实验诊断学
DESCRIPTION
laboratory. diagnostics. 实验诊断学. 临床. 选择检验项目(筛选). 分析检验结果. 进一步选择检验项目(鉴别、诊断). 诊断. 血液一般检查. general examination of blood. RBC neutrophil hematocyte eosinophil (45%) WBC basophil blood monocyte platelet lymphocyte Fg plasma water (55%) serum - PowerPoint PPT PresentationTRANSCRIPT
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general examination of blood
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RBC neutrophil hematocyte eosinophil 45% WBC basophilblood monocyte platelet lymphocyte Fg plasma water 55% serum solid element
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1.blood cell counterythrocyte countmethod reference interval clinical significanceleukocyte countplatelet countreticulocyte count
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1)
(1)()
0.38ml 20ul
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Neubauer
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3mm WBC WBC
WBC WBC
1mm WBC/L=N/41010620
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(2)automated hematology analyzer,AHAprincipal of coulter hematology ststemhistogram
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erythrocyte histrogam
normalcyte
microcyte macrocyte
36 360 fl
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leukocyte histogram
L M N 35 90 160 450 fl
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platelet histogram
2 20 fl
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3.5~51012/L 4~5.51012/L2)
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1anemia
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2
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granulocyte poolMitotic poolMaturation poolStorage poolMargin poolCirculating pool
10 Bone marrow 10h 1~2)
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4~10109/L
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2.determining the concentration of hemoglobinHemoglobin Structuremethodhemiglobincyanide (HiCN)method
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THE NORMAL HUMAN HEMOGLOBENS
HemoglobinGlobin ChainsMajor SourceEmbryoNeonateAdult%%%Gower12/2Yolk sac5000Gower22/2Yolk sac2500Portland2/2Yolk sac2500Hb F2/G2aLiver,spleen07512/A2Hba2/2Bone marrow02597HbA22/2Bone marrow013
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120160g /L110150g/L170200g/L7094.2122.2g/L86.5111.8g/L
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layer after blood centrifuged 3. hematocrit(packed cell volume) definition Relative volume of blood occupied by erythrocytes. An average figure for humans is 45 per cent, i.e. A packed red cell volume of 45ml in 100ml of blood.
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0.470.04 0.420.05 3HematocritCentrifugingHematocrit is % of total volume made of cellsAHAHCT=RBCMCV
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4.erythrocyte indicesMean corpuscular volume MCV=Hct1031012/RBC fL 80~90fLmean corpuscular hemoglobin MCH=Hb1012/RBCPg 27~32Pgmena corpuscular hemoglobin concentration MCHC=Hb/Hct 320~360
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MCV(fl) MCH(pg) MCHC (%) >100 >31 32-36
82-95 27-31 32-36
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5.red blood cell volume distribution width, RDWCV 11.6%14.6%
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1) 1983BessmanMCVRDW 2)iron deficiency anemia, IDA RDW95% 3) RDW-RDW
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6.Erythrocyte sedimentation rate(ESR310min40minThe ESR measures the distance a red blood cell falls in a vertical tube over a given period of time.
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1)2) () 18~50010mm/h020mm/h >65510mm/h
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3HIVESRSLEESRNHLHLM
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7. reticulocyte(Ret ribomucleic acidRNAbrilliant cresyl blue79mICSH4:0.20.3IV0.70.8III
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1) 2) -YRNAflow cytometryFCM 3)
0.005~0.015 (24~84)109/L
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RetRctRct%mean reticulocyte volume, MCVrreticulocyte hemoglobin distribution width , HDWrreticulocyte hemoglobin content , CHrmean reticulocyte hemoglobin concentration , MCHCrLFRMFRHFRreticulocyte maturity index RMIRMI=MFR+HFR/LFR100
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1 122 Ret3 clinical significance of reticulocyte count
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8blood film examinationmaking and staining blood film:
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obseve erythrocyte form and distributionobserve leukocyte formobserve platelet formobserve parasite
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observe erythrocytecoloursizeshapeabnormal structure normal erythrocytered cell observed under electric microscope
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(rouleaux formation)
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observe leukocytedifferential leukocyte count abnormal white cell
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(5%)10%25%1)shift to the left()
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2)shift to the right53%
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(1)(neutrophilia)70%7l09/L
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(1020) l09/L(2030) l09/L
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()1236h ,10l09/L12d112h(1020) l09/L
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(acute myelogenous leukemiaAML)(acute lymphocytic leukemiaALL)(1050) l09/L100l09/L10%(100600) l09/L 50l09/L
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2neutropenia l09/Lgranulocytopenia0.5l09/L(agranulocytosis)
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12(aleukemic leukemia)34systemic lupus erythematosusSLE5
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4
/
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1DhlePelgerHuetChediakHigashiMayHegglinAlder-Reilly
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21abnormal lymphocyte23ALLCLL
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3(plasma cellflame cell
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Dacie and Lewis PRACRICAL HAEMATOLOGY TENTH EDITIONClinical Laboratory MedicineKenneth D. McClatchey
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?Coulter,???Hct??Ret???