Hematology, Coagulation, Chemistry, Immunology, Microbiology

Hematology

Erythrocytes

red blood cells

leukocytes

white blood cells

thrombocytes

platelets

Coagulation

blood clotting process

Collection Tubes

Purple top tubes

-contain EDTA

-Prevents coagulation by binding calcium

-Most hematology tests require whole blood

Light blue tubes

-contain sodium citrate

o Prevents clotting by binding calcium

o Must be filled (9:1 ratio)

o Plasma is used for most coagulation tests

Complete Blood Count (CBC)

· Most commonly ordered lab test

-WBC, RBC, Hemoglobin, Hematocrit, Mean Cell Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Platelet Count

Red blood cells

o Function is to carry oxygen to cells and return CO2

o Hemoglobin in RBCs is oxygen carrier

o 4 chain compound

o Can carry 4 molecules of oxygen

o Iron is needed for hemoglobin

o EPO is a hormone that promotes RBC production

o EPO produced in kidneys

o Live for 120 days

o Low - anemia

o High - polycythemia

Hemoglobin

· Measured to assess patient's ability to carry oxygen

Hematocrit

· Percentage of RBC in whole blood

· Male 40-50%

· Female 35-46%

MCV

(mean corpuscular volume)

· Indicator of size of RBC

MCH

(mean corpuscular hemoglobin)

· Average amount of hemoglobin per RBC

MCHC

(mean corpuscular hemoglobin concentration

· Concentration of hemoglobin per given volume of RBC

White Blood cells

o Defend against pathogens

-Phagocytosis: by neutrophils or monocytes

-Produce enzymes that kill neutrophils

-Antibodies produced by lymphocytes

-Antigens stimulate antibodies

-Antigens are the foreign substance

-Antibodies produced to neutralize them

Neutrophil

phagocytosis and enzymes

Lymphocyte

produce antibodies

Monocyte

phagocytosis

eosinophil

allergies and parasitic infections

basophils

release histamine

Platelets

help to stop bleeding

-reference range 150-400 x 103/ul

Coagulation Process

1) Vasoconstriction

2)Platelet plug formation

-Primary hemostasis

3) Fibrin clot formation

-Secondary hemostasis

-Plasma clotting factors

4) Fibrinolysis

Deep vein thrombosis (DVT)

-Clot that forms in a vein (often the leg)

-Can break away and form an embolus

Arterial Thrombosis

condition where a blood clot (thrombus) forms in an artery, blocking blood flow to the organs or tissues supplied by that artery

Pulmonary Embolism

condition where a blood clot travels to the lungs and blocks one or more pulmonary arteries

Myocardial Infarction

Heart attack

Chemistry

Commonly Ordered Chemistry Panels

· Basic Metabolic Panel

· Comprehensive Metabolic Panel

· Renal Function Panel

· Hepatic or Liver Function Panel

· Lipid Profile

Glucose Metabolism

· Glucose is primary source of energy

-nervous system depends entirely on glucose

· Stored as glycogen in the liver

· Conversion to ketoacids, amino acids, or protein

· Insulin is produced by pancreas and lowers blood glucose levels

· Glucagon is produced by pancreas and raises blood glucose levels

Hyperglycemia

-glucose too high

-above 120mg/dL

Hypoglycemia

glucose too low

-below 70mg/dL

Diabetic

-2 or more fasting glucose of 126 or more

-Random - 200 or more

-Fasting normal 70-100

40 = critical low

-500 = critical high

Glycated Proteins

· Provide long-term glucose utilization measure

· Hemoglobin A1C or HA1C is most common

· Assesses glucose utilization for past 2 to 3 months

Pancreatic Function

aids in digestion and blood sugar regulation

Endocrine gland

-Releases hormones insulin and glucagon

-Insulin - lowers blood glucose levels

-Glucagon - raises blood glucose levels

Exocrine gland

-Releases enzymes amylase and lipase

-amylase - breaks down starches

-lipase - breaks down fats

-lipase better marker for pancreatitis

Diabetes Mellitus

-Type 1

-Insulin dependent

-Autoimmune

-No production of insulin

-Type 2

-Insulin resistance

-Not detecting insulin

-Gestational

-Pregnancy

Electrolytes

-Kidneys are the organ that regulate water and electrolyte balance

-Important in regulation of water balance

Ions

atom or molecule with a net electric charge due to the loss or gain of one or more electrons

Sodium

o Major extracellular cation

o Responsible for maintaining water balance

o Reference range 135 - 145 mEq/L

o Help transmit nerve impulses

Hypernatremia

· Ingesting too much salt

· Dehydration

· Nausea, vomiting, anorexia

· Rough, dry tongue

· Flushed dry skin

· Muscular twitching, tremor, hyperreflexia

· Elevated body temp

Hyponatremia

· Too much water

· Excessive vomiting and diarrhea

· Nausea, vomiting, diarrhea, abdominal cramps

· Tachycardia, hypotension

· Muscle weakness

· Confusion, depression, seizures

Potassium

o Major intracellular cation

o Important in contraction of muscles, including cardiac

o Reference range 3.5-5.2 mEq/L

Hyperkalemia

· Chronic kidney disease

· Inability to excrete K+

· Medication NSAIDS and ACE inhibitors

· Low BP, irritability, anxiety, muscle cramps, dysrhythmias, abdominal cramping, diarrhea

Hypokalemia

· GI losses from excessive vomiting and diarrhea

· Shallow respirations, irritability, confusion, drowsiness, weakness, tachycardia

Chloride

o Most abundant extracellular anion

o Follows sodium

o Reference range 96 - 106 mEq/L

o Acts as buffer

Bicarbonate (CO2)

o Aids in maintenance of acid-base balance

o CO2 is exchanged for O2 in lungs and vice versa in tissues

o Reference range 23 - 29 mEq/L

Calcium

o Found in teeth and bone

o Necessary for blood clotting

o Involved in nerve function and cardiac function

o Reference range 8.5 - 10.2 mg/dL

o Controlled by parathyroid hormone

Hypocalcemia

o Anxiety, irritability, tetany, muscle twitching

o Convulsion, abdominal and muscle cramps

o Fractures occur easily

o Reduction in prothrombin

o Inadequate absorption , decreased PTH, renal failure, pancreatitis

Hypercalcemia

o Depression, weak flabby muscles

o Pathologic fracture, thinning of bones

o Calcium stones in kidney

o Hyperparathyroidism

Magnesium

o Found within cell

o Reference range 1.7 - 2.2 mg/dL

o Need for bone health and nerve impulses

Hypomagnesemia

o Malnutrition, alcoholism, polyuria, pre-eclampsia

o Muscle tremor, difficulty breathing, hyperactive deep reflexes

Hypermagnesemia

o Renal insufficiency or failure

o Adrenal insufficiency

o Excessive use of antacids containing magnesium

Nonprotein

· Urea and creatinine are used to assess kidney function.

Lipid Testing

· Cholesterol produced in the liver

· Atherosclerosis

· Lipoproteins carry cholesterol

· Lipid Profile

-Cholesterol and Triglyceride

-HDL Cholesterol (Good): takes cholesterol back to the lover

-LDL Cholesterol (Bad): transports cholesterol through the arteries

Immunology

Immune System

cells, tissues, and organs that work together to protect the body from infection and disease

Innate/Natural Immunity

o Non-specific responses

-Skin

-FIRST LINE

-Mucus membranes and secretions

-Normal Flora

-SECOND Line

-innate immune cells

-Inflammatory Response

-Complement

-antimicrobial substances

-Phagocytic cells (neutrophils)

Adaptive/Acquired Immunity

-THIRD LINE

-Lymphocytes

-B Cells

- Antibodies

-T Cells

-Helper T Cells

-Killer T cells

Antigens

o A substance that elicits an immune response

o Stimulates the immune system to make antibodies

-Bacteria, virus, toxin

Antibody

-Proteins that recognize and bind to antigens

Types of Adaptive/Acquired Immunity

o Naturally acquired

-Active

-Enter the body naturally

-Passive

-Passed from mother to fetus

o Artificially acquired

-Active

-Body makes antibody to injected substance

-Vaccine

-Passive

-Antibodies directly injected

Immunology Tests

o Most are CLIA waived

o Always follow manufacturers' directions

-Based on antigen antibody reactions

Latex Flow

-Specimen is placed in a device and the specimen flows up the cartridge and lines appear.

-Control line to ensure cartridge is working

-Some test systems produce a line when positive

-Some test systems do not produce a line when positive

o Know your test systems !!!

Test Systems

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Latex Agglutination

-Latex particles are coated with antigen

-If patient has antibodies, agglutination (clumping will occur)

Infectious Mononucleosis

-Caused by the Epstein-Barr virus

-Symptoms include fever, sore throat, and swollen lymph glands

-MonoSpot test detects heterophile antibodies, not EBV antibodies

Group A Streptococcus Infection

-Caused by streptococcus pyogenes

-Strep throat

-Symptoms similar to mono

-Testing performed on a throat swab

-Rapid strep test

-Collect two swabs or use swab with two attached

-If negative, a throat culture is performed

-Blood agar plate will show hemolysis

Human Chorionic Gonadotropin (HCG)

-Hormone produced by corpus luteum

-Used to detect pregnancy

-Qualitative test

Flu and RSV Testing

-Nasal swabs are used for screening

-Swab is placed in each nostril and rotated 5 times

Microbiology

· The study of microorganisms

· Clinical microbiology identifies pathogens

· Nosocomial infections (hospital acquired infections)

· Normal flora

Pathogens

· Good Flora: Bifidobacteria, Escherichia coli, Lactobacilli

-bad flora: Campylobacter, Enterococcus faecalis, Clostridium difficile

· Bacteria, virus, protozoa, parasites, fungi

Microbiology Results

o Plates are read at 24 hours initially; will be read at 48 hours

o When positive, specimens will be reflexed to a sensitivity

o First read at 24hr, most kept for additional 24hr

o Result will be No growth, 24 hr

o Final result will be No growth

o Positive results are variable

o Physician must be alerted to positive result

Microorganisms

an organism that is so small it can only be viewed under a microscope

Bacteria

-Aerobes require oxygen

-Anaerobes do not

-Morphology relates to shape

-Coccus, bacillus

-Diplococci, cocci in chains

-Gram negative vs. gram positive

-Gram stain

-Specialized bacteria

-Obligate intracellular parasites

-Rickettsias

-Chlamydia

-Mycoplasma pneumoniae

Viruses

-Cannot be seen with a standard microscope

-Need electron microscope

-Microbes need living host - parasites

-Either DNA or RNA

-Most viral testing methods detect antibodies to the virus

-Measles, mumps, herpes, hepatitis, influenza

-Vaccines

-Most vaccines are designed to have host produce antibodies against the virus

-Blood tests are testing for immunity

Fungi

-Mycology is the study of fungi

-Disease caused by fungal - mycoses

-Can be difficult to diagnose

-Candida albicans (yeast)

-Immunocompromised are susceptible to infection

Lyme Disease

-Tick-borne disease

-Caused by Borrelia burgdorferi

-Carried by deer ticks

-Untreated disease can be debilitating

-Initial testing is for antibodies