investigation in hematology

Investigation in hematology

Chittima Sirijerachai

Investigation in hematology

•Anemia

•Bleeding

•Malignancy

Investigation in patient with anemia

Initial

• CBC, blood smear

• Red cell indicies

• Reticulocyte count

Specific

• Inclusion body

• Osmotic fragility

• Saline agglutination

• Coombs’ test

• Hb typing

• Ham’s test

• BM aspiration

CBC

Hb, HCT-anemia-polycythemia

WBC-leukocytosis

-leukopenia

-abnormal cells

Platelet -thrombocytosis-thrombocytopenia

Criteria for Diagnosis Anemia

Hb.( g/dl)Hb.( g/dl) Hct (%) Hct (%)

Children 11.0 33

Male 13.0 40

Female ( 15-50 ) 12.0 36

Female ( > 50 ) 13.0 40

Pregnant women 11.0 33

Criteria for diagnosis polycythemia

• Male 18 60

• Female 17.5 55

Hb Hct

CBC

Hb, HCT-anemia-polycythemia

WBC-leukocytosis

-leukopenia

-abnormal cells

Platelet -thrombocytosis-thrombocytopenia

Normal value

WBC 5,000 – 10,000 /cu.mm.

PMN 40-75 %

L 20-50 %

Eo 1-6 %

B 1 %

Leukocyte disorders

eosinophilia

basophilia

monocytosis

leukemoid reaction

leukoerythroblastic (myelophthisis)

leukemia

leukocytosis leukopenia

neutrophilia neutropenia

lymphocytosis lymphopenia

CBC

Hb, HCT-anemia-polycythemia

WBC-leukocytosis

-leukopenia

-abnormal cells

Platelet -thrombocytosis-thrombocytopenia

CBC and RBC indices

80-96 fl.27-33 pg.33-36 g/dl

12.0-13.6%

Reticulocyte count

Normal = 0.2-2 %

Corrected reticulocyte = Pt HCT X Reti.

Normal HCT

Inclusion body

Heinz body

Osmotic fragility (OF)

• Red cell + 0.33 % NSS

• One tube OF – screening for

thalassemia

• Hereditary spherocytosis

Bone marrow aspiration

Indication :-• Cytopenia • Myelophthisis anemia• Leukemia• Lymphoma staging• Myeloproliferative disorders• Fever of unknown origin

Thalassemia

- thalassemia

- thalassemia

- hemoglobinopathy

thalassemia1 trait = _ _ /2 trait = _ /

1 2 = _ _ / _

1 1 = _ _ / _ _

2 2 = _ _

thalassemia

0

+

Normal hemoglobin

22= Hb A

22 = Hb F

2 2 = Hb A2

thalassemia

4 = Hb H

4 = Hb Bart’s

Hb A

Hb A2

Hb F

thalassemia

Hb A

Hb A2

Hb F

Heterozygote hemoglob in E

E

22 = Hb A

2 = Hb E

25-35 %

thalassemia/Hb E

E

Hb A / absent

Hb A2/ Hb E

Hb F

Father Mother sibling 1 sibling 2

Hct 45% 33 % 42% 36 %

MCV 70 65 82 70%

Hb typing A2A A2ABart’s H A2A A2A

Hb A % 96 91 97 98

Hb A2 2.2 1.4 1.1 1.5

Hb F 1.3

Hb E

Hb Bart’s 3.3

Hb H 7.5

Hb CS

genotype

1 trait 122 trait 1 trait

Father mother sibling 1 sibling 2

Hct 40 % 40% 25 45%

MCV 72 84 65 85

Hb typing A2A EA EF A2A

Hb A % 94 98

Hb A2 5.5 1.5

Hb F 32

Hb E 30 65

Hb Bart’s

Hb H

Hb CS

genotype

trait E trait /E normal

Investigation in patient with

bleeding disorders

Investigation

CBC, platelet count

Bleeding time

Platelet function test

Venous clotting time

Prothrombin time (PT)

Partial thromboplastin time (PTT)

CBC and platelet

Platelet:< 20,000

20,000-50,000

50,000-70,000

Spontaneous bleeding

Bleed after minor trauma

Bleed after major trauma

CBC and platelet

Giant platelet

Bleeding time

•Platelet function

•Normal: 2-7 minute

PTT

PT

TT

Venous clotting time

Normal: 5-20 minute

Prolong if clotting factor is <5 %

Small clot - hypofribinogenemia

Clot retraction time (plt function)

Clot lysis time

Prothrombin time (PT)

Normal: 11.6-14.4 sec

PT ratio = Normal < 1.3

INR=

Control PTpatient PT

Control PTpatient PT ISI

ISI = international sensitivity index

Partial thromboplastin time (PTT)

Normal = 34-48 sec

Isolated PTT prolong:

•F VIII, IX, XI, XII deficiency

•F VIII, IX, XI inhibitor

•Antiphospholipid syndrome

Mixing test

Patient plasma

Normal plasma

PTT

0 hour

2 hour

Correctable PTT Factor deficiency