1. Investigation in hematology Chittima Sirijerachai

2. Investigation in hematology Anemia Bleeding Malignancy

3. 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

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

5. Criteria for Diagnosis Anemia Hb.( g/dl) Hct (%) Children 11.033 Male 13.040 Female ( 15-50 )12.036 Female ( > 50 ) 13.040 Pregnant women 11.033

6. Criteria for diagnosis polycythemia Male1860 Female17.555 HbHct

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

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

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

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

17. CBC and RBC indices 80-96 fl. 27-33 pg. 33-36 g/dl 12.0-13.6%

18. Reticulocyte count Normal= 0.2-2 % Corrected reticulocyte =Pt HCT X Reti. Normal HCT

19. Inclusion body Heinz body

20. Osmotic fragility (OF) Red cell + 0.33 % NSS One tube OF – screening for thalassemia Hereditary spherocytosis

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

22. Thalassemia -  thalassemia -  thalassemia - hemoglobinopathy

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

24.  thalassemia 00 ++

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

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

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

28. Heterozygote hemoglobin E  EE     2  2 = Hb A     2 = Hb E 25-35 %

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

30. FatherMothersibling 1sibling 2 Hct45%33 %42%36 % MCV70658270% Hb typingA2AA2AA 2 ABart’s HA2AA2AA2AA2A Hb A %96919798 Hb A 2 2.21.41.11.5 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

31. Fathermothersibling 1sibling 2 Hct40 % 2545% MCV72846585 Hb typingA2AA2AEAEFA2AA2A Hb A %9498 Hb A 2 5.51.5 Hb F32 Hb E3065 Hb Bart’s Hb H Hb CS genotype b trait E trait b /E normal

32. Investigation in patient with bleeding disorders

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

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

36. CBC and platelet

37. Giant platelet

39. Bleeding time Platelet function Normal: 2-7 minute

41. PTT

42. PT

43. TT

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

45. Prothrombin time (PT) Normal:11.6-14.4sec PT ratio= Normal < 1.3 INR= Control PT patient PT Control PT patient PT ISI ISI = international sensitivity index

46. Partial thromboplastin time (PTT) Normal= 34-48 sec Isolated PTT prolong: F VIII, IX, XI, XII deficiency F VIII, IX, XI inhibitor Antiphospholipid syndrome

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