Clinical Interpretating data

HEMATOLOGIC SYSTEM
Hematologic System

Blood consists of : Plasma and cells

suspended in plasma
Plasma c.o. : water, dissolved protein,
electrolytes, organic and inorganic
substances
Blood cells c.o. : Erythrocyte (RBC),
Leucocyte (WBC) and Thrombocyte
 Pluripotent stem cell

Thrombocyte RBC WBC

Granulocyte Lymphocyte Monocyte

Basophil

Eosinophil Myeloblast, Promyelocyte,

Neutrophil Myelocyte, Metamyelocyte,
Band neutrophils,
Polymorphonuclear cells
Laboratory test
1. Coagulation test
a. Bleeding time : duration of bleeding
b. Prothrombine time (PT) : evaluate the extrinsic
factor and common clothing pathways ( II, V, VII,
X, fibrinogen).
Evaluate warfarin therapy and hepatic function.
c. Activated Partial Thromboplastin Time (APTT) : to
evaluate intrinsic factor ( VIII, IX, XI) and to
monitor heparin therapy.
d. Thrombin Time : used to evaluate the heparin
therapy and thrombolytic drug, coagulation
abnormalities.
2. Complete Blood Count/ Full
blood count
a. Haemoglobine (Oxygen carrying
RBC protein)
b. Hematocrite /PCV/EVF (RBC in 100
ml blood)
c. RBC count (RBC in 1 ml blood)
d. WBC count
e. Platelet
a      red blood cell (rbc)
b      white blood cell (lymphocyte)
c      white blood cell (neutrophil)
d      white blood cell (eosinophil)
e      plasma (matrix)
Lab Test by specific
cell types
Fibrinogen
Serum protein electrophoresis (albumin, Globulin)
Platelets
Carboxyhemoglobine (CO Hb)
Coomb’s test
Erythrocyte sedimentation rate
Folate serum
Iron metabolism (Ferritin, Iron, TIBC, Transferrin)
MCH, MCHC, MCV , RCDW (RBC)
Reticulocytes (immature RBC contain RNA recidual)
Vit B 12
Eosino, Baso, Neutro (WBC)
Lymphocyte
Monocyte
Disease with haematologic lab

Anemia
Erythrocytes (RBC)

Erythropoesis
Erythropoetin
Producted on kidney
Increased RBC poduction on BM
Use Nutrients;Iron, B 12, Folate.
Anemia

Definition : Hb, symptom of an

underlying disease
• Anemia Causes :Iron deficiency,
Folate def, Vit B 12 def, haemolysis
• Due to decreased production
• Loss of erythrocytes
• Pregnancy
How’s the lab?
A decrease in level of hemoglobin
How to evaluate?
- Hemaglobin (ethnic, age, altitude)
- Hematocrit,
- Mean cell Hemoglobin (Hb/RBC)
- Mean cell hemoglobin concentration (Hb concentration
average in 100 ml RBC
- Mean cell volume (Average volume of single red cells)
- Red cell distribution width (histogram of the distribution of
RBC vol)
- Peripheral Blood smear (anisocytosis, poikilocytosis)
- specific causa
Micrositic anemia

Iron deficiency anemia (Low Iron,Low

ferritin,High TIBC )
MCHC and MCH
MCV < 80 µm 3
Hb, Htc
Megaloblastic anemia

Folate deficiency, B 12 deficiency

Htc
Increased of homocystein and
methylmalonic.
MCHC normal/fall
MCH
MCV >80 µm 3
Anemia of chronic disease
Chronic infections, inflammation and
malignancy
COPD, CHF,DM,Hypertension
Impairment in the delivery of iron to the
developing rbc.
DD : liver disease, connective tissue
disease (SLE, RA), infection, malignancy,
endocrine disorders (PTH,TH)
Low Iron, Low TIBC,High Ferritin
Spesific disease with anemia
Thalassemia : chain of the globin molecule is affected:
in α thalassemia, the production of α globin is
deficient, while in β thalassemia the production of β
globin is defective. (Micro Hypo, low MCV, low RBC)
Sickle Cell anemia
Aplastic anemia :is a condition where bone marrow
does not produce sufficient new cells to replenish
blood cells (low rbc, wbc and platelet)
PRCA (anemia characterized by absence of red cell
precursors in the bone marrow )
Hereditary anemia
Hemolytic anemia
Disease with Platelet
Disorders with Platelet count

1. Thrombocytopenia :
- Viral inf
- Immunologic (CLL, Lymphoma Hodgkin’s
, Non Hodgkin’s
- ITP
2. Thrombocytosis
-Physiologic (exercise, stress, epinephrine)
-Essential (CML, agnogenic myeloid
metaplasia, polycythemia vera)
-Reactive (blood loss, hemolytic anemia,
infectious disease, RA, IBD, lymphoma)
Disorders with Coagulation
cascade
Prolonged PTT

With normal PT : Heparin,Def.

Intrinsic Pathway factor (prekallikrein,
XII, Xi, IX, VIII), Inhibitor factor,
Willebrand disease, Lupus
anticoagulant
Prolonged PT

With normal PTT : Factor VIII def,

Liver disease, Vit K def, warfarin
therapy
INR estimation :
PT patient
PT control
What is INR for?
- Adjustmen anticoagulant dose
- Give therapy
Prolonged PT and PTT

Fac I, II, V, X def

Heparin therapy
Warfarin therapy
Vit K def
Liver disease
DIC
Disease with WBC
WBC

Neutrophils
Monocytes
Lymphocites
Eosinophil
Basophil
Disease with eosinophil
Contain numerous inflammatory
mediators
Parasitic inf ( helmintic) ,
Protozoa inf ( Isospora belii, Dientamoeba fragilis),
Other inf ( aspergillosis, coccidioidomycosis),
allergic reactions,
skin disorders,
neoplastic disease
Disease with Basophilia

Form heparin therapy

Hypersensitive, Infection,
malignancies, RA, DM, Fe deficiency.
Disease with Neutrophil
Refers to mature and band neutrophils
Increase in (neutrophilia): infections,
necrosis, inflammatory disease, leukemias,
metabolic disorders, gout, smoker
Increased by : corticosteroids, ephinefrine,
oral contraceptive
Decrease in (neutropenia): Some bacterial
infection, viral inf, protozoa inf, liver
disease, marrow depressant.
Decreased by : anticonvulsants,
antithyroid, NSAID
Disease with Lymphocyte

T,B,NK
Increase in : Viral infection ( hepatitis,
MMR, HIV), corticosteroids,
malignancies, SLE, bacterial disease,
chronic inflammation
Decrease in : immunodeficiency
syndromes, severe illness, lymphatic
circulatory system
Diseasse with Monocyte

Increase in : Infectious, collagen

vascular disease,
Infection (TB, Typhoid, endocarditis),
Malaria, Syphillis, Fungal