Introduction to the course Chang Gung University Department of Medical Biotechnology Clinical Hematology Spring, 2012 Course Coordinator: Dr. Daniel Tsun-Yee Chiu Participating Instructors: Drs. ML Cheng, CP Tseng, HY Ho, SJ Lin, CR Shen and DC Chu; vice chief Technologists: Ms. CC Tsao and PY Chang. Laboratory Coordinatior: Dr. Ching-Ping Tseng and Mr, Gen-Hung Lee, MT, MS. Technical Specialist: Ms. Yu-Han Chen, MT, MS

Text required 1.Hoffbrand AV, Pettit JE. "Essential haematology" 5th edition.Blackwell Science, 2006 (6th edition may come out later on this semester) 1.Dacie JV, Lewis SM. "Practical Haematology" 10th ed.,Churchill Livingstone, McDonald GA, et al. "Atlas of Haematology" 5th ed.,Church Livingstone, 1988(Highly recommended but not mandated)

Additional references 1.Jandl J. "Blood: Text book of Hematology". Little Brown, Hoffman et al. "Hematololgy". churchill Livingstone, Williams et al. "Hematology". McGrqw and Hill, Stamatoyannopoulos et al. "The molecular basis of blood diseases". 2nd ed., W.B. Sanders Co., Wintrobe MM et al. "Clinical Hematology" 9th ed. Lea & Febiger, Rapaport S. "Introduction to Hematology" 2nd ed.,J. B. Lippincott Co., 1987

Course Format This course is a team-teaching course and officially schedules 2 hours of lecture per week on Tuesday from 1:10-2:00PM & on Thursday from 1:10–2:00 PM. In addition, 2 laboratory sessions per week with 3 hours each has been officially scheduled on Tuesday. 2:10AM-5:00 PM and on Thursday from 2:10-5:00 PM. However, some of the officially scheduled lab. hours may be used for lecture and vise versa.

Subject matter covered The four major components of blood, namely, red cells, white cells, platelets and plasma, will be discussed. Major emphasis include: 1. Nomenclature (terminology) 2. Morphology of formed elements 3. Hematologic theories and techniques In addition, the molecular basis, biochemistry and pathophysiology of blood diseases will be discussed with a major emphasis on the laboratory aspects of differential diagnosis of these diseases.

Clinical Hematology 2012 Course Coordinator: Ching-Ping Tseng Lecture Tuesday, 1:10-2:00PM & Thursday, 1:10-2:00PM Laboratory---Tuesday, 2:10-5:00PM & Thursday, 2:10-5:00PM

Basis of Grading Office hours: Drop-in or by appointment. Ext. 5097

Chang Gung University Department of Medical Biotechnology Clinical Hematology RBC 1 － RBC function and RBC Indices

RBC function and Red cell indices I.Function of RBC : To transport oxygen and CO 2 II.Morphology : Biconcave donut shape or biconcave disc III.Hematocrit and Red cell count IV.Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration (MCHC) V.Red Cell distribution Width (RDW) VI. Required Reading: "Essential Haematology " by Hoffbrand & Pettit. pp 1-11 " Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp and pp

RBC Morphology Biconcave disc Diameter : 7 ~ 8 μm

RBC function and Red cell indices I.Function of RBC : To transport oxygen and CO 2 II.Morphology : Biconcave donut shape or biconcave disc III.Hematocrit and Red cell count IV.Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration (MCHC) V.Red Cell distribution Width (RDW) VI.Required Reading: "Essential Haematology " by Hoffbrand & Pettit. pp 1-11 " Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp and pp

Hematocrit (Hct) When anticoagulated whole blood is centrifuged, the space occupied by the packed red blood cells. Normal range : 42~52% for men 36~46% for women Plasma Buffy coat Red blood cells Capillary tube

Red blood cell count The red blood cells count (RBC) is the number of red blood cells in 1 μ l of whole blood. Normal range : 4.2~5.4 million / μl for men 3.6~5.0 million / μl for women

RBC function and Red cell indices I.Function of RBC : To transport oxygen and CO 2 II.Morphology : Biconcave donut shape or biconcave disc III.Hematocrit and Red cell count IV.Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration (MCHC) V.Red Cell distribution Width (RDW) VI.Required Reading: "Essential Haematology " by Hoffbrand & Pettit. pp 1-11 " Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp and pp

Mean Corpuscular Volume (MCV) The MCV indicates the average volume of the red blood cells. MCV = = (fl) Normal value for the MCV : 80~97 fl If the MCV is less than 80 fl, the RBCs are microcytic. If the MCV is greater than 97 fl, the RBCs are macrocytic. If the MCV is within the normal range, the RBCs are normocytic. Volume of RBC in femtoliters (fl) / μl of blood RBC / μl of blood Hematocrit * 10 RBC count in millions 1 μl = 10 9 fl

Mean Corpuscular Hemoglobin Concentration (MCHC) The MCHC is an expression of the average concentration of hemoglobin in the red blood cells. It gives the ratio of the weight of hemoglobin to the volume of the red blood cells. MCHC = = Normal value for the MCHC : 32~36 % Hemoglobin in g/dl Hematocrit /dl * 100 (to convert to %) Hemoglobin * 100 Hematocrit %

Mean Corpuscular Hemoglobin Concentration (MCHC) An MCHC below 32% indicates hypochromia, an MCHC above 36% indicates hyperchromia, and red blood cells with a normal MCHC are termed normochromic. Please note that an MCHC above 38% should not occur.

Mean Corpuscular Hemoglobin (MCH) The MCH indicates the average weight of hemoglobin in the red blood cells. MCH = = Normal value for the MCH : 27~31 pg An MCH lower than 27 pg is found in microcytic anemia and also with normocytic, hypochromic RBCs. An elevated MCH occurs in macrocytic anemia and in some cases of spherocytosis in which hyperchromia may be present. Weight of hemoglobin in 1 μl of blood Number of red blood cells in 1 μl of blood Hemoglobin * 10 Red blood cell count in millions (pg) 1 g = pg 1 ml = 10 3 μl

Red cell distribution width (RDW) RDW is an index of the variation of red cell size (volume) in a specimen of blood RDW= Size at 80% tile – size zt 20% tile Size at 80% tile + size zt 20% tile Normal range : 10 ± 1.5 % S.D. of size distribution MEAN size Normal range : 13 ± 1.5 %

Advantages of having RDW 1. Recognize RBC abnormality from CBC 2. Assist in differential diagnosis 3. Following the course of a disease

An example of Complete Blood Count (CBC)