8/2/2019 3947418 Hematology

1/47

HEMATOLOGYHEMATOLOGY

EMERITA C. MENDOZA,EMERITA C. MENDOZA,

R.N., M.D.R.N., M.D.

8/2/2019 3947418 Hematology

2/47

BloodBlood

Slide 10.1aSlide 10.1aCopyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

The only fluid tissue in the human body

Classified as a connective tissue

Living cells = formed elements

Non-living matrix = plasma

8/2/2019 3947418 Hematology

3/47

BloodBlood

Slide 10.1bSlide 10.1bCopyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 10.1

8/2/2019 3947418 Hematology

4/47

Physical Characteristics of BloodPhysical Characteristics of Blood

Slide 10.2Slide 10.2Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Color range

Oxygen-rich blood is scarlet redOxygen-poor blood is dull red

pH must remain between 7.357.45

Blood temperature is slightly higher thanbody temperature

8/2/2019 3947418 Hematology

5/47

Blood PlasmaBlood Plasma

Slide 10.3Slide 10.3Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Composed of approximately 90 percentwater

Includes many dissolved substances

NutrientsSalts (metal ions)

Respiratory gases

Hormones

Proteins

Waste products

8/2/2019 3947418 Hematology

6/47

Plasma ProteinsPlasma Proteins

Slide 10.4Slide 10.4Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Albumin regulates osmotic pressure

Clotting proteins help to stem bloodloss when a blood vessel is injured

Antibodies help protect the body fromantigens

8/2/2019 3947418 Hematology

7/47

Formed ElementsFormed Elements

Slide 10.5aSlide 10.5aCopyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Erythrocytes = red blood cells

Leukocytes = white blood cells

Platelets = cell fragments

8/2/2019 3947418 Hematology

8/47

Erythrocytes (Red Blood Cells)Erythrocytes (Red Blood Cells)

Slide 10.6Slide 10.6Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

The main function is to carry oxygen

Anatomy of circulating erythrocytes

Biconcave disks

Essentially bags of hemoglobin

Anucleate (no nucleus)

Contain very few organelles

Outnumber white blood cells 1000:1

8/2/2019 3947418 Hematology

9/47

HemoglobinHemoglobin

Slide 10.7Slide 10.7Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Iron-containing protein

Binds strongly, but reversibly, to oxygen

Each hemoglobin molecule has fouroxygen binding sites

Each erythrocyte has 250 millionhemoglobin molecules

8/2/2019 3947418 Hematology

10/47

Leukocytes (White Blood Cells)Leukocytes (White Blood Cells)

Slide 10.8Slide 10.8Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Crucial in the bodys defense againstdisease

These are complete cells, with a

nucleus and organellesAble to move into and out of blood

vessels (diapedesis)

Can move by ameboid motion Can respond to chemicals released by

damaged tissues

8/2/2019 3947418 Hematology

11/47

Leukocyte Levels in the BloodLeukocyte Levels in the Blood

Slide 10.9Slide 10.9Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Normal levels are between 4,000 and11,000 cells per millimeter

Abnormal leukocyte levels

LeukocytosisAbove 11,000 leukocytes/ml

Generally indicates an infection

Leukopenia

Abnormally low leukocyte level

Commonly caused by certain drugs

8/2/2019 3947418 Hematology

12/47

Types of LeukocytesTypes of Leukocytes

SlideSlide10.10a10.10a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Granulocytes

Granules in their

cytoplasm can bestained

Include

neutrophils,eosinophils, andbasophils

Figure 10.4

8/2/2019 3947418 Hematology

13/47

Types of LeukocytesTypes of Leukocytes

SlideSlide10.10b10.10b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Agranulocytes

Lack visiblecytoplasmicgranules

Include

lymphocytes andmonocytes

Figure 10.4

8/2/2019 3947418 Hematology

14/47

GranulocytesGranulocytes

SlideSlide10.11a10.11a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Neutrophils

Multilobed nucleus with fine granules

Act as phagocytes at active sites of infection

Eosinophils

Large brick-red cytoplasmic granulesFound in repsonse to allergies and parasitic

worms

8/2/2019 3947418 Hematology

15/47

GranulocytesGranulocytes

SlideSlide10.11b10.11b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Basophils

Have histamine-containing granules

Initiate inflammation

8/2/2019 3947418 Hematology

16/47

AgranulocytesAgranulocytes

Slide 10.12Slide 10.12Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Lymphocytes

Nucleus fills most of the cell

Play an important role in the immuneresponse

Monocytes

Largest of the white blood cells

Function as macrophages

Important in fighting chronic infection

8/2/2019 3947418 Hematology

17/47

PlateletsPlatelets

Slide 10.13Slide 10.13Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Derived from ruptured multinucleate

cells (megakaryocytes) Needed for the clotting process

Normal platelet count = 300,000/mm3

8/2/2019 3947418 Hematology

18/47

HematopoiesisHematopoiesis

Slide 10.14Slide 10.14Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Blood cell formation

Occurs in red bone marrow

All blood cells are derived from acommon stem cell (hemocytoblast)

Hemocytoblast differentiation

Lymphoid stem cell produces lymphocytes

Myeloid stem cell produces other formedelements

8/2/2019 3947418 Hematology

19/47

Fate of ErythrocytesFate of Erythrocytes

Slide 10.15Slide 10.15Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Unable to divide, grow, or synthesizeproteins

Wear out in 100 to 120 days

When worn out, are eliminated byphagocytes in the spleen or liver

Lost cells are replaced by division ofhemocytoblasts

8/2/2019 3947418 Hematology

20/47

Control of Erythrocyte ProductionControl of Erythrocyte Production

Slide 10.16Slide 10.16Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Rate is controlled by a hormone(erythropoietin)

Kidneys produce most erythropoietin asa response to reduced oxygen levels inthe blood

Homeostasis is maintained by negativefeedback from blood oxygen levels

8/2/2019 3947418 Hematology

21/47

HemostasisHemostasis

Slide 10.18Slide 10.18Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Stoppage of blood flow

Result of a break in a blood vessel

Hemostasis involves three phases

Platelet plug formation

Vascular spasms

Coagulation

8/2/2019 3947418 Hematology

22/47

Platelet Plug FormationPlatelet Plug Formation

Slide 10.19Slide 10.19Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Collagen fibers are exposed by a breakin a blood vessel

Platelets become sticky and cling tofibers

Anchored platelets release chemicals to

attract more platelets

Platelets pile up to form a platelet plug

8/2/2019 3947418 Hematology

23/47

Vascular SpasmsVascular Spasms

Slide 10.20Slide 10.20Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Anchored platelets release serotonin

Serotonin causes blood vessel musclesto spasm

Spasms narrow the blood vessel,decreasing blood loss

8/2/2019 3947418 Hematology

24/47

CoagulationCoagulation

SlideSlide10.21a10.21a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Injured tissues release thromboplastin

PF3

(a phospholipid) interacts with

thromboplastin, blood protein clottingfactors, and calcium ions to trigger aclotting cascade

Prothrombin activator convertsprothrombin to thrombin (an enzyme)

8/2/2019 3947418 Hematology

25/47

CoagulationCoagulation

SlideSlide10.21b10.21b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Thrombin joins fibrinogen proteins intohair-like fibrin

Fibrin forms a meshwork(the basis for a clot)

8/2/2019 3947418 Hematology

26/47

Blood ClottingBlood Clotting

Slide 10.22Slide 10.22Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Blood usually clots within 3 to 6 minutes

The clot remains as endotheliumregenerates

The clot is broken down after tissuerepair

8/2/2019 3947418 Hematology

27/47

8/2/2019 3947418 Hematology

28/47

Bleeding DisordersBleeding Disorders

Slide 10.24Slide 10.24Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Thrombocytopenia

Platelet deficiency

Even normal movements can causebleeding from small blood vessels thatrequire platelets for clotting

HemophiliaHereditary bleeding disorder

Normal clotting factors are missing

8/2/2019 3947418 Hematology

29/47

Blood Groups and TransfusionsBlood Groups and Transfusions

Slide 10.25Slide 10.25Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Large losses of blood have seriousconsequences

Loss of 15 to 30 percent causes weakness

Loss of over 30 percent causes shock,which can be fatal

Transfusions are the only way to

replace blood quickly

Transfused blood must be of the sameblood group

8/2/2019 3947418 Hematology

30/47

Human Blood GroupsHuman Blood Groups

SlideSlide10.26a10.26a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Blood contains genetically determinedproteins

A foreign protein (antigen) may beattacked by the immune system

Blood is typed by using antibodies thatwill cause blood with certain proteins toclump (agglutination)

8/2/2019 3947418 Hematology

31/47

Human Blood GroupsHuman Blood Groups

SlideSlide10.26b10.26b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

There are over 30 common red blood

cell antigens The most vigorous transfusion reactions

are caused by ABO and Rh blood group

antigens

8/2/2019 3947418 Hematology

32/47

ABO Blood GroupsABO Blood Groups

SlideSlide10.27a10.27a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Based on the presence or absence of twoantigens

Type A

Type B

The lack of these antigens is calledtype O

8/2/2019 3947418 Hematology

33/47

ABO Blood GroupsABO Blood Groups

SlideSlide10.27b10.27b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

The presence of both A and B is called

type AB

The presence of either A or B is calledtypes A and B, respectively

8/2/2019 3947418 Hematology

34/47

Rh Blood GroupsRh Blood Groups

Slide 10.28Slide 10.28Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Named because of the presence orabsence of one of eight Rh antigens

(agglutinogen D)

Most Americans are Rh+

Problems can occur in mixing Rh+

bloodinto a body with Rh blood

8/2/2019 3947418 Hematology

35/47

Rh Dangers During PregnancyRh Dangers During Pregnancy

SlideSlide10.29a10.29a

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Danger is only when the mother is Rhand the father is Rh+, and the childinherits the Rh+ factor

8/2/2019 3947418 Hematology

36/47

Rh Dangers During PregnancyRh Dangers During Pregnancy

SlideSlide10.29b10.29b

Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

The mismatch of an Rh mother carryingan Rh+ baby can cause problems for theunborn child

The first pregnancy usually proceeds withoutproblems

The immune system is sensitized after thefirst pregnancy

In a second pregnancy, the mothers immunesystem produces antibodies to attack the Rh+blood (hemolytic disease of the newborn)

8/2/2019 3947418 Hematology

37/47

Blood TypingBlood Typing

Slide 10.30Slide 10.30Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Blood samples are mixed with anti-A andanti-B serum

Coagulation or no coagulation leads to

determining blood type

Typing for ABO and Rh factors is done inthe same manner

Cross matching testing for agglutinationof donor RBCs by the recipients serum,and vice versa

8/2/2019 3947418 Hematology

38/47

Developmental Aspects of BloodDevelopmental Aspects of Blood

Slide 10.31Slide 10.31Copyright 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Sites of blood cell formation

The fetal liver and spleen are early sites of

blood cell formation

Bone marrow takes over hematopoiesis bythe seventh month

Fetal hemoglobin differs fromhemoglobin produced after birth

8/2/2019 3947418 Hematology

39/47

HEMATOLOGYHEMATOLOGY- study of the- study of theformed elements of theformed elements of theblood (red blood cells, whileblood (red blood cells, whileblood cells, platelets) as wellblood cells, platelets) as wellas blood typing and bloodas blood typing and blood

coagulation.coagulation.

http://images.google.com.ph/imgres?imgurl=http://www.aperfectworld.org/clipart/healthcare/blood.gif&imgrefurl=http://forums.vmacedonia.com/topic.asp%3FTOPIC_ID%3D5273%26whichpage%3D3&h=300&w=203&sz=8&tbnid=6Du6xfuVNucJ:&tbnh=110&tbnw=75&start=27&prev=/images%3Fq%3Dblood%26start%3D20%26hl%3Den%26lr%3D%26sa%3DN

8/2/2019 3947418 Hematology

40/47

HEMATOLOGIC SPECIMENSHEMATOLOGIC SPECIMENS

CBC basic tool for enumeration of RBC,CBC basic tool for enumeration of RBC,WBC,WBC,

plateletsplatelets RBCRBC

RBC Count polycythemia,RBC Count polycythemia,erythrocytosis,erythrocytosis,

high altitude, CVS diseaseshigh altitude, CVS diseases

Hemoglobin - Hg content of bloodHemoglobin - Hg content of blood

Hematocrit volume of packed cellsHematocrit volume of packed cells

RBC IndicesRBC Indices MCV (vitaminMCV (vitamin

deficiencies)deficiencies)

MCHMCH

MCHC (anemias,MCHC (anemias,

http://images.google.com/imgres?imgurl=training.seer.cancer.gov/module_diagnostic/images/img_lab_tests.jpg&imgrefurl=http://training.seer.cancer.gov/module_diagnostic/unit02_lab_tests.html&h=150&w=203&prev=/images%3Fq%3Dcomplete%2Bblood%2Bcount%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=training.seer.cancer.gov/module_diagnostic/images/img_lab_tests.jpg&imgrefurl=http://training.seer.cancer.gov/module_diagnostic/unit02_lab_tests.html&h=150&w=203&prev=/images%3Fq%3Dcomplete%2Bblood%2Bcount%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=training.seer.cancer.gov/module_diagnostic/images/img_lab_tests.jpg&imgrefurl=http://training.seer.cancer.gov/module_diagnostic/unit02_lab_tests.html&h=150&w=203&prev=/images%3Fq%3Dcomplete%2Bblood%2Bcount%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=training.seer.cancer.gov/module_diagnostic/images/img_lab_tests.jpg&imgrefurl=http://training.seer.cancer.gov/module_diagnostic/unit02_lab_tests.html&h=150&w=203&prev=/images%3Fq%3Dcomplete%2Bblood%2Bcount%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=training.seer.cancer.gov/module_diagnostic/images/img_lab_tests.jpg&imgrefurl=http://training.seer.cancer.gov/module_diagnostic/unit02_lab_tests.html&h=150&w=203&prev=/images%3Fq%3Dcomplete%2Bblood%2Bcount%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8

8/2/2019 3947418 Hematology

41/47

8/2/2019 3947418 Hematology

42/47

8/2/2019 3947418 Hematology

43/47

ABNORMALITIES INABNORMALITIES IN

HEMATOLOGIC SPECIMENSHEMATOLOGIC SPECIMENS Abnormalities in cell shapeAbnormalities in cell shape

- ovalocytosis- ovalocytosis - nucleated RBC- nucleated RBC

- sickling- sickling - Howell-Jolly- Howell-Jolly

bodiesbodies

- Burr cells- Burr cells - spherocytes- spherocytes

Hereditary disordersHereditary disorders

Sickle cell anemiaSickle cell anemia

ThalassemiaThalassemia- hereditary elliptocytosis- hereditary elliptocytosis

- G6PD deficiency- G6PD deficiency

http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=hsc.virginia.edu/medicine/clinical/pathology/educ/innes/images/nhjpeg/nh%2520plasmacytoid%2520L%2520x100%2520a.jpeg&imgrefurl=http://hsc.virginia.edu/medicine/clinical/pathology/educ/innes/text/nh/wcb.html&h=181&w=225&prev=/images%3Fq%3Dplasma%2Bcells%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.mdsmetro.com/images/sections/thalassemia.gif&imgrefurl=http://www.mdsmetro.com/patients/conditions/thalassemia.htm&h=145&w=182&prev=/images%3Fq%3Dthalassemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.mdsmetro.com/images/sections/thalassemia.gif&imgrefurl=http://www.mdsmetro.com/patients/conditions/thalassemia.htm&h=145&w=182&prev=/images%3Fq%3Dthalassemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.mdsmetro.com/images/sections/thalassemia.gif&imgrefurl=http://www.mdsmetro.com/patients/conditions/thalassemia.htm&h=145&w=182&prev=/images%3Fq%3Dthalassemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.mdsmetro.com/images/sections/thalassemia.gif&imgrefurl=http://www.mdsmetro.com/patients/conditions/thalassemia.htm&h=145&w=182&prev=/images%3Fq%3Dthalassemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.mdsmetro.com/images/sections/thalassemia.gif&imgrefurl=http://www.mdsmetro.com/patients/conditions/thalassemia.htm&h=145&w=182&prev=/images%3Fq%3Dthalassemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8

8/2/2019 3947418 Hematology

44/47

ABNORMAL BLOOD PRODUCTSABNORMAL BLOOD PRODUCTS

MethemoglobinMethemoglobin- increased ferrous iron is oxidized to- increased ferrous iron is oxidized toferric state ( resulting in derangedferric state ( resulting in derangedoxygen transport)oxygen transport)

-- inborn errors of metabolisminborn errors of metabolism

CarboxyhemoglobinCarboxyhemoglobin

- hg + CO2;- hg + CO2; carbon monoxide poisoningcarbon monoxide poisoning

* Cyanmethemoglobin * Cyanmethemoglobin cyanide poisoningcyanide poisoningdeterminationdetermination

http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.pueblo.gsa.gov/cic_text/health/sicklecell/sickle.gif&imgrefurl=http://www.pueblo.gsa.gov/cic_text/health/sicklecell/496_sick.html&h=288&w=288&prev=/images%3Fq%3Dsickle%2Bcell%2Banemia%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.cstl.nist.gov/biotech/831.jpg&imgrefurl=http://www.cstl.nist.gov/biotech/&h=153&w=192&prev=/images%3Fq%3Dcarboxyhemoglobin%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8http://images.google.com/imgres?imgurl=www.cstl.nist.gov/biotech/831.jpg&imgrefurl=http://www.cstl.nist.gov/biotech/&h=153&w=192&prev=/images%3Fq%3Dcarboxyhemoglobin%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8

8/2/2019 3947418 Hematology

45/47

OTHER BLOOD TESTSOTHER BLOOD TESTS

Osmotic FragilityOsmotic FragilityTest- hemolysisTest- hemolysis

Reticulocyte CountReticulocyte Count ErythrocyteErythrocyte

Sedimentation (ESR)Sedimentation (ESR)

Rate: M>FRate: M>F- increased in- increased in

acute and chronicacute and chronicinflammatoryinflammatoryconditionsconditions (PTB, ARF,(PTB, ARF,

RA)RA) Blood Typing-ABOBlood Typing-ABO

Rhesus factor: Rh+Rhesus factor: Rh+(majority) = Rh-(majority) = Rh-(minority(minority))

8/2/2019 3947418 Hematology

46/47

COAGULATION DISORDERSCOAGULATION DISORDERS

Hemophilia A - absence of Factor VIIIHemophilia A - absence of Factor VIIIHemophilia B absence of Factor IXHemophilia B absence of Factor IX

Idiopathic Thrombocytopenic PurpuraIdiopathic Thrombocytopenic Purpura

(ITP)(ITP)Glanzmanns diseaseGlanzmanns disease

(thrombasthenia) = normal platelet(thrombasthenia) = normal platelet

count but impaired functioncount but impaired function

Disseminated IntravascularDisseminated IntravascularCoagulation (DIC)- imbalanceCoagulation (DIC)- imbalance

between coagulation and fibrinolysisbetween coagulation and fibrinolysis

(trauma, shock, pregnancy,(trauma, shock, pregnancy,

arturitionarturition

8/2/2019 3947418 Hematology

47/47

PLATELET DIAGNOSTICSPLATELET DIAGNOSTICS

BLEEDING TIME prolonged inBLEEDING TIME prolonged indeficiencies or abnormalities of plateletsdeficiencies or abnormalities of platelets

CLOTTING TIME from a WHOLE bloodCLOTTING TIME from a WHOLE bloodspecimenspecimen

PLATELET COUNT increased in collagenPLATELET COUNT increased in collagendiseases; decreased in toxic or diseaseddiseases; decreased in toxic or diseasedstatesstates

PROTHROMBIN TIME time required toPROTHROMBIN TIME time required toform a clot. >1 (INR) means it isform a clot. >1 (INR) means it is

prolonged and may mean a deficiency ofprolonged and may mean a deficiency ofprothrombin, vitamin K, anticoagulantsprothrombin, vitamin K, anticoagulants

PARTIAL THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME clotting factor deficiency (N: 22 to 37clotting factor deficiency (N: 22 to 37secs)secs)