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Chapter 41

Chapter 41. Hematology. Hematologic Tests. Second most common type of tests performed in POL Cellular components of blood affected by changes in organs or tissues of body Click here to see an animation. Hemoglobin Hematocrit White blood cell (WBC) count Red blood cell (RBC) count

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Chapter 41

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  1. Chapter 41 Hematology

  2. Hematologic Tests • Second most common type of tests performed in POL • Cellular components of blood affected by changes in organs or tissues of body • Click here to see an animation

  3. Hemoglobin Hematocrit White blood cell (WBC) count Red blood cell (RBC) count Platelet count Differential WBC count Erythrocyte sedimentation rate (ESR) Prothrombin time Types of Blood Tests

  4. Hematologic Tests • Results of tests provide valuable information for diagnosis, evaluating patient’s progress, or regulating further treatment

  5. Complete Blood Count • Hemoglobin determination • Hematocrit determination • WBC count

  6. Complete Blood Count • RBC count • Differential WBC count • Erythrocyte indices

  7. Hemoglobin and Hematocrit • Hemoglobin • Major component of erythrocyte and carrier of oxygen in body; 85 percent of dry weight of RBC • Synthesis of heme requires iron • Adult male requires 0.5 mg/day of iron • Menstruating female requires 2 mg/day of iron

  8. Hemoglobin and Hematocrit • Hemoglobin • Carries 95 percent of oxygen to cells • Transports 27 percent of carbon dioxide back to lungs for removal • Acts as buffer system

  9. Hemoglobin and Hematocrit • Hematocrit • Separation of blood into liquid portion and solid portion by process of centrifugation • Erythropoietin • Hormone that triggers production of new red cells • Hemoglobinopathies • Group of diseases; abnormal forms of hemoglobin

  10. Hemoglobin and Hematocrit • Hematocrit • Iron deficiency anemia • Near-normal hematocrit with low hemoglobin value; hypochromic RBC lack hemoglobin • Determining hemoglobin values • Cyanmethemoglobin

  11. Hemoglobin and Hematocrit • Normal hemoglobin values or reference ranges by age or sex • Normal hematocrit values or reference ranges by age or sex

  12. Hemoglobin and Hematocrit • Microhematocrit • Centrifuge • Packed cell column showing separation of cellular components >>

  13. WBC and RBC Counts • WBC and RBC counts • Automated method • WBC differential • Normal leukocyte counts

  14. Leukocyte Identification Guide

  15. Leukocyte Differentiation • Groups • Myelocytic or granulocytic series • Lymphocytic • Monocytic

  16. Leukocyte Differentiation • Granulocytic group • Neutrophil • Eosinophil • Basophil • Differential leukocyte count • Normal values for a differential leukocyte count in adults

  17. Erythrocyte Indices • Include: • Mean corpuscular volume (MCV) • Mean corpuscular hemoglobin (MCH) • Mean corpuscular hemoglobin concentration (MCHC)

  18. Erythrocyte Indices • Provide information about size of RBC and hemoglobin content • Normal values

  19. Erythrocyte Indices • Using erythrocyte indices to diagnose • MCH and MCV increased in megaloblastic anemias • MCH and MCV decreased in hypochromic and microcytic anemias • MCHC increased in hereditary spherocytosis • MCHC normal in macrocytosis • MCHC decreased in iron deficiency anemia

  20. Erythrocyte Sedimentation Rate • Measures rate at which RBC fall toward bottom when placed in vertical tube >>

  21. Erythrocyte Sedimentation Rate • Also called “sed rate” • Used in diagnosis and treatment of many diseases • Inexpensive • Accurate • Easy to perform

  22. Erythrocyte Sedimentation Rate • Wintrobe method • EDTA venous blood sample mixed • Blood transferred with Pasteur pipette to Wintrobe tube • No air bubbles • Place tube vertically in rack to stand for 60 minutes • Read number of millimeters red cells settled • Normal values for Wintrobe method of ESR

  23. Erythrocyte Sedimentation Rate • Westergren method • Mix blood sample with 3.8 percent sodium citrate solution before filling tube • Normal values for Westergren method of ESR • Sediplast ESR system

  24. Erythrocyte Sedimentation Rate • Guidelines for Wintrobe and Westergren ESR procedures to measure accurate results Rouleaux >>

  25. Erythrocyte Sedimentation Rate • Using the ESR to diagnose • ESR increased in infections and inflammatory diseases, tissue destruction, and other conditions leading to increased plasma fibrinogen • ESR increased with anemia, menstruation, pregnancy, malignant neoplasms, and multiple myeloma • ESR normal in osteoarthritis, some cases of cirrhosis, and malaria • ESR decreased in polycythemia, spherocytosis, and sickle cell anemia

  26. Coagulation Studies • Prothrombin Time (PT) • “Protime” • Measures time it takes a patient’s blood to clot • Normal blood clots in 11-13 seconds • International Normalized Ratio (INR) • Can be universally applied

  27. Automated Hematology Instrumentation and Quality Control • Hematology instruments that require sample dilutions • Hematology instruments that do not require sample dilutions

  28. Automated Hematology Instrumentation and Quality Control • CLIA ’88 regulation for quality control in automated hematology

  29. Automated Hematology Instrumentation and Quality Control • Required procedures • Calibration • Control samples • Proficiency testing • Check manufacturer’s recommendations for particular piece of equipment

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