6. must to know in hematology[1]

8/17/2019 6. MUST to KNOW in Hematology[1]

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MUST TO KNOW IN HEMATOLOGY Hematology Greek:

-Haima = Blood-Logos = Study/science

EDTA(Laender to!"

#$elates calcium%nersion: &'Anticoagulant o c$oice or $ematology cell counts and cellmor!$ology

Blood smear: !re!are )/in * $rs+reerred anticoagulant or !latelet count:= %n some !atients )/ EDTA anticoagulated ,lood !lateletsatellitism= +latelet satellitism: !latelets ad$ere to neutro!$ils. Eect to automated !latelet count Decreased. 0emedy: 0e!eat !latelet count using citrate (0odak: +lateletcount ' 121" EDTA = S$rinkage o cells = Hct = ES03ot or coagulation tests:= %n$i,its 4,rinogen-t$rom,in reaction= 5actor 6 is not sta,le in EDTA

7odi4ed 8estergrenES0(Black to! tu,e"

*mL EDTA 9 2;mL 3SS/#itrate0atio = 1:< (Anticoagulant-to-Blood"

#itrate(Lig$t ,lue to! tu,e"

5or coagulation and !latelet studies= +reseres la,ile actors 6 and 6%%%= Buered 2*> (21?7" citrate%nersion: -


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B7 = 1 source o cell !roduction (Hemato!oiesis"Sternum = !rinci!al source o $emato!oiesis in adults

Adults H,A1 = O?;>H,A* = 12;->H,5 = I*>

3eonates H,5 = F-&>H,A = *-

7arro) s!ecimens 12 Tre!$ine (#ore" Bio!sy

= Tre!$ine ,io!sy needle (Pams$idi needle"*2 As!iration= As!iration needle (Qniersity o %llinois sterna needle"

+osterior iliac creast Saest site or B7 as!irate/,io!sy7:E ratio 3umeric e'!ression com!aring t$e relatie num,er o granulocytic

!recursors )/ t$e relatie eryt$roid !recursors in t$e B736 = *:1 to . Hemato!oietic elements = (Ae2 ;>"

ello) B7 5ats0ed B7 Hemato!oietic cells7arro) dierential 0ecommended t$at at least ;@ !reera,ly 1 cells ,e counted

or a marro) dierential7etamyelocyte/Puenile granulocyte

+redominant cell (8B#" in adult B7 (u! to *>"

Stem cells I1> cells in B7steo,lasts Bone orming cells

#onused )/ !lasma cells8ater,ug or comet a!!earance

steoclasts Bone destroying cells#onused )/ megakaryocytes

#D*@ #D T cells#D1?@ #D* B cells#D< Stem cell marker (lym!$oid and myeloid !recursor"#D1F@ #D;F 3R cells#D1 #ALLA (#ommon ALL Antigen"

Eryt$ro!oietin +roduced ,y t$e kidney+rimary regulator o eryt$ro!oiesis

T$rom,o!oietin +roduced ,y kidney and lier0egulator o t$rom,o!oiesis

Eryt$ro!oiesis 1 stimulus = Hy!o'ia%L- 7ulti-#S5 (#olony Stimulating 5actor"

Stimulates $emato!oietic cells12 +ronormo,last +roeryt$ro,last/ru,ri,last

3/# ratio = &:13ucleoli = 1-*

+age


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#an !roduce u! to 1F 0B#s !er 1 !ronormo,last/ru,ri,last*2 Baso!$ilicnormo,last

+roru,ricyte%ntensely ,aso!$ilic cyto!lasm3/# ratio = F:13ucleoli usually not isi,le

2 +olyc$romato!$ilicnormo,last

0u,ricyteBlue-gray to !ink-gray cyto!lasm

Last stage ca!a,le o mitosis1st: Hg, synt$esis (1st: +#+3B 0eticulocyte: Last"3/# ratio =


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%ndented/kidney-s$a!ed nucleus+redominant 8B# in B7

;2 Band Sta,/Sta oungest cell in t$e series !resent in t$e !eri!$eral ,lood (normal"+B = -F> or -K># or S s$a!ed nucleus#ured or Sausage s$a!ed nucleus0esem,les +elger-Huet cells

= +H cells: coarser c$romatin t$an sta, cellsFa2 Segmentedneutro!$il

0ose-!ink granules3ucleus: *-; lo,esDiurnal ariation (+7"S!eci4c granules:a2 Lysoyme,2 Lactoerrinc2 #ollagenased2 +lasminogen actiatore2 Amino!e!tidase

F,2 Eosino!$il 0eddis$-orange granules

3ucleus: usually * lo,esDiurnal ariation (A#TH"S!eci4c granules:LargerCa2 7aor ,asic !rotein,2 Acid $ydrolasec2 #at$e!sind2 Eosino!$il cationic !roteind2 Eosino!$il-deried neuroto'ine2 Eosino!$il !rotein U2 +$os!$oli!aseSmallerC

a2 Arylsulatase,2 Acid !$os!$atase

Fc2 Baso!$il Dark !ur!le to ,lue-,lack granules ()ater-solu,le"3ucleus: generally unsegmented or ,ilo,ed (rare: or


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#yto!lasm: ,luis$ (0o,ins egg ,lue"3ucleus: com!act

T lym!$ocytes F-&>Long-lied (+lasma cellsdierentiation

12 +lasma,last*2 +ro!lasmacyte2 +lasmacyte/+lasma cell

+lasma cell Large )ell-de4ned $o/!erinuclear $alo (lig$t staining area in t$ecyto!lasm near t$e nucleus"Eccentric nucleusDee!ly ,aso!$ilic cyto!lasm (0ed/!ink cyto!lasm: 5lame cellA,normalC"#$romatin: V#art )$eel !atternW

T$rom,o!oiesis ; days (7egakaryo,last +latelets"

12 7egakaryo,last 3/# ratio = 1:1*2 +romegakaryocyte 3ucleus: may s$o) slig$t lo,ulation (Endomitosis"3/# ratio =


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!H AYnity o Hg, or * H,5

S$it to t$e rig$t (D#" #* Tem!erature *@-D+G !H AYnity o Hg, or *

Heme synt$esis Succinyl coenyme A 9 Glycine 9 +yrido'al +<↓

(ALA synt$ase"↓

D-Aminoleulinic acid↓

(ALA de$ydrase"↓

+or!$o,ilinogen↓

(Qro!or!$yrinogen synt$ase"(Qro!or!$yrinogen cosynt$ase"

↓ Qro!or!$yrinogen

↓ (Qro!or!$yrinogen decar,o'ylase"

↓ #o!ro!or!$yrinogen

↓ (#o!ro!or!$yrinogen o'idase"

↓+roto!or!$yrinogen

↓(+roto!or!$yrinogen o'idase"

↓+roto!or!$yrin %U 9 5e*9

↓ (5erroc$eletase"

↓HEME

Arterial ,lood * saturation = ?;>!* = ?; mmHg

6enous ,lood * saturation = K>

!* =


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# $as *' or *1' greater aYnity or Hg, com!ared to *Smoking@ gas@ etc2

7et$emoglo,in/Hemiglo,in (Hi"

Blood: #$ocolate ,ro)n color0eersi,le5e*9 5e9

7et$emoglo,in reductase de4ciencyE'!osure to c$emicals/drugsE'!osure to nitrite@ c$lorine and nitrate

H,7 (A,normal $emoglo,in"Sul$emoglo,in Blood: 7aue laender

%rreersi,le#annot trans!ort *#an com,ine )/ # orming car,o'ysul$emoglo,in7i'ture o o'idied@ !artially denatured orms o $emoglo,in t$atorm during o'idatie $emolysis green $emoc$romeSulonamides@ aromatic amine drugsBacteremia: Clostridium perfringensEnterogenous cyanosis

Eryt$rocyte mem,rane ;> !rotein:

12 %ntegral !rotein: Glyco!$orin A= #ontains sialic acid: (-" c$arge= Meta !otential: red cells re!el eac$ ot$er*2 +eri!$eral !rotein: S!ectrin and Actin= 0es!onsi,le or ,iconcae s$a!e o red cells= A,n2 S!ectrin: Hereditary S!$erocytosis@ Hereditary Elli!tocytosis li!id:12 +$os!$oli!ids*2 #$olesterol = L#AT1> #H

Em,den-7eyer$o!at$)ay

7aor !at$)ay?> glycolysis (anaero,ic"

Glucose Lactic acid = * AT++R de4ciency: common enyme de4ciency

He'osemono!$os!$ate s$unt(+entose + o 0B#s/day ,roken do)n ,y t$e mononuclear !$agocyticsystem (7+S"

E'traascular$emolysis

?> aged red cell destruction)/in t$e 0ES)$en # is not/incom!letely actiated Qnconugated ,iliru,in Qrine and ecal uro,ilinogen

%ntraascular $emolysis 1> aged red cell destruction

+age &


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)/in t$e ,lood essels)$en # is com!letely actiated Ha!toglo,in Hemo!e'in(9" Hemoglo,inemia

Anisocytosis 6ariation in sie0D8 3umerical e'!ression t$at correlates )/ t$e degree o anisocytosis

36 = 112;-1

Anisoc$romia 6ariation in Hg, content (E'2 Dimor!$ic anemia"7#6 36 = &-1L (3ormocytic"

I&L = 7icrocyticZ1L = 7acrocytic

7#H 36 = *K-* !g7#H# 36 = 1-F> (3ormoc$romic"

I1> = Hy!oc$romicZF> = Hy!erc$romic

3ormocyticnormoc$romic anemia

12 Acute ,lood loss*2 Hemolytic anemia2 A!lastic anemia

7icrocytic $y!oc$romicanemia 12 #$ronic ,lood loss = most common cause*2 T$alassemia = 3-0D82 %DA = %ron@ T%B# (E'2 Hook)orm inections" 0D8


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6isi,le on 8rig$ts stainBlue-gray coloration@ !ink cyto!lasm%ndicates young 0B#s Eryt$ro!oietic actiitya2 Hemorr$age,2 Hemolysis

S!$erocytosis E5T7icrocytic@

$y!oc$romic

E5T

+oikilocytosis 6ariation in s$a!eES0 = 3o rouleau' ormation

7acrocytesal macrocytes7acrooalocytes

7egalocytes: 6it2 B1* or olic acid de4ciencyAsync$ronous deelo!ment: mature cyto!lasm ,ut immaturenucleus

Acant$ocyteS!ur cell

T$orn cell

%rregular s!ikes/s!iculesA,normal L:S ratio. A,etali!o!roteinemiaLier diseases

Ec$inocyte

Burr cellSea urc$in cell#renated 0B#s

Ec$inocyte: artiactual

Burr cell: !at$ologic0B#s )/ !roections o eJual lengt$ and distri,ution AT+. E'!osure to $y!ertonic solution. Artiact in air drying. Anemia associated )/ renal insuYciency

#odocyte Target cell7e'ican $at cell

Greek: Rodon = ,ell#entral $emoglo,inied area (,ulls eye"Scanning E7: Bell/tall $at s$a!ed Surace mem,rane to olume ratio #$olesterol N !$os!$oli!id. Hemoglo,ino!at$ies

. T$alassemia

. Lier disease@ !osts!lenectomy@ %DALe!tocyte T$in ariant o a codocyteS!$erocyteBallBrone cell

S!$eroidBicone' Surace area to olume ratioDeect o loss o mem,rane:. Hereditary s!$erocytosis = +ost-s!lenectomy: S!$erocytes. Hemolytic anemia. Burns. Banked ,lood stored or a long time

A%HA s2 HS A%HA = 5T@ 7#H#@ (9" DATHS = 5T@ 7#H#@ (-" DAT

Stomatocyte Greek: Stoma = mout$7out$@ slit-like !allor areaBo)l-s$a!ed +ermea,ility to 3a9 (3ormal: !ermea,ility to R 9". Hereditary stomatocytosis. 0$null disease

Elli!tocyte 0od/cigar s$a!ed3arro)er t$an oalocytesDeect in cytoskeleton

+age 1


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. 7egalo,lastic anemiaHein ,odies +reci!itated@ denatured Hg,

7ulti!le Hein ,odies +itted gol ,all a!!earance0eJuires Su!raital stain (0HH". GF+D de4ciency. Qnsta,le $emoglo,ins (H,H". 5aism (5aa ,eans". Drug-induced

Acetyl!$enyl$ydraine/!$enyl$ydraine = %nduce Hein ,odiesormation

H,H inclusions Tetramer o ,eta glo,in c$ains ([


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Dro! o 3SS Dis!erses rouleau' ormation True agglutination remains intact

He!o"lo#ino$athiesHemoglo,ino!at$ies \ualitatie deect in Hg,

E'2 Su,stitutionH,S ]*[*F Glu 6al

H,# ]*[*F Glu Lys

H,E ]*[**F Glu Lys

Sickle cell anemia &/?-1> H,S H,5 N H,A*

Sickle cell trait ;;-F> H,A1


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Tests or unsta,le Hg,(H,H"

12 Heat !reci!itation test: _;# or * $rs*2 %so!ro!anol !reci!itation test: 1K> solution

Sa!$le Criteria for Erthrocte Mor$holo" E%aluationMor$holo"

Characteristics&'in

Nor!alLi!its(OIO)

*+($er OIO)

,+($er OIO)

-+($er OIO)

.+($er OIO)

7acrocytes (Z? m" -; ;-1 1-* *-; Z;

7icrocytes (I? m" -; ;-1 1-* *-; Z;Hy!oc$romia -* -1 1-; ;-K; ZK;+oikilocytosis -* -1 1-* *-; Z;+olyc$romato!$ilia -- 1-; F-1 Z1 --0ouleau' -- Agg2 o -<

0B#sAgg2 o ;-1

0B#s3umerousaggregates

--

Nuclear A#nor!alities+elger-Huet Hy!osegmentation (neutro!$il"

Bilo,ed nucleus: Dum,-,ell s$a!ed/s!ectacle/!eanut-s$a!ed/W+ince-neW0esem,les Sta, cell (To dierentiate: +H cell $as more clum!edc$romatin". +elger-Huet anomaly = Autosomal Dominant. +seudo-+elger-Huet = AcJuired in myelo!rolieratie disorders

Hy!ersegmentation O F lo,es (neutro!$il"A,normal D3A synt$esis. Qndrit anomaly = $ereditary $y!ersegmentation. 7egalo,lastic anemia

Cto$las!ic A#nor!alitiesAlder-0eilly granules Large !ur!le-,lack coarse cyto!lasmic granules

Accumulation o degraded muco!olysacc$arides (all leukocytes". Alder-0eilly anomaly = Autosomal 0ecessie. 7uco!olysacc$aridoses: Hurler@ Hunter@ San4li!!o syndrome

0esem,le to'ic granules (%T" To'ic granules Large !ur!le to ,lack granules resem,ling AL0 granules

. %nections

. To'ic states To'ic acuoles %nections

To'ic statesAuer rods +ink or red rod s$a!ed structures

5used !rimary granules (!ero'idase !ositie"7yeloid and monocytic series only

5aggot cells )/ mass o Auer rods7 (A+L" = associated )/ D%#

#$ediak-Higas$igranules

Giant red@ ,lue to grayis$ round inclusions (large lysosomalgranules"Seen in lym!$ocyte@ neutro!$il and monocyteLysosomal deects+latelets lack dense granules. #$ediak-Higas$i syndrome = Autosomal 0ecessie (Al,inism"

7ay-Hegglin inclusion +ale ,lue inclusions deried rom 03A. 7ay-Hegglin anomaly= Autosomal 0ecessie= Giant !latelets= T$rom,ocyto!enia

+age 1


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0esem,le Do$le ,odies (%T"Do$le ,odiesDo$le-Amato ,odies

Single or multi!le ,lue inclusionsAggregates o ree ri,osomes o roug$ E00esem,les. %nections. To'ic states

%T: %nections@ To'icstates

Do$le ,odies To'ic granules

To'ic acuolesA#nor!alities in /unction

Po,s syndrome 3ormal random actiityA,normal c$emotactic actiity

Lay leukocytesyndrome

A,normal random and c$emotactic actiity

#$ronic GranulomatousDisease (#GD"

%na,ility o !$agocytes to kill ingested microorganisms%m!aired 3AD+H o'idase%m!aired o'idatie meta,olism/res!iratory ,urst

Test: 3BT dye testCells E0hi#itin" 1ha"octosis

LE cell 3eutro!$il )/ large !ur!le $omogeneous round inclusionBeliee to ,e a neutro!$il t$at ingested anot$er neutro!$ilBuy coatSmoot$ and eenly stained. SLE

Tart cell 7onocyte )/ ingested lym!$ocyte0oug$ and uneenly stained

A#nor!alities In%ol%in" L!$hoctes0eactie lym!$ocyteAty!ical lym!$ocyteStimulated lym!$ocyte6ariant lym!$ocyteDo)ney cell

a2 Ty!e %= Turks irritation cell= +lasmacytoid lym!$ocyte )/ large ,lock o c$romatin,2 Ty!e %%= %nectious mononucleosis: caused ,y EB6 (target: B cells #D*1C"= Aty!ical lym!$ocyte in %7: T cells reacting to B cells inected )/EB6c2 Ty!e %%%= 6acuolated= S)iss c$eese/mot$ eaten a!!earance

Basket cellSmudge cell

Lym!$ocyte )/ t$um,!rint a!!earance. Due to !ressure in smear !re!aration Automated cell count. 0emedy: Add ,oine al,umin

. #LLHairy cells B cells )/ $air-like !roection

. Hairy cell leukemia = T0A+ (9"Seary cells )/ cere,riorm nucleus (V,rain-likeW"

. Seary syndrome

. 7ycosis ungoidesA#nor!alities In%ol%in" Monoctes'Macro$ha"es'Histioctes

(Li$i2oses'Li$i2 Stora"e 3iseases)Gauc$ers disease Accumulation o glucocere,roside

(-" glucocere,rosidase/[-glucosidase8rinkled/crum!led cyto!lasm (#$icken scratc$"

+age 1;


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3iemann-+ick disease Accumulation o s!$ingomyelin(-" s!$ingomyelinase5oamy cyto!lasm5oam cells )/ s!$ingomyelin

Tay Sac$s disease Accumulation o glycoli!id and ganglioside(-" He'osaminidase A6acuolated cyto!lasm

Sand$os disease Accumulation o glycoli!id and ganglioside

(-" He'osaminidase A N B6acuolated cyto!lasm

Sea ,lue $istiocytosis Qnkno)n enyme de4ciencyBlue-green cyto!lasm

A#nor!alities Associate2 &' 1las!a Cells5lame cell +lasma cell )/ red to !ink cyto!lasm

. 7ulti!le myeloma o %gA originGra!e cell7ott cell7orula cellBerry cell

+lasma cell )/ acuolesAccumulation o 0ussell ,odies. 7ulti!le myeloma

0ussell ,odies %ndiidual glo,ules o immunoglo,ulinDutc$ers ,odies %ntranuclear !rotein inclusions1latelet A#nor!alities (Mor$holo"ic)

Giant !latelet . Bernard-Soulier syndrome. 7ay-Hegglin anomaly

Small/micromegakaryocyteLarge megakaryocyte7ononuclearmegakaryocyte6acuolatedmegakaryocyte

. 7yelodys!lastic syndromes

Leuke!iaLeukemia A,normal@ uncontrolled !rolieration and accumulation o one or

more o t$e $emato!oietic cellsSym!toms: 5eer@ )eig$t loss@ s)eating` $e!atos!lenomegaly@enlarged lym!$ nodes (c$ronic leukemia" B70

Acute leukemia Days to F mont$s+redominantly immature cells (,lasts and V!roW stages"

Su,acute leukemia * to F mont$s#$ronic leukemia 6aria,le

7inimum o 1 or * years

+redominantly mature cellsLeukemic leukemia 8B# Z1;@/LSu,leukemic leukemia 8B# I1;@/L

(9" A,normal and immature cells in +BAleukemic leukemia 8B# I1;@/L

(-" A,normal and immature cells in +B5renc$-American-Britis$(5AB" #lassi4cation oAcute Leukemias

Diides acute leukemias into lym!$o,lastic and mono,lastic= Su,diided according to cellular mor!$ology@ cytoc$emicalstaining results@ cytogenetic studies and T N B lym!$ocytes markerresults

+age 1F


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Acute leukemia 3ormocytic@ normoc$romic 0B#s5AB = O> ,lastsHenry: 8H (3o) t$e standard or diagnosis" = O*>

Acute leukemia inc$ildren

&> ALL*> A3LL

Tests to dierentiateALL rom A3LL

12 7+: 7yelo!ero'idase= (9" A7L= (-" ALL

*2 SBB: Sudan Black B= (9" A7L= (-" ALL2 TdT: Terminal Deo'yri,onucleotidyltranserase= 7arker or immature lym!$ocyte= (9" ALL= (-" A3LLAcute L!$ho#lastic Leuke!ias (ALL)

L1 Lym!$o,lasts are small and $omogeneous (ary little in sie"#$ild$ood ALL

L* Lym!$o,lasts are large and $eterogeneous (ary in sie"

Adult ALLL Burkitt-ty!e0areLym!$o,lasts are large ,ut $omogeneous@ and acuolated

Acute Nonl!$hoctic Leuke!ias (ANLL)71 Acute myelo,lastic leukemia )/o maturation (A7L )/o mat"

B7:Z> ,lastsI1> granulocytic cells

7* Acute myelo,lastic leukemia )/ maturation (A7L )/ mat"B7:Z> ,lastsZ1> granulocytic cells

7 Acute !romyelocytic leukemia (A+L"Z> ,lastsZ1> granulocytic cellsZ> or Z;> !romyelocytes(9" 5aggot cells = Associated )/ D%#

7< Acute myelomonocytic leukemia (A77L"3aegelis leukemia*> to I&> monocytic cells

7;a Acute mono,lastic leukemia )/o maturationSc$illings leukemia

Z&> monocytic cells (Z&> mono,lasts"7;, Acute mono,lastic leukemia )/ maturation

Z&> monocytic cells (I&> mono,lasts"7F Eryt$roleukemia

Eryt$remic myelosisDi Guglielmos syndromeZ> ,lastsZ;> eryt$rocytic !recursors

7K Acute megakaryocytic leukemiaZ> ,lastsZ> megakaryocytic cells

+age 1K


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Chronic Melo$roliferati%e 3isor2ers7+D +rolieration o a,normal !luri!otential stem cell

Stem cell dierentiates into t$e granulocytic (myeloid stem cell"@megakaryocytic and eryt$roid cell lines

12 #$ronic7yelogenous Leukemia(#7L"

(9" +$iladel!$ia c$romosome: t(?9`**-" - ,ot$ long arms% (-" +$ c$romosome = !oor !rognosisSimilar to leukomoid reaction@ to dierentiate:a2 #$romosome studies

,2 LA+ = ( in Leukomoid reaction@ in #7L"*2 7yelo4,rosis )/myeloid meta!lasia(777"

5i,rosis and granulocytic $y!er!lasia o B7@ )/ granulocytic andmegakaryocytic !rolieration in t$e lier and s!leen(e'tramedullary"(9" Dacryocytes LA+B7 as!irate = im!ossi,le (dry ta!"B7 ,io!sy = a!!ro!riate

2 Essential T$rom,ocyt$emia (ET"

T$rom,ocytosis: 1@ ' 1?/L5unctionally a,normal !latelets

;-*>

+age 1&


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(0AEB"0AEB in transormation(0AEBt"

Z;> *->

#$ronic7yelomonocyticLeukemia (#77L"

I;> ;-*>+ersistentmonocytosis

L!$ho$roliferati%e 2isor2ersL+D +rolieration o cells deried rom lym!$oid stem cell T/B cells

12 T/B cell leukemia --*2 Lym!$oma 7alignancy inoling lym!$oid tissue

a2 3on-Hodgkins lym!$oma= !rolieration o neo!lastic lym!$ocytes= 0a!!a!ort classi4cation,2 Hodgkins lym!$oma= !rolieration o cells reacting to neo!lasm= (9" 0eed-Stern,erg cell: large cell )/ large nucleoli ()ls eye". Diagnosis: Lym!$ node ,io!sy= 0ye classi4cation: ,ased on $istologic a!!earance o lym!$ node,io!sy

= Ann-Ar,or: staging ,ased on t$e e'tent o tissue inoled2 Hairy cell leukemia Leukemic reticuloendot$eliosisriginally B cells )/ $airlike !roections(9" T0A+: Tartrate-resistant acid !$os!$atase


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esterase 7arker or monocytes@ megakaryocytes and !lasma cells(9" A7oL 7;C = in$i,ited ,y buoride(9" A7egL 7KC(-" A7L

]-3a!$t$yl Butyrateesterase

3ons!eci4c esterase%denti4es monocytes@ !romonocytes and mono,lasts(9" A7oL 7;C = in$i,ited ,y buoride(-" A7L

Acid !$os!$atase +resent in all $emato!oietic cells and ound in lysosomes(9" Hairy cell leukemia = T0A+ (9"(9" T cell leukemia(-" 3on-T cell leukemia#annot ,e stored

Tartrate resistant acid!$os!$atase (T0A+"

E'cellent marker or $airy cell leukemia

Leukocyte alkaline!$os!$atase (LA+"/3eutro!$il AL+ (3A+"

3eutro!$il is t$e only leukocyte t$at contains t$is actiity5ound in granules (7etamyelocytes" Leukomoid reaction@ 777@ +6@ rd trimester o !regnancy #7L@ #GL@ +3H

S$ould ,e done on res$ s!ecimen. Ra!lo) count:= #ount 1 neutro!$ils= Grade to

7odi4ed 3BT )/ stimulating agent Test:. Buy coat (8B#" 9 Bacterial sus!ension ---(3BT"---Z (9"5ormaan36 = &-1> ormaan#GD = I;> ormaan

5eulgen reaction S!eci4c reaction or D3A

+age *


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Ho)ell-Polly ,odies = 5eulgen (9"+russian ,lue stain Stain or $emosiderin

(9" Sidero,last(9" Siderocytes

Su!raital stain (0HH" 0HH = 3#B0eticulum = 3e) met$ylene ,lueHein ,odies = #rystal ioletHemoglo,in H = Brilliant cresyl ,lue

B#B Stain or automated cell counter

+age *1


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HEMOSTASIS+rimary $emostasis %noles ,lood essels and !latelets

5ormation o !latelet !lug Test: Bleeding time

+latelets 5unctions:Ad$esionActiation0elease

AggregationSecondary $emostasis %noles t$e coagulation actors

5ormation o sta,le 4,rin clot Test: #lotting time

Arteries #arry ,lood rom t$e $eart to t$e ca!illaries1ri!ar He!ostasis

6eins 0eturn ,lood rom t$e ca!illaries to t$e $eart#a!illaries %nured essel: asoconstriction

= initiated ,y serotonin and t$rom,o'ane A* deried rom !lateletsand endot$elial cells

Maturation Sta"e Cto$las!ic

Granules

Cto$las!ic

Ta"s

Nuclear

/eatures

Thro!#octe

s 5isi#le7egakaryo,last (-" (9" Single nucleus5ine c$romatin

(9" 3ucleoli

(-"

+romegakaryocytes 5e) (9" * nucleus (-"7egakaryocytes 3umerous Qsually (-" * or more

nuclei(-"

7etamegakaryocytes Aggregated (-" < or morenuclei

(9"

+latelet structure F> !roteins> li!ids&> car,o$ydrate6arious minerals@ )ater@ nucleotides12 +eri!$eral one = res!onsi,le or ad$esion and aggregationa2 Glycocaly' = outer surace,2 +lasma mem,rane = consists o or more glyco!roteinc2 Su,mem,ranous area*2 Sol-gel one = !latelet s$a!e N contractile elementsa2 7icro4laments: actin N myosin (actomyosin/t$rom,ostenin"= res!onsi,le or clot retraction,2 7icrotu,ules = consists o tu,ulin: maintain t$e !latelet s$a!e2 rganelle one= al!$a N dense granules

= mitoc$ondria@ lysosomal granules


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(Giant !lateletsyndrome"6on 8ille,rand disease (-" 85 = or !latelet ad$esion+latelet Actiation 7or!$ologic and unctional c$anges in !latelets

Agonists: su,stance t$at initiate actiationArac$idonic acid ---(#ycloo'ygenase"---Z T$rom,o'ane A*

T'A* 6asoconstrictorStimulate !latelet secretion

As!irin %n$i,its #U ,leeding time

+latelet Secretion 0elease o granulesa2 Al!$a granules= +latelet actor= +latelet deried gro)t$ actor= 5i,rinogen= 5actor 6= 85= [-t$rom,oglo,ulin= T$rom,os!ondin

= 5i,ronectin= Al,umin,2 Dense granules (#A+AS"= #alcium= AD+= +yro!$os!$ate= AT+= Serotonin

0elease disorders Storage !ool deects:a2 Al!$a-granule de4ciency. Gray !latelet syndrome. \ue,ec !latelet disorder = (-" 5actor 6 ,inding !rotein

(multimerin",2 Dense granule de4ciencies. Hermansky-+udlak. #$ediak-Higas$i. 8iskott-Aldric$ syndrome (] N dense granule deiciency"

I!$ortant Su#stances Secrete2 # 1latelets 6 Their 7ole in He!ostasis+romote coagulation H78R (]"

5i,rinogen (]"5actor 6 (]"5actor 6%%%:85 (]"

+romote aggregation AD+ (d"

#alcium (d"+latelet actor < (]"

T$rom,os!ondin (]"+romoteasoconstriction

Serotonin (d" T$rom,o'ane A* !recursors (m,2+L"

+romote ascular re!air +latelet-deried gro)t$ actor (]" = !romotes smoot$ musclegro)t$[-t$rom,oglo,ulin (]" = c$emotactic or i,ro,lasts

t$er systems aected +lasminogen (]"]*-anti!lasmin (]"#1 esterase in$i,itor (]"

+age *


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+latelet aggregation +latelet attac$ment to eac$ ot$er0eJuires 4,rinogen and #a*9

Glanmannst$rom,ast$enia

(-" g!%%,/%%%a com!le': rece!tor or 4,rinogen

+etec$iae +in!oint $emorr$agic s!ots+ur!ura Hemorr$age o ,lood into small areas o skinEcc$ymosis Blood esca!es into large areas o skinE!ista'is 3ose,leed

Hemart$rosis Leakage o ,lood into oint caitiesHematemesis 6omiting o ,loodHematoma S)elling or tumor in t$e tissues or a ,ody caity t$at contains

clotted ,loodHematuria 0B# in urineHemoglo,inuria Hg, in urine7elena Stool containing dark red or ,lack ,lood7enorr$agia E'cessie menstrual ,leeding

5ascular 3isor2ersHereditary $emorr$agictelangiectasia

(sl)er-8e,er-0endudisease"

7ost common in$erited ascular disorderBlood essels are t$in N lack smoot$ muscle

#ongenital$emangiomata(Rasa,ac$-7errittsyndrome"

Tumor com!osed o ,lood essels

E$ler-Danlos syndrome7arans syndrome

ascular ragility

+seudo'ant$omaelasticum

Elastic 4,ers are calci4ed N structurally a,normal

Senile !ur!ura Degradation o collagen N elastin

Scury (-" 6itamin # = or collagen synt$esisDeectie synt$esis o collagenHenoc$-Sc$onlein!ur!ura

%mmunologic damage to endot$elial cells

8uantitati%e 1latelet 3isor2ers T$rom,ocyto!enia +latelet !roduction o B7 = a!lastic anemia

Surial time = !latelet destruction (D%#@ %T+" +latelet seJuestration ,y t$e s!leen = s!lenomegalyDilution o !latelet count = T$rom,ocyto!enia ] X o unitstransused Qnits transused = T$rom,ocyto!enia7ulti!le transusion: stored ,lood contains nonia,le !latelets

T$rom,ocytosis 0eactie = moderate increase@ asym!tomatic (ater $emorr$age@s!lenectomy"Autonomous = marked increase@ associated )/t$rom,otic/$emorr$agic com!lications (E'2 ET: !latelet unction isa,normal"

8ualitati%e 1latelet 3isor2ers+latelet ad$esion 12 8D = (-" 85

. +latelet aggregation test:= 3ormal: E!ine!$rine@ #ollagen@ AD+= A,normal: 0istocetin

+age *


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*2 BSS = (-" g!%,(9" Giant !latelets. +latelet aggregation test:= 3ormal: 0istocetin= A,normal: E!ine!$rine@ #ollagen@ AD+2 Storage !ool deects= Gray !latelet (]"@ H+@ 8AS@ #HS (d"

AcJuired Qremia: to'ic meta,olites

+ara!roteinemias: coating o !latelet mem,rane )/ a,normal!roteinA7L: a,normal megakaryocytes7+DDrugs: As!irin = in$i,its #U

La#orator Tests for 1ri!ar He!ostasis+latelet count 12 Direct (3eu,auer counting c$am,er"

+lt2 count/mm = X !lt ' A5 ' D#5 ' D5 = X !lt ' 1 ' 1 ' * = X!lt ' *@(0B# !i!ette = 1:* dilution". 1 !latelet uncounted = -*@ !lt/mm

a2 0eese-Ecker- Sodium citrate- 5ormalde$yde- Brilliant cresyl ,lue,2 Guy and Leake- Sodium o'alate- 5ormalde$yde- #rystal ioletc2 Brecker-#ronkite

- 1> ammonium o'alate (!$ase contrast microsco!y"------------------------------------------------------------------------------------------------------d2 Qno!ette*2 %ndirect (smear"+latelet count = (X o !lts 1 0B#" ' 0B# counta2 Dames$ek,2 5oniosc2 les

Qno!ette Diluent: 1> Ammonium o'alateStand moist c$am,er or 1;-*mins to allo) !latelets to settle

12?&mL diluent2*mL ,lood T6 = *mLDilution = 1:1+lt2 count/mm = X !lt ' A#5 ' D#5 ' D5 = X !lt ' 1 ' 1 ' 1 =X !lt ' 1@. 1 !latelet uncounted = -1@ !lt/mm

+latelet estimate(8edge smear"

&-* !latelets/%5actor: *@

8B# estimate (H+5" 5actor: *@1latelet Esti!ates (S!ear)

+age *;


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%n lier disease@ all coagulation actors are e'ce!t actor 6%%%com!le'5actor 6%%% com!le':a2 6%%%: #oagulant (6%%%:#",2 85: !roduced ,y megakaryocytes and endot$elial cellsActiated at cold tem!2 = 6%% N U%

Coa"ulation /actorsNu!eral 1referre2 Na!e Snon!s

% 5i,rinogen%% +rot$rom,in +ret$rom,in%%% Tissue actor Tissue t$rom,o!lastin%6 #alcium6 +roaccelerin La,ile actor

Accelerator glo,ulin (a#g"6%% +roconertin Sta,le actor

Serum !rot$rom,in conersionaccelerator (S+#A"

6%%%:# Anti$emo!$ilic actor Anti$emo!$ilic actor glo,ulin(AHG"

Anti$emo!$ilic actor A+latelet coactor 1%U +lasma t$rom,o!lastin

com!onent#$ristmas actorAnti$emo!$ilic actor B+latelet coactor *

U Stuart-+ro)er actor Stuart actor+ro)er actorAuto!rot$rom,in %%%

U% +lasma t$rom,o!lastincom!onent

Anti$emo!$ilic actor #

U%% Hageman actor Glass actor#ontact actor

U%%% 5i,rin sta,iliing actor Laki-Lorand actor5i,rinase+lasma transglutaminase5i,rinoligase

- +rekallikrein 5letc$er actor- Hig$-molecular )eig$t kininogen 5itgerald actor

#ontact actiation coactor8illiams actor5laueac actor

Stage %: Generation o T$rom,o!lastin

%ntrinsic: U%%U%%U6%%% (#oactor"E'trinsic: %%%6%%

#ommon: U6 (#oactor"----Z #ommon t$rom,o!lastin/+rot$rom,inase (6a-Ua-#a*9-+L"

Stage %%: #onersion o!rot$rom,in tot$rom,in

%% ---(+rot$rom,inase"---Z T$rom,in

Stage %%%: #onersion o4,rinogen to 4,rin clot

% ---(T$rom,in"---Z 5i,rin clotU%%%---(T$rom,in"---Z U%%%a5i,rin clot ---(U%%%a"---Z Sta,le 4,rin clot

5i,rinogen 7ost concentrated#alcium %noled in all stages o coagulation e'ce!t contact !$ase

+age *K


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3isor2ers of Coa"ulation Causin" Clottin" /actor 3e;ciencies

/actorInherite2 Coa"ulo$athies Ac


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36 = K-1;mins+rot$rom,in time Detect coagulation actor de4ciencies inoling e'trinsic and

common !at$)ay#itrated ,lood #entriuge at *g or 1mins ++++++ 9 T$rom,o!lastin-#a#l* rgt (9" #lotBegin timing or clot ormation on t$e addition o #a#l* rgt36 = 1-1* secs

Actiated !artial

t$rom,o!lastin time

Detect coagulation actor de4ciencies inoling intrinsic and

common !at$)ay+++ 9 A+TT rgt:12 Actiators:a2 7icronied silica,2 Ellagic acidc2 #elited2 Raolin*2 +$os!$oli!ids: su,stitute or !latelets2 #a#l*Begin timing or clot ormation on t$e addition o #a#l* rgt36 = *;-; secs

Sty!en time/0usseli!er enom time East %ndian i!er enom Vipera russelli: directly actiates actor UDetect coagulation actor de4ciencies inoling common !at$)ay+++ 9 Sty!en rgt: !latelin-#a#l* rgt36 = F-1 secs

T$rom,in time +rolonged in:a2 5i,rinogen de4ciency,2 +resence o 5D+ or 5S+c2 +resence o t$rom,olytic agent (E'2 stre!tokinase"d2 +resence o $e!arin+++ 9 T$rom,in-#a#l* rgt36 = 1-1< secs

0e!tilase time Enyme ound in t$e enom o Bothrops atrox snake+rolonged in:a2 5i,rinogen de4ciency,2 +resence o 5D+ or 5S+c2 +resence o t$rom,olytic agent3ot aected ,y $e!arin+++ 9 Atro'inBegin timing or clot ormation u!on t$e addition o atro'in36 = 1-1; secs

Duckerts test;7 urea solu,ility test

5or actor U%%% de4ciency0gt: ;7 Qrea

Su,stitutes or urea:- 1> monoc$loroacetic acid- *> acetic acid3ormal = #lot is insolu,le to urea (*< $rs"52 U%%% de2 = #lot is solu,le to urea (*< $rs"

#irculatinganticoagulants

+rolonged A+TT and +T not corrected

Lu!us in$i,itor Against t$e !$os!$oli!id !ortion o !rot$rom,inase com!le' (6a-Ua-#a*9-+L"

Instru!entation for Tests of He!ostasis Tilt tu,e met$od 6isual detection o 4,rin clot ormation

+age


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7anual tec$niJueEnd !oint = clot ormation

5i,rometer Electromec$anical detection o 4,rin clot ormation5i,rin strand ormation is detected using a )ire loo! or $ook )/c$as ,een incor!orated into a semi-automated mec$anicalinstrument

+$oto-o!tical detectiono clot ormation

Detection o 4,rin clot ormation de!ends on in lig$t scatteringassociated )/ conersion o 4,rinogen 4,rin

. Semi-automated instruments:- Electra K; and K;A- 5i,rintimer series- 5+ ?1 coagulation analyer. Automated instruments:- rt$o Roagula, 1FS and


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3o 4,rin !olymer3o D-dimer +lasminogen actiators rom damaged/malignant cells#onerts !lasminogen !lasmin in t$e a,sence o 4,rin ormation. +rostatic carcinoma

Secondary 4,rinolysis D%# = uncontrolled@ ina!!ro!riate ormation o 4,rin )/in t$e ,loodessels)/ 4,rin monomer

)/ 4,rin !olymer)/ D-dimer = most s!eci4c or D%#. %nection: N. meningitidis. 3eo!lasm. Snake ,ite. HT0La#orator E%aluation of /i#rinolsis

8$ole ,lood clot lysistime (8B#LT"

#lot s$ould remain intact or a!!ro'imately


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. %30 = *2;-2;- 5or !atients )/ mec$anical $eart ales

%S% %nternational Sensitiity %nde' (+T rgt"+T rgt is cali,rated )/ 7anc$ester rgt = rom $uman ,raint$rom,o!lastin

+age


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HEMATOLOGY 17OCE3U7ESBrig$t4eld microsco!y E'amine ,lood 4lmsil immersionmicrosco!y

Eryt$rocyte mor!$ology N leukocyte dierential

+$ase-contrastmicrosco!y

5or manual !latelet counts

5luorescencemicrosco!y

A3A and T/B cell studies

Electron microsco!y ,seration o 4ne ultrastructures o cells (1@'magni4cation"

Basic com!onent oStandard lig$tmicrosco!e

Dio!ter rings: adust or ocusing dierences ,et)een eyes0u,,er eyeguard: adust or comortEye!iece tu,e clam! scre): loosen to rotate $ead0eerse acing nose!iece: or ease in s!ecimen mani!ulation0eoling nose!iece: use to rotate o,ecties,ecties: lenses )/c orm !rimary image o s!ecimen5ield dia!$ragm: a!erture dia!$ragm )/c restricts area oillumination5ield dia!$ragm control ring: adust sie o!ening o 4eld dia!$ragm

#oarse ocus kno,: ,rings slide into ie)5ine ocus kno,: s$ar!ens imageLam! socket: $olds lig$t source%nter!u!illary distance scale: indicates distance ,et)een eyesEye!iece: magniy image ormed ,y o,ectie lensStage: $olds s!ecimenSlide $older: $olds slide in !lace#ondenser control ring: adusts sie o!ening o condenser#ondenser: a!erture dia!$ragm t$at controls lig$t#ondenser centering scre)s: center t$e 4eld o ie)#ondenser ocus kno): ocuses lig$t onto slideU/ trael kno,s: moes slides on stage

Brig$tness control dial: turns microsco!e on/o@ adusts lig$tintensity

Total magni4cation T7 = cular ' ,ectie(1"(L+: 1" = 1'(1"(H+:


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Hemiglo,incyanidemet$od

Dilution = 2*mL ,lood: ;mL rgt (1:*;1"0eagents: Dra,kins reagent (Bro)n container"a2 +otassium erricyanide = errous erric,2 +otassium cyanide = Hi Hi#3c2 3onionic detergent = lysis o red cells@ decreases tur,idityd2 Sodium ,icar,onate (rig2 Dra,kins" = result is read ater1;mins

e2 Di$ydrogen !otassium !$os!$ate (7od2 Dra,kins" = result isread ater mins#olor intensity is measured at ;


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rd: Leukocytes


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*; ' 1F =


38/45


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Gauc$ers diseaseS$it to t$e let (9" immature granulocytic cells

LeukemiaBacterial inections

S$it to t$e rig$t Hy!ersegmented neutro!$ils (OF lo,es"0eticulocyte count 36:

Adult = 2;-12;> (Ae: 12>"3e),orn = *-F>

> 0etics X 0etics X 0B# (1"C ' 1A,solute reticulocytecount

A0# = (> 0etics 1" ' 0B# count (11*/L" ' 1@36 = *;-K; ' 1?/L

#orrected reticulocytecount

#0# = > 0etics ' (+atient Hct 3ormal Hct 2*2 days = Hct: *; f ;>*2; days = Hct: 1; f ;>

0+% Z AdeJuate res!onse o B7 to anemia- #$ronic $emolysis- 0ecent $emorr$age- 0es!onse to t$era!y

0+% I * %nadeJuate res!onse o B7 to anemia- A!lastic anemia- %neectie eryt$ro!oiesis (megalo,lastic anemia"

7iller disk > 0etics = 0etics (A" 0B# (B" ' ?C ' 1Eosino!$il count 36 = ;-; ' 1F/LEosino!$ilia Allergic reactions

+arasitic inectionsBrucellosisLeukemias

Eosino!enia Hy!eradrenalism (#us$ings disease"S$ockAdministration o A#TH

Eosino!$il dilutingbuids

#om!osition:a2 +$lo'ine/eosin/neutral red iodide = stains eosino!$ils,2 +ro!ylene glycol = lyses 0B#s

c2 3a*# = lyses 8B#s e'ce!t eosino!$ils@ intensi4es staining ogranulesd2 He!arin = !reents clum!ingDiluting buids:12 +ilots = !$lo'ine*2 7anners = !$lo'ine2 0andol!$s = !$lo'ine


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Sam!le *: < $rs ater administration o A#TH (eo2 count"3ormal: Eo2 count: 1 Z * (lo)er ,y ;>"A,normal: Eo2 count: 1 = * ($y!oadrenalism"Erthrocte In2ices (Wintro#e In2ices)

0B# indices #lassiy anemia according to 0B# mor!$ology7#6 7#6 = (Hct 0B#" ' 1

36 = &-1 L (old: m"7#H 7#H = (Hg, 0B#" ' 1

36 = *K-* !g (old: g"0arely used

7#H# 7#H# = (Hg, Hct" ' 136 = 1-F> (1-F g/dL"

Deectie centriuge 6alues aected:= Hct= 7#6= 7#H#

7#H# Z&> does notoccur

%ncorrect calculation(9" cold agglutinins

7#H# )ill not all

I**>

Li!emia

(9" H,S N H,#Erthrocte Se2i!entation 7ate (ES7)ES0 3ons!eci4c measurement used to detect N monitor an

inbammatory res!onse to tissue inury ES0 Eryt$rocytes:

7acrocytesAnemia+lasma com!osition: most im!ortant determinant5i,rinogen]1-glo,ulin]*-glo,ulin[-glo,ulin^-glo,ulin#$olesterol

Tec$nical actor:* Tilting = angle = > error Tem!2

ES0 Eryt$rocytes:7icrocytes+oikilocytes+olycyt$emiaAnisocytes+lasma actor: most im!ortant determinant

Al,uminLecit$in

Tec$nical actor:eranticoagulation = EDTA = s$rinkage o 0B# = Hct@ ES0

Stages o ES0 1 mins = 12 %nitial rouleau'


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42/45

mins Test: +atient 8B incu,ate at Blood 9 glucose ---Z Hemolysis: -2&>Blood 9 AD+ ---Z Hemolysis: -2?>

------------------------------------------------------------------------------------------------------GF+D de4ciency (+++" = corrects )/ glucose only+R de4ciency (E7+" = corrects )/ AD+ onlyH2 S!$erocytosis = corrects )/ AD+ and glucose

1otential Causes of Erroneous 7esults &ith Auto!ate2 Cell Counters1ara!eter Causes of S$urious Increase Causes of S$urious 3ecrease

8B# count #ryoglo,ulin#ryo4,rinogenHe!arin7onoclonal !roteins

3ucleated 0B#s+latelet clum!ingQnlysed 0B#s

#lottingSmudge cellsQremia !lusimmunosu!!ressants

+latelet count #ryoglo,ulin#ryo4,rinogenHemolysis7icrocytic 0B#s0B# inclusions8B# ragments

#lottingGiant !lateletsHe!arin+latelet clum!ing+latelet satellitism

0B# count #ryoglo,ulin#ryo4,rinogenGiant !latelets

8B# Z;@/L

Autoagglutination#lottingHemolysis

7icrocytic 0B#sHemoglo,in H,# Z1>

#ryoglo,ulin#ryo4,rinogenHemolysisHe!arin8B# Z;@/LHy!er,iliru,inemiaLi!emia7onoclonal !roteins

#lottingSul$emoglo,in

Hematocrit

(automated"

#ryoglo,ulin

#ryo4,rinogenGiant !latelets8B# Z;@/LHy!erglycemia ZFmg/dL

Autoagglutination

#lottingHemolysis7icrocytic 0B#s

Hematocrit (micro$ct" Hy!onatremia+lasma tra!!ing

E'cess EDTAHemolysisHy!ernatremia

7#6 Autoagglutination8B# Z;@/LHy!erglycemia0educed red cell deorma,ility

#ryoglo,ulin#ryo4,rinogenGiant !lateletsHemolysis

+age


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7icrocytic 0B#sS)ollen 0B#s

7#H# Autoagglutination#lottingHemolysisS!uriously $ig$ Hg,S!uriously lo) Hct

8B# Z;@/LS!uriously lo) Hg,S!uriously $ig$ Hct

#ryoglo,ulin

#ryo4,rinogen

%ncreased: 8B# count@ 0B# count@ +latelet count@ Hg,@ Hct

Decreased: 7#6He!arin %ncreased: 8B# count@ Hg,

Decreased: +latelet count

#lotting %ncreased: 7#H#Decreased: 8B# count@ 0B# count@ +latelet count@ Hg,@ Hct

Hemolysis %ncreased: Hg,@ 7#H#@ +latelet countDecreased: 0B# count@ Hct@ 7#6

Autoagglutination %ncreased: 7#6@ 7#H#Decreased: 0B# count@ Hct

De4,rinated ,lood Blood Glass Beads/cli!s

Tests: VAAW- 5T- Auto$emolysis test- Acidi4ed serum test

Auto!ate2 Cell Counter!tical lig$t scattering Blood cells )$en su,ect to lig$t )ill create or)ard N side lig$t

scatters )/c are detected ,y !$otodetector5or)ard LS = cell sieSide LS/?/rig$t angle scatter = cell granularityE'2 Tec$nicon autoanalyer

Electrical im!edance Blood cells are nonconductors o electricity2 t$ey create im!edanceor resistance o current )$en !assed in a solution t$at conductelectricityE'2 Sysme' counter@ #oulter counter

#oulter counter Tri!licate count ('"a2 Blood is diluted 1:F*; (isotonic"♫ 0B#s = F-FL♫ +lts = *-*L,2 Blood is diluted 1:*;1 ($y!otonic"♫ Lym!$ocytes = ;-?L♫ 7onocytes = ?-1FL♫ Granulocytes = 1F-


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+ositie error #ount: VBEAW♫ Bu,,les♫ E'traneous electrical !ulses♫ A!erture !lug

3egatie error #ount♫ %m!ro!er setting o a!erture error

+olyc$romasia grading > o 0B#s t$at are !olyc$romato!$ilicSlig$t = 1>

19 = >*9 = ;>9 = 1>

3ormocytic@3ormoc$romic 0B#s

12 Deectie ormation o 0B#s or t$e !resence o tumor cells inB7:A!lastic anemiaLeukemiaHodgkins disease7ulti!le myelomaLeukoeryt$ro,lastosis

7etastatic cancerAnemia o renal N endocrine diseaseAnemia o inbammatory disease*2 A,normal $emoglo,in@ increased destruction o 0B#s#ertain acJuired $emolytic anemia+3HSickle cell anemiaHD3Anemia o c$ronic renal insuYciency

Hemolytic anemias 12 %ntrinsic deects )/in 0B#a2 Hereditary mem,rane deectsS!$erocytosis

Elli!tocytosisAcant$ocytosisStomatocytosis0$ null disease,2 Hereditary enyme deectsGF+D+R c2 Hereditary $emoglo,ino!at$iesSickle cell diseaseHemoglo,in # diseased2 Qnsta,le $emoglo,in disease

Hemoglo,in E diseasee2 Hereditary deectie glo,in synt$esisT$alassemia2 AcJuired+3H*2 E'tracor!uscular causes: nonimmune acJuired $emolyticanemias#$emicals@ to'ins@ enoms+$ysical trauma: disorders causing ragmentation (,urns@ cardiacre!lacement ales@ 7AHA@ HQS"2 E'tracor!uscular causes: immune $emolytic anemias

+age


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%soimmune anti,odies: incom!ati,le ,lood transusion@ HD3Autoimmune anti,odies: )arm/cold reacting@ drug-induced

6. must to know in hematology[1]

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