HEMATOLOGY

• the branch of medicine devoted to the study of blood, blood-producing tissues, and diseases of the blood

What is blood made up of?

• Plasma

• Blood Cells

Blood Cells

• Red Blood Cells (erythrocytes)

• White Blood Cells (leucocytes)

• Platelets

Complete Blood Count(CBC)

A complete blood count (CBC) test measures the following:

•Red Blood Cells •White blood cells •Hemoglobin •Hematocrit •Mean Corpuscular Volume (MCV)•Mean corpuscular hemoglobin (MCH) •Mean corpuscular hemoglobin concentration (MCHC)•Platelet Count

• Hematocrit is a blood test that measures the number of red blood cells and the size of red blood cells. It gives a percentage of red blood cells found in whole blood.

• Hemoglobin is a protein in red blood cells that carries oxygen. A blood test can tell how much hemoglobin you have in your blood

• A platelet count is a test to measure how many blood cells, called platelets, you have in your blood. Platelets help the blood clot.

CBC Normal Values

• WBC 4,300 – 10,800/cmm

• RBC 4.2 – 5.9 million cells/cmm

• HGB 13 – 18 grams/dl (Male)

12 – 16 grams/dl (Female)

• HCT 45 – 52% (Male)

37 – 48% (Female)

• MCV 80 -100 femtoliters• MCH 27 – 32 picograms• PLT 150,000 – 400,000/cmm

• http://www.youtube.com/watch?v=HpV449p_zQE

White Blood Cell Differential Count

• Neutrophils

• Eosinophils

• Basophils

• Lymphocytes

• Monocytes

Normal Blood Smear

Neutrophils

• Segmented Neutrophil

• Band Neutrophil

• Monocyte

• Lymphocyte

• Eosinophil

• Basophil

Red Blood Cells & Platelets

• Red Blood Cells

• Platelets

Myeloblast

Promyelocyte

Myelocyte

Metamyelocyte

Neutrophilic band

Segmented Neutrophil

Bone Marrow

Peripheral Blood

Normal Values for White Blood Count and Differential

• Total WBC: 4,500 - 10,000/cmm• Differential

• Segmented Neutrophils : 50 - 70% • Bands : 1 - 5 % • Eosinophils: 1 - 3%• Basophils: 0.4% - 1%• Lymphocytes: 20 - 40% • Monocytes: 1 - 6%• **Varies by age and sex

Disease Processes

• Mononucleosis• Sickle Cell • Thalessemia• Paroxysmal Nocturnal Hemoglobinuria• Malaria• Iron Deficiency Anemia• Acute Myelogenous Leukemia• Acute Lymphocytic Leukemia• Chronic Myelogenous Leukemia• Thrombotic Thrombocytopenic Purpura• Megaloblastic Anemia• Lead Poisoning

Mononucleosis

Reactive lymphocytes

Sickle Cell Anemia

ThalessemiaThe thalessemias are the most common group of hereditary anemias. It is most commonly seen in people of Mediterranean descent.

Thrombotic Thrombocytopenia Purpura

This is a hemolytic anemia whose origin remains unclear. It is characterized by schistocytes and thrombocytopenia (decrease in platelets).

schistocytes

Malaria

Parasites

Malaria is an acute or chronic protozoan disease transmitted to humans through the bite of an infected female mosquito.

Iron Deficiency AnemiaThe RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).

Hereditary SpherocytosisHereditary spherocytosis is a hemolytic disorder inherited as an autosomal dominant trait.

spherocytes

Acute Myelogenous Leukemia• Here are very large, immature myeloblasts with many nucleoli. A distincitve feature of

these blasts is a linear red "Auer rod" composed of crystallized granules. These findings are typical for acute myelogenous leukemia (AML) that is most prevalent in young adults.

Acute Lymphocytic Leukemia• The WBC's seen here are lymphocytes, but they are blasts--very immature cells with

larger nuclei that contain nucleoli. Such lymphocytes are indicative of acute lymphocytic leukemia (ALL). ALL is more common in children than adults. Many cases of ALL in children respond well to treatment, and many are curable.

Chronic Myelogenous Leukemia• There are numerous granulocytic forms seen here, including immature myeloid cells

and bands. This condition is one of the myeloproliferative states and is known as chronic myelogenous leukemia (CML) that is most prevalent in middle-aged adults.

Megaloblastic Anemia• Here is a hypersegmented neutrophil that is present with megaloblastic anemias.

There are 8 lobes instead of the usual 3 or 4. Such anemias can be due to folate or to B12 deficiency. The size of the RBC's is also increased (macrocytosis, which is hard to appreciate in a blood smear).

Lead Poisoning

Basophilic stippling in cytoplasm

Multiple Myeloma

Bone Marrow Smear

Multiple myeloma is the most common plasma cell disorder characterized by an increase proliferation of plasma cell in the bone marrow.

Bibliography

• How to Make a Blood Smear." You Tube. Perkins Lab. 20 April 2009 <http://www.youtube.com/watch?v=HpV449p_zQE>.

• "Medicine Plus". U.S. National library of Medicine, National Institutes of Health. 4/20/09 <http://medlineplus.gov/>. ( Hereditary spherocytosis slide)

• "The Internet Pathology Laboratory ". Mercer University School of Medicine, The University of Utah Eccles Health Sciences Library. 4/20/09 <http://library.med.utah.edu/WebPath/>. (Multiple Myeloma slide, thrombotic thrombocytopenia purpura, iron deficiency anemia, acute myelogenous leukemia, acute lymphocytic leukemia, chronic myelogenous leukemia, megalobastic anemia, lead poisoning, multiple myeloma slides)

• Sallah, Sabah and Bell, Ann. The Morphology of Human Blood Cells.

Abbott Diagnostics, 1970.