hematology lecture notes 1 & 2

Hematopoiesis - Sites of Blood Cell Production

- First trimester - ___ ___

- Second trimester - ____, _____

- Third trimester - ____ ____

- Birth to 20 - _____, _____

- Age 20 - _____, ______, ______

- First trimester - yolk sac

- Second trimester - liver, spleen

- Third trimester - bone marrow

- Birth to 20 - tibia, femur

- Age 20 - vertebra, sternum, ribs

Hb F =

(alpha 2; gamma 2) - 0.5%

Hb A

(alpha 2, beta 2) - 95-98%

Hb A2

(alpha 2, delta 2) - 1.5-2.5%

heme =

porphyrin + iron

globin =

two pairs of polypeptide chains

hemoglobin derivatives =

deoxyhemoglobin, oxyhemoglobin, carboxyhemoglobin

the following statements describe ___

• Affinity of hemoglobin for CO is 210X greater than for O2

• ↑ smokers, tax drivers

carboxyhemoglobin (really bright red)

lifespan of an RBC

120 days

(don't get caught not knowing)

extravascular hemolysis = ____ %

90%

- spleen, liver, lymph nodes

if anemia is present what is the best test to do

hemoglobin

decrease Hb =

anemia

increase Hb =

erythrocytosis

why do a Hb test

respiratory protein of RBC, detecting anemia or erythrocytosis

Causes for erythrocytosis

high altitude, lung/cardiac conditions, polycythemia veracity, dehydration

Hb test limitations

- tourniquet on too long (>1 min)

- dehydration

Hb references ranges

women:

men:

anemia women:

anemia men:

women: 14.0 g/dL +/-2

men: 16.0 g/dL +/- 2

anemia women: < 11 g/dL

anemia men: 13.0 g/dL

increased RBCs =

erythrocytosis

decreased RBCs =

anemia

total RBC count reference range

women:

men:

women: 3.5-5.5 million/mL

men: 4.3-5.9 million/mL

the following statements describe _____

• Ratio of spun RBCs to plasma

• Abnormalities in Hct parallel those for Hb

hematocrit

hematocrit reference range

women:

men:

women: 37-47%

men: 40-54%

limitations of hematocrit

similar to Hb

- Hb x 3 = Hct

RBC indices

• Determine morphologic type of anemia

• RBC count, hemoglobin, and hematocrit used to calculate indices

• MCV, MCH, MCHC, MPV, RDW

Mean Corpuscular Volume (MCV) =

MCV = Hct/ RBC count

MCV reference range

80-100

Mean Corpuscular Hemoglobin

(MCH)

increased =

decreased =

increased = macrocytic anemias

decreased = microcytic and normocytic anemias

MCH reference range

27-33 pg

Mean Corpuscular Hemoglobin

Concentration (MCHC) =

hemoglobin/hematocrit

- average concentration of Hb in the average RBC

MCHC reference range

32-36 g/dL

earliest indicator of the potential for anemia

Red Blood Cell Distribution

Width (RDW)

Red Blood Cell Distribution

Width (RDW) =

distribution of individual RBC volume

Red Blood Cell Distribution

Width (RDW) reference range

11-15%

RDW is never ___

decreased

_____ is best for determining morphological type of anemia

PBS

abnormality in RBC size =

anisocytosis

- microcytosis <80

- macrocytosis >100

macrocytosis causes

- B12/folate deficiency

- liver disease

- alcoholism

- myxedema

- reticulocytosis

microcytosis causes

- IDA

- thalassemia

- anemia of chronic disease

- sideroblastic anemia

hypochromatic image

decrease MCHC

hyperchromatic image

*lack of central pallor

increase MCHC

polychromatic reticulocytes

WBC count reference range

4500-11000/mL

leukopenia

- viral

decrease in WBC count

leukocytosis

increase WBC count

- bacteria

- general inflammation

neutrophils normal range

50-70%

elevation of neutrophils =

neutrophilia

neutrophilia causes

physiologic:

pathologic:

physiologic: stress

pathologic: acute bacterial infection & general inflammation

decrease in neutrophils =

neutropenia

- viral

lymphocytes normal range

20-40%

lymphocytes elevations

lymphocytosis

- viral infection

lymphocytes decrease

lymphocytopenia/lymphopenia

- bacterial infection

monocytes normal range

2-10%

elevation in monocytes

monocytosis

- good sign, recovery from infection

eosinophils normal range

1-5%

eosinophils elevation

eosinophilia

- allergies (6-10%)

- parasite (25-30%)

- malignancies

basophils normal range

0-1%

basophils elevation

basophilia

- hypersensitivity reactions

- myxedema

- myeloproliferative conditions

platelet count reference range

150000-400000

increased platelets

thrombocythemia aka thrombocytosis

*malignancy

thrombocytopenia =

<70,000 clinically evident bleeding tendency

why would you do a reticulocyte count

• Count of immature RBCs w/o

nuclei

• Estimate rate of RBC

production

• Increased reticulocyte count

- increased number of RBCs

put into peripheral blood in

response to some stimulus

what test is good for monitoring treatment of anemia

reticulocyte count

reticulocyte count reference range

0.5-1.5%

MCC of reticulocytosis increase =

- hemolytic anemia

- acute bleeding

- after treatment of anemia

causes of decreased reticulocytes

- conditions w/inadequate hematopoiesis

- bone marrow failure

- lack of EPO (renal disease)

mean platelet volume (MPV)

- size of platelets

- ordered alongside platelet count

elevated MPV =

myeloproliferative disorders, cancers, cardiovascular disease

low MPV =

aplastic anemia

erythrocyte sedimentation rate (ESR)

• Aid in detecting inflammatory

conditions

- distance/time

Factors that ↑ ESR:

Plasma proteins - fibrinogen, immunoglobulins

limitations of ESR

• Non-specific test

• Can sometimes remain normal when it should not be

• Anemias can increase or decrease

• Poikilocytosis (abnormal shape RBC) will falsely decrease ESR

if the ESR is >100

- immediate action

- labs & imaging

if ESR is 50-100 it is

history dependent

ESR reference range

males under 40:

women under 40:

males under 40: 1-15 mm/hr

women under 40: 1-20 mm/hr

ESR formula for maximum NL at a given age

Males = Age/2

Females = Age + 10/2

accelerate ESR could indicate

• Bacterial infections

• Severe anemia

• Leukemia

• Lymphoma

• Metastatic tumor

• Multiple myeloma

• Ulcerative colitis

• Acute pancreatitis

• Cholecystitis

• Rheumatic fever

• Lupus erythematosus

• Scleroderma

• Acute glomerulonephritis

• Pyelonephritis

• Inflammatory arthritis

• Inflammation

• Hypothyroidism

• Surgery

• Pregnancy

C-Reactive Protein (CRP)

• Acute phase reactant

• Virtually absent from serum of healthy person

• One of the most sensitive acute phase reactants

• Begins to rise 4-6 hours after onset of inflammation

• Half life: 5-7 hours

is CRP better for chronic or acute

acute

elevated CRP could indicate

• Bacterial infections

• Severe anemia

• Leukemia

• Lymphoma

• Metastatic tumor

• Multiple myeloma

• Ulcerative colitis

• Acute pancreatitis

• Cholecystitis

• Rheumatic fever

• Lupus erythematosus

• Scleroderma

• Acute glomerulonephritis

• Pyelonephritis

• Inflammatory arthritis

• Inflammation

• Hypothyroidism

• Surgery

• Pregnancy

CRP =

- no interference from anemia or serum protein changes

- more sensitive

- response to care

ESR =

chronic inflammatory

spherocytes

- hereditary spherocytosis

- increase MCHC

schistocyte

- traumatic hemolytic

bite cell

- G6PD anemia

sickle cells

tear drop cell

- myeloproliferative disease

- leukemias

rouleaux

- inflammation (fibrinogen)

codocyte (target cell)

- thalassemia

what does > 5 nuclear lobes for neutrophils indicate

= B12/folate deficiency

reactive lymphocyte

acute viral infection