HEMATOLOGIC DISORDERS: DIAGNOSTIC

TESTSBY: JOHN ARBIE T. TATTAO, RN

A. Blood Examinations (CBC) Used to monitor a patient’s

progress response to treatment Most common laboratory test:

Hgb and Hct levels1. Hgb test : measures the amount

of Hgb in the peripheral blood by weightHct test : measures the ratio of RBC volume to the whole blood volume

I. LABORATORY TESTS

2. RBC Indicesa. Mean Corpuscular Volume

(MCV) – N: 80 – 95%Formula: Hct/RBCb. Mean Corpuscular Hgb (MCH)

N: 27 – 32% Mean Corpuscular Hgb Conc.

(MCHC) – N: 32 – 36%Formula: MCH: Hgb/RBC

MCHC: Hgb/Hct

3. Reticulocyte Count – measures the number of immature RBC’s circulating in the blood

- Provides useful info. about the erythropoietic activity of the bone marrow

4. Differential WBC Count5. Platelet Count6. RBC Count

Laboratory Test of Blood CellsTest Male Female

Hgb Levels 13 – 18 g/dl 12 – 16 g/dl

Hct Levels 45 – 52% 37 – 48%

RC 1 – 2% of total RBC Count

MCV 80 – 95%

MCHC 32 – 36%

Differential WBC Count

Neutrophils 55 – 70%

Eosinophils 1 – 4%

Basophils Up to 1%

Monocytes 2 – 6%

Lymphocytes 25 – 40%

B. PERIPHERAL BLOOD SMEARIdentifies the color, size, shape and contents of RBC

1. Color: (Normochromic, Hypochromic)

2. Anisocytosis: (Normocytic, Microcytic, Macrocytic)

3. Poikilocytosis: (Leptocytes, Spherocytes)

I. LABORATORY TESTS

C. Coagulation Studies1. aPTT : N: 25 – 35 secondsMeasure the number of seconds in which a clot forms

2. PT: N: 10 – 13 secondsAlso measures the time needed to form a clot, but specifically measures clotting factors (I, II, V, VII, X)

I. LABORATORY TESTS

A. Lymphangiography A radologic technique used for

visualization of the lymphatic system flow and nodes to detect the presence or stage of disease

Radiologist makes a small incision between the toes or fingers and instills dye. An iodine-based dye is injected and rediographs are taken then and again after 24 and 48 hrs after instillation of dye

II. RADIOLOGIC TEST

Nursing Responsibility:Pre-procedure:1. Obtain informed consent2. Assess pt. For allergy to iodine

3. Local anaesthesia is used before the needle insertion

Lymphangiography

4. Inform patient that he may experience a sensation of warmth and flushing as the iodine based dye is injected

5. The examiner may ask the patient to walk

Post Procedure:1. Elevate affected limb for 24 hrs.

Lymphangiography

2. Assess pt. For signs of bleeding/adverse reaction to the dye

3. Assess the affected extremity for any change in sensorimotor function

Lymphangiography

Purposes:1. To evaluate abnormal blood

cells2. Monitor the effects of bone

marrow depressants3. Monitor the patient’s

response to treatment4. Help diagnose disorders

associated with abnormal hematopoiesis

III. BONE MARROW EXAMINATION

1. Bone Marrow Aspiration Most common procedure for

obtaining a bone marrow sample

√Most common site for BMA: Other site: sternum,

anterior/posterior iliac spines

III. BONE MARROW EXAMINATION

Indication of BMA:Severe anemiaThrombocytopeniaAcute leukemiaNeutropenia

III. BONE MARROW EXAMINATION

2. Bone Marrow BiopsyIndicated when a large sample of bone marrow is needed

√Most common site of BMBOther site: sternum, proximal tibia

III. BONE MARROW EXAMINATION

Indication of BMB:PancytopeniaLymphomaMyelofibrosisMetastatic tumorMutliple myeloma

III. BONE MARROW EXAMINATION

Pre-procedure:1. Education, preparation, and

emotional support of the patient before bone marrow aspiration

2. Remind the pt. to lie still during the entire procedure

Post-procedure:1. Apply pressure dressing over

the aspiration site

Nursing Responsibility

2. Advise patient to lie on the biopsied side.

3. Monitor the site every 15 minutes.

4. An ice bag maybe applied to the site

Nursing Responsibility