hematology review by felicia magee tardy, m.s., mt (ascp) department of clinical pathology...
TRANSCRIPT
Hematology Review
By
Felicia Magee Tardy, M.S.,
MT (ASCP)
Department of Clinical Pathology
University of Mississippi Medical Center
Jackson, Mississippi
Introduction
• Hematology: the study of blood and blood forming tissues.
• Blood consists of 55% plasma and 45% formed elements.
• Formed elements include erythrocytes, leukocytes, and thrombocytes.
Erythrocytes• Normal range 4.2-
5.5 million per mm3 in adults.
• Biconcave shape.• Diameter 7
microns.• Cells for transport
of O2 and CO2.
• Life span 120 days.
Leukocytes• Normal range 4 -
11 thousand per mm3 in adults.
• Five types.• Size 8-20 microns.• Involved in fighting
infection, combatting allergic reactions, and immune responses.
Thrombocytes
• Smallest cells in the blood.
• Normal range 130,000-400,000.
• Active role in coagulation and hemostasis.
Routine Hematology
Anticoagulant of choice: EDTA• Complete Blood Counts (CBCs)
• Manual WBC Differentials
• Erythrocyte Sedimentation Rates (ESRs)
• Sickle Screens
• Reticulocyte Counts
Automated Counting
Coulter Principle
Electrical impedance: resistance or change in current when cell passes between two electrodes in NaCl solution.
Automated Counting
Flow Cytometry
Uses lasers to measure both forward and side scatter.
Forward scatter measures size.
Side scatter measures granularity.
Sources of Error• Inadequate mixing of specimen.• Hemolyzed specimens.
• Lipemic specimens.
• Cold agglutinins.
• Clotted specimens.
• Platelet clumps or platelet satellitosis.
• Diluted specimens.
Know Normal Ranges!!!
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT
MPV
SEGS
LYMPHS
MONOCYTES
EOSINOPHILS
BASOPHILS
Erythrocytic Maturation Series
Rubriblast
Prorubricyte
Rubricyte
Metarubricyte
Reticulocyte
Erythrocyte
RBC Morphology
Elliptocytes Target Cells
Tear Drops Stomatocytes
Sickle Cells Schistocytes
RBC Inclusions
Howell-Jolly Bodies
• Round, purple inclusions in RBCs.
• Composed of DNA.• Commonly seen in
in patients with hypofunctioning spleens.
• Splenectomy.
Basophilic Stippling
• Numerous, small purple inclusions in RBCs.
• Aggregates of ribosomal RNA.
• Most commonly seen in lead poisoning.
Pappenheimer Bodies
• Clusters of dark blue granules, irregular in size and shape.
• Composed of iron and ribosomal RNA.
• Seen in sideroblastic and hemolytic anemias.
Classifications of Anemias
Microcytic, Hypochromic– Iron deficiency– Sideroblastic– Chronic disease, Inflammation– Lead poisoning– Thalassemia trait
Microcytic, Hypochromic
• Many RBCs smaller than
nucleus of normal
lymphocytes, increased central pallor.
• Iron deficiency, thalassemias, anemia of chronic disease.
Classifications of Anemias
Normochromic– Hereditary Spherocytosis– Hereditary Elliptocytosis– PNH– G6PD deficiency– Aplastic anemia– Acute blood loss
Classifications of Anemias
Macrocytic– Vitamin B12 deficiency– Folate deficiency– Liver disease
Macrocytic RBCs
• Most RBCs larger than nucleus of normal
lymphocytes, increased MCV.
• Folate or Vitamin B12 deficiencies, alcoholism, and liver disease.
Reticulocytes• Immature RBCs.• Contain residual
ribosomal RNA.• Reticulum stains
blue using a supravital stain (new methylene blue).
• Counted and expressed as % of total red cells.
Reticulocyte Count
Uses supravital stain which stains cells in the living state.
Retic % = # retics per 1000 RBCs
10
Corrected retic= % retics x pt. HCT
45
Hemoglobinopathies
Beta Chain Substitutions
Hgb S: Valine for glutamic acid
(6th position, beta chain)
Hgb C: Lysine for glutamic acid
(6th position, beta chain)
Hemoglobinopathies
Alkaline Electrophoresis
- C S F A +
A2 D
E GO
WBCEvaluation
MyelocyticMaturation Series
Myeloblast
Promyelocyte
Myelocyte
Metamyelocyte
Band Neutrophil
Segmented Neutrophil
Toxic Granulation
• Increased basophilic granules
in neutrophils.• Seen in severe
infections, burns, malignancies, and pregnancy.
• Distinguish from basophils.
Dohle Bodies
• Sky blue inclusions in cytoplasm of neutrophils.
• Seen in infections, burns, myleproliferative disorders, and pregnancy.
• Composed of RER and glycogen granules.
Pelger-Huet Anomaly
Special Stains
PAS: ALL, Erytrholeukemia
LAP: CML v. Leukomoid Reaction
Myeloperoxidase: AML, AMMoL (weak+)
Sudan Black: AML, AMMoL (weak+)
Specific Esterase: AML, AMMoL
Non-specific Esterase: AMML, AMoL
TRAP: Hairy Cell Leukemia
TDT: ALL
Prussian Blue: Sideroblastic Anemia
CML versusLeukomoid Reaction
Characteristic CML Leukomoid
LAP score Decreased Increased
Toxic gran. Decreased Increased
Dohle bodies Absent Present
Philadelphia May be present Absent
chromosome
WBC Disorders
Alder-Reilly: Large azurophilic granules, increased mucopolysaccharides
Chediak-Higashi: Membrane defect of lysosomes, large primary granules in segs
May-Hegglin: Familial disorder with large platelets and Dohle bodies
Pelger-Huet: Hyposegmented neutrophils
FAB Classifications
M1: Myeloblastic without maturation
M2: Myeloblastic with maturation
M3: Promyelocytic
M4: Myelomonocytic
M5a: Monocytic, poorly differentiated
M5b: Monocytic, well differentiated
M6: Erythroleukemia, DiGuglielmo’s
M7: Megakaryoblastic
Acute Myeblastic Leukemia (M1)
Chronic MyelogenousLeukemia
FAB Classifications
L1: Small, uniform lymphoblasts
L2: Large, pleomorhphic lymphoblasts
L3: Burkitt’s type (vacuolated and
deeply basophilic cytoplasm)
Acute Lymphoblastic Leukemia
Chronic Lymphocytic Leukemia
Body Fluids
Types of Body Fluids
• Cerebrospinal Fluid (CSF)
• Pleural Fluid
• Pericardial Fluid
• Peritoneal Fluid
• Synovial Fluid
• Amniotic Fluid
• Miscellaneous Fluids
Body Fluids Testing
• Physical examination
• RBC and WBC counts
• WBC differential
• Crystal examination*
• Rope’s test*
*Refers to synovial fluids only.
Cerebrospinal Fluid (CSF)
• Examined to determine the presence of meningitis or intracranial hemorrhage.
• Multiple tubes drawn (4).• Differentiate between traumatic tap
and intracranial hemorrhage.• Xanthochromia is indicative of
intracranial hemorrhage.
Quick Review
• Differentiate between traumatic tap and intracranial hemorrhage.
• Differentiate between transudate and exudate.
• Crystal identification and associated conditions.
Traumatic Tap v. Intracranial Hemorrhage
Traumatic Tap• Decreasing amounts
of blood with each tube drawn
• May contain clots• No xanthochromia• Supernatant clear
Intracranial Hemorrhage• Blood evenly distributed
throughout collection tubes
• No clots• Xanthochromia• Hemosiderin, hematoidin
crystals
Transudates v. Exudates
Characteristic Transudate Exudate
Appearance Clear, colorless Yellow, turbid, purulent, bloody
Specific gravity <1.015 >1.015
Protein <3 g/dL >3 g/dL
LD <200 IU >200 IU
Cell count <1000/uL >1000/uL
Conditions Congestive Infections,
Heart failure Malignancies
Crystal Identification
• Monosodium urate (uric acid)Yellow when parallel to the compensator,
and blue when perpendicular.
Seen in gout.
• Calcium pyrophosphateBlue when parallel to the compensator,
and yellow when perpendicular.
Seen in pseudogout.
Crystal Identification
Good Luck!!!!