Hematology and Coagulation Procedures Chapter 42 Hematology and Coagulation Procedures

Learning Objectives List the components and functions of blood List tests included in complete blood count (CBC) Describe the different cellular elements and their roles Describe the components of hemoglobin and hematocrit and their functions

Learning Objectives Describe the different leukocytes and their functions State the normal range for the different hematological tests State the importance of a differential cell count

Learning Objectives List the tests associated with coagulation determination Describe the importance of knowing the patient’s International Normalized Ratio (INR) in reference to prothrombin time

Hematology and Coagulation Hematology—the study of the formed cellular elements of blood Hematology testing includes the morphologic appearance and function of blood cells Coagulation—evaluates the overall process of hemostasis

Blood Transports nutrients, gases, medications, wastes, and other substances throughout the body Average adult has 5–6 liters of blood Blood samples can be whole blood, plasma, and serum Whole blood sample—anticoagulant in tube

Plasma Liquid portion of blood Clear, straw-yellow 90% water, 10% solutes 55% total body volume Not allowed to clot

Substances Found in Plasma Hormones Nutrients Plasma proteins Blood cells

Serum Clear, yellow fluid Blood has been allowed to clot Substances include nutrients, hormones, and antibodies

Blood Cells Erythrocytes Leukocytes Thrombocytes

Erythrocytes Live about 120 days Are old RBCs destroyed by macrophages Are formed in bone marrow Carry oxygen and nutrients to tissues Carry carbon dioxide and waste away from tissues

Leukocytes Five different types Formed in bone marrow Help to fight off infection Phagocytosis Granulocytes and agranulocytes

Neutrophils 40–60% Phagocytosis Many-lobed nucleus Increase numbers in bacterial infections

Eosinophils 0–4% Assist inflammatory response Increase numbers in allergic reactions, skin infections, and parasitic infections Phagocytosis

Basophils 0–1% Assist in inflammatory response by releasing substances such as histamine and heparin Phagocytosis

Lymphocytes 20–40% Produce antibodies Increase numbers in viral infections and infectious mononucleosis B cells, T cells

Monocytes 3–8% Phagocytosis Effective against chronic infection Leaves bloodstream and travels to tissues

Platelets Small, irregular-shaped cell fragments Life span 9–12 days Necessary for blood-clotting process

Hematology Tests Platelet Red blood cell count (RBC) Hemoglobin (hgb) Hematocrit (hct) White blood cell count (WBC) Differential—100 wbc differential count Platelet Erythrocyte sedimentation rate (ESR) Protime (PT) Prothrombin time (PTT) INR Bleeding time

Complete Blood Count (CBC) Red blood cell count White blood cell count Hemoglobin Hematocrit Blood cell indices Platelets Differential

CLIA Waived Tests Medical assistants may perform Hemoglobin Hematocrit

Erythrocyte Sedimentation Rate ESR Shows rate of erythrocyte settling Used to determine nonspecific inflammation Screening test

Reticulocyte Count Retic count Evaluates ability of bone marrow to produce and release RBCs into bloodstream Increased count may indicate hemolytic anemia or problem with bone marrow

Hematologic Disorders Anemia Leukemia Polycythemia Thrombocytopenia Leukopenia Leukocytosis

Coagulation Tests Prothrombin time INR Activated partial thromboplastin time Bleeding time Thrombin time Fibrin degradation product D-dimer Fibrinogen

Therapeutic Ranges Anticoagulant therapy Prevention of thrombosis in atrial fibrillation and myocardial infarction INR 2.0–3.0 Mechanical prosthetic heart valve and recurrent systemic embolism INR 2.5–3.5

Diseases Associated With Coagulation Disorders Disseminated intravasular coagulation (DIC)—coagulation abnormalities that are systematic instead of local Thrombophilic disorder is an inherited disorder, person is at risk for developing blood clots

Diseases Associated With Coagulation Disorders Hemophilia—hereditary disorder characterized by abnormal clotting, affects more males than females

Discussion Name the five types of white blood cells Identify white blood cells capable of phagocytosis Identify white blood cells known as a macrophage Explain the abnormality that may indicate an elevated ESR

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