1. CHAPTER 18
HEMATOLOGY

2. PRETEST
True or False
Plasma makes up approximately 55% of the blood volume.
A mature erythrocyte is biconcave in shape and contains a nucleus.
Erythrocytes are responsible for defending the body against infection.
The life span of a red blood cell is 120 days.
The function of hemoglobin is to assist in blood clotting.

3. PRETEST, CONT. True or False
Leukocytosis is an abnormal increase in the number of leukocytes.
Another name for a thrombocyte is a platelet.
A low hemoglobin reading occurs with polycythemia.
A neutrophil is classified as a granular leukocyte.
An increase in neutrophils occurs during an acute infection.

4. Content Outline Introduction to Hematology
Hematology: the study of blood
Includes:
Morphologic appearance of blood cells
Function of blood cells
Diseases of the blood and blood-forming tissues

5. Introduction to Hematology, cont.
Laboratory analysis in hematology includes:
Purpose: Examining blood to detect pathologic conditions
Includes
Performing blood cell counts
Evaluating clotting ability of blood
Identifying cell types
Determines if each blood component falls within normal range
What are the two best known types of blood cells?
Can you name a third type?

6. Introduction to Hematology, cont.
Specific hematology tests
Hemoglobin (Hgb or Hb)
Hematocrit (Hct)
White blood cell count (WBC)
Complete blood count (CBC) is a screening test.
What are these tests for? 6

7. Introduction to Hematology, cont.
Red blood cell count (RBC)
Differential white blood cell count (diff)
Erythrocyte sedimentation rate (ESR)
Platelet count (Plt)
What are these tests for? 7

8. Introduction to Hematology, cont.
Hematology tests
May be performed in the medical office
Automated blood analyzers designed for the medical office
Perform laboratory tests
With accurate test results
In a short period of time
Why is it convenient for the patient that the tests are done in the office? 8

9. Introduction to Hematology, cont.
Operating manual
Accompanies each analyzer
Information included:
Operation
Test parameters
Care an maintenance
Why is it important for the MA to study the manual and know how to perform the functions listed on the slide? 9

10. Introduction to Hematology, cont.
Complete blood count (CBC):
Most frequently performed hematologic test
Performed on new patients
Performed on patients with a pathological condition
Why is it performed on new patients? 10

11. Introduction to Hematology, cont.
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 11

12. Components and Function of Blood
Blood consists of two parts:
Plasma: liquid portion
Consists of clear yellowish fluid
Makes up 55% of blood volume
What percentage of plasma is water? 12

13. Components and Function of Blood
Function of plasma:
Transports nutrients to tissues of body
Picks up wastes from tissue: excreted through kidneys
Transports: antibodies, enzymes, and hormones
Define antibodies, enzymes, and hormones. 13

14. Components and Function of Blood, cont.
Cells: solid portion
Erythrocytes
Leukocytes
Thrombocytes
Makes up 45% of blood volume
Average adult body: 10 to 12 pints of blood
Where are thrombocytes formed? 14

15. Erythrocytes In an adult: erythrocytes formed in red bone marrow of
Ribs
Sternum
Skull
Pelvic bone
Ends of long bones of limbs
What is a condition in which erythrocytes are affected? 15

16. Erythrocytes, cont. Immature form: contains a nucleus As RBC matures:
Loses nucleus as cell matures
Acquires shape of biconcave disc
Provides more surface area for exchange of substances 16

17. Erythrocytes, cont. Red blood count range:
Adult female: 4 to 5.5 million/cubic mm of blood
Adult male: 4.5 to 6.2 million/cubic mm of blood
Why is it important to know the ranges? 17

18. Erythrocytes, cont. Hemoglobin Makes up major portion of erythrocyte
Transports oxygen
Responsible for red color of RBC
A pulse oximeter is used as a screening test for oxygen saturation in the medical office. How is it related to hemoglobin? 18

19. Erythrocytes, cont. Normal range: Hemoglobin molecule consists of:
Adult female: 12 to 16 g/dL
Adult male: 14 to 18 g/dL
Hemoglobin molecule consists of:
Globin: protein
Heme: iron-containing pigment
What conditions may occur if the hemoglobin is too low? 19

20. Erythrocytes, cont. Transfer of oxygen and carbon dioxide: Oxygen:
Hemoglobin: picks up oxygen in the lungs
One Hgb molecule combines with 4 oxygen molecules
Oxyhemoglobin: hemoglobin that has combined with oxygen
What functions does the oxyhemoglobin perform?
Oxyhemoglobin is transported and distributed to tissues
Oxygen released from the hemoglobin to tissues 20

21. Erythrocytes, cont. Carbon dioxide: Waste product
Picked up from the tissues by the blood
Transported to lungs and expelled
In what structure in the lungs does the gas exchange take place? (alveoli surrounded by capillaries) 21

22. Erythrocytes, cont. Arterial blood Carries oxyhemoglobin
Causes blood to have a bright red color
An arterial blood gas test may be ordered to determine the concentration of oxygen, carbon dioxide, and bicarbonate, as well as the pH. 22

23. Erythrocytes, cont. Venous blood Lower oxygen content:
Causes blood to have a dark red color
Venous blood can be obtained by venipuncture. 23

24. Erythrocytes, cont. Average life span of RBC: 120 days
Hemolysis: breakdown of RBCs
RBC becomes fragile and ruptures
Hemoglobin released from RBC
How is it possible for us to live if our RBCs die in 120 days? 24

25. Erythrocytes, cont. Hgb breaks down into: Iron: stored and reused
Globin (protein): metabolized by body
Bilirubin:
Excreted as waste product in bile
Orange bile pigment
Produced by the breakdown of heme from the Hgb molecule
Transported to liver
Bilirubin is responsible for the yellow color in our bruises. 25

26. Leukocytes Clear, colorless cells that contain a nucleus
Adult normal range: 4,500 to 11,000/cubic mm of blood
What does a leukocyte look like? 26

27. Leukocytes, cont.
Leukocytosis: An abnormal increase in the number of leukocytes
Above 11,000/cubic mm of blood
Leukopenia: An abnormal decrease in the number of leukocytes
Below 4,5000/cubic mm of blood
What symptoms might a person have if he or she has leukocytosis?
What symptoms might a person have if he or she has leukopenia? 27

28. Leukocytes, cont.
Function of leukocytes: defend body against infection
Destroys invading pathogens
Removes them from the body
White blood cells (WBCs) do their work in the tissues
Transported to site of infection by circulatory system
What types of infections might the leukocyte fight off? 28

29. Leukocytes, cont. During inflammation:
Blood vessels dilate in affected area
Results in increased blood supply
More oxygen, nutrients, and WBCs delivered to infected area
Aids in healing process
What medications are given for infection?
What medications are given for inflammation? 29

30. Leukocytes, cont. Cells making up capillary wall spread apart
WBCs squeeze through pores by ameboid movement
Move into tissues to fight infection
Diapedesis: the movement of leukocytes through the pores of capillaries and into the tissues
Ameboid movement: movement used by leukocytes that permits them to propel themselves from the capillaries into the tissues
If a person has a low WBC count, can he or she fight off infection? 30

31. Leukocytes, cont. Some white blood cells exhibit phagocytosis:
Engulf pathogens
Destroy pathogens 31

32. Leukocytes, cont. Destroy damaged cells
Pus may form in infected area and consists of:
Dead leukocytes
Dead bacteria
Dead tissue cells 32

33. Thrombocytes Also known as platelets
Small, clear, and shaped like discs
Do not have a nucleus
What are megakaryocytes? 33

34. Thrombocytes, cont. Formed in red bone marrow
Function: participate in blood-clotting mechanism
Adult normal range: 150,000 to 400,000/cubic mm of blood
Why is it important for the blood to clot? 34

35. Hemoglobin Determination
Hemoglobin (Hgb): major component of RBCs
Hgb transports oxygen to tissue cells
Responsible for red color of RBCs 35

36. Hemoglobin Determination, cont.
Normal range
Adult female: 12 to 16 g/dL
Adult male: 14 to 18 g/dL
Hgb performed as individual test or as part of CBC 36

37. Hemoglobin Determination, cont.
Decreased Hgb level occurs with:
Anemia (especially iron-deficiency anemia)
Hyperthyroidism
Cirrhosis of liver
Severe hemorrhaging
What other conditions may cause the Hgb to be low? (kidney failure, Crohn’s, cancer) 37

38. Hemoglobin Determination, cont.
Hemolytic reactions
Certain systemic diseases
Leukemia
Hodgkin's disease
What is Hodgkin’s disease? 38

39. Hemoglobin Determination, cont.
Increased Hgb level occurs with:
Polycythemia
Chronic obstructive pulmonary disease
Congestive heart failure
What are other conditions may cause the Hgb to be high? (smoking, kidney disease, dehydration) 39

40. Hemoglobin Determination, cont.
Blood analyzer:
Most accurate and reliable method
Can use capillary or venous blood
Processes specimen in a short time
Results obtained while patient is still at office
What is the difference between capillary and venous blood? 40

41. Hematocrit Abbreviated Hct Hematocrit means "to separate blood"
Solid cellular elements separated from plasma
By centrifuging an anticoagulated blood specimen
Heavier RBCs become packed and settle to bottom of tube
See slide 43 for diagram. 41

42. Hematocrit, cont. Top layer: contains clear, straw-colored plasma
Between layers is small, thin, yellowish-gray layer
Buffy coat: contains platelets and WBCs
See slide 43 for diagram. 42

43. Hematocrit

44. Hematocrit, cont.
Purpose of Hct: measures percentage of packed RBCs in whole blood
Normal range
Adult female: 37% to 47%
Adult male: 40% to 54%
Why is it important to know the range for hematocrit? 44

45. Hematocrit, cont. Low reading: may indicate anemia
High reading: may indicate polycythemia
7. Used with other tests to diagnose patient's condition
With what other tests may we use hematocrit? 45

46. Hematocrit, cont. Microhematocrit method
Most often used in medical office
Blood obtained by skin puncture
Using a disposable capillary tube lined with anticoagulant
Blood drawn into tube
- Sealed with a sealing compound
Besides what is listed on the slide, what equipment is needed to perform a microhematocrit determination? 46

47. Hematocrit

48. Hematocrit, cont. Centrifuged for 3 to 5 minutes Packs the RBCs
Where does the sealing compound face?

49. Hematocrit, cont. Results read at top of packed cell column
Where should you place the sealing compound?

50. What Would You Do? What Would You Not Do?

51. What Would You Do? What Would You Not Do?

52. White Blood Cell Count
Approximate measurement of number of WBCs in circulating blood
Adult normal range: 4,500 to 11,000 WBC/cubic mm of blood
Expressed as 4.5 to 11.0 (× 103/mm3) on laboratory reports
If a patient’s WBC count was 15,000, would it be within normal range? 52

53. White Blood Cell Count, cont.
Leukocytosis: increase in the number of WBCs (above 11,000)
Most commonly seen in acute infections:
Appendicitis
Chickenpox
Diphtheria
Infectious mononucleosis
Meningitis
Rheumatic fever
Why would WBCs be high with these infections? 53

54. White Blood Cell Count, cont.
Normal elevation can occur in:
Pregnancy
Strenuous exercise
Stress
Treatment with corticosteroids
Why would WBC be high during pregnancy? 54

55. White Blood Cell Count, cont.
Leukopenia: decreased WBC
Viral infections
Chemotherapy
Radiation therapy
Why would WBC be low with radiation therapy? 55

56. White Blood Cell Count, cont.
Blood cell counter used to determine WBC
Can also perform
RBC
Platelet count
Hemoglobin
Hematocrit
Differential WBC count
Calculation of RBC indices
Who will use a blood cell counter? 56

57. Automated Blood Cell Counter

58. Red Blood Cell Count Measurement of number of RBCs in whole blood
Normal range
Female: 4 to 5.5 million/cubic mm of blood
On laboratory report expressed as: 4.0 to 5.5 (x 106 mm3)
Male: 4.5 to 6.2 million/cubic mm of blood
On laboratory report expressed as : 4.5 to 6.2 (x 106 mm3)
Why would the counts be different between males and females? 58

59. Red Blood Cell Count, cont.
Performed using blood cell counter
Decrease in red blood count
Anemia
Hodgkin's disease
Leukemia 59

60. Red Blood Cell Count, cont.
Increase in red blood count
Polycythemia
Dehydration
Pulmonary fibrosis 60

61. What Would You Do? What Would You Not Do?

62. What Would You Do? What Would You Not Do?

63. White Blood Cell Differential Count
Five types of WBCs each having certain:
Appearance
Size
Shape
Function
Name the five WBCs. 63

64. White Blood Cell Differential Count, cont.
Purpose of differential
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
Can be performed automatically or manually
What is the difference in technique between automatic and manual? 64

65. Automatic Method Blood cell counter used (e.g., Coulter counter)
Specimen requirement
Ethylenediaminetetraacetic acid–anticoagulated (EDTA-anticoagulated) blood specimen
Lavender-stoppered tube
What would happen if you used the wrong kind of tube? 65

66. Automatic Method, cont.
Blood cell counter automatically performs differential count
Prints results on a laboratory report
What happens to the lab report after it is printed? 66

67. Differential Manual Method
Blood specimen can be made from:
Fresh whole blood (preferred)
EDTA-anticoagulated blood
Other anticoagulants alter:
Morphology of WBCs
Staining reaction of WBCs
What does “fresh whole blood” mean? 67

68. Differential Manual Method, cont.
MA makes two blood smears
From Rodak BF: Hematology: clinical principles and applications,
Philadelphia, 1995, Saunders.

69. Differential Manual Method, cont.
Slides placed in protective container for transport to outside laboratory
Laboratory personnel stain smear (Wright's stain)
Because WBCs are clear and colorless
After staining:
Nucleus, cytoplasm, and granules: take characteristic color of their cell type
Aids in identification of the five different types of white blood cells
Why must slides be contained in a protective covering? 69

70. Differential Manual Method, cont.
Minimum of 100 WBCs identified
Each assigned to appropriate category:
Neutrophils
Eosinophils
Basophils
Lymphocytes
Monocytes
Identify the different cells on the slide.
From Custer RP: An atlas of the blood and bone marrow, ed 2,
Philadelphia, 1974, Saunders. 70

71. Differential Manual Method, cont.
Number of each type recorded as a percentage
Reflects overall distribution of WBCs in patient's blood 71

72. Types of White Blood Cells
Classified into two categories
Granular: contain distinct granules in cytoplasm:
Neutrophils
Eosinophils
Basophils
Identify the granular WBCs on the slide.
From Custer RP: An atlas of the blood and bone marrow, ed 2,
Philadelphia, 1974, Saunders. 72

73. Types of White Blood Cells, cont.
Nongranular: few or no granules in cytoplasm:
Lymphocytes
Monocytes
Identify the nongranular WBC on the slide.
From Custer RP: An atlas of the blood and bone marrow, ed 2,
Philadelphia, 1974, Saunders. 73

74. Types of White Blood Cells, cont.
Description of WBCs:
Neutrophils: 50% to 70%
Most numerous WBC
Multilobed nucleus that stains purple
May contain three to five lobes or segments
Why would we need neutrophils? 74

75. Types of White Blood Cells, cont.
Known as "segs"
Cytoplasm: stains a faint pink
Contains many fine granules: stain violet-pink
Exhibit high degree of ameboid movement
Function: actively phagocytic
Phagocytosis: The engulfing and destruction of foreign particles such as bacteria
Segs are also known as “polys” or “polymorphs.” 75

76. Types of White Blood Cells, cont.
Immature form: band
Has a curved, nonsegmented nucleus
Normal range: up to 5%
Increase in neutrophils (and bands)
Occurs during an acute infection
What distinguishes immature forms of neutrophils? What are these called? 76

77. Types of White Blood Cells, cont.
Eosinophils: 1% to 4%
Contain a segmented nucleus: of no more than 2 lobes
Cytoplasm: contains large granules
Stain bright reddish-orange
Increase in eosinophils:
Allergic conditions
Parasitic infestations
Name a parasitic infestation. 77

78. Types of White Blood Cells, cont.
Basophils: up to 1%
Least numerous WBC
Contains S-shaped nucleus
Cytoplasm: contains large, coarse, dark bluish-black granules
Almost completely obscure details of nucleus
What is the main function of basophils? 78

79. Types of White Blood Cells, cont.
Lymphocytes: 20% to 35%
Smallest WBC
Round, slightly indented nucleus
Almost completely fills cell
Stains deep purplish blue
What is the main function of the lymphocytes? 79

80. Types of White Blood Cells, cont.
Small rim of sky-blue cytoplasm around nucleus
Contains few or no granules
Involved with immune system and production of antibodies 80

81. Types of White Blood Cells, cont.
Increase occurs with viral diseases
Infectious mononucleosis
Mumps
Chickenpox
Rubella
Viral hepatitis
Why would there be an increase in the lymphocytes? 81

82. Types of White Blood Cells, cont.
Monocytes: 3% to 8%
Largest WBC
Large nucleus
Usually kidney or horseshoe shaped
Can be round or oval
Cytoplasm: stains grayish blue
What are the main functions performed by the monocytes? 82

83. Types of White Blood Cells
From Custer RP: An atlas of the blood and bone marrow, ed 2,
Philadelphia, 1974, Saunders.

84. Types of White Blood Cells, cont.
Normal range for diff count:
Neutrophils 50% to 70%
Eosinophils 1% to 4%
Basophils up to 1%
Lymphocytes 20% to 35%
Monocytes 3% to 8% 84

85. What Would You Do? What Would You Not Do?

86. What Would You Do? What Would You Not Do?

87. POSTTEST
True or False
A function of the plasma is to transport antibodies, enzymes, and hormones.
The red bone marrow of the sternum produces red blood cells in the adult.
The normal range for a red blood cell count for an adult female is 4 to 5.5 million.
The normal range for hemoglobin for an adult male is 12 to 16 g/dL.
The normal adult range for a white blood cell count is 4,500 to 11,000.

88. POSTTEST, CONT. True or False Leukocytes do their work in the tissues.
Bilirubin is an orange pigment that comes from the breakdown of hemoglobin.
Leukopenia occurs when a patient has appendicitis.
An immature form of a neutrophil is known as a seg.
The primary function of a neutrophil is to form antibodies.