Investigation in hematology Chittima Sirijerachai

Investigation in hematology Anemia Bleeding Malignancy

Investigation in patient with anemia Initial CBC, blood smear Red cell indicies Reticulocyte count Specific Inclusion body Osmotic fragility Saline agglutination Coombs’ test Hb typing Ham’s test BM aspiration

CBC Hb, HCT -anemia -polycythemia WBC -leukocytosis -leukopenia -abnormal cells Platelet -thrombocytosis -thrombocytopenia

Criteria for Diagnosis Anemia Hb.( g/dl) Hct (%) Children Male Female ( ) Female ( > 50 ) Pregnant women

Criteria for diagnosis polycythemia Male1860 Female HbHct

CBC Hb, HCT -anemia -polycythemia WBC -leukocytosis -leukopenia -abnormal cells Platelet -thrombocytosis -thrombocytopenia

Normal value WBC5,000 – 10,000 /cu.mm. PMN40-75 % L20-50 % Eo1-6 % B1 %

Leukocyte disorders eosinophilia basophilia monocytosis leukemoid reaction leukoerythroblastic (myelophthisis) leukemia leukocytosis leukopenia neutrophilia neutropenia lymphocytosis lymphopenia

CBC Hb, HCT -anemia -polycythemia WBC -leukocytosis -leukopenia -abnormal cells Platelet -thrombocytosis -thrombocytopenia

CBC and RBC indices fl pg g/dl %

Reticulocyte count Normal= % Corrected reticulocyte =Pt HCT X Reti. Normal HCT

Inclusion body Heinz body

Osmotic fragility (OF) Red cell % NSS One tube OF – screening for thalassemia Hereditary spherocytosis

Bone marrow aspiration Indication :- Cytopenia Myelophthisis anemia Leukemia Lymphoma staging Myeloproliferative disorders Fever of unknown origin

Thalassemia -  thalassemia -  thalassemia - hemoglobinopathy

 thalassemia  1 trait=_ _ /   2 trait=_  /   1  2 = _ _ / _   1  1 = _ _ / _ _  2  2 = _  _ 

 thalassemia 00 ++

Normal hemoglobin      2  2 = Hb A  2  2 = Hb F  2  2 = Hb A 2

 thalassemia      4 =Hb H  4 =Hb Bart’s Hb A Hb A 2 Hb F

 thalassemia     Hb A Hb A 2 Hb F

Heterozygote hemoglobin E  EE     2  2 = Hb A     2 = Hb E %

 thalassemia/Hb E  EE   Hb A / absent Hb A 2 / Hb E Hb F

FatherMothersibling 1sibling 2 Hct45%33 %42%36 % MCV % Hb typingA2AA2AA 2 ABart’s HA2AA2AA2AA2A Hb A % Hb A Hb F1.3 Hb E Hb Bart’s3.3 Hb H7.5 Hb CS genotype a 1 trait a1a2a1a2 a 2 trait a 1 trait

Fathermothersibling 1sibling 2 Hct40 % 2545% MCV Hb typingA2AA2AEAEFA2AA2A Hb A %9498 Hb A Hb F32 Hb E3065 Hb Bart’s Hb H Hb CS genotype b trait E trait b /E normal

Investigation in patient with bleeding disorders

Investigation CBC, platelet count Bleeding time Platelet function test Venous clotting time Prothrombin time (PT) Partial thromboplastin time (PTT)

CBC and platelet Platelet: < 20,000 20,000-50,000 50,000-70,000 Spontaneous bleeding Bleed after minor trauma Bleed after major trauma

CBC and platelet

Giant platelet

Bleeding time Platelet function Normal: 2-7 minute

PTT

PT

TT

Venous clotting time Normal: 5-20 minute Prolong if clotting factor is <5 % Small clot - hypofribinogenemia Clot retraction time (plt function) Clot lysis time

Prothrombin time (PT) Normal: sec PT ratio= Normal < 1.3 INR= Control PT patient PT Control PT patient PT ISI ISI = international sensitivity index

Partial thromboplastin time (PTT) Normal= sec Isolated PTT prolong: F VIII, IX, XI, XII deficiency F VIII, IX, XI inhibitor Antiphospholipid syndrome

Mixing test Patient plasma Normal plasma PTT 0 hour 2 hour Correctable PTTFactor deficiency