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Investigation in hematology

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Investigation in hematology

  1. 1. Investigation in hematology Chittima Sirijerachai
  2. 2. Investigation in hematology • Anemia • Bleeding • Malignancy
  3. 3. Investigation in patient with anemia Specific Initial • Inclusion body• CBC, blood smear • Osmotic fragility• Red cell indicies • Saline agglutination • Coombs’ test• Reticulocyte count • Hb typing • Ham’s test • BM aspiration
  4. 4. CBC -anemiaHb, HCT -polycythemia -leukocytosis WBC -leukopenia -abnormal cells -thrombocytosisPlatelet -thrombocytopenia
  5. 5. Criteria for Diagnosis Anemia Hb.( g/dl) Hct (%)Children 11.0 33Male 13.0 40Female ( 15-50 ) 12.0 36Female ( > 50 ) 13.0 40Pregnant women 11.0 33
  6. 6. Criteria for diagnosis polycythemia Hb Hct• Male 18 60• Female 17.5 55
  7. 7. CBC -anemiaHb, HCT -polycythemia -leukocytosis WBC -leukopenia -abnormal cells -thrombocytosisPlatelet -thrombocytopenia
  8. 8. Normal valueWBC 5,000 – 10,000 /cu.mm.PMN 40-75 %L 20-50 %Eo 1-6 %B 1 %
  9. 9. Leukocyte disordersleukocytosis leukopenianeutrophilia neutropenialymphocytosis lymphopeniaeosinophiliabasophiliamonocytosisleukemoid reactionleukemialeukoerythroblastic (myelophthisis)
  10. 10. CBC -anemiaHb, HCT -polycythemia -leukocytosis WBC -leukopenia -abnormal cells -thrombocytosisPlatelet -thrombocytopenia
  11. 11. CBC and RBC indices 80-96 fl. 27-33 pg. 33-36 g/dl 12.0-13.6%
  12. 12. Reticulocyte count Normal = 0.2-2 %Corrected reticulocyte = Pt HCT X Reti. Normal HCT
  13. 13. Inclusion bodyHeinz body
  14. 14. Osmotic fragility (OF)• Red cell + 0.33 % NSS• One tube OF – screening for thalassemia• Hereditary spherocytosis
  15. 15. Bone marrow aspirationIndication :-• Cytopenia• Myelophthisis anemia• Leukemia• Lymphoma staging• Myeloproliferative disorders• Fever of unknown origin
  16. 16. Thalassemia - α thalassemia - β thalassemia- hemoglobinopathy
  17. 17. α thalassemiaα1 trait = _ _ /ααα2 trait = _ α/ααα1 α2 = __/_αα1 α1 = __/__α 2 α2 = _ α/ _ α
  18. 18. β thalassemia β 0 β +
  19. 19. Normal hemoglobin α 2β 2 = Hb A βα α 2γ 2 = Hb F γ α2 δ2 = Hb A2 δ
  20. 20. α thalassemia Hb A β Hb A2 Hb Fα γ δ β4 = Hb H γ4 = Hb Bart’s
  21. 21. β thalassemia Hb Aα β Hb A2 γ Hb F δ
  22. 22. Heterozygote hemoglobin E β α 2β 2 = Hb A Αα βE α 2β Ε = Hb E γ 2 δ 25-35 %
  23. 23. β thalassemia/Hb E Hb A / absentα β E Hb A2/ Hb E γ Hb F δ
  24. 24. Father Mother sibling 1 sibling 2Hct 45% 33 % 42% 36 %MCV 70 65 82 70%Hb typing A2A A2ABart’s H A2A A2AHb A % 96 91 97 98Hb A2 2.2 1.4 1.1 1.5Hb F 1.3Hb EHb Bart’s 3.3Hb H 7.5Hb CS α 1 trait α 1α 2 α 2 trait α 1 traitgenotype
  25. 25. Father mother sibling 1 sibling 2Hct 40 % 40% 25 45%MCV 72 84 65 85Hb typing A2A EA EF A2AHb A % 94 98Hb A2 5.5 1.5Hb F 32Hb E 30 65Hb Bart’sHb HHb CS β trait E trait β /E normalgenotype
  26. 26. Investigation in patient with bleeding disorders
  27. 27. InvestigationCBC, platelet countBleeding timePlatelet function testVenous clotting timeProthrombin time (PT)Partial thromboplastin time (PTT)
  28. 28. CBC and plateletPlatelet: < 20,000 Spontaneous bleeding 20,000-50,000 Bleed after minor trauma 50,000-70,000 Bleed after major trauma
  29. 29. CBC and platelet
  30. 30. Giant platelet
  31. 31. Bleeding time•Platelet function•Normal: 2-7 minute
  32. 32. PTT
  33. 33. PT
  34. 34. TT
  35. 35. Venous clotting timeNormal: 5-20 minuteProlong if clotting factor is <5 %Small clot - hypofribinogenemiaClot retraction time (plt function)Clot lysis time
  36. 36. Prothrombin time (PT)Normal: 11.6-14.4 secPT ratio = patient PT Normal < 1.3 Control PT ISIINR = patient PT Control PTISI = international sensitivity index
  37. 37. Partial thromboplastin time (PTT) Normal = 34-48 sec Isolated PTT prolong: •F VIII, IX, XI, XII deficiency •F VIII, IX, XI inhibitor •Antiphospholipid syndrome
  38. 38. Mixing testPatient plasma 0 hour PTTNormal plasma 2 hourCorrectable PTT Factor deficiency

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