hematology review by felicia magee tardy, m.s., mt (ascp) department of clinical pathology...
TRANSCRIPT
![Page 1: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/1.jpg)
Hematology Review
By
Felicia Magee Tardy, M.S.,
MT (ASCP)
Department of Clinical Pathology
University of Mississippi Medical Center
Jackson, Mississippi
![Page 2: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/2.jpg)
Introduction
• Hematology: the study of blood and blood forming tissues.
• Blood consists of 55% plasma and 45% formed elements.
• Formed elements include erythrocytes, leukocytes, and thrombocytes.
![Page 3: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/3.jpg)
Erythrocytes• Normal range 4.2-
5.5 million per mm3 in adults.
• Biconcave shape.• Diameter 7
microns.• Cells for transport
of O2 and CO2.
• Life span 120 days.
![Page 4: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/4.jpg)
Leukocytes• Normal range 4 -
11 thousand per mm3 in adults.
• Five types.• Size 8-20 microns.• Involved in fighting
infection, combatting allergic reactions, and immune responses.
![Page 5: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/5.jpg)
Thrombocytes
• Smallest cells in the blood.
• Normal range 130,000-400,000.
• Active role in coagulation and hemostasis.
![Page 6: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/6.jpg)
Routine Hematology
Anticoagulant of choice: EDTA• Complete Blood Counts (CBCs)
• Manual WBC Differentials
• Erythrocyte Sedimentation Rates (ESRs)
• Sickle Screens
• Reticulocyte Counts
![Page 7: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/7.jpg)
Automated Counting
Coulter Principle
Electrical impedance: resistance or change in current when cell passes between two electrodes in NaCl solution.
![Page 8: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/8.jpg)
Automated Counting
Flow Cytometry
Uses lasers to measure both forward and side scatter.
Forward scatter measures size.
Side scatter measures granularity.
![Page 9: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/9.jpg)
Sources of Error• Inadequate mixing of specimen.• Hemolyzed specimens.
• Lipemic specimens.
• Cold agglutinins.
• Clotted specimens.
• Platelet clumps or platelet satellitosis.
• Diluted specimens.
![Page 10: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/10.jpg)
Know Normal Ranges!!!
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT
MPV
SEGS
LYMPHS
MONOCYTES
EOSINOPHILS
BASOPHILS
![Page 11: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/11.jpg)
Erythrocytic Maturation Series
Rubriblast
Prorubricyte
Rubricyte
Metarubricyte
Reticulocyte
Erythrocyte
![Page 12: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/12.jpg)
RBC Morphology
![Page 13: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/13.jpg)
Elliptocytes Target Cells
![Page 14: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/14.jpg)
Tear Drops Stomatocytes
![Page 15: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/15.jpg)
Sickle Cells Schistocytes
![Page 16: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/16.jpg)
RBC Inclusions
![Page 17: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/17.jpg)
Howell-Jolly Bodies
• Round, purple inclusions in RBCs.
• Composed of DNA.• Commonly seen in
in patients with hypofunctioning spleens.
• Splenectomy.
![Page 18: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/18.jpg)
Basophilic Stippling
• Numerous, small purple inclusions in RBCs.
• Aggregates of ribosomal RNA.
• Most commonly seen in lead poisoning.
![Page 19: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/19.jpg)
Pappenheimer Bodies
• Clusters of dark blue granules, irregular in size and shape.
• Composed of iron and ribosomal RNA.
• Seen in sideroblastic and hemolytic anemias.
![Page 20: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/20.jpg)
Classifications of Anemias
Microcytic, Hypochromic– Iron deficiency– Sideroblastic– Chronic disease, Inflammation– Lead poisoning– Thalassemia trait
![Page 21: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/21.jpg)
Microcytic, Hypochromic
• Many RBCs smaller than
nucleus of normal
lymphocytes, increased central pallor.
• Iron deficiency, thalassemias, anemia of chronic disease.
![Page 22: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/22.jpg)
Classifications of Anemias
Normochromic– Hereditary Spherocytosis– Hereditary Elliptocytosis– PNH– G6PD deficiency– Aplastic anemia– Acute blood loss
![Page 23: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/23.jpg)
Classifications of Anemias
Macrocytic– Vitamin B12 deficiency– Folate deficiency– Liver disease
![Page 24: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/24.jpg)
Macrocytic RBCs
• Most RBCs larger than nucleus of normal
lymphocytes, increased MCV.
• Folate or Vitamin B12 deficiencies, alcoholism, and liver disease.
![Page 25: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/25.jpg)
Reticulocytes• Immature RBCs.• Contain residual
ribosomal RNA.• Reticulum stains
blue using a supravital stain (new methylene blue).
• Counted and expressed as % of total red cells.
![Page 26: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/26.jpg)
Reticulocyte Count
Uses supravital stain which stains cells in the living state.
Retic % = # retics per 1000 RBCs
10
Corrected retic= % retics x pt. HCT
45
![Page 27: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/27.jpg)
Hemoglobinopathies
Beta Chain Substitutions
Hgb S: Valine for glutamic acid
(6th position, beta chain)
Hgb C: Lysine for glutamic acid
(6th position, beta chain)
![Page 28: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/28.jpg)
Hemoglobinopathies
Alkaline Electrophoresis
- C S F A +
A2 D
E GO
![Page 29: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/29.jpg)
WBCEvaluation
![Page 30: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/30.jpg)
MyelocyticMaturation Series
Myeloblast
Promyelocyte
Myelocyte
Metamyelocyte
Band Neutrophil
Segmented Neutrophil
![Page 31: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/31.jpg)
Toxic Granulation
• Increased basophilic granules
in neutrophils.• Seen in severe
infections, burns, malignancies, and pregnancy.
• Distinguish from basophils.
![Page 32: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/32.jpg)
Dohle Bodies
• Sky blue inclusions in cytoplasm of neutrophils.
• Seen in infections, burns, myleproliferative disorders, and pregnancy.
• Composed of RER and glycogen granules.
![Page 33: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/33.jpg)
Pelger-Huet Anomaly
![Page 34: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/34.jpg)
Special Stains
PAS: ALL, Erytrholeukemia
LAP: CML v. Leukomoid Reaction
Myeloperoxidase: AML, AMMoL (weak+)
Sudan Black: AML, AMMoL (weak+)
Specific Esterase: AML, AMMoL
Non-specific Esterase: AMML, AMoL
TRAP: Hairy Cell Leukemia
TDT: ALL
Prussian Blue: Sideroblastic Anemia
![Page 35: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/35.jpg)
CML versusLeukomoid Reaction
Characteristic CML Leukomoid
LAP score Decreased Increased
Toxic gran. Decreased Increased
Dohle bodies Absent Present
Philadelphia May be present Absent
chromosome
![Page 36: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/36.jpg)
WBC Disorders
Alder-Reilly: Large azurophilic granules, increased mucopolysaccharides
Chediak-Higashi: Membrane defect of lysosomes, large primary granules in segs
May-Hegglin: Familial disorder with large platelets and Dohle bodies
Pelger-Huet: Hyposegmented neutrophils
![Page 37: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/37.jpg)
FAB Classifications
M1: Myeloblastic without maturation
M2: Myeloblastic with maturation
M3: Promyelocytic
M4: Myelomonocytic
M5a: Monocytic, poorly differentiated
M5b: Monocytic, well differentiated
M6: Erythroleukemia, DiGuglielmo’s
M7: Megakaryoblastic
![Page 38: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/38.jpg)
Acute Myeblastic Leukemia (M1)
![Page 39: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/39.jpg)
Chronic MyelogenousLeukemia
![Page 40: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/40.jpg)
FAB Classifications
L1: Small, uniform lymphoblasts
L2: Large, pleomorhphic lymphoblasts
L3: Burkitt’s type (vacuolated and
deeply basophilic cytoplasm)
![Page 41: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/41.jpg)
Acute Lymphoblastic Leukemia
![Page 42: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/42.jpg)
Chronic Lymphocytic Leukemia
![Page 43: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/43.jpg)
Body Fluids
![Page 44: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/44.jpg)
Types of Body Fluids
• Cerebrospinal Fluid (CSF)
• Pleural Fluid
• Pericardial Fluid
• Peritoneal Fluid
• Synovial Fluid
• Amniotic Fluid
• Miscellaneous Fluids
![Page 45: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/45.jpg)
Body Fluids Testing
• Physical examination
• RBC and WBC counts
• WBC differential
• Crystal examination*
• Rope’s test*
*Refers to synovial fluids only.
![Page 46: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/46.jpg)
Cerebrospinal Fluid (CSF)
• Examined to determine the presence of meningitis or intracranial hemorrhage.
• Multiple tubes drawn (4).• Differentiate between traumatic tap
and intracranial hemorrhage.• Xanthochromia is indicative of
intracranial hemorrhage.
![Page 47: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/47.jpg)
Quick Review
• Differentiate between traumatic tap and intracranial hemorrhage.
• Differentiate between transudate and exudate.
• Crystal identification and associated conditions.
![Page 48: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/48.jpg)
Traumatic Tap v. Intracranial Hemorrhage
Traumatic Tap• Decreasing amounts
of blood with each tube drawn
• May contain clots• No xanthochromia• Supernatant clear
Intracranial Hemorrhage• Blood evenly distributed
throughout collection tubes
• No clots• Xanthochromia• Hemosiderin, hematoidin
crystals
![Page 49: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/49.jpg)
Transudates v. Exudates
Characteristic Transudate Exudate
Appearance Clear, colorless Yellow, turbid, purulent, bloody
Specific gravity <1.015 >1.015
Protein <3 g/dL >3 g/dL
LD <200 IU >200 IU
Cell count <1000/uL >1000/uL
Conditions Congestive Infections,
Heart failure Malignancies
![Page 50: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/50.jpg)
Crystal Identification
• Monosodium urate (uric acid)Yellow when parallel to the compensator,
and blue when perpendicular.
Seen in gout.
• Calcium pyrophosphateBlue when parallel to the compensator,
and yellow when perpendicular.
Seen in pseudogout.
![Page 51: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/51.jpg)
Crystal Identification
![Page 52: Hematology Review By Felicia Magee Tardy, M.S., MT (ASCP) Department of Clinical Pathology University of Mississippi Medical Center Jackson, Mississippi](https://reader036.vdocument.in/reader036/viewer/2022062321/56649e4c5503460f94b41332/html5/thumbnails/52.jpg)
Good Luck!!!!