1. Hematological investigations like complete blood count and blood smear examination provide important information for cancer diagnosis by evaluating red blood cells, white blood cells, platelets, and detecting any morphological abnormalities. 2. Tumor markers found in blood can indicate certain cancer types and help monitor treatment effectiveness. Common tumor markers include PSA, CEA, CA125, and beta-HCG. 3. Hormonal assays of substances like PTH, calcitonin, ACTH help identify endocrine tumors as their source. Biochemical markers such as enzymes, metabolic products, and proteins are also analyzed to provide clues about cancer presence and behavior.

1. Blood investigations
PREPARED BY
MS THEERTHA P KRISHNA
IIND YEAR MSC NURSING
MIMS CON

2. Introduction
• The diagnosis of cancer is very complex and provokes high anxiety.
• An accurate cancer diagnosis is essential in planning treatment and anticipating treatment outcomes.
• It necessitates a team effort.
• Lab investigation provides information of great value in the diagnosis.
• The value of laboratory test lies in its efficiency in predicting or confirming the presence / absence of disease.

3. Classification
Blood
investigations
Haematological
Tumor MarkersHormonal Assay
Biochemical

4. 1. Haematological Investigations
• Hematology is the study of blood in health and in pathological conditions.
• Blood is the window to the body; it is a predictor of vitality, of long life.
• Haematological Laboratory Investigations reports the enumeration of cells in circulation, haemoglobin concentration and differential count
of leukocytes based on the study of the stained blood smear.
• Hematological investigations are of prime importance in achieving a diagnosis.

5. 1. Haematological Investigations
• Haematological Laboratory Investigations includes the following:
1. Erythrocyte or red blood corpuscle (RBC)
2. Leukocytes or white blood corpuscle (WBC)
3. Thrombocytes or platelets (PLT)

6. Specimen For Haematology
• Collection of blood specimens: Capillary, venous and arterial blood specimens are used for hematological studies.
• Specimens are obtained by two ways:
1. Skin punctures (capillary blood)
2. Venipuncture (venous blood)

7. Complete Blood Count (CBC)
• 1. Erythrocyte or red blood corpuscle (RBC)
• RBCs are least affected by myelosuppressive cancer drugs.
• A common anaemia inducing cancer drug is CISplatin.
• Other contributing factors are chronic disease, chronic blood loss, inadequate nutrition, tumor invasion into the bone
marrow, prior cancer drug treatment and radiation therapy.

8. Complete Blood Count (CBC)
2. Leukocytes or white blood corpuscle (WBC)
• Normal value – 4000 – 10,000 per cubic millimetre.
• WBC count is one of the index of systemic infection and it should also be used to rule out possibility of leukemia.
• There are five types of WBC; Neutrophils, Eosinophils, Basophils, Monocytes and Lymphocyte.

9. Interpretation Of Differential Count
Neutrophil Lymphocyte
Increase: Mylogenous leukemia Increase: Lymphocytic Leukemia
Decrease: Malignant Neutropenia Lymphocytic leukemia Decrease: Myelogenous Leukemia
Monocyte Eosinophil
Increase: Monocytic leukemia Hodgkins disease
Lymphomas
Increase: Chronic Myelocytic Leukemia, Eosinophilic
Leukemia
Basophil
Increase: Hodgkin's disease

10. Morphological Abnormalities in WBCs
• Hypopigmentation: This anomaly is characterized by failure of normal lobe development (less than 3) in neutrophil. Nucleus
may table up a dumbbell shape or may appear band neutrophil found in acute myelocytic leukemia, severe infection.
• Auer bodies These are cytoplasmic inclusions formed in myeloblasts with Romanovsky stain in case of acute mylogenous
leukemia.
• Smudge cell These are degenerated lymphocytes that look like baskets often called basket cells with no cellular walls,
associated with chronic lymphocytic leukemia.

11. Platelet Changes Associated With Cancer
• Increase (Thrombocytosis): Chronic myelocytic leukemia
• Decrease (Thrombocytopenia): Acute/chronic leukemia
• Bleeding Time: Hodgkin's disease is suspected if there is decreased bleeding time.
• Thrombin Time: In chronic liver disease the thrombin time is often prolonged. Long thrombin time is seen in multiple
myeloma.

12. 2. Tumor Markers
• Tumor markers may be either a protein product excreted by the cancer cells or protein product released in response to
the presence of cancer or other conditions.
• Tumor markers may also be useful in determined the prognosis of specific cancers, detecting occcurance and
assessing the effectiveness of treatment.

13. Classifications
• Prostate specific antigen (PSA)
• S-100
• Thyroglobulin
• Estrogen & Progesterone receptors
• CA15-3 & CA 27-29
• Carcinoembryonic Antigen (CEA) & CA 19-9
• CA125
• Human Chorionic Gonadotropin (HCG) & Alpha Fetoprotien (AFP)
• Beta2 Microglobulin (B2M)
• HER2
• Chromogrannin A(CgA)

14. Prostate specific antigen (PSA)
• Prostate specific antigen (PSA) can be elevated in proatate cancer.
• However PSA, levels can also be elevated in the presence of benign prostatic hyperplasia (BPH), in older men and
men with larger prostate glands.

15. S-100
• S-100 is found in melanoma cells.
• It is usually elevated in patients with metastatic melanoma.

16. Thyroglobulin
• Thyroglobulin is a protein may be the thyroid gland. It is elevated in many thyroid diseases, including thyroid
cancers.
• A rise in thyroglobulin level, indicates cancer recurrence.

17. Estrogen & Progesterone receptors
• Breast cancers tissue been tested for the presence of oestrogen & progesterone receptors.

18. CA15-3 & CA 27-29
• Both test are commonly used to monitor fro recurrence in women who have been treated for breast cancer.

19. Carcinoembryonic Antigen (CEA) & CA 19-9
• Carcinoembryonic Antigen (CEA) & CA 19-9 are commonly elevated in advanced colorectal cancer.
• CEA is also elevated I other circumstances including breast, lung, pancreas, liver, stomach, ovary and bladder
cancer.

20. CA125
• A women with advanced ovarian cancer have an elevated level of CA125.
• Women with a strong family history of ovarian cancer are often screened with both CA 125 testing and USG.

21. Human Chorionic Gonadotropin (HCG) & Alpha
Fetoprotein (AFP)
• Female with germ cell ovarian tumors and men with non seminomatous testicular cancer often display elevated levels
of HCG & AFP.

22. Beta2 Microglobulin (B2M)
• Beta2 Microglobulin (B2M) is elevated in persons with multiple myeloma, chronic lymphocytic leukaemia and some
lymphomas.

23. HER2
• HER2 / neu is overexpressed or elevated in patients diagnosed with breast cancer.

24. Chromogrannin A(CgA)
• Chromogrannin A(CgA) is produced by neuroendocrine tumors including carcinoid, neuroblastoma, and small cell
lung cancers.

25. 3. Hormonal Assay
Laboratory Test Associated Test
Parathyroid hormone (PTH) Ectopic hyperparathyroidism from cancer of the kidney, lung (squamous
cell), pancreas, ovary, myeloma
Calcitonin Medullary thyroid, small cell lung cancer, breast cancer, and carcinoid
Antidiuretic hormone (ADH) Small cell lung cancer, adenocarcinomas
Adrenocorticotropic hormone (ACTH) Lung, prostate, gastrointestinal cancers, neuroendocrine tumors
Human chorionic gonadotropin, beta subunit (B-HCG) Germ cell tumors of testicle and ovary; ectopic production in cancer of
stomach, pancreas, lung, colon, liver

26. 4. Biochemical Investigations
Laboratory Test Associated Malignancy
Enzymes
Lactic dehydrogenase (LDH) Lymphoma, seminoma, acute leukemia, metastatic carcinoma
Prostatic acid phosphate (PAP) Metastatic cancer of prostate, myeloma, lung cancer, osteogenic
sarcoma
Placental alkaline phosphatase (PLAP) Seminoma, lung, ovary, uterus Small cell lung cancer, neuroendocrine
tumors, neuroblastoma, medullary thyroid cancer
Creatine kinase-BB (CK-BB) Breast, colon, ovary, prostate cancers, small cell lung cancer
Terminal deoxynucleotidal transferase (TdT) Lymphoblastic malignancy

27. 4. Biochemical Investigations
Laboratory Test Associated Malignancy
Metabolic Products
5-Hydroxindoleacetic acid (5-HIAA)
Vanillylmandelic acid (VMA)
Carcinoid, lung
Neuroblastoma
IgG IgG myeloma
IgA IgA myeloma
IgM Waldenstrom’s macroglobulinemia
IgD IgD myeloma
IgE
Beta-2 microglobulin
IgE myeloma
Myeloma, lymphoma

28. Nurses responsibility
• Identification of patient.
• Container labelling
• Specimen discrepancy
• Patient preparation
• Site selection and preparation
• Tube mixing
• Working in senses

29. Conclusion
• Laboratory investigation has become an important part of medical diagnostic procedure by adding its objective information to
the more subjective history and physical examination of the patient.
• Thus hematological investigation is an important part of medical diagnostic procedures for the purpose of diagnosis and
treatment.