03 - hematopoiesis, - erythrocytic disorders

7/23/2019 03 - Hematopoiesis, - Erythrocytic Disorders

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[email protected] || 1stsemester, AY 2011-2012

3 Hematopoiesis

Hematopoiesis

Defined as cellular formation, proliferation,

differentiation and maturation of blood cells

Hematopoietic system (tissues/organs involved in the

proliferation, maturation and the destruction of

blood cells)

Spleen

Lymph nodes

Thymus

Bone marrow

Liver

Reticuloendothelial system

Stages of Hematopoiesis

1. Mesoblastic

Usually begins as early as the 19thday of gestation

(blood island of the yolk sac of the human embryo)

Blood island remain active for 8-12 weeks

Most hematopoietic activity is confined to

erythropoiesis

Earliest cells is megaloblastic cells

Hgb production is limited to embryonic varieties

called Portland Gower-1 and Gower-2

2. Hepatic

The yolk sac discontinues functioning by 3rd

month of

life where the fetal liver become active

Both erythrocytes and granulocytes are beingproduced

End of 4th

month: the primitive cells are disappearing

with an increased production of erythroblasts,

granulocytes, monocytes, lymphocytes, and

megakaryocytes

Hemoglobin production consist of hemoglobin F,A

and A2

Also active in hematopoiesis are the spleen, thymus

and lymph nodes

3. Myeloid

5th

and 6th

month of gestation

The bone marrow becomes the primary site of

hematopoiesis

At birth the bone marrow is the primary source of

blood production

Bone Marrow

Myeloid to Erythroid ratio

Numeric expression comparing the relative number of

granulocyte precursors which includes the neutrophil

eosinophil and basophil with the relative number of

erythroid precursors in the bone marrow

The ratio is obtained by

Count a minimal number of 200 cells

at 100 X magnification

N.V. (M:E ratio)

2:1 4:1

Example:

Infection = 6:1

Leukemia = 25:1

Bone Marrow cellularity

Percentage of marrow space occupied by

hematopoietic cells compared with fat

Interpretation

Normocellular marrow

Mature Adult:10% to 50% fat +

40% to 60% hematopoiesis + z

A child under elements under 2

years of age:

100% red marrow


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[email protected] || 1st

semester, AY 2011-2012


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Pronormoblast Earliest recognizable and largest cells of the erythrocytic series

Medium-sized cell resembling myeloblast

Nuclear chromatin is coarser than myeloblast and has strand like

arrangement as cell ages

Presence of nucleoli

Presence of thin rim of deep blue homogenous cytoplasm Proerythroblast

Delicate and finely granular

Early (Basophilic)

Normoblast

Nucleoli disappearance

Chromatin has a definite coarse network or strand-like pattern

Basophilic erythroblast

Coarse and granular

Intermediate

(Polychromatic)

Normoblast

Reduction in the size of nucleus and cytoplasm

Chromatin has become much coarser, forming dark chunks

In the cytoplasm , the first traces of hemoglobin appear next to the

nucleusPolychromatic erythroblast

Condensed, loose, coarse, and

wheel-spoke like

Late (Acidophilic or

Orthochromatic)

Normoblast

Last nucleated stage

Progression of hemoglobin formation/hemoglobin production is

almost complete

Disappearance of basophilic pattern

Cytoplasm usually has dull copper appearance

Shrinkage of nucleus to a dense blackish brown mass of chromatin

materials (pyknotic degeneration) to finally break up, lost from the

cell by extrusion

Orthochromatic erythroblast

Condensed; the chromatin

network is hardly visible

Reticulocytes Slightly larger than mature RBC with residual amount of RNA

Loss of nuclei, leaving their cytoplasmic RNA contents

Appear as a blue network inside the RBC (reticulo-)

Continues to mature or be seen for one or two more days in

peripheral blood

Matured Erythrocytes

(RBC)

Life span 120 days

Biconcave

No nucleus or organelles

Contents:

A. Membrane

B. Internal stroma

C. Cell content (90% Hgb)

Properties

Flexible and deformable

(characteristics which allows red cells to pass through

micro circulation)

Normal erythrocyte

Changes in the process of RBC maturation

1. Progressive diminution in cell size

2. Ripening of the cytoplasm

3. Ripening of the nucleus

For normal erythrocyte production,

the following are required:

1. Protein as a source of amino acids

2. Iron

3. Vitamin B 12

4. Folic Acid

5. Vitamin B 6

6. Traces of metals ( cobalt, nickel)

Maturation sequence of cells of the erythroid series

(The sequence is basically the same in other series of blood cells.)

The size of a cell decreases as it matures. The cytoplasm stains deep blue in immature cells because of the vigorous protein

synthesis and abundance of ribosomes. It turns reddish due to protein (hemoglobin) production and less blue due to the decrease

in ribosome amount. The size of the nucleus decreases more significantly than the cell. The nuclear chromatin structure is delicate

in immature cells but becomes coarser as the cells mature. Immature cells have nucleoli which disappear as the cells mature.


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Classification of Leukocytes

Granulocytic Leukocytes Agranulocytic Leukocytes

Neutrophils Lymphocytes

Eosinophils Monocytes

Basophils

Differentiation (Granulocytic Series)

Based on: Granules (cytoplasm)

Granules Color Color

Neutrophilic Small, irregular fine Pinkish

Eosinophilic Coarse Reddish or red orange

Basophilic Coarse Blue to black

Morphological Characteristics

Myelocytic Series:

Myeloblasts Large nucleus

Very uniform appearing light staining chromatin

Presence of one or two nuclei

Cytoplasm contain few azurophilic granules

Promyelocytes Similar to blast cells but have variable number of

cytoplasmic granules

Myelocytes Nuclear chromatin is condensed

No nucleolus

Nucleus is round or oval with slight flattening alongone side

Cytoplasm is mildly basophilic and is granular

Metamyelocytes (Juveniles) Nucleus begins to indent

Bands (Stabs) Nucleus becomes more and more indented

(indentation more than its diameter)

Chromatin becomes more and more condensed

Cytoplasm becomes progressively less basophilic

Segmenters

(Segmented Neutrophils or

Polymorphonuclear Neutrophils)

Nucleus has segmented into 2 or more lobes, each

lobe is connected by thread-like filament to the

next lobe

Chromatin is dense and clumped

Cytoplasm is slightly eosinophilic in color


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Monocytic Series (MonoblastPromonocyteMonocyte)

Monocytes Often confused with metamyelocytes or bands

Larger than juveniles or bands

Nuclear chromatin is less dense

Nucleus has several pseudopods

Cytoplasm light blue or light gray, irregular in shape,no granule

Lymphocytic Series(LymphoblastProlymphocyteLymphocyte)

Lymphocytes Mononuclear cells without specific cytoplasmic

granules

Nucleus sharply defined, generally round,

sometimes indented on one side

Chromatin dense and darkly staining

Cytoplasm pale blue with Wrights stain, except with

clear perinuclear zone

Eosinophils Nucleus usually bilobed, rarely with more than 3

lobes

Chromatin stain less deeply than neutrophil

Cytoplasm - colorless but contains large round to

oval acidophilic granules, appear bright red with

eosin

Basophils Nucleus less segmented than neutrophil, usually

indented or partially lobulated

Cytoplasmic granules larger with strong affinity to

basic stains, with mauve color using Wrights stain

Normal Cellular Constituents of Adult Blood


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5 Erythrocytic Disorders

Erythrocytic Disorders

I. Alteration in numbers

1. in the numbers of red cells polycythemia vera

2.

in the number of red cells anemia

II. Abnormality in RBC Morphology

1. Size

2. Shape

3. Hemoglobin content and concentration

4. Inclusions

5. Immaturity

Can be determined by doing CBC count

Anemia

Reduction in the concentration of Hgb or Hct level in

the peripheral blood below the normal (lower limit of

95% of reference interval for individual age, sex and

geographical location [altitude])

Causes:

1. Impaired red cell production

2. Blood loss

3. Accelerated red cell destruction (hemolysis) in

excess of the ability of bone marrow to replace

these losses

Assessment:

I. CBC

- Expected Results

- Hemoglobin- - Hematocrit -

- RBCCount-

II. Blood Indices

- MCV - or or normal

- MCH -

- MCHC -

I. Peripheral Smear

- Size: anisocytosis (small/large RBC)

- Shape: poikilocytosis

- Hgbcontent: central pallor

Anemia Panel1. CBC with indices

2. Reticulocyte count

3. Osmotic fragility test

4. Sucrose hemolysis test

5. Hams test

6. Iron

7. Total iron binding capacity

8. Ferritin

9. B12

10. Folate

11. Electrophoresis

Anemia classification based on:

Blood indices:

1. MCV (Mean Corpuscular Volume)

2. MCH (Mean Corpuscular Hemoglobin)

3. MCHC (Mean Corpuscular Hemoglobin

Concentration)

Mean corpuscular volume (MCV)

Is the average volume of individual RBC

Allows classification of cells into normocytic,

macrocytic and microcytic

MCV = __ HCT x_10__

RBCs (x 1012

/L)

NV = 87 5 cu microns (fl)

(82 92 fL)

Normocytic between 82-92 fL

Peripheral smear:

Microcytic less than 82 fL

1. Iron deficiency anemia

2. Secondary anemia

Macrocytic more than 92 fL

1. Vitamin B 12 deficiency

2. Folic acid deficiency

Macrocytes, anisocytosis and poikilosis

Macrocytes (megalocytes) are oval. Since a hypersegmented

neutrophil is also present, as shown by the arrow, the diagnosis

is almost certainly megaloblastic anemia.

Anisocytosis

Term refers to pathologic variation in cell size

Anisocytosis

A few polychromatic erythrocytes are also observed. In the

presence of hemolysis, such an appearance suggests

hereditary (congenital) non-spherocytic hemolytic anemia.

Red cell enzyme deficiencies, such as pyruvate kinase

deficiency, or unstable hemoglobin disease should be

considered.


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Mean corpuscular hemoglobin (MCH)

Is the amount of Hgb by weight in an average RBC

Allows classification of cells into normochromic,

hypochromic and hyperchromic

In newborn and macrocytic anemia

- MCH is high

In deficiency anemia,- MCH is low

MCH = __Hgb gm% x 10__

RBCs (x 1012

/L)

NV = 27-31 ug (pg)

Mean corpuscular hemoglobin concentration (MCHC)

Is the concentration of hemoglobin in an average RBC

If below normal, hypochromic

Higher than normal concentration are not possible as

normal RBC contains the maximum amount of Hgb Normochromic, within normal MCHC

MCHC = __Hgb gm % x 100__

Hct

NV = 33-38%

Mean Corpuscular Hemoglobin (MCH) and

Mean Corpuscular Hemoglobin Concentration (MCHC)

Normochromic

MCH

MCHC

27 31 pg

33 38%

Hypochromic

MCH

MCHC

< 27 pg

< 33%

Hyperchromic

MCH

MCHC

> 31 pg

> 38%

Conditions associated with changes in Hgb content

Hypochromasia Decrease in Hgb concentration thus giving a

central pallor to the red cells

Central pallor exceed of diameter of red

cell

Seen in:

a) Iron deficiency anemia

b) Thalassemia

Hypochromic microcytic red cells

(leptocytes or planocytes)

The bright central area is larger, while the cell is

slightly smaller than normal. Anisocytosis is more

conspicuous. Suspect iron deficiency anemia first.

Anisochromasia Describes the morphology of red cells which

stain unequally with only a proportion of the

cells appearing hypochromic

Seen in:

a) After transfusion in iron

deficiency anemia

Hyperchromasia Unusual deep staining of the RBC

No central pallor

Is not related to oversaturation of the Hgb in

the cell ( as indicated by the upper limit of

the MCHC

o Important aspect: assess the mean

cell thickness

e.g., spherocyte

Polychromasia RBC takes a slightly basophilic hue having

blue-gray coloration Presence of RNA which means RBCs

delivered prematurely to circulation

Seen in:

a) Increased erythropoietic activity

b) Hemorrhage

c) Hemolysis


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Poikilocytosis

- variation in shape of the erythrocytes

- increased poikilocytosis is indicative of abnormal erythropoiesis due to:

o Bone marrow deficit (Vitamin B deficiency)

o Abnormal erythrocyte destruction

Marked microcytosis and poikilocytosis

with macrocytes and microcytes

Conditions associated with changes in erythrocyte shape

Spherocytes Cells lose the biconcave disc shape and assume a spheroidal

shape

Defect in shape:

- Lowest surface area to volume ratio

- Loss of membrane function due to defect to Na pump

leading to retention of Nathus increasing the

osmolarity and attracting more water into the cells

Morphological appearance:

- Smaller in diameter that normal red blood cells with

concentrated hemoglobin content

- Appear smaller and very dense called hyperchromic

spherocytes

Seen in:

a) Hereditary spherocytosis

b) Immune-induced hemolysis

c) Post-transfusion

Echinocyte

(Crenated RBC)

Morphological appearance

- Have regular, smooth tipped projections all around the

periphery of the cells

Defect:

- Depletion of ATP

- Exposure to hypertonic solution

- Artifact in air drying

Seen in:

- Very anemic patients

- Uremia

- Cirrhosis

- Hepatitis

- Chronic renal failure

Acanthocytes Morphological appearance:

- Spheroid with 3-12 irregular spike spicules

Cause:

-

Abnormally crenated erythrocytes caused bya. Increased ratio of cholesterol to lecithin

Seen in:

- Congenital or acquired abetalipoproteinemia

- Hemolytic anemia

- End stage liver disease

- Pyruvate kinase deficiency

Schistocytes Morphological appearance:

- red cell fragments

Defect:

- Trapping of the RBC between violently opposed

mechanical surfaces caused by

a. fibrin

b.

altered blood vessel wallsc. prosthetic heart-valves

Seen in:

- Disseminated intravascular coagulation (DIC)

- Thrombotic thrombocytopenic purpura (TTP)

- Burns

- Microangiopathic hemolytic anemia


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Ovalocytes Morphological appearance:

- Egglike or oval shaped cell; wider than eliptocytes

- mature red cells that assume an oval shape

Defect:

- Hgb has bipolar arrangement

- Reduction in membrane cholesterol

Seen in:

- Megaloblastic bone marrow

- Myelodysplasia

- Sickle cell anemia

Target cells Morphological appearance:

- Abnormally thin cell resembling a target

Seen in:

- Thalassemia major

- Obstructive jaundice

- Hb SC disease

- Lecithin-cholesterol acyltransferase (LCAT) deficiency

Stomatocytes Morphological appearance:

- Erythrocytes with a central stoma or mouth which

appear as an unstained central biconcave area

Defect:

- Occurs as artifact of slow drying

- Known to have increased permeability to sodium

Seen in:

-

Hereditary stomatocytosis- Acute alcoholism

- Liver disease

Sickle cells

(Drepanocyte)


- Crescent shape cell that lacks zone of central pallor

Defect:

- Polymerization of deoxygenated hemoglobin

Seen in:

- Sickle cell anemia

- Sickle cell disease

- Sickle thalassemia

Dacryocytes

Morphological appearance:- Teardrop or pearshape with single elongated point or tail

Defect:

- Squeezing and fragmentation of cells during spleeninc

passage

Seen in:

- Myeloid metaplasia

- Thalassemia

- Megaloblastic anemia

- Hypersplenism

Elliptocytes Morphological appearance:

- rod or cigar shape

Defect:

-

Polarization of hemoglobin

Seen in:

- Thalassemia

- Iron deficiency anemia

- Hereditary elliptocytism


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Erythrocyte Inclusions

Basophilic

stippling


- Fine or coarse gray-black granules in the red cells

Defect:

- Fine granules represent polychromasia(reticulocytes)

- Coarse granules

-

Represents impaired erythropoiesis Seen in:

- Lead poisoning

- Thalassemia

- Heavy metals

- Increased reticulocytosis

Howell-jolly

bodies


- Coarse round densely stained 1-2 um granules

eccentrically located on the periphery of membrane

Defect:

- Remnants of nuclear chromatin within the red cell

containing DNA

Seen in:

- Megaloblastic anemia

- Severe hemolytic process

- Thalassemia

- Accelerated erythropoisis

Cabot rings Morphological appearance:

- Red violet structures appearing as rings, incomplete rings

or figure of eight

Defect:

- Remnants of microtubueles of mitotic spindle

Seen in:

- Severe anemia

Siderocytes Morphological appearance

-

Non-nucleated red cells containing bright blue non-hemoglobin iron granules

Defect:

- Excessive iron overloading in mitochondria of

normoblasts

- Due to defective heme synthesis

Seen in:

- Hemolytic anemia and after splenectomy

Reticulocyte

Young red cells that have matured enough to have

lost their nuclei leaving their cytoplasmic RNA

content, which are detected by supravital stain (Newmethylene blue)

Anucleated cell containing small amount of

basophilic reticulum(RNA)

Is an index of bone activity or effective erythropoisis

Indication

- Increased:

Increased erythropoiesis as in blood loss

- Decreased:

Aplasia of bone marrow

Reticulocyte in % = No. of reticulocytes counted x 100__

1,000 RBC

NV = 0.5 1.5% (5-15 x 10-3

)

In Romanowski-stained smears, reticulocytes can be difficult to

identify. They are polychromatic, staining slightly bluish. On

supravital staining with New methylene blue, they can be

identified as containing dark blue granular or retiform

substances (the substantia reticulofilamentosa; RNA-possessingprotein-producing ribosomes degenerated during the stain, as

shown by this smear. They are juvenile erythrocytes that have

been produced in the bone marrow about two days before and

have just entered into the peripheral blood. In normal blood, 1-

2% of erythrocytes are reticulocytes. This smear from a patient

with hemolytic anemia contains an increased number of

reticulocytes. Reticulocytes become mature erythrocytes after

one day in the peripheral blood.


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Osmotic Fragility Test

Reagent: 0.5% NaCl (hypotonic solution)

Principle:

Cells are suspended in a series of tubes containing hypotonic

NaCl varying from 0.9% to 0.0%, incubated at roomtemperature for 30 mins and centrifuged. The % of hemolysis

in the supernatant solution is observed and measured for each

NaCl concentration

Interpretation:

Cells that are more spherical, with a decreased

surface/volume ratio, have a limited capacity to expand in

hypotonic solution and lyzed at higher concentration than

normal cells and are said to have increased O.F. It is increased

in hemolytic spherocytosis.

Sucrose Hemolysis Test

Indication:

Used to diagnose PNH, hypoplastic and megaloblastic anemia

Principle:

Isotonic sucrose solution provides a medium of low ionic

strength which promotes binding of complement to red cells.

In PNH, a portion of red cells is abnormally sensitive to

complement-mediated lysis

Procedure:

Patients washed RBC are mixed with sucrose, incubate for 30mins, centrifuged and observed for hemolysis. Make also a

control using NSS with patients blood the control tube

should be negative

Hams Test (Acidified Serum Test)

Indication:

For definitive diagnosis of paroxysmal nocturnal

hemoglobinuria (PNH)

Principle:

In acidified serum, complement is activated by alternatepathway, binds to RBC and lyses the PNH cells which are

unusually susceptible to complement.

Procedure:

The washed RBC are mixed with ABO compatible normal

serum (fresh) and acidified, after an hour incubation at 37C,

the PNH cells are lysed

Iron

Indication:

It is essential to living organisms for cellular oxidationmechanism and transport of oxygen to tissues

Methods of Determining Values

Based on the principle that when pH is decreased in serum,

iron is released from transferrin, Fe3to Fe2and complexes

Diurnal variation demonstrates normal values in the

morning, decreasing in the afternoon

Patient preparation: morning specimen (red top)

NV = 0.5-17 ug/dl

Interpretation

Decreased iron values are observed in menstrual cycle,

pregnancy, inflammation, MI, malignancy, and iron deficiency

anemia

Increased iron values are seen in hepatitis, oral contraceptive

usage and increased ingestion

Total Iron Binding Capacity (TIBC)

Transferrin is usually measured indirectly by the amount of

iron that it can bind , this is the TIBC

% saturation of TIBC is the ratio of serum iron to TIBC

Cobalamine (Vit B12)

Vitamin B 12 is the only vitamin exclusively

synthesized by microorganisms

Stored in the liver, released by digestion of proteins

by animal origin and is then bound by gastric

intrinsic factor

Absorbed cobalamine is delivered to the liver,hemopoietic cells and other dividing cells

NV = 200-900 ng/L (pg/ml)

Cobalamine deficiency due to:

1. Inadequate intake (vegetable)

2. Defective production of intrinsic factor

(gastrectomy)

3. Pernicious anemia ( failure of gastric mucosa to

secrete intrinsic factor)

4. Defective absorption (tapeworm infestation)

Deficiency results in megaloblastic anemia

Diagnostic Procedures

Serum cobalamine assay

Therapeutic trial

Urinary methyl maloric assay

Deoxyuridine suppression test

Laboratory Findings (cobalamine deficiency):

1. Macrocytosis

2. Presence of hyperlobulated neutrophils (5-6 lobes in

more than 5% neutrophils)

3. High MCV

4.

Reticulocyte and NRBC elevated5. Vitamin B 12 decreased

In pernicious anemia, there is decreased cobalamine

intrinsic factor and megaloblastic anemia

Ferritin

Absorbed iron becomes attached to plasma protein.

Excess iron combines with the protein apoferritin to

form ferritin, these are stored form of iron in the

liver, bone marrow and spleen

If the amount of apoferritin is insufficient to bind the

remaining iron, it is deposited in the tissues as iron

oxide granules called hemosiderin

Seen in:

BTR iron overload (excess blood transfussion or

overloading) used as in thalassemia.

Check diagnosis by requesting ferritin

NV = 12-300 ug/L (adult)

1-142 ug/L (infant)


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Folic Acid (Pteroyl Monoglutamic Acid)

Sources: food like eggs, milk, leafy vegetables,

yeast, liver, fruits,

Formation: intestine absorbed in the jejunum

plasma cells tissue for utilization

NV = 5-21 ng/ml

Laboratory Findings:

Cobalamine deficiency are also seen in folate

deficiency except in leukopenia and

thrombocytopenia

Seen also in pernicious anemia

Folic Acid Deficiency Due to:

1. Inadequate intake of folic acid

2. Increased demands as in pregnancy, infancy,

infection or hemolytic anemia, liver disease

associated with alcoholism

3.

Defective absorption as in malabsorption syndrome

To diagnose deficiency thru laboratory methods needed are:

1. Serum folic acid

2. Serum folate

3. Red cell folate

Evaluation of Hemolytic Anemia

Hematology Testing

CBC: check for spherocytes, sickle cells, target cells,

evidence of infection or leukemias, malarial

parasites Reticulocyte count: increased production of RBCs

Urine Testing

Urobilinogen

Urobilin

Urine hemosiderin

Special Testing

Plasma hemoglobin

Bilirubin fractionation (direct, indirect)

Direct antiglobulin test (DAT)

If hereditary or congenital anemia is suspected

Osmotic fragility

Autohemolysis test

G6PD

Glutathione stability

Hemoglobin electrophoresis and hemoglobin F

Heinz body stain

Suggested testing if autoimmune process is suspected:

Direct and indirect coombs test using polyvalent IgG

and C sera

Cold agglutinins and hemolysis Antibody elutions from patients cells

Donath-Landsteiner test for paroxysmal cold

hemoglobinuria

Hams test, sucrose hemolysis test for PNH

Serum protein electrophoresis and

immunoelectrophoresis or immunofixation

Rapid plasma reagin (RPR) or venereal disease

research laboratory (VDRL) test to rule out syphilis

Electrophoresis

Methodology:

The Paragon Hemoglobin Electrophoresis kit is

intended for electrophoretic separation of human

hemoglobins to screen for clinically important Hgb

variants

Alkaline hemoglobin electrophoresis on agarose gelis used as a screening procedure for Hgb A, F, S and

C

The principle of electrophoresis is based upon the

fact that hemoglobins, when placed in an electrical

field will migrate toward one of the electrode poles.

There is an electrophoretic separation of

hemoglobins in alkaline buffered agarose gel. After

electrophoresis, the hemoglobins in the gel are

immobilized in a fixative solution and the gel is dried

to a film. The Hgb pattern is visualized by staining

the film with a protein specific stain. This pattern

may be visually interpreted or quantitated bydensitometry.

Hematology Reference Values

Test Adult

Male

Adult

Female

Newborn

(1-3 days)

1-2

yrs

White Blood Cell

(WBC) (x103/ul)

3.9 -

10.6

3.5 - 11 19 - 22 10.6 -

11.4

Red Blood Cell

(RBC) (x106/ul)

4.4 -

5.9

3.8 - 5.2 4.7 - 6.1 3.5 -

5.2

Hemoglobin (Hb)(g/dL)

13.3 -17.7

11.7 -15.7

16.5 - 21.5 9.6 -15.6

Hematocrit (Hct)

(%)

40 -

52

35 - 47 48 - 68 34 -

48

Mean Cell

Volume (MCV)

(fL)

80 -

100

80 - 100 95 - 125 76 -

92

Mean Cell

Hemoglobin

(MCH) (pg)

27 -

34

27 - 34 30 - 42 23 -

31

Mean Cell

Hemoglobin

Concentration

(MCHC) (g/dL)

31 -

36

31 - 36 30 - 42 23-31

Red Cell

Distribution

Width (RDW) (%)

11.5 -

14.5

11.5 -

14.5

11.5 - 14.5 11.5 -

14.5

Platelet (x103/ul) 150 -

400

150 -

400

150 - 400 150 -

400

Mean Platelet

Volume (MPV)

(fL)

7.4 -

10.4

7.4 -

10.4

7.4 - 10.4 7.4 -

10.4

Band (%) 0 - 5 0 - 5 4 - 14 0 - 5

Neutrophil (%) 54 -

62

55 - 62 37 - 67 30 -

60

Lymphocyte (%) 20 -

40

20 - 40 18 - 38 29 -

65

Monocyte (%) 4 - 10 4 - 10 1 - 2 2 - 11

Eosinophil (%) 1 - 3 1 - 3 1- 4 1 - 4

Basophil (%) 0 - 1 0 - 1 0 - 1 0 - 1


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[email protected] || 1st

semester, AY 2011-2012

Quick Reference to Erythrocyte Disorders

AnemiaDecreased RBCDecreased HgbDecreased HCT

Microcytic-Hypochromic

Decreased MCVDecreased MCHC

Serum iron

LOWIDCD

BM stores

Low ID

High CD

NORMALThalassemia

Hgb electrophoresis

Thalassemia minorAFNA2

A2>F

Thassemia major

A0FA2A2


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03 - hematopoiesis, - erythrocytic disorders

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