1. Introduction to Haematology Dr Kate Foley ST5 Haematology

2. Definitions Haematology- ‘ the branch of medical science concerned with diseases of the blood and blood-forming tissues. ’

3. This includes... Disorders of red cells, white cells and platelets Disorders of coagulation factors Transfusion Malignancies related to blood, bone marrow and lymphatic tissue. Stem cell transplantation Paediatric Haematology

4. Role of a Haematologist Working as part of a clinical team looking after patients with a spectrum of haematological disorders Clinical interpretation of laboratory data and morphology of blood and bone marrow Advisory and consultancy service for hospital clinicians and GPs Clinical responsibility for the haematology and transfusion laboratory Holistic approach to clinical care

5. Whole Blood PlasmaFormed Elements Nitrogenous Waste Electrolytes Gases Proteins Nutrients Amino acids Fibrinogen Albumins Globulins Myelocytes Leukocytes Platelets Basophils Eosinophils Neutrophils Lymphocytes Monocytes B cell T Cell NK Cell Erythrocytes

7. Neutrophil Erythrocyte Platelet

8. Neutrophil Monocyte Lymphocyte Eosinophil Basophil

9. Full blood count Manual –WBC and RBC counted using neubauer chamber –Differential, platelets and morphology on thin smear –RBC indices calculated using formulas Automated –Computerised multichannel analysers sort and size cells on the basis of changes in electrical impedence or light pulses as the cells pass in front of a laser.

10. Full Blood Count Normal Ranges –Group of normal subjects sampled under strict conditions –Mean +/- 2SD range (95%) –BUT counts also influenced by age, gender, build, ethnic origin, environment –Need to make sure the reference range is appropriate for your patient.

11. Interpretation Right patient? Clinical information –Pregnancy, surgery, known comorbidities, smoker, ETOH XS Any abnormal values –One or more cell lines abnormal –High/low –Sampling errors

12. ParameterResultNormal Range Haemoglobin142g/L130-175 White Cells4.5 x 10 9 /L4.0-11.0 Platelets230 x 10 9 /L150-450 Neutrophils2.9 x 10 9 /L1.8-7.5 Lymphocytes1.3 x 10 9 /L1.5-4.0 Monocytes0.3 x 10 9 /L0.2-0.8 Eosinophils0.0 x 10 9 /L0.0-0.4 Haematocrit (HCT)0.450.4-0.52 MCV92fl82-98 MCH29.9pg27.0-34.0 MCHC326g/L310-360

13. ParameterResultNormal Range Haemoglobin142g/L130-175 White Cells20.4 x 10 9 /L4.0-11.0 Platelets460 x 10 9 /L150-450 Neutrophils17.8 x 10 9 /L1.8-7.5 Lymphocytes2.6 x 10 9 /L1.5-4.0 Monocytes0.3 x 10 9 /L0.2-0.8 Eosinophils0.0 x 10 9 /L0.0-0.4 Haematocrit (HCT)0.450.4-0.52 MCV92fl82-98 MCH29.9pg27.0-34.0 MCHC326g/L310-360

14. Blood Film Smear made from FBC sample. Look at the number and appearance of red cells, white cells and platelets. Film comment usually appears at end of FBC Can give useful information and clinical advice

15. Blood Film Comment ‘Neutrophilia and mild thrombocytosis with toxic granulation and left shift.’

16. ParameterResultNormal Range Haemoglobin75g/L130-175 White Cells45.2 x 10 9 /L4.0-11.0 Platelets30 x 10 9 /L150-450 Neutrophils0.1 x 10 9 /L1.8-7.5 Lymphocytes 0.5 x 10 9 /L1.5-4.0 Monocytes0.3 x 10 9 /L0.2-0.8 Eosinophils0.0 x 10 9 /L0.0-0.4 Haematocrit (HCT)0.450.4-0.52 MCV92fl82-98 MCH29.9pg27.0-34.0 MCHC326g/L310-360

18. Conclusion Haematology is a diverse speciality bringing together laboratory and clinical aspects Blood results more informative within clinical context Have a systematic approach Ask a friendly Haematologist!