This document provides an overview of a complete blood count (CBC) or hemogram test. It discusses the components of a CBC including red blood cell count, hemoglobin levels, hematocrit, mean corpuscular volume (MCV), white blood cell count, and platelet count. It defines and provides the normal ranges for these components. It also summarizes various types of anemia such as iron deficiency anemia, thalassemia, anemia of chronic disease, and hemolytic anemia, how they present on a CBC, and approaches to differentiating between them. The document emphasizes the importance of the CBC in evaluating patients for many medical conditions.
Hematology is the branch of medicine, that is concerned with the study of blood, blood forming organs and blood diseases. It includes study of etiology, diagnosis, treatment, prognosis and prevention of blood diseases .
After the completion of this presentation we will know about:
What is hematology and its purpose.
hematology laboratory.
Blood and its compositions and collections
Hematology lab equipment's
Some hematological tests , disease and hazards too.
Hematology is the branch of medicine, that is concerned with the study of blood, blood forming organs and blood diseases. It includes study of etiology, diagnosis, treatment, prognosis and prevention of blood diseases .
After the completion of this presentation we will know about:
What is hematology and its purpose.
hematology laboratory.
Blood and its compositions and collections
Hematology lab equipment's
Some hematological tests , disease and hazards too.
Notes about blood hemoglobin estimation, lecture notes to Medical Laboratory Students at Medical Laboratory Technology, Middle Technical University, Baqubah, Iraq
anemia is define as decrease in Hb concentration below the lower limit of normal value according to the age and sex of the individual is call anemia. anemia can be classify by different ways some are as in this presentation
Urine examination how to approach final.ppt1Sachin Verma
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
the presentation will allow you to identify the different state maturation of RBC and to see the the different abnormally including the cell membrane abnormality , the inclusion bodies may appear in RBC ,and other cell abnormality.
A complete blood count (CBC) is a group of tests that provide information about blood cells like Red Blood Cells (RBC), White Blood Cells (WBC) and platelets. It is routinely performed to provide an overview of a patient's general health status.
Reference: https://www.1mg.com/labs/test/complete-blood-count-1717
This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
A presentation made by Dr Gauhar Mahmood Azeem on the interpretations of a simple CBC and the information it can give us, Various conditions which may cause derangement are mentioned,
Notes about blood hemoglobin estimation, lecture notes to Medical Laboratory Students at Medical Laboratory Technology, Middle Technical University, Baqubah, Iraq
anemia is define as decrease in Hb concentration below the lower limit of normal value according to the age and sex of the individual is call anemia. anemia can be classify by different ways some are as in this presentation
Urine examination how to approach final.ppt1Sachin Verma
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
the presentation will allow you to identify the different state maturation of RBC and to see the the different abnormally including the cell membrane abnormality , the inclusion bodies may appear in RBC ,and other cell abnormality.
A complete blood count (CBC) is a group of tests that provide information about blood cells like Red Blood Cells (RBC), White Blood Cells (WBC) and platelets. It is routinely performed to provide an overview of a patient's general health status.
Reference: https://www.1mg.com/labs/test/complete-blood-count-1717
This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
A presentation made by Dr Gauhar Mahmood Azeem on the interpretations of a simple CBC and the information it can give us, Various conditions which may cause derangement are mentioned,
Seven Basic Tools of Quality
A designation given to a fixed set of graphical techniques identified as being most helpful in troubleshooting issues related to quality.
CBC interpretation in routine clinical practice.pptxDibyajyoti Prusty
CBC: Basic haematologic and systemic evaluation
-It offers a comprehensive assessment of the cellular components that circulate within the bloodstream revealing wide range of medical conditions
We will discuss :
Blood, Blood components, Blood cells, Haematopoiesis
CBC parameters and clinical significance
Use in Clinical Practice
CBC analyser, Technical aspects
What next after analysing a CBC report
Futuristic aspects
Blood is a specialized body fluid
Transporting oxygen and nutrients to the lungs and tissues: RBCs
Forming blood clots to prevent excess blood loss: Platelets
Carrying cells (WBCs) and antibodies (Plasma) that fight infection
Bringing waste products to the kidneys and liver, which filter and clean the blood
Regulating body temperature
Plasma : a mixture of water, sugar, fat, protein, and salts. Transport blood cells throughout body along with nutrients, waste products, antibodies, clotting proteins, hormones, and proteins that help maintain the body's fluid balance.
Red blood cells (Erythrocytes): Controlled by erythropoietin. No nucleus and can easily change shape. Contain a special protein called haemoglobin. The percentage of whole blood volume that is made up of red blood cells is called the haematocrit.
White blood cells (Leukocytes): White blood cells protect the body from infection
Platelets (Thrombocytes): Platelets are not actually cells but rather small fragments of cells. Helps in blood clotting process
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Cbp (3)complete blood picture
1. Complete blood count in primary
care
COMPLETE
BLOOD PICTURE
Dr.N.R.K.Anil Kumar,
Ist Year Post Graduate,
Vishnu Dental College.
2. INTRODUCTION
• CBP or hemogram:
One of the most common lab investigations.
• It assesses:
• Red blood cells
(RBC count, hemoglobin, ESR, PCV, MCV, MCH,
MCHC)
• White blood cells (WBC, DC)
• Platelets (platelet count, BT, CT)
• Blood grouping
5. Anemia- when blood has low O2 carrying
capacity; insufficient RBC or iron deficiency.
-Due to blood loss
-Due to nutritional deficiency
-Due to destruction of RBC
-Due to defects in bone marrow
6. Polycythemia- abnormal increase in the RBC count.
-8-11 million cells/mm3
-Physiologically seen in people living in high altitudes.
-Pathologically it can be primary or secondary.
-Primary is polycythemia vera, a myeloproliferative
disorder.
-Secondary seen in conditions like
- respiratory disorders like emphysema
- congenital heart disease
- chronic carbon monoxide poisoning
- repeated mild heamorrhages.
7. Hb %
AGE Hb%
At birth 25 gm%
After 3rd
month 20 gm%
After 1 year 17 gm%
Adult male 15 gm%
Adult female 14.5 gm%
Hb often accompanied by PCV can reflect
- Decreased plasma volume (eg: dehydration, alcohol,
cigarette, smoking, diuretics) or
- Increased red cell mass (eg polycythaemia)
8. HEMATOCRIT (PCV)
% of blood volume consisting of erythrocytes (red blood
cells)
In Males 40 – 45 %
In Female 38 – 42 %
9. ESR
• Normally, red blood cells remain suspended
uniformly in circulation called suspension stability of
RBC.
• When blood mixed with an anticoagulant is allowed
to stand in a vertical tube, the red cells settle down
due to gravity with a supernatant layer of clear fluid.
• The rate at which the cells settle down is called
erythrocyte sedimentation rate.
• Methods
• 1) westergren’s method :
• 2) wintrobe’s method :
10. • Factors affecting ESR :
specific gravity of RBC, rouleaux formation, size
of RBC, viscosity of blood, RBC count.
variations in ESR :
- less in infants and children
- more in females
- from 3rd
month until parturition increased
upto 35mm per hr.
11. ESR INCREASED ESR DECREASED
All types of anemia’s except sickle
cell anemia
Sickle cell anemia
Tuberculosis Allergic conditions
Malignant tumors Polycythemia
Rheumatoid arthritis Extreme leukocytosis
Rheumatic fever Peptone shock
Liver diseases
It is especially useful in assessing the chronic diseases and
their prognosis during treatement
12. MCV
• MCV (Mean corpuscular volume)
PCV in 100 ml of blood x 10
• MCV =
RBC count in million per cc
This is the average volume of the RBC
Useful to classify the anaemia
– Microcytic, MCV < 80 cu.microns
– Normocytic, MCV 80 – 100 cu.microns
– Macrocytic, MCV > 100 cu.microns
13. MCH
• MCH (Mean corpuscular hemoglobin)
Hb% in 100 ml of blood x 10
• MCH =
RBC count in million per cc
This is the quantity of hemoglobin present in one RBC.
Useful to classify the anaemia
– Normochromic, MCH 27 – 33 pg
– Hypochromic, MCH < 27 pg
14. MCHC
• MCHC (Mean corpuscular hemoglobin concentration)
Hb% in 100 ml of blood x 100
• MCHC =
PCV IN 100 ml of blood
• Indicates the concentration of hemoglobin in one RBC.
• Most important absolute value in diagnosis of anemia.
• Normal range is 30 to 38 %.
15. RETICULOCYTE COUNT
• Reticulocytes: immature RBCs
• Number helps to determine causes of anemia. Normal
reticulocyte count is 1.0-2.0%
• Low reticulocyte <2.5%= decreased marrow production of
RBCs causing anemia
• Elevated reticulocyte > 2.5% = indicates anemia caused
by RBC loss
16. RDW
RDW = Red blood cell distribution width
Standard deviation of red cell volume
× 100
mean cell volume
– Normal value is 11-15%
– If elevated, suggests large variability in sizes of RBCs
17. Definition of Anemia
Deficiency in the oxygen-carrying capacity
of the blood due to a diminished erythrocyte
mass.
May be due to:
Erythrocyte loss (bleeding)
Decreased Erythrocyte production
low erythropoietin
Decreased marrow response to erythropoietin
Increased Erythrocyte destruction (hemolysis)
18. Evaluating the Patient with Anemia
• Check Hemoglobin/Hematocrit
– If female, is Hgb < 12 or Hct < 36?
– If male, is Hgb < 13.5 or Hct < 41?
– If Yes, Patient has ANEMIA!
– If No, they are fine.
19. Evaluating the Patient with Anemia
• Are the other cell lines also low?
– If WBC and platelets are both low, consider
APLASTIC ANEMIA!
– Check medication list
» NSAIDS (phenylbutazone), Sulfonamides,
Acyclovir, Gancyclovir, chloramphenicol, anti-
epileptics (phenytoin, carbamazepine, valproic
acid), nifedipine
» Check parvovirus B19 IgG, IgM
» Consider hepatitis viruses, HIV
– If Platelets are low consider TTP or HUS!
– Must check smear for schistocytes (for sign of
microangiopathic hemolytic anemia)
– If renal failure, E. Coli O157:H7 exposure → HUS
– If renal failure, neurologic changes, fever → TTP
20. ANEMIA
RETICULOCYTE COUNT
LESS THAN 2.5
RETICULOCYTE COUNT
MORE THAN 2.5
RED CELL MORPHOLOGY
NORMOCYTIC
NORMOCHROMIC
MARROW DAMAGE,
DECREASED
ERYTHROPOITIN
MICROCYTIC OR
MACROCYTIC
NUCLEAR : B12 DEF, FOLATE DEF,
DRUG TOXICITY
CYTOPLASMIC : Fe DEF ANEMIA,
THALASSEMIA, SIDEROBLASTIC
HEMOLYTIC ANEMIA
OR
HEAMORRHAGE
21. Evaluating the Patient with Anemia
– If MCV < 80, then it’s a microcytic anemia
The three most common causes for microcytic
anaemia are:
– Iron deficiency
– Thalassaemia
– Anaemia of Chronic disease
• Check serum iron, ferritin, TIBC
– If iron-deficiency anemia, look for sources of
chronic bleeding – heavy menstrual bleeding,
consider colonoscopy
• Consider lead poisoning, copper deficiency,
thalassemias.
22. Differentiating Microcytic Anemias
Type of
Anemia
Ferritin TIBC Iron Other
Features
IDA ↓ ↑ ↓ Fe/TIBC<18%
Thalassemia Normal Normal Normal Basophilic
Stippling
ACD N or ↑ ↓ ↓ Fe/TIBC>18%
Sideroblastic ↑ Normal ↑ Ringed
Sideroblasts
23. Iron Deficiency Anemia – Lab
Findings
• Serum Iron
• LOW (< 60 micrograms/dL)
• Total Iron Binding Capacity (TIBC)
• HIGH ( > 360 micrograms/dL)
• Serum Ferritin
• LOW (< 20 nanograms/mL)
• Can be “falsely”normal in inflammatory
states
25. Anemia of Chronic Disease
• Usually normocytic, normochromic (but
can become hypochromic, microcytic over
time)
• Occurs in people with inflammatory
conditions such as collage vascular
disease, malignancy or chronic infection.
26. Evaluating the Patient with Anemia
– If MCV 80-100, then it’s a normocytic anemia
• Any inflammatory conditions that could result
in anemia of chronic disease?
• Consider checking indirect bili, LDH,
haptoglobin, reticulocyte count
27. Normocytic anaemia
The causes of normocytic anaemia include:
– Bleeding
– Early nutritional anaemia (iron, B12, folate
deficiencies)
– Anaemia of renal insufficiency
– Anaemia of chronic disease/chronic
inflammation
– Haemolysis
– Primary bone marrow disorder
28. Evaluating the Patient with Anemia
– If MCV > 100, then it’s a macrocytic anemia
• Check Vit. B 12, folate
• Consider liver disease, alcoholism,
myelodysplastic syndrome
• Check medications: hydoxyurea, AZT,
methotrexate
29. Macrocytic anaemia
Common causes:
– Alcohol
– Liver disease
– B12 or folate deficiency
– Thyroid disease
– Some drugs (especially hydroxyurea)
31. Pernicious anemia:
-ANTIBODIES TO intrinsic factor
- diagnosed by checking antibody levels
-Schilling test
-Smear shows macrocytosis with hypersegmentattion of
-Polymorphonuclear cells, with possible basophilic stippli
33. Vitamin B12 Deficiency Versus
Folate Deficiency
Vitamin B 12
Deficiency
Folate Deficiency
MCV > 100 > 100
Smear Macrocytosis with
hypersegmented
neutrophils
Macrocytosis with
hypersegmented
neutrophils
Pernicious
anemia
Yes NO
Homocystine Elevated Elevated
Methylmalonic
Acid
Elevated NORMAL
34. Evaluating the Patient with Anemia
• Any jaundice, elevated bilirubin, suspicious for
hemolysis?
– Check for increased indirect bilirubin,
increased LDH, decreased haptoglobin,
increased reticulocyte count
– Any sign of infection? Malaria? Babesiosis?
– Is Coombs test positive?
– If yes, may be warm antibody hemolytic
anemia; Consider drug as cause
35. hemolytiicbs
LDH: elevated
Indirect bilirubin: elevated (due to catabolism of
Hgb)
Haptoglobin: decreased
Binds to Hgb and taken up by liver
In a series of reports:
Elevated LDH, low Haptoglobin was 90% specific
Normal LDH, Haptoglobin >25 was 92% sensitive for ruling out
hemolysis
Reticulocyte Count: elevated
Normal is 0.5-1.5%
Anemia leads to increase Epo production leading to a
reticulocytosis (4-5% increase above baseline)
Positive Direct Antiglobulin Test (Coombs)
37. Lab Analysis in Hemolytic Anemia
• Increased indirect bilirubin
• Increased LDH
• Increased reticulocyte count
• Normal reticulocyte count is 0.5 to 1.5%
• > 3% is sign of increased reticulocyte
production, suggestive of hemolysis
• Reduced or absent haptoglobin
• < 25 mg /dL suggests hemolysis
• Haptoglobin binds to free hemoglobin
released after hemolysis
38. Special Considerations in
Determining Anemia
• Acute Bleed
• Drop in Hgb or Hct may not be shown until 36 to
48 hours after acute bleed (even though patient
may be hypotensive)
• Pregnancy
• In third trimester, RBC and plasma volume are
expanded by 25 and 50%, respectively.
• Labs will show reductions in Hgb, Hct, and RBC
count, often to anemic levels, but according to
RBC mass, they are actually polycythemic
• Volume Depletion
• Patient’s who are severely volume depleted may
not show anemia until after rehydrated
46. WHITE BLOOD CELLS
•Definition:
Blood cells that fight
infection.
•Elevated = leukocytosis
•Decreased = leukopenia.
Leukopenia
Anaphylactic shock
Cirrhosis of liver
Disorders of spleen
Pernicious anemia
Typhoid and paratyphoid fevers
Viral infections
Leukocytosis
Infections
Common cold
Tuberculosis
Allergy
Glandular fever
47. Leukopenia
• Definition: total WBC < 4,300
• Differential dx:
• Infection including bacterial or viral
• Chemotherapy
• Other medications (anti-epileptics, penicillins,
sulfonamides, cephalosporins, thiazides, cimetidine,
ethanol, immunosuppressants)
• Hematologic malignancy
• Aplastic anemia
• Hypersplenism
• Auto-immune disorders
• Low wbc can be normal in certain populations
48. Leukopenia
• Signs and Symptoms: may be none, symptoms of
infection, fever, lymphadenopathy, weight loss,
night sweats. Check medications
• Physical findings: lymphadenopathy, splenomegaly,
may be asymptomatic
• Management: determine underlying cause
• Blacks can have asymptomatic leukopenia as
baseline
49. Leukocytosis
• Definition: WBC > 10,800
• Differential dx:
• Infection
• Chronic inflammation
• Medications (steroids)
• Recovery post chemotherapy
• WBC growth factors (neupogen, leukine, neulasta)
used in cancer therapies
• Hematologic malignancy (leukemia) or bone
marrow dysfunction
50. Leukocytosis
• Signs and Symptoms: may be asymptomatic, fever,
infectious symptoms, cough, SOB, dysuria, skin
infection/abscess, rash, weight loss, fatigue, night
sweats
• Physical findings: may be none. Erythema, edema,
skin rash, lymphadenopathy, cachexia,
hepatosplenomegaly, abnormal heart sounds,
adventitious lung sounds
• Management: determine underlying cause.
• If unable to determine cause or if leukocytosis
persists or is rising after treating for infection,
consult for bone marrow biopsy
51. Leukemia
• Definition: hematologic malignancy of the bone
marrow whereby abnormal immature cells crowd
out normal cells. WBC can be elevated or
decreased in leukemia. RBC and platelets can be
normal or decreased
• Types of leukemia:
• Acute Myelogenous Leukemia
• Acute Lymphocytic Leukemia
• Chronic Myelogenous Leukemia
• Chronic Lymphocytic Leukemia
52. 52
Neutrophils
• 60% of all WBCs
• Nuclei of 2-6 lobes
• Other names:
– Polymorphonuclear cells (PMNs, polys, segs)
– Granules have enzymes
– Can damage tissue if severe or prolonged
– Pus
53. Neutrophils – Low
Significant levels
< 0.5 x 109
/L (high risk infection)
Most common causes
– viral (overt or occult)
– autoimmune/idiopathic
– Drugs
54. Neutrophils – High
Most common causes
– infection/inflammation
– Necrosis/malignancy
– any stress/heavy exercise
– drugs
– pregnancy
– CML
55. Eosinophils
• 1-4 % of leukocytes
• Bilobed nucleus
• Granules have digestive enzymes
• Role in ending allergic reactions and in fighting
parasitic infections
56. Eosinophils
Eosinophils – Low
– no real cause for concern
Eosinophils – High
Most common causes:
– allergy/atopy: asthma/hayfever
– parasites (less common in developed countries)
Rarer causes:
– Hodgkins
– myeloproliferative disorders
57. 57
Basophils
• Rarest WBC
• Bilobed nucleus
• Dark purple granules
• Later stages of reaction to allergies and parasitic
infections
58. Basophils
Basophils – Low
– difficult to demonstrate
Basophils – High
Associated with
– myeloproliferative disorders
– other rare causes
59. Lymphocytes
• Most important WBC
• 20-45%
• Most are enmeshed in lymphoid connective tissue,
e.g. lymph nodes, tonsils, spleen
• Response to antigens (foreign proteins or parts of
cells) is specific
• Two main types attack antigens in different ways
• T cells
• B cells
• plus “natural killer cells”
nucleus occupies most of the cell volume
60. Lymphocytes
Lymphocyte – Low
– not usually clinically significant
Lymphocyte – High
– isolated elevated count not usually significant
Causes
• acute infection (viral, bacterial)
• smoking
• hyposplenism
• acute stress response
• autoimmune thyroiditis
• CLL
61. 61
Monocytes
• 4-8% of WBCs
• Largest leukocytes.
• In connective tissue they transform into
macrophages (phagocytic cells with
pseudopods)
62. Monocytes
Monocytes – Low
– not clinically significant
– acute stress reaction
– pt on steroids
– chemo and immunosuppressant therapies
Monocytes – High
– usually not significant
– watch levels > 1.5 x109
/L more closely
– Infection
– granulomatous disease (sarcoid)
– collagen vascular disease.
63. Total WBC may be misleading
The absolute count of each of the cell types is more
useful than the total.
The total count may be misleading, eg: low
neutrophils with an elevated lymphocyte count may
produce a total white count that falls within the
reference range.
65. Thrombocytosis
• Definition: elevated platelet count > 500,000
• Diff Dx includes: bone marrow myeloproliferative
disorder as in essential thrombocythemia (ET) or
secondary to iron deficiency, splenectomy,
infection, malignancy or inflammatory disease
• Lab findings: CBC showing elevated platelet count.
Iron studies may show iron deficiency.
• Signs and Symptoms: often asymptomatic and
found on routine CBC. ET patient may experience
headaches, TIAs
66. Thrombocytosis
Most likely causes
– reactive conditions eg infection, inflammation
– pregnancy
– iron deficiency
– post splenectomy
– essential thrombocythaemia
67. Thrombocytopenia
• Definition: platelet count < 100,000.
• Differential Dx: bone marrow dysfunction,
malignancy, auto-immune response, medication,
chemotherapy, acute bleeding, acute thrombosis,
DIC, HIT, lab error
• Incidence: ITP: 100 cases per million people per
year with children accounting for half of those.
Females more likely to be affected.
Most common causes
– viral infection
– idiopathic thrombocytopenic purpura
– liver disease
– hypersplenism
– autoimmune disease
– pregnancy
68. Thrombocytopenia
• Lab/diagnostic studies:
• check CBC for other cytopenias,
• platelet aggregation studies,
• anti-platelet antibodies,
• bleeding time,
• bone marrow biopsy would show elevated
megakaryocytes (platelet precursors) in destruction
problem however low megakaryocytes in bone
marrow production disorder.
• Splenic ultrasound to evaluate for sequestration
69. Thrombocytopenia
• Lab Error: can have platelet clumping due to EDTA
tube this may cause platelet count to appear falsely
low – peripheral smear examination can confirm
normal platelet count. Blood can be collected in NA
citrate tube and re-run to confirm normal count
• For TTP (thrombotic thrombocytopenic purpura) this
rare disorder of the anticoagulation system will
cause patient to require plasmapheresis to remove
inhibitors of VW factor. Give pt FFP (fresh frozen
plasma) to replace normal VW factor. This is a rare
but serious disease that requires care under
hematologist.
70. Bleeding Disorders
• Hemophilia
• Definition: genetic disorder characterized by lack of
blood clotting factors.
• Hemophilia A: lack of factor VIII (most common).
Sex linked occurring in 1:10,000 males
• Hemophilia B: lack of factor IX (Christmas factor)
occurring in 1:100,000 males
• Labs/diagnostic testing: diagnosed by checking
factor activity levels, CBC, PT/PTT, bleeding time.
• Signs and symptoms: easy bruising, prolonged
bleeding, painful joints due to hemarthrosis. Older
hemophiliacs likely to be infected with HIV due to
receiving contaminated factor products
71. HEMOPHILIA
• Physical findings: Ecchymoses, bleeding,
edematous painful joints
• Management:
• Patients with hemophilia require replacement of
factor when bleeding occurs or sometimes daily
based on severity of disease.
72. Bleeding Disorders
• Von Willebrand disease (VWD)
• Definition: bleeding disorder caused by lack of Von
Willebrand factor which interferes with platelet
function thereby increasing risk for bleeding. Most
forms of VWD are mild
• Incidence: most common blood clotting disorder
occurring in 1 in 800-1000 people
• Labs: normal CBC, bleeding time (prolonged), Von
Willebrand factor assay (reduced), platelet
aggregation study (reduced).
73. Von Willebrand Disease
• Signs and symptoms: easy bruising, prolonged
bleeding after surgery, dental procedure,
menorrhagia, epistaxis
• Physical findings: may be normal or may see
ecchymoses, petechiae, bleeding
• Management:
• Desmopressin (DDAVP) nasal spray – helps to
increase factor VIII and VW factor in the blood
• Fresh frozen plasma/cryoprecipitate in acute
bleeding or surgery
75. ABO blood group types
Bloodtype Antigen on
RBC
Antibodies in
blood
Can receive blood from: Can donate blood to
(usually RBCs only):
Frequenc
y
in US
A A anti-B A
O
not B (you have anti-B) *
not AB (you have anti-B) *
A
AB
40%
B B anti-A B
O (no Ags so you won’t
reject)
not A (you have anti-A) *
not AB (you have anti-A) *
B
AB
10%
AB A and B none to
A or B
AB AB is universal
recipient
A
B
O
AB 4%
O not A nor
B
Anti-A and anti-
B
not A (have anti-A)*
not B (have anti-B)*
not AB (have both
antibodies)*
O
A
B
AB
O O is universal
donor
46%
Ag = antigen on red blood cell. *=transfusion reaction (hemolysis of new cells)
The blood types are “codominant” – i.e. if genotype is
AB, then you have both A and B antigens on your RBCs
76. 76
If a blood transfusion is given to a person who has
antibodies to that type of blood, then the transfused
blood will be attacked and destroyed (transfusion
reaction)
77. 77
Rh FACTOR
• The “Rh factor” is another major antigen on the RBC,
called D Antigen.(autosomal recessive)
– DD: Rh+, Dd: Rh+, dd: Rh-
• Rh Incompatibility(Erythroblastosis Fetalis).
• If mom is Rh- then give “Rhogam” during pregnancy
[(is anti- Rh(D): Rh(D) Ig (immunoglobin)], an antibody
which will destroy any of the baby’s RBCs which leak
into mom’s blood during the pregnancy so she will not
mount an immune response to the D antigen
78. INTERPRET RESULTS IN CLINICAL
CONTEXT
• All haematology results need to be interpreted
in the context of a thorough history and
physical examination, as well as previous
results.