Hemoglobin/ hematocrit/ sed rates

 Values lower than the normal reference range means the patient is/has ___________.

Anemia

Most common cause of anemia is

anemia

thalassemia

Globin deficiency

porphyrias

Porphyrin ring synthesis issues

composition of 1 hemoglobin

• 4 porphyrin rings

• 4 ferrous iron atoms

• 2 alpha and 2 non alpha chains

when glucose level is increased

extra glucose will attach to the end of the beta globin (hgb A1c for diabetes, looks at about three month average)

A1c is a re surgical screen because

predict which patients at more at-risk for post-op infections and levels of glucose can be tightly monitored.

oxy hemoglobin

tense form

deoxyhemoglobin

relaxed form

what are the abnormal hemoglobins

• carboxyhemoglobin

• methemoglobin

• sulfhemoglobin

carboxyhemoglobin

• caused by CO

• reversed by O2

methemoglobin

• iron in the ferric hemoglobin (Fe3+)

• causes cyanosis

• can be given reducing agents to reverse

• rusty blood

sulfhemoglobin

• not reversible

• caused by medications

• green blood

cyan methohemoglobin

• measure hemoglobin and measure in spectrophotometer

• less light gets through = higher hemoglobin

• more light= lower hemoglobin

falsley elevated hemoglobin

• lipemia

• extremely high WBC (over 100)

• Hemoglobin C or S (lyse resitant hemoglobin, sickle cell)

• Abnormal proteins (multiple myeloma)

lipemia fix

replace plasma with equal amount of saline, remix and reanalyze

High WBC fix

centrifuge reaction mixture before reading to remove the WBC

Hgb C or Hgb S fix

mix 1:1 with water before performing analysis. Multiply x2

abn proteins

use KCO3 to make more alkaline and proteins won’t precipitate

 Hematocrit is the proportion of red cells as compared to a [________  ________] of blood

total amount (its a percent)

how to measure hematocrit

• Wintrobe

• Microhematocrit

• automated hematocrit

microhematocrit

• capillary tube

• good for babies, problems, special reading cdevice

when reading hematocrit always read

under the buffy coat

clots

• make hematocrit high with the clot in the tube

• low if the clot is too big for the tube

incomplete seal

• hematocrit is low

read above the buffy coat

• hematocrit is high

excess EDTA

• hematocrit is lower

manual brake

false high hematocrit

allowed to sit in centrifuge

falsely high

clay not flat

false high or low depending on which side is baseline

centrifuge for too short a time

hematocrit false high

sedimentation rate

When RBC settle to the bottom of a tube, the speed of their fall in mm/hr

Sed raate of fall is inversely proportional to _____ viscosity and directly proportional to _____ mass.

• plasma

• RBC

someone who has more inflamation like rhematoid arthritis will have

heavy red blood cells so they settle faster

Someone who is sick with a disease has plasma that is ______ which ______ sed rate

• thicker

• decreases

Fewer cells in greater volume =

increased sed rate

Polycythemia=

slow rate of fall

temperature affect sed rate

• increase temp= increase fall

sed rates older than 4 hrs

• will rouleaux less readily han fresh blood

rouleaux

stacking of RBC

reading a sed rate before 60 min

results will be low

reading a sed rate after 60 min

results will be high

abnormal cells (sickle cells) sed rate

will be lower cause they can’t rouleaux

cold agglutinins can increase sed rates by

small aggregates

cold agglutinins can decrease sed rates by

large aggregates

increases in sed rates see in

• acute and chronic infections

• degenerative disorders

• tumors