 43. Body Fluids
  44. 44. Types of Body Fluids <ul><li>Cerebrospinal Fluid (CSF) </li></ul><ul><li>Pleural Fluid </li></ul><ul><li>Pericardial Fluid </li></ul><ul><li>Peritoneal Fluid </li></ul><ul><li>Synovial Fluid </li></ul><ul><li>Amniotic Fluid </li></ul><ul><li>Miscellaneous Fluids </li></ul>
  45. 45. Body Fluids Testing <ul><li>Physical examination </li></ul><ul><li>RBC and WBC counts </li></ul><ul><li>WBC differential </li></ul><ul><li>Crystal examination* </li></ul><ul><li>Rope’s test* </li></ul><ul><li>*Refers to synovial fluids only. </li></ul>
  46. 46. Cerebrospinal Fluid (CSF) <ul><li>Examined to determine the presence of meningitis or intracranial hemorrhage. </li></ul><ul><li>Multiple tubes drawn (4). </li></ul><ul><li>Differentiate between traumatic tap and intracranial hemorrhage. </li></ul><ul><li>Xanthochromia is indicative of intracranial hemorrhage. </li></ul>
  47. 47. Quick Review <ul><li>Differentiate between traumatic tap and intracranial hemorrhage. </li></ul><ul><li>Differentiate between transudate and exudate. </li></ul><ul><li>Crystal identification and associated conditions. </li></ul>
  48. 48. Traumatic Tap v. Intracranial Hemorrhage <ul><li>Traumatic Tap </li></ul><ul><li>Decreasing amounts of blood with each tube drawn </li></ul><ul><li>May contain clots </li></ul><ul><li>No xanthochromia </li></ul><ul><li>Supernatant clear </li></ul><ul><li>Intracranial Hemorrhage </li></ul><ul><li>Blood evenly distributed throughout collection tubes </li></ul><ul><li>No clots </li></ul><ul><li>Xanthochromia </li></ul><ul><li>Hemosiderin, hematoidin crystals </li></ul>
  49. 49. Transudates v. Exudates <ul><li>Characteristic Transudate Exudate </li></ul><ul><li>Appearance Clear, colorless Yellow, turbid, purulent, bloody </li></ul><ul><li>Specific gravity <1.015 >1.015 </li></ul><ul><li>Protein <3 g/dL >3 g/dL </li></ul><ul><li>LD <200 IU >200 IU </li></ul><ul><li>Cell count <1000/uL >1000/uL </li></ul><ul><li>Conditions Congestive Infections, </li></ul><ul><li> Heart failure Malignancies </li></ul>
  50. 50. Crystal Identification <ul><li>Monosodium urate (uric acid) </li></ul><ul><ul><li>Yellow when parallel to the compensator, and blue when perpendicular. </li></ul></ul><ul><ul><li>Seen in gout. </li></ul></ul><ul><li>Calcium pyrophosphate </li></ul><ul><ul><li>Blue when parallel to the compensator, and yellow when perpendicular. </li></ul></ul><ul><ul><li>Seen in pseudogout. </li></ul></ul>
  51. 51. Crystal Identification
  52. 52. Good Luck!!!!

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