1. 1 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chapter 32 Hematology

2. 2 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pretest True or False 1.The study of blood is known as serology. 2.The function of hemoglobin is to assist in blood clotting. 3.The normal hemoglobin range for a female is 12 to 16 g/dL. 4.A low hemoglobin reading occurs with polycythemia. 5.The normal hematocrit range for a female is 40% to 54%.

3. 3 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pretest, cont. True or False 6.Leukocytosis is an abnormal decrease in the number of leukocytes. 7.Strenuous exercise can result in an increase in the white blood cell count. 8.Leukemia can cause a decrease in the red blood cell count. 9.The normal range for a platelet count is 150,000 to 400,000. 10.The normal range for neutrophils is 50%- 70%.

4. 4 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Content Outline 1.Hematology: the study of blood a.Includes: Morphologic appearance of blood cells Function of blood cells Diseases of the blood and blood-forming tissues Introduction to Hematology

5. 5 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. 2.Laboratory analysis in hematology includes: a.Purpose: examining blood to detect pathologic conditions b.Includes Performing blood cell counts Evaluating clotting ability of blood Identifying cell types c.Determines if each blood component falls within normal range

6. 6 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. 3.Specific hematology tests a.Hemoglobin (Hgb or Hb) b.Hematocrit (Hct) c.White blood cell count (WBC)

7. 7 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. d.Red blood cell count (RBC) e.Differential WBC count (diff) f.Erythrocyte sedimentation rate (ESR) g.Platelet count (Plt)

8. 8 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. 4.Hematology tests a.May be performed in the medical office b.Automated blood analyzers designed for the medical office Perform laboratory tests –With accurate test results –In a short period of time

9. 9 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. Operating manual –Accompanies each analyzer –Information included: 1)Operation 2)Test parameters 3)Care and maintenance

10. 10 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. 5.Complete blood count (CBC): a.Most frequently performed hematologic test Performed on new patients Performed on patients with a pathologic condition

11. 11 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Introduction to Hematology, cont. b.Tests included in a CBC: White blood cell count (WBC) Red blood cell count (RBC) Platelet count Hemoglobin (Hgb or Hb) Hematocrit (Hct ) Differential white blood cell count (diff) Red blood cell indices

12. 12 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination 1.Hemoglobin (Hgb): major component of RBCs 2.Hemoglobin transports oxygen to tissue cells 3.Responsible for red color of RBCs

13. 13 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination, cont. 4.Normal range a.Adult female: 12-16 g/dL b.Adult male: 14-18 g/dL 5.Hgb performed as individual test or as part of CBC

14. 14 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination, cont. 6.Decreased hemoglobin level occurs with: a.Anemia (especially iron-deficiency anemia) b.Hyperthyroidism c.Cirrhosis of liver d.Severe hemorrhaging

15. 15 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination, cont. e.Hemolytic reactions f.Certain systemic diseases Leukemia Hodgkin's disease

16. 16 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination, cont. 7.Increased hemoglobin level occurs with: a.Polycythemia b.COPD c.CHF

17. 17 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemoglobin Determination, cont. 8.Blood analyzer: a.Most accurate and reliable method b.Can use capillary or venous blood c.Processes specimen in a short time d.Results obtained while patient is still at office

18. 18 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit 1.Abbreviated Hct 2. Hematocrit means "to separate blood" a.Solid cellular elements separated from plasma By centrifuging an anticoagulated blood specimen b.Heavier RBCs become packed and settle to bottom of tube

19. 19 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. c.Top layer: contains clear, straw-colored plasma d.Between layers is small, thin, yellowish-gray layer Buffy coat: contains platelets and WBCs

20. 20 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont.

21. 21 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. 3.Purpose of hematocrit: measures percentage of packed RBCs in whole blood 4.Normal range a.Adult female: 37%-47% b.Adult male: 40%-54%

22. 22 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. 5.Low reading: may indicate anemia 6.High reading: may indicate polycythemia 7.Used with other tests to diagnose patient's condition

23. 23 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. 8.Microhematocrit method a.Most often used in medical office b.Blood obtained by skin puncture Using a disposable capillary tube lined with anticoagulant c.Blood drawn into tube Sealed with a sealing compound

24. 24 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont.

25. 25 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. d.Centrifuged for 3-5 minutes Packs the RBCs

26. 26 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hematocrit, cont. e.Results read at top of packed cell column

27. 27 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

28. 28 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

29. 29 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Count 1.Approximate measurement of number of WBCs in circulating blood 2.Adult normal range: 4500-11,000 WBC/cubic mm of blood a.Expressed as 4.5-11.0 (x10 3 /mm 3 ) on laboratory reports

30. 30 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Count, cont. 3.Leukocytosis: increase in the number of WBCs (above 11,000) a.Most commonly seen in acute infections: Appendicitis Chickenpox Diphtheria Infectious mononucleosis Meningitis Rheumatic fever

31. 31 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Count, cont. b.Normal elevation can occur in: Pregnancy Strenuous exercise Stress Treatment with corticosteroids

32. 32 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Count, cont. 4.Leukopenia: decreased WBC count a.Viral infections b.Chemotherapy c.Radiation therapy

33. 33 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Count, cont. 5.Blood cell counter used to determine WBC count a.Can also perform RBC count Plt Hgb Hct Differential WBC count Calculation of RBC indices

34. 34 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Automated Blood Cell Counter

35. 35 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Red Blood Cell Count 1.Measurement of number of RBCs in whole blood 2.Normal range a.Female: 4-5.5 million/cubic mm of blood On laboratory report expressed as: 4.0-5.5 (x10 6 mm 3 ) b.Male: 4.5-6.2 million/cubic mm of blood On laboratory report expressed as : 4.5-6.2 (x10 6 mm 3 )

36. 36 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Red Blood Cell Count, cont. 3.Performed using automated blood cell counter 4.Decrease in red blood count a.Anemia b.Hodgkin's disease c.Leukemia

37. 37 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Red Blood Cell Count, cont. 5.Increase in red blood count a.Polycythemia b.Dehydration c.Pulmonary fibrosis

38. 38 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

39. 39 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

40. 40 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Differential Count 1.Five types of WBCs, each having certain: a.Appearance b.Size c.Shape d.Function

41. 41 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Differential Count, cont. 2. Types of WBCs: a. Neutrophils b. Eosinophils c. Basophils d. Lymphocytes e. Monocytes

42. 42 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. White Blood Cell Differential Count, cont. 3. Purpose of differential a.To identify and count the five types of WBCs in a representative blood sample Increase or decrease in one or more types –Assists physician in making a diagnosis 4. Can be performed automatically or manually

43. 43 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Automatic Method 1.Blood cell counter used (e.g., Coulter counter) 2.Specimen requirement a.Ethylenediaminetetraacetic acid–anticoagulated (EDTA-anticoagulated) blood specimen Lavender-stoppered tube

44. 44 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Automatic Method, cont. 3.Blood cell counter automatically performs differential count a.Prints results on a laboratory report

45. 45 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Manual Method 1.Blood specimen can be made from: a.Fresh whole blood (preferred) b.EDTA-anticoagulated blood Other anticoagulants alter: –Morphology of WBCs –Staining reaction of WBCs

46. 46 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Manual Method, cont. 2.Medical assistant makes two blood smears From Rodak BF: Hematology: clinical principles and applications, Philadelphia, 1995, Saunders

47. 47 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Manual Method, cont. 3.Slides placed in protective container for transport to outside laboratory 4.Laboratory personnel stain smear (Wright's stain) a.Because WBCs are clear and colorless b.After staining: Nucleus, cytoplasm, and granules: take characteristic color of their cell type –Aids in identification of the five different types of WBCs

48. 48 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Manual Method, cont. 5.Minimum of 100 WBCs identified a.Each assigned to appropriate category: Neutrophils Eosinophils Basophils Lymphocytes Monocytes From Custer RP: An atlas of the blood and bone marrow, ed 2, Philadelphia, 1974, Saunders

49. 49 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Manual Method, cont. 6.Number of each type recorded as a percentage a.Reflects overall distribution of WBCs in patient's blood

50. 50 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Types of White Blood Cells, cont. 7. Normal range for differential count: a.Neutrophils 50%-70% b.Eosinophils 1%-4% c.Basophils 0%-1% d.Lymphocytes 20%-35% e.Monocytes 3%-8%

51. 51 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

52. 52 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. What Would You Do? What Would You Not Do?

53. 53 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Posttest True or False 1.Red and white blood counts are included in a CBC. 2.The normal range for hemoglobin for an adult male is 14 to 18 g/dL. 3.An increase in the Hgb level occurs with CHF. 4.The term hematocrit means “to separate blood.” 5.The buffy coat consists of red blood cells.

54. 54 Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Posttest, cont. True or False 6.Hematocrit test results should be read at the top of the red blood cell column. 7.The normal adult range for a white blood cell count is 4500 to 11,000. 8.Leukopenia occurs when a patient has appendicitis. 9.The normal range for a red blood cell count for a woman is 4 to 5.5 million. 10.Two blood smears must be prepared for a differential white blood cell count.