Physiology ospe

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Identify

Osmotic fragility test

Mention 2 materials in osmotic fragility test

1. Distilled water.

2. NaCl solution of a concentration 1gm %

3. Test tubes and test tube rack.

4. Pipettes 1 ml and 5ml.

in OFT normally cells don’t heamolyse until concentration of NACL is below …..

0.45%

complete hemolysis occurs at ….. NaCl.

0.35%

mention two significance in OFT 

used to diagnose hereditary spherocytosis
High osmotic fragility 
Low osmotic fragility 

hereditary spherocytosis →RBCs begin to hemolyse at …. and complete at ….

RBCs begin to hemolyse at 0.7% and complete at 0.5 %

in High osmotic fragility what it tend to increase and mention occurring disease 

increased tendency to hemolysis 
autoimmune hemolytic anemia, severe burns, chemical poisoning, or in

hemolytic disease of the newborn. ( erythroblastosis fetalis )

Low osmotic fragility RBCs begin at …..   and complete at ….
Tell me also about hemolysis 

RBCs begin at 0.4% and complete at 0.2%
Increased resistance to hemolysis 

Identify

Erythrocyte Sedimentation Rate (ESR)
Westergren on left ( tube and rack )
wintrobe on right

identify

ESR ( westernberg method ) 

identify

ESR ( wintrobe method )

mention definition and methods of ESR

Def —> It is the rate of the downward descent of RBCs in a vertical column of blood
It is measured by 2 methods

1. Westergren method.

2. Wintrobe method

what rate of RBCs decent depends on ?

A —- Plasma viscosity
B —- Rouleaux Formation

what is the Rouleaux Formation means ?

Means clumping of RBCs together to form clumps like a coins
This will increase the weight of RBCs and decrease frictional resistance, so it increases ESR

Materials of Westergren Method ? 

Westergren tubes 
Special racks
3.8% sodium citrate
5 ml sterile syringes and test tubes

diameterاعرف الفرق بين الطريقتين كويس في شكل الانابيب وال

ومترقمه لغايه كام

Normal values of ESR in Westergren method

in Male first hour — 3-5mm second hour — 6-10mm

in Female first hour — 8-10 mm second hour — 16-20mm

Normal Values of ESR in Wintrobe method 

Male 15mm /hour. 
Female 20mm /hour. 

physiological factors increases ESR

1. Old age

2. Females

3. Pregnancy

4. During menstruation

5. Muscle exercise

physiological factors decreases ESR

1. Newborn

2. Males

3. High altitudes

pathological  factors increases ESR

1. Acute inflammation such as tonsillitis

2. Chronic infections such as T.B.

3. Malignancy

4. Tissue trauma

5. Fevers and Rheumatic fevers

pathological factors decreases ESR

1. Polycythemia

2. High cholesterol contents

3. Hyperviscosity of plasma

Clinical Significance of ESR ?

ESR is not a specific and diagnostic test but it is prognostic test
1. It detect the presence and severity of disease

2. It gives an idea about the activity of disease

3. It is used to follow up of disease and effect of treatment

Haemoglobin (Hb) represents ….. of RBC volume
consists of….. heme groups combined with … molecule of globin

34%
4
1

Normal value of HB

1. Adult male: 14-16 gm % (average 15gm %).

2. Adult female: 12-16 gm % (average 14gm %).

3. Newly born infant : 18 gm %

4. Children : 12 gm %

???? 

Sahli hemoglobinometer set 

why we use it ?

determination of Hb content

Advantages of Sahli Method ?

1. The method is simple, quick, and fairly accurate.

2. It does not require any costly apparatus because it needs only direct color matching.

3. Its cost is minimal and can, therefore, be used in mass surveys.

Significance of Hb determination ?

Diagnosis of anemia, polycythemia
Calculations of some blood indices MCH ,MCHC
and useful in determination of the type of anemia hypochromic or normochromic

Definition of Hematocrite (HCT)

• It is the ratio of RBCs volume to total blood volume.

• RBCs volume/total blood volume x 100

other name ?

Packed Cell Volume (PCV)

Normal value of HCT 

• Adult male : 42-48%

• Adult female: 38-42%.

• Newly born : 55%

• Children : 36%

mention two methods of HCT measurement

A) Macrohematocrite method or (Wintrobe tube method)

B) Microhematocrite method or (Capillary tube method)

???

Macrohematocrite method

???

Microhematocrite method 

in Macrohematocrite method 
Venous blood anticoagulated with ….. or ……
Centrifuge the tube at …. r.p.m for …. minutes. 

Venous blood anticoagulated with EDTA or Na citrate
Centrifuge the tube at 3000 r.p.m for 15 minutes

in Microhematocrite method
The tubes are centrifuged at a higher speed ….. r.p.m for …… minutes.

The tubes are centrifuged at a higher speed 6000 r.p.m for 5 minutes.

advantage for Microhematocrite method

Microhaematocrit is easier, more accurate and use a small amount of blood (commonly used in newly born infants)

Factors affecting hematocrite ? 

Significance of hematocrite measurement ?

1. Diagnosis of anemia, polycythemia.

2. Calculation of blood indices (MCV, MCHC).

3. Calculation of renal blood flow, blood volume.

Significance of hematocrite measurement ? مش بالغلط

Calculation of renal blood flow
Hbديه مهمه جدا لان ده اللي بيفرق بينها وبين ال

MCV ? Formula ? 

It measure the average volume of single RBC

normal value ?
mention other conditions

90±7 fl
MCV is high (above 97 micro³ ) → macrocytic
MCV is low (below 83 micro³) → microcytic
normal → normocytic

MCH ? formula ?

Expresses the average amount of Hb present in single RBC

significance in MCH

➢Normochromic cell: 30±3 pg.

➢Hypochromic cell: below 27 pg.

MCHC ? Formula ?

Expresses the %ratio of Hb concentration in a single RBC in relation to its volume

Significance of MCHC ?

• Normochromic cell: 30- 36 gm%

• Hypochromic cell: below 30 gm%

info 

➢ There is no hyperchromic RBC because, it contains the maximal concentration of Hb.

➢A large cell may contain more Hb, but its percentage saturation will not be more than 36%.

info 2

Types of anemia ? مهمه جدا الدكتور ماكده عليها

Mention the two systems related to the surface of red blood cell surface 

ABO system 
Rh system 

النسب لكل جروب
وصور توضيحيه

Importance of ABO system ?

1. Blood transfusion

2. Disputed parenthood

3. Medicolegal importance

4. Susceptibility to certain diseases

There are six common types of Rh antigens named …..,….,….,….,…,….,….,

There are six common types of Rh antigens named C, D, E, c, d, and e.

which type is most antigenic ?

type D-antigen

Presence of D-antigen→ Rh +ve.

Absence of D-antigen→ Rh -ve.

مين اشهر في المصريين

Rh positive

Is Rh have antibody ? 

Noooo

Importance of Rh-factor ?

1- Blood transfusion
2- Hemolytic disease of the newborn (erythroblastosis foetalis)

Manifestation of erythroblastosis foetalis ?

1. Anemia.

2. Severe jaundice.

3. Many immature RBC’s (erythroblasts) in the foetal blood.

4. Kernicterus: it is a neurologic disease develops due to deposition of excess bilirubin in some brain centers (mainly motor areas) causing their damage

Neurologic disease develops due to deposition of excess bilirubin in some brain centers (mainly motor areas) causing their damage ? 

Kernicterus 

Treatment and Prevention ?

بص على دول

This test is used to measure ?

Bleeding time

def ?
from where we take the species ?

 It is the time needed for bleeding to stop from small puncture
finger-tip ear-lobe

Significance of Bleeding time
time ?
measures ?
prolonged in…..?
normal in ….?

2-6 minutes
It measures the functions of platelets
prolonged in purpura and Von willbrand disease
usually normal in hemophilia

This test is used to measure  ? 

Clotting time 

Significance of clotting Time
time ?
prolonged in ….?
normal in … ?

5-8 minutes
prolonged in hemophilia and other clotting factor disorders e.g. vit K deficiency, liver diseases, and use of oral anticoagulants
it is normal in purpura

to measure the extrinsic pathway of coagulation we use …. ?

Prothrombin time

significance of PT 
time ? 
prolonged in…. ? 

Normally  prothrombin time is 12-16 seconds.
it is prolonged if there is a deficiency of one or more factors of the extrinsic pathway of coagulation e.g. in liver diseases , oral anticoagulants and vitamin K deficiency

to measure the intrinsic pathway of coagulation we use …. ?

aPTT ( Activated partial thrombosisplastin Time )

Normal time for aPTT ? 

25 -- 39 Seconds 

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