1. full blood count 2013-2014 (37pages)

8/18/2019 1. Full Blood Count 2013-2014 (37pages)

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OVERVIEW of Third YearHaematology

Plus

Full/Complete Blood Count

Third years

2013-2014

OVERVIEW OF THIRD YEAR

HAEMATOLOGY


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...... GOOD NEWS, BAD NEWS……

DATE TOPIC LECTURER

SEPTEMBER 5, 2013

PRETEST

PLUS

INTRODUCTION AND OVERVIEW

PLUS

CBC INTERPRETATION and FOLLOW UP

DR. S. VUMA

SEPTEMBER 12, 2013 Approach to MICROCYTIC ANAEMIAS 1:

PLUS

1: IRON DEFICIENCY ANAEMIA

2: ANAEMIA of CHRONIC DISEASE

DR. S. VUMA

(Dr K. JAIME)

SEPTEMBER 19, 2013 MICROCYTIC ANAEMIAS 2:

THALASSAEMIAS

DR. K. CHARLES

SEPTEMBER 26, 2013 MACROCYTIC ANAEMIAS

1: MEGALOBLASTIC ANAEMIA

DR. K. CHARLES

OCTOBER 3, 2013 APPROACH TO HAEMOLYTIC ANAEMIAS DR. S. VUMA

OCTOBER 10, 2013 MACROANGIOPATHIC HAEMOLYTIC ANAEMIAS

(NB: RESEARCH DAY…?)

DR K. CHARLES

OCTOBER 17, 2013 SICKLE CELL DISORDERS DR. K. CHARLES


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FIRST YEAR….

–

WHAT IS HAEMATOLOGY…….!!!....???

–

Basics …………..

THIRD YEAR –

APPLICATION of basic knowledge………

Omg….How much amI supposed to knowabout this topic…?


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My job

IS

–

very Simple

– To simply help you to focus

–

To simply help with prac�cal applica�on

THIRD YEAR haematology is to HELP you

FUNCTION as an INTERN!

Quizz 1 : Problem

As discussed in class


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Making a diagnosis….

1-History (70%)

2-Examinaon

3- APROPRIATE

Laboratory invesgaons

–

Main emphasis of Year 3!

(Relevant quesons, labs)

Perform 1-2-3 to

– A-Make the diagnosis

Confirm/refute diagnosis

– B- Complicaons

– C- Stage the condion

– D- Plan Therapy

Making a diagnosis Ability to

–

synthesize informa�on from history, physical examinaon and

preliminary blood tests

Provisional diagnosis

– plan further inves�ga�ons and come up with a treatment plan

recognize clinically urgent condi�ons


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Remember: peripheral blood components

MDSC 1002

Blood composion – Fluid component

Plasma: contains clong factors

Serum: no clong factors

Proteins, electrolytes, gases,hormones, lipids

– CELLULAR component

Red cells

Platelets

White cells – Granulocytes

» Neutrophil

»

Eosinophil» Basophil

– Agranulocytes

» Lymphocytes

» (B, T, NK cells)

» Monocytes

(Buffycoat)

Formed elements (cells)

FIRST YEAR

Described in terms of 5S

(CBC/FILM)

– NumberS

– Size

– Shape

– IncluSions

– Staining

Simple stains - Giemsa

THIRD YEAR

– Special stains

– Cell markers

Deviaon from normal

– Specific disease


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OVERVIEW OF 3rd YEAR: HAEM

MDSC 3311 – Red blood cell disorders

– Anaemias

MDSC 3312 – Haemostasis/thrombosis

– Transfusion medicine

MDSC 3313 – Haematologic malignancies

MDSC 3314 – Exposure to clinical/laboratory aspects

– Covering ALL components

MDSC3311 / 3312/ 3313

CLERKSHIP WILL CLARIFY A LOT!!

(Buffycoat)

PREREQUISITES…! – You have to remember material covered in MDSC 1002

Full/Complete Blood Count

Interpretaon

AndFOLLOW up invesgaons


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OBJECTIVES:

Write down THREE things you KNOW about

CBC/FBC

Write down THREE things you want to learn

about the CBC/FBC

Objecves 1: Prerequisites

Review Peripheral blood cells/haemopoiesis (MDSC 1002)

2: Discuss indica�ons for a CBC/FBC

3: Discuss blood collecon and manual and automated methods of

blood cell coun�ng

4: Describe the different CBC parameters and recognizeabnormali�es in a CBC

5: Interpret a CBC/FBC print out

6: Suggest appropriate follow up inves�ga�ons

7: PLUS prac�cal applica�on: Clinical scenarios and correlates…..!ALWAYS

THIRD YEAR is to HELP you FUNCTION as an INTERN!


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Objecves cont.

PBL

– 90

– 91

– 92

References

–

ESSENTIAL HAEMATOLOGY

AV Ho�rand

JE Pet

PAH Moss

–

Dr Vuma’s CLERKSHIP NOTES

CBC/FBC: Objecve 2

What?

When?

Why?

Helps in diagnosis of

– Haematologic condions

– Haematologic manifestaons of systemic

disease

Haematology is very CENTRAL in medicine in

general

USUALLY the FIRST POINT of CALL and

DIRECTS what FOLLOW UP inves�ga�ons


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Blood cell counts

In health – Normal adult – Neonate

– Older child

Physiological differences – Age – Male/female

– Pregnancy

– Race/ethnic differences

–

Transient Exercise

Posture

Diurnal variaons

Altude

In disease – Infecon – Malignancy

– Etc

Erroneous……..! (pre analy�cal/analy�cal/post analy�cal)

– Collecon technique

– Ancoagulant : blood rao – Age of specimen

(doctor control)

Objecve 3: Blood collecon

EDTA specimen


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Objecve 3: The haemocytometer

Objecve 3: Automated counters


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Principles of blood counters

Known volume of blood plus dilluent

Lyse red blood cells

1) Hb – (converted to HbNC) – spectrophotometrically- (Cyanhaemoglobin)

2) WCC – Impedance

– Light scaering technology

3) Platelets- thresholds for platelets, –

Red blood cells

– White blood cells (size)

Differenal count


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OBJECTIVE 2: CBC/FBC parameters


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Reference ranges (Hg g/dl)

Cord blood 13.5 – 20.5

First day of life 15.0 - 23.5

Chn 6months-6years 11.0 – 14.5

Chn 6-14years 12.0 - 15.5

Adult males 13.0 – 17.0 Adult females (non pregnant) 12.0 - 15.5

Females (pregnant) 11.0 – 14.0


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Objec�ve 4: FBC/CBC parameters

Measured – Haemoglobin

– Red cell count

– MCV

– White cell count

– Platelets

Calculated – MCH

– MCHC

– Hct

Haematocrit

– Measured automacally

Packed cell volume

– Measured by centrifuging the blood and

manually measuring the proporons

RDW

MPV and PDW

HOW DO THESE PARAMETERS

HELP US MAKE A DIAGNOSIS?


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HCT MCV MCH MCHC

M – 0.37 – 0.53 / L37 - 53 %

F – 0.32 – 0.48 / L32 – 48 %

Average size of rbc

80-95 fl

Hb content per rbc

27.5 – 30.5pg

Average Hb content/rbc

32-36g/dl

HCT = MCV x RCC

MCV-90fl

RCC- 5x 1012

MCV = PCV ÷ RCC

MCV-90flRCC- 5 x 1012

HB divided by RCC

HB - 15g/dL

RCC - 5 x 1012

Hb ÷ (MCV x RCC)

HB- 1 5g/dL,

MCV- 90fl,

RCC - 5 x 1012 / L

HCT=90 x (5 x 1012 )= 45%

MCV=45 ÷ (5 x 1012 )= 90 fl

MCH =15g/dL

÷(5x1012)

= 30pg

MCHC =15÷(90x5x 1012)

= 33g/dL

Morphologic

classificaon of

anaemias


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Quizz 3

As discussed in class: Review

Film/smear

See video on my-elearning : MDSC 3314: “preparation of slides”


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Quizz 4: Name the different cells.

Neutrophil (Band Cell)

Platelet

Eosinophil

Monocyte

Lymphocyte

MatureNeutrophil

Basophil

Red Blood Cell(Mature Erythrocyte)

FILM: Diagnosis ? (numberS)

Size

Shape

Staining

inclusionS

SPECIAL STAINS?


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OBJECTIVE 5 : CBC interpreta�on

OBJECTIVE 6 : Follow up inves�ga�ons

How to interpret a CBC/FBC Understand the different parameters

Explain “normal range”/reference range

Recognize abnormal levels of the parameters

Explain the different terminologies to explain abnormalies

– WHAT FOLLOW UP INVESTIGATIONS TO BE PERFORMED…??


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CBC interpretaon

Quan�ty

– Too many/much

– Normal

– Too few/lile

Quality

– Size

Too big Normal

Too small

Appearance

– Morphology

– Film

Func�on

Quizz 5 23year old female: CBC / FBC-

–

Hb 6g/dl

– MCV –67 fl

– Wcc- 5.9 x 109 /L – Platelets –709 x 109 /L

Comment? Diagnosis?

Follow up invesgaons…?

Comment …?

Film…….

– Abnormal red blood cell

– Size - microcytosis

– Shape –anisocytosis, pencil cells – Staining - hypochromia

Further invesgaons?


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Microcyc Anemia (IDA)

Quizz 6 78year old man

Lemon yellow jaundice

FBC

– Hb - 4.3g/dl

– MCV - 123fl – Platelet – 70 x 109 /L

– Wcc – 3 x 109 /L

Comment?

Diagnosis?

Comment?

Film

– RBC: Abnormal shape, size

– Macrocytes

– Ovalocytes

– Hypersegmented neutrophils

– Tear drop cells

– Fragments

Further invesgaons?


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Macrocyc Anemia (Meg.):

Quizz 7 CBC

– Hb- 21g/dL

Comment ?

2day old neonate?

50 year old male?

– Differenal Diagnosis?

– Clinical features?


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Peripheral blood components

Blood composion – Fluid component

Plasma: contains clong factors

Serum: no clong factors

Proteins, electrolytes, gases,hormones, lipids

– CELLULAR component

Red cells

Platelets

White cells – Granulocytes

» Neutrophil

»

Eosinophil» Basophil

– Agranulocytes

» Lymphocytes

» (B, T, NK cells)

» Monocytes

(Buffycoat)

Increased rcc / Hb :

Erythrocytosis / Polycythaemia Types/causes

– Rela�ve (decreased fluid component)

– Absolute- Primary

– Polycythaemia Rubra Vera

Secondary- – high altude, – chronic heart/lung disease

– renal tumours, etc

Effects – Hyperviscosity

Sluggish flow Thrombosis

– Decreased oxygen delivery Tiredness

Weakness

Headaches

Dizziness


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Control of erythropoiesis : EPO

(Negave feedback model)

O2 detectionin kidneys

EPORBCs in blood

Erythropoiesisin bone marrow


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Quizz 8

6 year old boy

– Chronic diarrhoea

– Anal itching

Wcc-16 x 109/L

N-47%L-19%E-43%M-2

Eosinophillia

– Reacve or malignant

– Reac�ve

Parasite infestaon

Drugs

Allergies

Skin diseases

Autoimmune diseases

– Malignant

Hodgkin lymphoma Acute leukemia

Chronic eosinophil leukemia

HES

Further invesgaons?


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Quizz 9

57 year old man

Cough

– Purulent, yellow sputum

CBC

– Hb – 13g/dL

– MCV -80fl

– Platelet – 499 x 109/L

– Wbc- 31 x 109 /L

FILM

–

FEATURES?

Review MDSC 1002: Haemopoiesis


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Wcc maturaon…

Cell type Growth

factors

Regulation Function Life span Too much Too few

Neutrophil

Eosinophil

Lymphocyte

Red blood

cell

Platelet


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Bacterial Viral Parasitesworms

CBC Leucocytosis Leucocytosis Leucocytosis

DIFF Neutrophillia Lymphocytosis Eosinophillia

FilmLeft shift

Toxicgranulation

Reactivelymphocytes

Atypical

lymphocytes

Infecons

Quizz 10 CBC

– HB-14g/dl

– Mcv- 85fl

– Wcc –5.7 x 109/L

– Platelet –21 x 109/L

COMMENT?

Thrombocytopenia

– 1: Producon

Bone marrow problem

– 2: Destrucon

Peripheral problem

– 3: Distribuon

sequestraon


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Quizz 11 cont….

6 year old boy

FBC

– Hb-5,3

– MCV- 90 fl

– Wcc- 1,3 x 109/L

– Pl- 34 x 109/L

COMMENT?

Produc�on/destruc�on/distribu�on..? – Follow up invesgaons?

FILM…?

Follow up invesgaons…?

As discussed in class…

Indicaons for bone marrow aspirate and trephine biopsy


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A

B

C


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Quizz 13

27year old male

CBC

– HB-14g/dl

– Mcv- 85fl

– Wcc –5.7 x 109/L

– Platelet –21 x 109/L

Basketball player

– Previously well

– No bleeding

– Pre-op bloods for elecve le kneearthroscopy

TREATMENT/MANAGEMENT?

EXPLAIN….!

Does the result look like the paent!!??

We do NOT treat RESULTS.. We Treat pa�ents!!

Errors

–

Pre-analycal

–

Analycal

–

Post-analycal


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Quizz 14

Known sickle cell anaemia

Chest pain,

Jaundiced

Temp –390 C

FBC

– Hb- 6g/dl

– MCV- 95fl

– Wcc –37 x 109/L

–

Platelet – 372 x 109/L

EXPLAIN….!

Take home…

Does the result look like the paent!

Remember the principles of the CBC/FBC machine!


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Quizz 14: Follow up invesgaons

65 year old man Chronic backache

Painful le forearm

– No trauma

– Fracture humerus

CBC

– Hb – 8g/dL MCV – 83fl

FILM………..?

Follow up inves�ga�ons..?

Mechanism of ESR……?


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Invesgaons

CBC/DIFF

Film

Re�c count

ESR

PT

APTT

BT

Bone marrow aspirate/

trephine biopsy

– Flow cytometry

– Cytochemistry

– Cytogenecs

Lymph node biopsy

Iron studies

Folate/B12

X-rays, USS, CT, MRI

– (Staging)

High ESR

Inflammatory condions –

SLE, RA

Collagen disease

Malignancies –

Haem- MM, Lymphoma

–

Non-haematological

Infecons –

TB

Etc etc etc

Other tests…?

Eg CRP


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SUMMARY

CELL TYPE TOO FEW TOO MUCH ABNORMAL

RED

Anaemia

--microcytic

--normocytic

--macrocytic

Polycythemia

Erythrocytosis

Sickle

Spherocyte

Target

Bite

WHITE

Leucopenia

--neutropenia

--lymphopenia

Leucocytosis

--neutrophillia

--lymphocytosis

--eosinophillia

Left shift

Immature

Blasts

Leucoerythroblastic

PLATELET Thrombocytopenia Thrombocytosis Thrombasthenia


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Abnormal results : Disease states

–

THAT IS WHAT THIRD YEAR IS ABOUT…!

–

You have to understand normal FIRST…!

Assignment

On my e-learning:

Assignment 2

–

Case B, Case C, Case D

Video: making blood films

1. full blood count 2013-2014 (37pages)

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