Study Guide Blood & Immunology Module
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Section 8: Hematology CHAPTER 47: ANEMIA
Section 8: Hematology CHAPTER 47: ANEMIA Q.1. A 56-year-old man presents with symptoms of severe dyspnea on exertion and fatigue. His laboratory values are as follows: Hemoglobin 6.0 g/dL (normal: 12–15 g/dL) Hematocrit 18% (normal: 36%–46%) RBC count 2 million/L (normal: 4–5.2 million/L) Reticulocyte count 3% (normal: 0.5%–1.5%) Which of the following caused this man’s anemia? A. Decreased red cell production B. Increased red cell destruction C. Acute blood loss (hemorrhage) D. There is insufficient information to make a determination Answer: A. This man presents with anemia and an elevated reticulocyte count which seems to suggest a hemolytic process. His reticulocyte count, however, has not been corrected for the degree of anemia he displays. This can be done by calculating his corrected reticulocyte count ([3% × (18%/45%)] = 1.2%), which is less than 2 and thus suggestive of a hypoproliferative process (decreased red cell production). Q.2. A 25-year-old man with pancytopenia undergoes bone marrow aspiration and biopsy, which reveals profound hypocellularity and virtual absence of hematopoietic cells. Cytogenetic analysis of the bone marrow does not reveal any abnormalities. Despite red blood cell and platelet transfusions, his pancytopenia worsens. Histocompatibility testing of his only sister fails to reveal a match. What would be the most appropriate course of therapy? A. Antithymocyte globulin, cyclosporine, and prednisone B. Prednisone alone C. Supportive therapy with chronic blood and platelet transfusions only D. Methotrexate and prednisone E. Bone marrow transplant Answer: A. Although supportive care with transfusions is necessary for treating this patient with aplastic anemia, most cases are not self-limited. -
A Rapid and Quantitative D-Dimer Assay in Whole Blood and Plasma on the Point-Of-Care PATHFAST Analyzer ARTICLE in PRESS
MODEL 6 TR-03106; No of Pages 7 ARTICLE IN PRESS Thrombosis Research (2007) xx, xxx–xxx intl.elsevierhealth.com/journals/thre REGULAR ARTICLE A rapid and quantitative D-Dimer assay in whole blood and plasma on the point-of-care PATHFAST analyzer Teruko Fukuda a,⁎, Hidetoshi Kasai b, Takeo Kusano b, Chisato Shimazu b, Kazuo Kawasugi c, Yukihisa Miyazawa b a Department of Clinical Laboratory Medicine, Teikyo University School of Medical Technology, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan b Department of Central Clinical Laboratory, Teikyo University Hospital, Japan c Department of Internal Medicine, Teikyo University School of Medicine, Japan Received 11 July 2006; received in revised form 7 December 2006; accepted 28 December 2006 KEYWORDS Abstract The objective of this study was to evaluate the accuracy indices of the new D-Dimer; rapid and quantitative PATHFAST D-Dimer assay in patients with clinically suspected Deep-vein thrombosis; deep-vein thrombosis (DVT). Eighty two consecutive patients (34% DVT, 66% non-DVT) Point-of-care testing; with suspected DVT of a lower limb were tested with the D-Dimer assay with a Chemiluminescent PATHFAST analyzer. The diagnostic value of the PATHFAST D-Dimer assay (which is immunoassay based on the principle of a chemiluminescent enzyme immunoassay) for DVT was evaluated with pre-test clinical probability, compression ultrasonography (CUS). Furthermore, each patient underwent contrast venography and computed tomogra- phy, if necessary. The sensitivity and specificity of the D-Dimer assay using 0.570 μg/ mL FEU as a clinical cut-off value was found to be 100% and 63.2%, respectively, for the diagnosis of DVT, with a positive predictive value (PPV) and negative predictive value (NPV) of 66.7% and 100%, respectively. -
The Complete Blood Count Sample Report 1
THE COMPLETE BLOOD COUNT SAMPLE REPORT 1. Name and address of the lab where the test was performed. Tests may be run in a physician office lab, a lab located in a Different laboratories generate reports that can vary greatly in appearance and in the order and kind of The Complete Blood Count Sample Report clinic or hospital, and/or samples may be sent to a reference information included. This is one example of what a lab report for a Complete Blood Count may look like. laboratory for analysis. NamesDifferent and laboratories places used generate have been reports made that up can for vary illustrative greatly inpurposes appearance only. andThe innumbered the order keyand tokind the of right 2. Date this copy of the report was printed. This date may be explainsinformation a few included. of the reportThis is elements.one exampl e of what a lab report for a Complete Blood Count may look like. different than the date the results were generated, especially Names and places used have been made up for illustrative purposes only. Point your cursor at a number on cumulative reports (those that include results of several to learn about the different report elements. different tests run on different days). 3. Patient name or identifier. Links results to the correct person. 1 University Medical Center, Dept. of Pathology Report Date/Time: 123 University Way, City, ST 12345 02/10/2014 16:40 2 4. Patient identifier and identification number. Links results to the correct person. 3 Name: Doe, John Q. Age/Sex: 73/M DOB: 01/01/1941 5. -
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”. -
Evaluation of Complete Blood Count Parameters for Diagnosis In
Original Investigation / Özgün Araştırma DOI: 10.5578/ced.68886 • J Pediatr Inf 2020;14(2):e55-e62 Evaluation of Complete Blood Count Parameters for Diagnosis in Children with Sepsis in the Pediatric Intensive Care Unit Pediatrik Yoğun Bakım Ünitesinde Sepsisli Çocuklarda Tanı İçin Tam Kan Sayımı Parametrelerinin Değerlendirilmesi Fatih Aygün1(İD), Cansu Durak1(İD), Fatih Varol1(İD), Haluk Çokuğraş2(İD), Yıldız Camcıoğlu2(İD), Halit Çam1(İD) 1 Department of Pediatric Intensive Care, Istanbul University School of Cerrahpasa Medicine, Istanbul, Turkey 2 Department of Pediatric Infectious Diseases, Istanbul University School of Cerrahpasa Medicine, Istanbul, Turkey Cite this article as: Aygün F, Durak C, Varol F, Çokuğraş H, Camcıoğlu Y, Çam H. Evaluation of complete blood count parameters for diagnosis in children with sepsis in the pediatric intensive care unit. J Pediatr Inf 2020;14(2):e55-e62. Abstract Öz Objective: Early diagnosis of sepsis is important for effective treatment Giriş: Erken tanı sepsiste etkili tedavi ve iyi prognoz için önemlidir. C-re- and improved prognosis. C-reactive protein (CRP) and procalcitonin aktif protein (CRP) ve prokalsitonin (PKT) sepsiste en sık kullanılan bi- (PCT) are the most commonly used biomarkers for sepsis. However, their yobelirteçlerdir. Fakat rutinde kullanımı maliyet etkin değildir. Tam kan routine usage is not cost-effective. Complete Blood Count (CBC) param- sayımı (TKS) parametrelerinden eritrosit dağılım genişliği (EDG), nötrofil eters including red cell distribution width (RDW), neutrophil to lympho- lenfosit oranı (NLO), trombosit lenfosit oranı (TLO), ortalama trombosit cyte ratios (NLR), platelet to lymphocyte ratios (PLR), mean platelet vol- hacmi (OTH) basit ve kolay olarak hesaplanmaktadır. Bu çalışmanın ama- ume (MPV), and hemoglobin are simple and easily calculated. -
Introduction to Hematological Assessment (PDF)
UPDATED 01/2021 Introduction to Hematological Assessment Objectives After completing this lesson, you will be able to: • State the main purposes of a hematological assessment. • Explain the procedures for collecting and processing a blood sample. • Understand the importance of hand washing. • Understand the importance of preventing blood borne pathogen transmission. • Describe and follow the hemoglobin test procedure using the Hemocue Hemoglobin Analyzer. Overview The most common form of nutritional deficiency is “iron deficiency”. It is observed more frequently among children and women of childbearing age (particularly pregnant women). Iron deficiency can result in developmental delays and behavioral disturbance in children, as well as increased risk for a preterm delivery in pregnant women. Iron status can be determined using several different types of laboratory tests. The two tests most commonly used to screen for iron deficiency are hemoglobin (Hgb) concentration and hematocrit (Hct). Proper screening for iron deficiency requires sound laboratory methods and procedures. Often, CPAs will hear the following questions: “Do you have to stick my finger? What does this have to do with my WIC foods anyway? Will it hurt?” For most of us, the thought of having blood taken, even from a finger, is not pleasant. However, evaluating the results of a blood test is a part of screening for nutritional risk. Why Does WIC Require Hematological Assessment? WIC requires that each applicant be screened for risk of a medical condition known as iron deficiency anemia. Anemia is a condition of the blood in which the amount of hemoglobin falls below a level considered desirable for good health. -
Your Blood Cells
Page 1 of 2 Original Date The Johns Hopkins Hospital Patient Information 12/00 Oncology ReviseD/ RevieweD 6/14 Your Blood Cells Where are Blood cells are made in the bone marrow. The bone marrow blood cells is a liquid that looks like blood. It is found in several places of made? the body, such as your hips, chest bone and the middle part of your arm and leg bones. What types of • The three main types of blood cells are the red blood cells, blood cells do the white blood cells and the platelets. I have? • Red blood cells carry oxygen to all parts of the body. The normal hematocrit (or percentage of red blood cells in the blood) is 41-53%. Anemia means low red blood cells. • White blood cells fight infection. The normal white blood cell count is 4.5-11 (K/cu mm). The most important white blood cell to fight infection is the neutrophil. Forty to seventy percent (40-70%) of your white blood cells should be neutrophils. Neutropenia means your neutrophils are low, or less than 40%. • Platelets help your blood to clot and stop bleeding. The normal platelet count is 150-350 (K/cu mm). Thrombocytopenia means low platelets. How do you Your blood cells are measured by a test called the Complete measure my Blood Count (CBC) or Heme 8/Diff. You may want to keep track blood cells? of your blood counts on the back of this sheet. What When your blood counts are low, you may become anemic, get happens infections and bleed or bruise easier. -
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. -
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.