Hematology

  • The stuff of blood, and tissues that produces it 

  • Ot is very important for the MA to understand how to correctly collect, handle package and analyze a blood specimen 

Blood specimen collection:

  • He collection and testing of all blood and all body fluid is strictly regulated by OSHA and the CDC 

  • Standard precaution MUST BE FOLLOWED AT ALL TIME

  • The function of the blood is to take nutrients and O2 to the body and eliminates CO2 

  • Blood takes waste produces to the lungs liver, kidney and skin for elimination 

  • Blood carries WBC to help fight infections and contain platelets for heating 

  • Blood regulates body temp 


Blood components: 

  • The liquid components is plasma 

  • Plasma carries blood cell and other substance to the difference parts of the body 

  • Key components of blood is fibrinogen 

  • This help the formation of clots

  • Serum is plasma without the fibrogen 

  • 90 percent of plasma is H2O 

  • The rest is solid substances called solutes 

  • These may required albumin, globulin, fibrogen, prothrombin, and electrolytes


Formed elements:

  • The formation of the blood cell is hematopoiesis

  • This begins during the fetal development when stem cell are formed and housed in the bone marrow 

  • This helps replaced damaged or aged cell as needed 

  • RBC

  • WBC

  • Platelets are all formed elements 



Reveiw:

RBC: transport oxygen and carbon 

WBC: defense 

Three types of granular leukocytes: 

Non granular neutrophils, eosinophils and basophils 

Thrombocytes: clotting 

RBC test:

  • Vessels that carry hemoglobin through the body 

  • Thjeu are formed in the bone marrow and rep;lcaed every few months 

  • We have hemoglobin which is a vital protein found in RBC

  • It carries O2 from the lungs to the cells and CO2 from throughout the body back to the lungs where it can be exhaled 

  • RBC sound 4.5-6 million and 4-5.5 million for females

  • RBC fromatom is controlled by erythropoietin  which is secreted by the kidney in an adult and liver in a fetus 


Anemia:

  • When The blood cell has a lower than normal level of RBC. 

  • Procrit an artificial erythropoietin can assist in reproduction of rbc

  • Polycythemia is where blood has higher than normal RBC level 

  • This is an overproduction of 


Reticulocyte

  • These are immature blood cell 

  • They are generally mature within 48 hours 

  • Reticulocyte count is the percentage of reticulocyte in the blood in relation to the number of mature RBCs

  • Measuring this allow you to determine the ability of bone marrow to compensate for RBC loss 

  • THis can help tell you if anemia tx is working 

  • These count can be low in renal or bone marrow disease, alcoholism, folic acid deficiency 


Hemoglobin

  • A low Hgb may indicate iron deficiency anemia 

  • May see hgh levels in burns 

  • Adult female level is 12-16g/dL

  • Adult male 14-18g/dL



Hematocrit 

  • This percentage of packet RBC’s in total volume of blood 

  • This Is spun in a centrifuge for approximately 15 min 

  • Normal RBC and Hgb level, hematocrit should be about three times the hemoglobin level 

  • 40-50 percent males and 35-45 percent in females 


RBC indices: 

  • MCV: mean corpuscular volume: this is the average size of RBC and classified them according to size

  • MCH: Mean corpuscular hemoglobin: measures the average amount of hemoglobin in RBC 

  • MCHC: Measures the amount of hemoglobin relative to the cell 

  • When MCV, MCH, MCHC is decreased iron deficiency anemia is likely 

  • When increased B-12 or folic acid and deficiency 


ESR:

  • This is not part of your a CBC but does measure 

  • It determines the rate of RBC settle at the bottom of the tube 

  • It relates to the condition of the RBC and the amount of fibrinogen om the plasma 

  • Note ESH itself is not diagnostic of a condition that causes increase fibrogen 

  • For example: ESR + ANA


WBC Test: 

  • Several leukocyte are produced in bone marrow 

  • There are five types of WBC 

  • Neutrophils 

  • Acts as the body's primary defense mechanism and make up the largest percentage of WBC’s 

  • they are continuously produced for the purpose of combating infection by means of phagocytosis

  • Phagocytosis: where the neutrophil surrounds swallows and digest the bacteria 

  • Eosinophils 

    • Produced in the bone marrow 

    • Large number can indicate parasite condition or allergic conditions 

  • Basophils 

    • Are produced by bone marrow and produce heparin/heparin is a substance that prevent clotting 

    • If a person is experience inflammation heparin can help in diminishing or preventing clotting 

    • Increased basophils can be seen on someone who had their spleen removed Pts who have had excessive exposure to radiation 

    • Basophils have a vasodilator histamine and can be seen

  • Lympohils 

  • WBC produced in the bone marrow and lymphoid tissue

  • Example: the spleen and lymphoid tissue 

  • They produce antigen against foreign substance such as bacteria viruses and pollens

  • Lymphocytes are small and large and can proliferate into B and T cells 

  • In HiV testing is used to evaluate the type and amount of T cells presents 


  • Monophils 

    • WBC formed in the bone marrows from stern cells 

    • Monocyte assist in phagocytes 

    • They ingest foreign particles or bacteria that neutrophils are unable to digest 

    • When do we see an increase in monocyte: TB, thyroid 

  • WBC are larger than RBC 

  • They also have a shorter life life span of 2-3 weeks 

  • Elevated level can indicate leukemia 

  • Decreased levels can indicates viral infections or autoimmune deficiency



When do neutrophils increase: In response to infection, hemorrhage, cancer, poisoning, - hemolysis, inflammation

When do neutrophils decrease 

  • virus/serious infections


Platelets: aka thrombocytes 

  • The smallest cell found in the blood 

  • They are formed in bone marrow 

  • They live about 10 days and are continuously reproduced 

  • Platelets will increase around an area that is bleeding to assist in the formation of clots

  • Platelet and the injured tissue release thrombocytes 

  • Thrombin acts on fibrinogen thereby reducing fibrin 

  • There are typically 150000 and 400000 platelets 

  • Concerns with platelets counts are when greater than 750000 and less than 50000

  • Several low countries can lead to internal bleeding and possibly death

  • Thrombocytopenia can result in either reduced platelet production or increase platelet destruction 


CMP: Comprehensive Metabolic Panel: 

  • Used to evaluate organ functions 

  • Used to evaluate organ function, check for common disorders, monitor the progress of current conditions and responses to meds 

  • Help in a general eval of the kidneys, liver, endocrine and acid bases balance 

  • A 12 hour fast is recommended 


PT/PTT/INR 

  • Pt is a coagulation test that measures the amount if time ut tracked to form a clot 

  • PT does not reveal specific bleeding disorders in a pt with liver failure or other systemic disease 

  • It usually help to screen out with symptoms of bleeding 

  • Hugh than 30 seconds or (4.5 INR) indicates a risk for bleeding

  • More than 40 sec is critical


When might the levels be elevated 

  1. Bone marrow depression

  2. CA

  3. Liver or collagen disease 

  4. Pancreatitis 

  5. DIC(disseminated intravascular coagulation 

  6. Toxic shock syndrome 

Decrease libel may be seen in MI, multiple myeloma, pulmonary embolism, thrombophlebitis 

PTT: can help determine which specific clotting factor are missing

  • It determines the length if time it takes for a fibrin clot to for

  • It helps determine the effectiveness of anticoagulant therapy such as coumadin or heparin 

  • This Is normally 60-70 seconds 


PKU: is a congenital disease caused by a detected in the metabolism of the amino acid phenylalanine 

  • The unmetabolized protein accumulated in the void stream and it undetected or treated, will result in mental retardation 

  • The PKU test should be performed on all newborns 


Mono testing

  • Done to r/o infectious mononucleosis 

  • Usually ordered with a CBC

  • Can also be with a strep test to see if the symptoms of a sore throat is caused try a streptococcal infection or mono