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Imaging session Haematology MBChB V

Imaging session Haematology MBChB V. Session 1 MJ Coetzee. Normal blood picture. Normal blood smear. Normal white cells. Normal red cells & platelets. Eosinophil. Basophil. Normal band cell. Normal bone marrow.

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Imaging session Haematology MBChB V

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  1. Imaging sessionHaematologyMBChB V Session 1MJ Coetzee

  2. Normal blood picture

  3. Normal blood smear Normal white cells Normal red cells& platelets

  4. Eosinophil Basophil

  5. Normal band cell

  6. Normal bone marrow

  7. Stem cells give rise toe cells that develop into mature cells in the circulation • Problems with stem cells cause bone marrow failure and even leukaemia

  8. Normal bone marrow cells

  9. Normal bone marrow smear Normal bone marrow particle (1/3 adipose cells)

  10. Hypercellular bone marrow Biopsy (histological picture) Particle on smear

  11. Hypocellular bone marrow Adipose cells have replaced normal bone marrow Bone Aspirate particle

  12. Full blood count

  13. Full blood count-1 • The FBC is a group of tests that provides us with information about: • Red cells and their properties • Total white cell count and concentrations of types of white cells (differential count) • Concentrations of platelets • A blood smear is made and the morphology of the blood cells are reported • Often the ESR is done simultaneously

  14. Full blood count -2 • Blood for a FBC is drawn into a purple tube,thatcontainsthe anticoagulant EDTA • The tube should reach the lab. within 2 hours - otherwise artifacts can occur • Manual blood counts entails involves pipetting by mouth and involves a risk of infection • Automated cell counters count red cells, white cells & platelets, en does Hb and red cell indices

  15. Haemoglobin-1 • Normal Hb varies with age, sex & height above sea level • In Bloemfontein (1300 m) the normal Hb for adults is: • Men: 14,5-18,5 g/dl • Women: 12,5-16,5 g/dl

  16. Haemoglobin-2 • Hb can also be measured in g/l and mmol/l • World Health Organisation • At sea level • Definitions of anaemia by experts • Children < 10 j < 9 g/dl • Adult men < 13 g/dl • Adult women < 12 g/dl • Pregnant women < 11 g/dl

  17. Red cell indices-1 • The Hb shows the presence/absence of anaemia • The red cell indices show the type of anaemia • The MCV (mean. corpuscular volume) is usually between 80-100 fl • MCV < 80 fl: microcytic • MCV 80-100 fl: normocytic • MCV > 100 fl: macrocytic

  18. Red cell indices-2 • The haematocrit reflects the portion of the blood that consists of RBCs. • It is used exstensively in the USA as an indicator of anaemia, but not elsewhere • The MCH (mean cell haemoglobin) reflects the amount Hb/RBC • The MCHC gives an idea of the colour of the RBCs • Nowadays the MCV is accurately measured and it is the most important

  19. FBC direct from the cell counter

  20. Haematocrit

  21. White cell count • The total WCC is 4,0-11,0 x 109/l • Most of the white cells are neutrophils • A leucopenia is mostly caused by a decreased number of neutrophils, but not always • A leucocytosis is mostly caused by an increased number of neutrophils, but not always • Therefore it is important to know the absolute count of individual types white cells

  22. Report of the blood smear • Although one can obtain a lot of information from the FBC, always read the comments on the blood morphology • The morphology can give information about e.g. malaria, left shift, activated lymphocytes, etc, while most machines cannot do this • Comments put the counts in perspective and lead one to determine the cause of an anaemia, etc.

  23. Red cell shapes

  24. Round macrocytosis(e.g. alcohol) Oval macrocytes (e.g. megaloblastic anaemia

  25. Acanthocytes(e.g. liver disease) Blood smear Electron microscopy

  26. polychromasia, e.g. haemolysis Rouleaux (e.g. TB, HIV)

  27. Spherocytes: blood smear Shape of normal RBCs & spherocytes

  28. Target cells (e.g. liver disease)

  29. Common white cell disorders

  30. Neutrophils • Neutropenia • Mostly caused by suppression • Also called agranulocytosis • Causes: antithyroid, anti-inflammatory drugs, anticonvulsants, antipsychotics, cytostatics chemotherapy, radiation • Effects: infections (esp. respiratory), opportunistic, fungi • Neutrophilia (neutrophil leucocytosis) • Mostly caused by bacterial infections • With severe infections they can show toxic granulation • A leftshift indicates immature WBCs - infection

  31. Neutrophil leucocytosis Toxic granulation

  32. Band cell (left shift) Döhle bodies (infection)

  33. Leucoerythroblastic anaemia:White cell & red blood cell precursors

  34. Leucoerythroblasticanemia:bone marrow infiltrate by cancer cells

  35. Lymphocytes • Lymphopenia • Mostly caused by drugs, e.g. steroids • Lymphocytosis • Mostly caused by viral infections • With severe virus infections the lymphocytes can appear activated

  36. The leucocyte in viral infection:reactive lymphocytes

  37. Monocytes & eosinophils • Monocytosis • Mostly caused by chronic infections, e.g. TB • Eosinophilia • Parasitic infections, allergies, skin conditions, neoplasia

  38. Storage artefact(blood that lies around)

  39. Other infections

  40. HIV Loose nuclear fragments Acid-fast bacilli in bone marrow (TB)

  41. Malaria Thick smears Falciparum trophozoites Falciparum gametocytes(longstandinginfection Non-falciparum malaria (large cells)

  42. Geographic distribution malaria- and haemoglobinopathies 2002

  43. Fe deficiency

  44. Pallor “Strawberry” tongue:Fe deficiency Hands useful, regardless of ethnicity

  45. Fe deficiency: spoon nails

  46. Hypochromic microcytic RBCs

  47. No Fe stainin marrow particle Normal (blue) Fe stain of marrow particle

  48. Gastrointestinal bleed because of cancer(Ba contrast)

  49. Megaloblastic anaemia

  50. Oval macrocyte Megaloblastic BM

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