formed elements and associated tests leukocyte or white blood cell (wbc) count – complete wbc...
TRANSCRIPT
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Formed Elements and Associated Tests
• Leukocyte or White Blood Cell (WBC) Count– Complete WBC count includes the total
number of all types of white blood cells in a microliter of blood
– Normal WBC or leukocyte counts in adults range from approximately 4.5 to 11 thousand/mm3
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Formed Elements and Associated Tests
• Leukocyte or White Blood Cell (WBC) Count– Elevated level usually indicates infection– If grossly elevated, leukemia could be
the cause
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Formed Elements and Associated Tests
• Leukocyte or White Blood Cell (WBC) Count– Low level usually indicates a viral
infection or autoimmune deficiency– Extreme bacterial infection also can
destroy enough white blood cells to significantly reduce their numbers
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Formed Elements and Associated Tests
• Leukocyte or White Blood Cell (WBC) Count–Manual method is through use of
hemocytometer–MAs require further training to perform
manual WBC count in a medical laboratory
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Formed Elements and Associated Tests
• Differential White Blood Cell Count– Determines the percentages of each
type of leukocyte in a given sample–Most commonly performed by the
automated analyzer
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Formed Elements and Associated Tests
• Differential White Blood Cell Count– Types of leukocytes that are counted are
neutrophils, eosinophils, basophils, lymphocytes, and monocytes
– Results may be read as percentages or as numbers in a given quantity depending on the laboratory and equipment being used.
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FIGURE 48-12 For a differential white blood cell count, (A) the slide is examined under oil immersion. (B) Cells are viewed using a bright light and 100× magnification.
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FIGURE 48-13 Types of white blood cells.
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Preparing Slides
• Refer to Procedure 48-4: Preparing Slides for details about this technique.
• MAs require further training to perform this test in a medical laboratory; it is commonly performed in an educational setting to further understanding.
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PROCEDURE 48-4 Preparing Slides
FIGURE A Blood smear.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE B Blood smear.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE C Blood smear.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE D Blood smear.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE E Wright’s
staining process.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE F Wright’s
staining process.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE G Wright’s
staining process.
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PROCEDURE 48-4 (continued) Preparing
SlidesFIGURE H Wright’s
staining process.
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Formed Elements and Associated Tests
• Neutrophils– Act as the body's primary defense and
make up the largest percentage of white blood cells
– Granules are neutral in color on laboratory-stained slides
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Formed Elements and Associated Tests
• Neutrophils– Phagocytosis• The process in which the neutrophil
surrounds, swallows, and digests the bacteria
– Segmented• Mature cells with a nucleus that is divided
into multiple segments connected by small thin threads
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Formed Elements and Associated Tests
• Neutrophils– Nonsegmented neutrophils• Immature cells; also called stabs or bands
– Nicknamed a "shift to the left" and indicates an early white blood cell response
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Formed Elements and Associated Tests
• Neutrophils– Tend to increase in response to
infection; may also increase from hemorrhage, cancer, poisoning, hemolysis, and inflammation
– Tend to decrease in response to a virus or serious bacterial infection
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FIGURE 48-14 Phagocytosis. The cell engulfs and digests a
bacterium.
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FIGURE 48-15 Band and segmented neutrophils.
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Formed Elements and Associated Tests
• Eosinophils–White blood cells assumed also to be
produced by the bone marrow– A large number can indicate a parasitic
condition or the presence of certain allergic conditions
– Have granules that produce a red color on laboratory-stained slides
–Make up less than 3 percent of white blood cell volume
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Formed Elements and Associated Tests
• Basophils– Thought to be produced by the bone
marrow – Produce heparin– Increased amounts may be found in
patients who have had their spleen removed or in patients with excessive exposure to radiation.
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Formed Elements and Associated Tests
• Basophils– Contain the vasodilator histamine– Appear in tissues where an allergic
reaction is occurring
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Formed Elements and Associated Tests
• Basophils– Concentration of basophils may
contribute to the severity of allergic reactions
– Normal laboratory results generally show basophils as less than 1 percent of white blood cell volume.
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Formed Elements and Associated Tests
• Lymphocytes–White blood cells produced in the bone
marrow and in the lymphoid tissue– Primary function is to produce
antibodies against foreign substances– Small and large, and can proliferate into
B and T cells
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Formed Elements and Associated Tests
• Lymphocytes– B cells may convert into plasma cells– T cells can produce helper cells,
cytotoxic cells, and suppressor cells
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Formed Elements and Associated Tests
• Lymphocytes– Do not have granules and are
nonsegmented–Make up the second largest volume of
white blood cells, comprising 25 to 30 percent
– To diagnose an individual with HIV, testing is performed to evaluate the type and amount of T cells present.
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Formed Elements and Associated Tests
• Monocytes–White blood cells formed in the bone
marrow from stem cells; assist in phagocytosis
– Ingest foreign particles or bacteria that the neutrophils are unable to digest
– Assist in cleaning up cellular debris that may have been left from the infection
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Formed Elements and Associated Tests
• Monocytes– Increase is seen in patients with
tuberculosis, typhoid, and Rocky Mountain spotted fever
– In a typical adult, make up 3 to 7 percent of the total white blood cell volume
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Formed Elements and Associated Tests
• Platelets and Coagulation Studies– Platelets (thrombocytes): the smallest
cells found in the blood; formed in the bone marrow
– Live for about ten days and are continuously reproduced
– Assist in the clotting of blood to stop bleeding or assist in healing
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Formed Elements and Associated Tests
• Platelet Counts– Typically between 150,000 and 400,000
platelets/mm3 in adults– Testing is typically performed in an
outside laboratory or by automated testing.
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Formed Elements and Associated Tests
• Platelet Counts– Over 750,000 (thrombocytosis)– Less than 50,000 (thrombocytopenia)– Severely low counts can lead to internal
bleeding and even death
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Formed Elements and Associated Tests
• Prothrombin Time (PT, Protime) International Normalized Ratio (INR)/(PT/INR)– PT• coagulation test that measures the amount
of time it takes to form a clot
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Formed Elements and Associated Tests
• Prothrombin Time (PT, Protime) International Normalized Ratio (INR)/(PT/INR)– INR• Standard protocol that allows specimens
performed at different laboratories to have consistent results• Does not reveal specific bleeding disorders
in patients with liver failure or other systemic diseases
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Formed Elements and Associated Tests
• Prothrombin Time (PT, Protime) International Normalized Ratio (INR)/(PT/INR)– Typically used to screen patients with
symptoms of bleeding– Protime for an average healthy adult will
show clotting at 10–14 seconds– Higher than 30 seconds (or 4.5 INR)
indicates a risk for bleeding; more than 40 seconds is considered critical
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Formed Elements and Associated Tests
• Prothrombin Time (PT, Protime) International Normalized Ratio (INR)/(PT/INR)– Elevated levels seen in patients with
severe bone marrow depression, cancer, liver or collagen diseases, pancreatitis, disseminated intravascular coagulation, and toxic shock syndrome
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Formed Elements and Associated Tests
• Prothrombin Time (PT, Protime) International Normalized Ratio (INR)/(PT/INR)– Decreased levels seen in patients with
myocardial infarction, multiple myeloma, pulmonary embolus, or thrombophlebitis
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Formed Elements and Associated Tests
• Partial Thromboplastin Time (PTT)– Determines the length of time it takes
for a fibrin clot to form– Can help to determine which specific
clotting factors are affected– Commonly used to determine the
effectiveness of anticoagulant therapy
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Formed Elements and Associated Tests
• Partial Thromboplastin Time (PTT)– Helps to screen for bleeding tendencies
and identify more precise causes– Normal findings are typically 60–70
seconds.
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Other Blood Tests
• Common panels include the lipid panel and the liver panel
• Lipid panel– Cholesterol, triglycerides, and high-
density lipoproteins (HDL)
• Liver panel– SGOT and SGPT
• CBC• Coagulation studies
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Other Blood Tests
• Refer to the following tables in the student text:– Table 48-1: Common Blood Test Groups– Table 48-2: Common Laboratory Tests
and Their Normal Values – Table 48-3: Common Blood Chemistry
Tests
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TABLE 48-1 Common Blood Test
Groups
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TABLE 48-2 Common
Laboratory Tests and
Their Normal Values
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TABLE 48-3 Common
Blood Chemistry
Tests
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TABLE 48-3 (continued)
Common Blood
Chemistry Tests
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TABLE 48-3 (continued)
Common Blood
Chemistry Tests
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Other Blood Tests
• Comprehensive Metabolic Panel (CMP)– Screening tool used to:• Evaluate organ function• Check for common disorders• Monitor the progress of current conditions
and response to medications
– Includes 14 essential tests included among the basic metabolic panel, renal panel, liver function tests, and electrolytes
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Other Blood Tests
• Comprehensive Metabolic Panel (CMP)– Abnormality in any area may indicate a
need for further, more-specific testing– Recommended that the patient fast for
12 hours before testing– Normal values can be found in Table 48-
3 Common Blood Chemistry Tests
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Other Blood Tests
• Glucose– A simple sugar required by all body cells
to produce energy; circulates in the blood
– Used to give energy to the cells
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Other Blood Tests
• Glucose– Hyperglycemia• When glucose cannot get into the cells for
consumption, it builds up in the blood and clogs up the organs
– Critical, life-threatening levels above 700 mg/dL while fasting
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Other Blood Tests
• Glucose– Hypoglycemia (low blood sugar)• Can happen rapidly and can become lethal
before treatment may be considered
– Suspected blood glucose abnormalities are always treated as if they are low, until blood testing can be performed.