HEMATOLOGY

Jane Finley, BS MT (ASCP)Nov 1, 2004

HEMATOLOGY AND LAB LANGUAGE

• Blood• Serum• Plasma• Erythrocytes

(RBC)• Granulocytes

(WBC)• Platelets (Plt)

Lab Language: Hematology Testing

• Complete Blood Count (CBC)• Erythrocyte Sedimentation Rate

(ESR)• Sickle Cell Screening• Hemoglobin Electrophoresis• Ferritin• Iron• Total Iron Binding Capacity (TIBC)• Transferrin

Lab Language : CBC

• Hemoglobin• Hematocrit• RBC• WBC• Plt ct• RDW• MCV• MCH• MCHC

• Segmented Neutrophil

• Lymphocyte• Monocyte• Eosinophil• Basophil• Reticulocyte• Reticulcyte

Production Index (RPI)

Complete Blood Count

• White Blood Count (WBC)• Red Blood Cell Count (RBC)• Platelet Count (Plt)• Hemoglobin (Hb or Hgb)• Hematocrit (Hct)• Red Cell Indices (MCV,MCHC,MCH)• Red Cell Distribution Width (RDW)• Differential Count (Diff)

CBC Differential -WBC

• Segs• Lymphs/Atypical• Mono’s • Eo’s• Baso’s

• Bands• Metamyelocyte• Myelocyte• Promyelocyte• Blast

CBC Differential-RBC

• Anisocytosis• Microcytes• Macrocytes• Nucleated RBC• Howell Jolly Bodies• Basophilic

Stippling• Hypochromia• Riticulocytes

• Poikilocytosis• Teardrop• Ovalocytes• Helmet cells• Sickle Cells

Cell Counts:Number of cells per liter of whole

blood WBC4.5-11.0 x 109/L RBCMales: 4.3-5.7

x1012/LFemales: 3.8-5.1 “ Plt150-400 x109/L

Terms Leukocytosis

Erythrocytosis Erythropenia

Thrombocytosis Thrombopenia

Hemoglobin

• Heme + protein (globulin)

• Main purpose is to carry O2

• Three main types• Variants result in identifiable

disorders• Normal ranges are age and gender

related

Hematocrit

• Packed Cell Volume• Measures what percentage of

whole blood is represented by RBC• Compares RBC and hemoglobin• Normal ranges are age and gender

related

Lab Language: Red Cell Indices

• MCV- Mean Corpuscular Volume

• MCH-Mean Corpuscular Hemoglobin

• MCHC-Mean Corpuscular Hemoglobin Concentration• RDW-Red Cell Distribution Width

Mean Corpuscular Volume (MCV)

The average size (volume) of an RBC.

MCV (in fL) = (hematocrit x 10) (rbc count [in millions/µL])

Normal values: 80-100 fL

The MCV is a useful tool in the differential diagnosis of anemia

Mean Corpuscular hemoglobin (MCH)

The average hemoglobin content of a RBC.

Normal values: 26-34 pg. MCH (in pg) = hemoglobin x 10 rbc count

Mean Corpuscular Hemoglobin Concentration (MCHC)

The percentage of a RBC's volume which contains hemoglobin.

Normal values: Usually between 31-37%.

MCHC may be decreased with severe iron deficiency anemia.

MCHC [in g/dL] = hemoglobin [in g/dL] hematocrit [in L/L]

RED CELL DISTRIBUTION WIDTH(RDW)

• Degree of Red Cell size variability in a blood sample

• Coefficient of variation of the size of the RBCs

• Expressed as %• Derived from automated

instruments that can directly measure the MVC

• Normal: 11-15 %

Using the RBC Indices

• MCV reveals the average size of the RBCs

• RDW reveals a variation in size among the RBCs

• MCHC reveals how much of the cell is being taken up by hemoglobin

• Together can reveal anemia or physiologic disorders that affect quality of life

Lab Language: Indices

• Anemia• Microcytic• Macrocytic• Hypochromic• normochromic

ERYTHROCYTOSIS• Polycythemia vera• Secondary Polycythemia -COPD

-Inappropriate stimulation of erythropoietin, such as tumors• Relative Polycythemia -dehydration, -severe burns

ERYTHROPENIA (ANEMIA)

• Anemias - may result from:– chronic or acute blood loss– decreased synthesis – increased destruction or

decreased survival• dilutional effect:

– postural (lower in recumbent position)

– overhydration

Anemia Classifications

• Microcytic, hypochromic

• Microcytic, normochromic

• Normocytic, normochromic

• Macrocytic, normochromic

NORMOCYTIC, NORMOCHROMIC ANEMIA

• MCV normal

• MCHC normal

• Examples:

– acute blood loss

– aplastic anemia

– most leukemia's

– bone marrow infiltration

MICROCYTIC, HYPOCHROMIC ANEMIA

• MCV decreased

• MCHC decreased

• Examples:

– iron deficiency

– thalassemia

– lead poisoning

– anemia of chronic disease

MICROCYTIC, NORMOCHROMIC ANEMIA

• MCV decreased

• MCHC normal

• Examples:

–mid-stage iron deficiency

–thalassemia

MACROCYTIC, NORMOCHROMIC ANEMIA

• MCV increased

• MCHC normal

• Examples:

– folate deficiency

– vitamin B12 deficiency

– pernicious anemia

Hemoglobin & HematocritNormal Ranges

• Cord blood:

- Hb - 16.5 ± 3 g/dl

- Hct - 51 ± 9 %

• 0.5-2 years:

- Hb: 12.0 ± 1.5g /dl

- Hct - 36 ± 3 %

• 12-16 yrs:

Female:

-Hb 14.0 ± 2 g/dl

-Hct 41 ± 4%

Male:

-Hb 14.5 ± 1 g/dl - Hct 43 ± 6%

Hemoglobin & HematocritAdult Normal Ranges

– Male: Hb 15.5 ± 2 g/dl Hct 47 ± 6%

–Female: Hb 14.0 ± 2 g/dl Hct 41 ± 5%

RULES OF THREE

• Used for quality control

• Hb X 3 = Hct ± 3%

• RBC X 3 = Hb

• Hct X 100,000 = RBC

Complete Blood Count

• White Blood Count (WBC)• Red Blood Cell Count (RBC)• Platelet Count (Plt)• Hemoglobin (Hb or Hgb)• Hematocrit (Hct)• Red Cell Indices (MCV,MCHC,MCH)• Red Cell Distribution Width (RDW)• Differential Count (Diff)

RBC 5.25 x 10[12]/LHGB 15.4 g/dLHCT 46.1 %MCV ______MCH _____MCHC ______RDW _____

CBC 1

RBC 5.25 x 10[12]/LHGB 15.4 g/dLHCT 46.1 %MCV 87.9 fLMCH 29.3 pgMCHC 33.4 g/dLRDW 12.2

 

CBC 1

CBC 1

RBC 3.71 x 10[12]/LHGB 5.9 g/dLHCT 20.9 %MCV ______ MCH ______MCHC ______ RDW ______

CBC 2

RBC 3.71 x 10[12]/LHGB 5.9 g/dLHCT 20.9 %MCV 56.2 fLMCH 15.9 pgMCHC 28.3 g/dLRDW 20.2

CBC 2

CBC 2

RBC 3.36 x 10[12]/LHGB 10.9 g/dLHCT 31.2 %MCV _______ MCH ________

MCHC ________  

CBC 3

RBC 3.36 x 10[12]/LHGB 10.9 g/dLHCT 31.2 %MCV 92.8 fLMCH 32.4 pgMCHC 34.9 g/dL 

CBC 3

CBC 3

RBC 1.26 x 10[12]/LHGB 5.7 g/dLHCT 16.3 %MCV ________MCH ________MCHC ________RDW 18.1

CBC 4

RBC 1.26 x 10[12]/LHGB 5.7 g/dLHCT 16.3 %MCV 130 fLMCH 45.2 pgMCHC 34.9 g/dL

CBC 4

CBC 4