Blood is composed of plasma and cells. Diseases of the blood present with issues like anemia, abnormal cell counts, bleeding, clotting problems, and infections. Evaluation of blood diseases involves a complete blood count, blood film examination, and tests of coagulation factors and bone marrow aspiration. A complete blood count provides information on red blood cell count, hemoglobin, hematocrit, platelet count, and differential white blood cell count which can indicate various diseases. Additional tests like red cell indices, reticulocyte count, coagulation tests, and peripheral blood smear aid in diagnosis. Bone marrow examination is often necessary.

1. BLOOD
 Blood is a fluid connective
tissue composed of:
 Plasma : Proteins
Coagulation factors
Metabolic substances
 Cells : Red blood cells
White blood cells
Platelets

2. Presenting problems in Blood
disease
 Anaemia
 High haemoglobin
 Leucopenia (low white cell count)
 Leucocytosis (high white cell count)
 Lymphadenopathy
 Splenomegaly
 Bleeding
 Thrombocytopenia (low platelet count)
 Thrombocytosis (high platelet count)
 Pancytopenia
 Infection

6. Investigation of diseases of the
blood
• Full blood count
• Blood film examination
• Bone marrow examination
• Investigation of coagulation

7. 1. History and
examination
2. Blood tests:
• Complete blood count
 Total count:WBC
 Neutrophils(N)
 Lymphocytes(L)
 Eosinophil(E)
 Basophil(B)
 Hb:
 Platelets

8. • Correlation of CBC with disease condition .
• What things can u identify?
 Hb Anemia. Normal Level:Male:14-18g/dl
Female: 12-16g/dl
Polycythemia
 Complete blood count Importance of
Total count :5000-10000 microlitre
High /Low: Malignancy
High: infection
Neutrophil:40-60%: Infection
Lymphocytes: 20-40%:Tuberculosis
Eosinophil:1-4%:Allergies,worm infestations
Monocytes:2-8%
Basophils:0.5-1%
 Platelets:1,50,000-4,00,000 microlitre

10. Red cell indices
• MCV(Mean corpuscular volume):Size of red
blood cells
• For Hemoglobin content
• MCH(Mean corpuscular hemoglobin)
• MCHC(Mean corpuscular hemoglobin
concentration)
• Packed cell volume(Hematocrit)
• Red cell Distribution width

11. Packed cell volume(PCV)
• Hematocrit (HCT), also called packed cell volume (PCV), is the
percentage of blood volume occupied by RBCs.
• HCT = ([RBC x MCV]/10).
• Male:41-50%
• Female:36-48%
• Low hematocrit:
Chronic bleeding
Aplastic anemia
Sickle cell anemia
High: smoking
High altitude.

12. Mean corpuscular volume
• Measure of average volume of RBC
• Measured by: Hematocrit(%) X 10/ RBC count
• Measured in femtolitre
• Normal:80-100 fl
• Microcytic: Red cell with reduced volume <80fl
• Macrocytic: Red cell with increase volume:>100 fl
• Causes of microcytic: iron deficiency
• Sideroblastic
• Thalessemia
• Causes of macrocytic: Vit.B12 deficiency
• Folate deficiency

13. Mean corpuscular hemoglobin
concentration
• Average concentration of Hb in deciliter of erythrocytes.
Measured in g/dl.
• Ratio of Hb mass to volume
• MCHC: Hb x100/ Hematocrit
• Normochromic:32-36 g/dl
• Hypochromic:<32 g/dl
• Hyperchromic:>36 g/dl
• Causes of hypochromic: vit B6 def, Iron deficiency
• Causes of hyperchromic: Vit B12,Folate def

14. Mean cell Hemoglobin
• Measurement of individual
weight of Hb in individual
erythrocytes
• Measured in picogram
• MCH: Hb x10/RBC
• Normal value is 28-34 pg

15. Red cell distribution width
• Used along with MCV.
• Used to identify variation in
blood cell size and volume.
• RDW:11.6-14.6 in adult
• Importance: Helps to
identify heterogenous cell
size or presence of two types
of red cell population
• Other RBC indices reflects
RBC values not RBC changes.

16. Other tests

17. Reticulocyte count

19. Prothrombin time
• Measures time it takes plasma to clot when exposed to tissue
factor that assess extrinsic and common pathway
• PT:11-13 seconds
• INR(International normalized ratio):
• Ratio of patients prothrombin time to control prothrombin time
• Dimensionless
Uses: Unexplained bleeding
Patinet under anticoagulant
DIC

20. Activated partial throboplastin time
• measures the time it takes plasma to clot when exposed to
substances that activate the contact factors, which assesses
the intrinsic and common pathways of coagulation .
• Normal range:25-35 seconds
• Uses: Unexplained bleeding
Under heparin therapy

21. Fibrinogen and D-dimer
• Fibrinogen is the precursor to fibrin, the principle component of
a fibrin clot
• Normal value:5—100 mg/dl
• Clinical use: DIC,Liver disease
D-dimer:Fibrin D-dimer is one of the major fibrin degradation
products released upon cleavage of crosslinked fibrin by plasmin.
• Normal plasma levels of D-dimer by ELISA testing are <500
ng/mL
• Uses: Deep vein thrombosis
• Pulmonary embolism
• DIC

22. Peripheral blood smear
• Examination of the peripheral blood smear provides a window
into the functional status of the bone marrow.
• The peripheral smear is indispensable for evaluating the number,
size, and shape of red cells, white cells, and platelets.
• RBC:Review the color, shape, irregular borders, and presence of
nuclei, inclusions, or parasites.
• WBC:Review the presence of early (immature) cells, abnormal
lobulation or nuclear contour, abnormal or absent granulation,
presence of parasites or other inclusions
• Platelets – Review any increase or decrease in platelet number
and size, absence of granules, presence of platelet aggregation,
megakaryocyte fragments.

28. Other tests
• Perpiheral smear always supported by Bone marrow aspiration
and biopsy.
• AML: Myeloperoxidase on peripheral blood smear
• Flow cytometry
• Bone marrow aspiration and biopsy: Usually hypercellular
• Prsence of Auer rod on microscopy
• Cytochemistry: Myeloperoxidase,Sudan black B test.
• ALL: Anemia,neutropenia,thrombocytopenia
• Tests: Peripheral blood smear,Periodic acid shiff test,Non
esterase
• Flow cytometry/cytogenetics.

29. Bone marrow aspiration and cytology

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