APUTS) Reporting Terminology and Codes Haematology (V1.0
Total Page:16
File Type:pdf, Size:1020Kb

Load more
Recommended publications
-
We Get Biased on Things That Make Sense
DIALOGUE AND DISCUSSION We Get Biased on Things That Make Sense MERIH T. TESFAZGHI When I was teaching third year medical students, and bench- reaction might be characterized by a marked left shift lecturing clinical laboratory science students, I emphasized which may display a range of immature cells that are also the importance of clinical details and the history of patients seen in CML. Severe left shift especially in the absence of in laboratory test processing, especially in the evaluation of evident infection (or other underlying diseases) may peripheral blood films. During those times, one of my strongly suggest direct bone marrow involvement. In students stated, “but including details of patients might such scenario, clinical details of patients such as absence somehow affect the decision of the reviewer, and may lead to or presence of enlargement of extramedullar organs is Downloaded from a bias.” I responded that we are biased on things that make highly sought. sense. This means that we decide based on the evidence we see from a microscopy evaluation in the light of the clinical Ø The coexistence of multiple conditions in a given detail and history. How do clinical details and history help us patient. One condition may mask the presence of the reach decisions? other condition. For example, the coexistence of megaloblastic anemia with iron deficiency anemia. http://hwmaint.clsjournal.ascls.org/ If specimens are the “in vitro ambassadors” of patients to the Usually, megaloblastic anemia is characterized by laboratory, then properly completed request forms are their increased size of red blood cells (MCV), but when “credentials”. -
Syllabus: Page 23
The University of Texas at El Paso College of Health Sciences Clinical Laboratory Science Program CLSC 3364 Hematology II Course Outline Spring What do you see? What is in your Head? Video or audio recordings will not be permitted. Instructor M. Lorraine Torres, Ed. D, MT (ASCP) College of Health Sciences Room 423 Phone: 747-7282 E-Mail: [email protected] Office Hours TR 3:00 – 4:00 p.m., Friday 2 – 3 p.m. or by appointment Class Schedule Monday and Wednesday 11:00 – 12:30 A.M. HSCI 135 Course Description This course is a sequel to Hematology I. It will include but is not limited to the study of the white blood cells with emphasis on white cell formation and function and the etiology and treatment of white blood cell disorders. This course will also encompass an introduction to hemostasis and laboratory determination of hemostatic disorders. Prerequisite; CLSC 3356 & CLSC 3257. Topical Outline 1. Maturation series and biology of white blood cells 2. Disorders of neutrophils 3. Reactive lymphocytes and Infectious Mononucleosis 4. Acute and chronic leukemias 5. Myelodysplastic syndromes 6. Myeloproliferative disorders 7. Multiple Myeloma and related plasma cell disorders 8. Lymphomas 9. Lipid (lysosomal) storage diseased and histiosytosis 10. Hemostatic mechanisms, platelet biology 11. Coagulation pathways 12. Quantitative and qualitative vascular and platelet disorders (congenital and acquired) 13. Disorders of plasma clotting factors 14. Interaction of the fibrinolytic, coagulation and kinin systems 15. Laboratory methods REQUIRED TEXTBOOKS: same books used for Hematology I Keohane, E.M., Smith, L.J. and Walenga, J.M. 2016. Rodak’s Hematology: Clinical Principles and applications. -
The Role of the Laboratory in Treatment with New Oral Anticoagulants
Journal of Thrombosis and Haemostasis, 11 (Suppl. 1): 122–128 DOI: 10.1111/jth.12227 INVITED REVIEW The role of the laboratory in treatment with new oral anticoagulants T. BAGLIN Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK To cite this article: Baglin T. The role of the laboratory in treatment with new oral anticoagulants. J Thromb Haemost 2013; 11 (Suppl. 1): 122–8. tion of thromboembolism in patients with atrial fibrilla- Summary. Orally active small molecules that selectively tion. For some patients, these drugs offer substantial and specifically inhibit coagulation serine proteases have benefits over oral vitamin K antagonists (VKAs). For the been developed for clinical use. Dabigatran etexilate, majority of patients, these drugs are prescribed at fixed rivaroxaban and apixaban are given at fixed doses and doses without the need for monitoring or dose adjustment. do not require monitoring. In most circumstances, these There are no food interactions and very limited drug inter- drugs have predictable bioavailability, pharmacokinetic actions. The rapid onset of anticoagulation and short half- effects, and pharmacodynamic effects. However, there life make the initiation and interruption of anticoagulant will be clinical circumstances when assessment of the therapy considerably easier than with VKAs. As with all anticoagulant effect of these drugs will be required. The anticoagulants produced so far, there is a correlation effect of these drugs on laboratory tests has been deter- between intensity of anticoagulation and bleeding. Conse- mined in vitro by spiking normal samples with a known quently, the need to consider the balance of benefit and risk concentration of active compound, or ex vivo by using in each individual patient is no less important than with plasma samples from volunteers and patients. -
Hematology Unit Lab 1 Review Material
Hematology Unit Lab 1 Review Material Objectives Laboratory instructors: 1. Facilitate lab discussion and answer questions Students: 1. Review the introductory material below 2. Study and review the assigned cases and questions in small groups before the Lab. This includes the pathological material using Virtual Microscopy 3. Be prepared to present your cases, questions and answers to the rest of your Lab class during the Lab Erythropoiesis: The process of red blood cell (RBC) production • Characterized by: − Increasing hemoglobin synthesis Erythroid maturation stages (Below): − Decreasing cell size - Average of 4 cell divisions during maturation − Decreasing cytoplasmic basophilia [One pronormoblast gives rise to 16 red cells] (increasing pink color) - pronormoblast → reticulocyte = 7 days − Progressive chromatin condensation of the - reticulocytes → mature RBC =1-2 days nuclei − Extrusion of nucleus (orthochromatic stage) − Extruded nuclei are subsequently phagocytized − Loss of mitotic capability after the early stage of polychromatophilic normoblast • Picture below: Erythroid progenitors (normoblasts) cluster around macrophages (arrows) in the bone marrow and spleen • Macrophages store iron • Iron is transferred from macrophages to erythroid precursor cells • Iron is used by normoblasts for hemoglobin synthesis aka nucleated rbc aka reticulocyte 1 Mature Red Blood Cell 7-8 microns; round / ovoid biconcave disc with orange-red cytoplasm, no RNA, no nucleus; survives ~120 days in circulation Classification of Anemia by Morphology 1. -
Approach to Coagulopathy in the Icu Dic and Thrombotic Emergencies
APPROACH TO COAGULOPATHY IN THE ICU DIC AND THROMBOTIC EMERGENCIES NEIL KUMAR, MD UNIVERSITY OF ROCHESTER MEDICAL CENTER Disclosures u I have no financial disclosures u I am NOT A HEMATOLOGIST Outline u Review of hemostasis and coagulopathy u Discuss laboratory markers for coagulopathy u Discuss an approach to a few specific coagulopathies and thrombotic emergencies Outline u Review of hemostasis and coagulopathy u Discuss laboratory markers for coagulopathy u Discuss an approach to a few specific coagulopathies and thrombotic emergencies Coagulation u Coagulation is the process in which blood clots u Fibrinolysis is the process in which clot dissolves u Hemostasis is the stopping of bleeding or hemorrhage. u Ideally, hemostasis is a balance between coagulation and fibrinolysis Coagulation (classic pathways) Michael G. Crooks Simon P. Hart Eur Respir Rev 2015;24:392-399 Coagulation (another view) Gando, S. et al. (2016) Disseminated intravascular coagulation Nat. Rev. Dis. Primers doi:10.1038/nrdp.2016.37 Coagulation (yet another view) u Inflammation and coagulation intersect with platelets in the middle u An example of this is Disseminated Intravascular Coagulation. Gando, S. et al. (2016) Disseminated intravascular coagulation Nat. Rev. Dis. Primers doi:10.1038/nrdp.2016.37 Outline u Review of hemostasis and coagulopathy u Discuss laboratory markers for coagulopathy u Discuss an approach to a few specific coagulopathies and thrombotic emergencies PT / INR u Prothrombin Time u Test of Extrinsic Pathway u Take plasma (blood without cells) and re-add calcium u Calcium was removed with citrate in tube u Add tissue factor u See how long it takes to clot and normalize PT to get INR Coagulation (classic pathways) Michael G. -
Copyrighted Material
CHAPTER 1 The Blood Film and Count Blood Blood is a life‐sustaining fluid that circulates through the heart and blood vessels. It carries oxygen and nutrients to the tissues and waste products to the lungs, liver and kidneys, where they can be removed from the body. Usually when blood is removed from the body it forms a solid blood clot. However, if clotting is prevented by mixing with an anticoagulant, the blood separates, under the influence of gravity, into three layers (Fig. 1.1). The bottom layer is deep red in colour and is composed of red cells. The top layer is clear and pale yellow. It is called plasma and is composed of various salts and proteins dissolved in water. In between is a narrow layer called the buffy coat because of its buff or yellowish white colour. The buffy coat is composed mainly of cells of a variety of types, collectively known as white cells. In addition there are small cellular fragments, called platelets, which have a role in blood clotting. The bloodCOPYRIGHTED film MATERIAL Although we can judge the proportions of red cells and white cells in a tube of sedimented blood, we get far more information if the blood is carefully mixed and a thin layer is spread on a glass A Beginner’s Guide to Blood Cells, Third Edition. Barbara J. Bain. © 2017 John Wiley & Sons Ltd. Published 2017 by John Wiley & Sons Ltd. 1 0003049575.indd 1 2/24/2017 9:50:31 AM 2 A Beginner’s Guide to Blood Cells Plasma Buffy coat Red cells Fig. -
Blood Film Preparation and Staining Procedures
INTERPRETATION OF THE PERIPHERAL 00. ם BLOOD FILM 0272–2712/02 $15.00 BLOOD FILM PREPARATION AND STAINING PROCEDURES Berend Houwen, MD, PhD The blood film is one of the world’s most widely and frequently used tests and has undergone remarkably few changes since its introduction as a clinical diagnostic tool in the late 1800s. The origins of stained blood film microscopy are somewhat obscure, and a clear reference for the ‘‘first person or persons’’ to describe its use as a clinical laboratory procedure cannot be established with certainty. Antonie van Leeuwenhoek, in the seventeenth century, was the first to describe blood cells, using whole blood preparations and not blood films for his observations on blood corpuscles. In fact, he would not have been able to use blood film–based microscopy because it requires considerably more sophisti- cated optics than were available in his day. A second technologic innovation enabling blood film microscopy was the introduction of aniline dyes in the second half of the nineteenth century. This made it possible to study individual blood cells by light microscopy after a small amount of blood had been placed and smeared onto glass slides, dried, fixed, and then stained. Paul Ehrlich introduced eosin as the first of these dyes for staining blood films in 1856, followed by hematoxylin in 1865, and later by the metachromatic Romanowsky dyes. A few refinements have since been made, consisting mainly of improve- ments in dye quality, staining procedures, automation of slide preparation, and staining, but the basic elements of blood film preparation and analysis have not changed for over a century. -
The Use of Mean Corpuscular Volume (MCV) to Classify the Anemia As
The Frequency of Iron Deficiency Anemia and Thalassemia Trait among Children: Experience at Prince Rashed Bin Al- Hassan Military Hospital Zuhair Nusair MD*, Abdelrazzaq Al-Wraikat MD**, Nazih Abu Al-Shiekh MD**, Sameer Kofahi MD^, Mohammad Zoubi MD^ ABSTRACT Objectives: To determine the frequency of iron deficiency anemia and thalassemia trait among children attending the Pediatric Department at Prince Rashed Bin Al-Hassan Military Hospital in the North of Jordan. Methods: This hospital based study was conducted in the year 2008 on 1,012 children aged 6 months to 14 years who attended the Pediatric Department at Prince Rashed Bin Al-Hassan Military Hospital in North of Jordan using fully automated blood count of the mean corpuscular volume, serum ferritin level and high performance liquid chromography, or genotyping. None of the subjects included in the study had been on any hematinic in the previous six months, had infection in the past one month or had a chronic disease. The diagnosis of iron deficiency anemia was defined as mean corpuscular volume ≤ mean – 1 standard deviation corrected for age, with a ferritin level < 7 ng/ml of the serum (normal reference range 7 – 140 ng/ml). The diagnosis of thalassemia trait, for subjects with normal or high serum ferritin and those whose mean corpuscular volume was non-compliant to iron therapy, was obtained by high performance liquid chromography or polymerase chain reaction, which was performed at Princess Eman Research and Laboratory Science Center. Results: The frequency of iron deficiency anemia and thalassemia trait was 13.3% and 5.8% respectively. They were equally frequent among males and females. -
Complete Blood Count in Primary Care
Complete Blood Count in Primary Care bpac nz better medicine Editorial Team bpacnz Tony Fraser 10 George Street Professor Murray Tilyard PO Box 6032, Dunedin Clinical Advisory Group phone 03 477 5418 Dr Dave Colquhoun Michele Cray free fax 0800 bpac nz Dr Rosemary Ikram www.bpac.org.nz Dr Peter Jensen Dr Cam Kyle Dr Chris Leathart Dr Lynn McBain Associate Professor Jim Reid Dr David Reith Professor Murray Tilyard Programme Development Team Noni Allison Rachael Clarke Rebecca Didham Terry Ehau Peter Ellison Dr Malcolm Kendall-Smith Dr Anne Marie Tangney Dr Trevor Walker Dr Sharyn Willis Dave Woods Report Development Team Justine Broadley Todd Gillies Lana Johnson Web Gordon Smith Design Michael Crawford Management and Administration Kaye Baldwin Tony Fraser Kyla Letman Professor Murray Tilyard Distribution Zane Lindon Lyn Thomlinson Colleen Witchall All information is intended for use by competent health care professionals and should be utilised in conjunction with © May 2008 pertinent clinical data. Contents Key points/purpose 2 Introduction 2 Background ▪ Haematopoiesis - Cell development 3 ▪ Limitations of reference ranges for the CBC 4 ▪ Borderline abnormal results must be interpreted in clinical context 4 ▪ History and clinical examination 4 White Cells ▪ Neutrophils 5 ▪ Lymphocytes 9 ▪ Monocytes 11 ▪ Basophils 12 ▪ Eosinophils 12 ▪ Platelets 13 Haemoglobin and red cell indices ▪ Low haemoglobin 15 ▪ Microcytic anaemia 15 ▪ Normocytic anaemia 16 ▪ Macrocytic anaemia 17 ▪ High haemoglobin 17 ▪ Other red cell indices 18 Summary Table 19 Glossary 20 This resource is a consensus document, developed with haematology and general practice input. We would like to thank: Dr Liam Fernyhough, Haematologist, Canterbury Health Laboratories Dr Chris Leathart, GP, Christchurch Dr Edward Theakston, Haematologist, Diagnostic Medlab Ltd We would like to acknowledge their advice, expertise and valuable feedback on this document. -
Can Hemoglobin-Hematocrit Relationship Be Used to Assess Hydration Status?
OPINI Can Hemoglobin-Hematocrit Relationship Be Used to Assess Hydration Status? Hubertus Hosti Hayuanta Resident in the Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia ABSTRACT There is an opinion that if the hematocrit is lower than multiplied hemoglobin (Hct< 3 x Hb), the patient is overhydrated, and if it is higher (Hct> 3 x Hb), the patient is dehydrated. This practice is flawed. Hemoglobin-hematocrit relationship is not affected by a patient’s hydration status, and thus its alteration cannot be used to assess it. The relationship can only be altered if the red blood cells (RBCs) are abnormal, or look altered because of technical factors.Instead of multiplying hemoglobin value and comparing it to the hematocrit, a quicker way to assess is to evaluate the mean corpuscular hemoglobin concentration (MCHC). Clinicians can still predict hydration status by comparing the hematocrit to its baseline value or the laboratory’s reference range, by physical examination, or use other laboratory tests such as urine specifi c gravity and osmolality. Keywords: Hematocrit, hemoglobin, hydration ABSTRAK Ada pendapat bahwa jika nilai hematokrit lebih rendah dari nilai kadar hemoglobin dikalikan tiga maka pasien mengalami kelebihan cairan, dan jika lebih tinggi maka pasien mengalami dehidrasi. Praktik penilaian seperti ini tidak benar. Hubungan hemoglobin-hematokrit tidak dipengaruhi oleh status hidrasi pasien, dan oleh karena itu tidak dapat digunakan untuk menilainya. Hubungan tersebut hanya bisa diubah jika eritrosit tidak normal, atau terlihat seakan-akan berubah karena faktor teknis. Cara yang lebih cepat adalah menilai mean corpuscular hemoglobin concentration (MCHC). Klinisi masih bisa menilai status hidrasi dengan membandingkan hematokrit dengan nilai basalnya atau nilai rujukan laboratorium, dengan pemeriksaan fisik, atau melakukan pemeriksaan laboratorium lain seperti berat jenis urin dan osmolalitas. -
Mean Corpuscular Hemoglobin (MCH) As a Predictor of Iron Deficiency in Infants
Pediatr. Res. 16: 168-170 (1982) Diagnosis of Iron Deficiency: Mean Corpuscular Hemoglobin (MCH) as a Predictor of Iron Deficiency in Infants G. J. KNIGHT, H. DE V. HEESE,"'' W. S. DEMPSTER, AND G. KIRSTEN Department of Paediatrics and Child Health, Institute of Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Rondebosch 7700, Cape Town, Republic of South Africa Summary an infant population. Their interpretation during childhood is further compounded by factors such as age and periods of rapid Hematologic variables were measured in 240 apparently healthy growth. To overcome some of these difficulties, various combi- infants ranging from 1-12 months of age attending a well baby nations of tests have been suggested to assist in the diagnosis of clinic. There were 20 infants for each month of age. Hematologic mild iron deficiency (3, 7, 10, 12, 13, 14). In our hands they have parameters were measured in each infant by Coulter Counter not proved satisfactory and their cost prohibitive in a developing Model S. Serum iron, total iron binding capacity, free erythrocyte country. protoporphyrin (FEP) and serum ferritin levels were measured in A statistical exercise was embarked upon to establish the most most infants. Their weights together with their serum iron, total useful single hematologic parameter for the assessment of the iron iron binding capacity, and serum ferritin were judged to be inde- status of an infant. It formed part of a study to determine the pendent variables of iron status, whereas the hematologic variables prevalence of iron deficiency anemia during infancy in a com- were considered to be response variables indicative of iron status. -
Complete Blood Count
Print Entire Test Page 1 of 6 Close Window email this page print this page Complete Blood Count Also known as: CBC, Hemogram, CBC with differential Related tests: Blood smear, Hemoglobin, Hematocrit, Red blood cell (RBC) count, White blood cell (WBC) count, White blood cell differential count, Platelet count At A Glance Why get tested? To determine general health status and to screen for a variety of disorders, such as anemia and infection When to get tested? As part of a routine medical exam or as determined by your doctor Sample required? A blood sample drawn from a vein in the arm or a fingerstick or heelstick (newborns) The Test Sample What is being tested? The Complete Blood Count (CBC) test is an automated count of the cells in the blood. It provides information about the white blood cell (WBC), red blood cell (RBC), and platelet populations present. This information includes the number, type, size, shape, and some of the physical characteristics of the cells. In only a minute or two, the hematology instrument (the machine that is used to run the test) can measure thousands of RBCs, WBCs, and platelets and compare them against established normal ranges. Any abnormalities found are noted, and the clinical laboratory scientist (CLS) running the instrument then uses his or her expertise and experience to accept the automated findings and/or to target the sample for further analysis. In most cases, the automated CBC is very accurate and the test is complete at this point. If, however, there are significant abnormalities in one or more of the cell populations, a blood smear test may be performed.