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Figure 10.2 The evolution of toxic granulation. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Figure 10.3 Toxic granulation. Note heavier granulation throughout the cytoplasm. Normal granulation in the segmented neutrophils shows a dustlike appearance, with the red and blue granules being difficult to observe. Toxic granulation is excessive granulation in amount and intensity, with more prominent granules in segmented neutrophils in direct response to...

Modified Westergren Sedimentation Rate

The erythrocyte sedimentation rate (ESR) is a nonspecific screening test indicative of inflammation. It is used as an initial screening tool and also as a follow-up test to monitor therapy and progression or remission of disease. This test measures the distance that RBCs will fall in a vertical tube over a given time period. The ESR is directly proportional to red cell mass and inversely proportional to its surface area. The ESR is reported in millimeters. Any condition that will increase...

Evaluation Of A Bleeding Disorder And Types Of Bleeding

Patients who experience recurrent bleeding episodes are a select group of individuals that need to be evaluated for the source of their bleeding disorder. Bleeding may occur due to an inherited clotting factor defect or an acquired deficiency secondary to some other cause. Factors that should be considered in evaluating a bleeding disorder are the patient history, physical examination, laboratory testing, and family bleeding history. Often, the abnormal bleeding that they experience is not...

Iron Deficiency Anemia

IDA can be a primary condition due to blood loss or inadequate iron intake. It may also be a secondary condition due to a disease process or conditions that deplete iron stores, such as GI bleed or pregnancy. In either case, IDA will manifest itself as a microcytic, hypochromic process, where the red cells are small and deficient in hemoglobin (Table 5.5). The CBC will be characterized by a low red count, hemoglobin, hemat-ocrit, MCV and MCHC. The development of IDA is a three-stage process...

Review Questions

Which one of the following is the predominant red cell morphology in patients with MDS 2. Which one of the MDS groups has the best prognosis b. Refractory anemia with ringed sideroblasts 3. What is considered a significant number of ringed sideroblasts in the MDS classification 4. Which mechanism accounts for the reticulocy-topenia seen in most cases of MDS a. Heavy blast tumor burden in the marrow 5. What is the cutoff blast count used to distinguish a patient with MDS as opposed to a patient...

Info

Figure 11.9 Acute myelomonocytic leukemia. (A) AMML with prominent monoblasts, promonocytes, and spectrum of myeloid monocytic cells. (B) AMML with promonoblast, promonocytes, and eosinophil on edge of frame at arrow (AMMLe) Figure 11.9 Acute myelomonocytic leukemia. (A) AMML with prominent monoblasts, promonocytes, and spectrum of myeloid monocytic cells. (B) AMML with promonoblast, promonocytes, and eosinophil on edge of frame at arrow (AMMLe) is associated with favorable prognosis, whereas...

Condensed Case

A 47-year-old man on a surgical floor was having daily CBCs ordered. A sample was received at 8 a.m. in the morning with the morning draw specimen. The results were delta checked and reported to the floor. Later in the day, the technologist received another sample for the same patient at 2 p.m. The results on this sample were vastly different and failed the delta check. On a hunch, the technologist retrieved the sample from the a.m. draw and took both samples to the blood bank for an ABO type....

The Microscope

The microscope is an essential tool to the hematology laboratory professional. It is a piece of equipment that is stylistically simple in design, yet extraordinarily complex in its ability to magnify an image, provide visual details of that image, and make the image visible to the human eye.2 Most commonly used today are compound microscopes, which use two lens systems to magnify the image. The ocular devices on the microscope provide an initial X10 magnification, and then additional...

Cd103

Note the folded or convoluted nuclear membrane that may appear cerebriform. and individuals who progress to this phase have decreased survival rates. Sezary cells shown CD2, CD3, CD4, and CD5 markers10 (Fig. 13.4). Prolymphocytic leukemia (PLL) is a variant of chronic lymphocytic leukemia. A rare disorder, this peripheral smear of individuals with PLL shows a majority of circulating prolymphocytes. These cells of lymphoid origin have more abundant cytoplasm than mature...

Manual Reticulocyte Procedure

The reticulocyte count is an index of bone marrow red cell production. The reticulocyte is the cell stage immediately before the mature erythrocyte. This cell spends 2 to 3 days maturing in the bone marrow before it is released into the peripheral circulation, where it spends an additional day of maturation. The reticulocyte count is the most effective measure of erythropoietic activity. Reticulocytes contain RNA and can be observed using supravital stains such as New Methylene Blue or...

Reticulocyte Procedure With Miller Eye Disc

A Miller Eye Disc is placed inside the microscope eyepiece as an aid to counting reticulocytes. This reticule is a large square inside a small square and provides the technologist the ability to isolate the reticulocytes while counting. 1. New Methylene Blue (Supravital Stain) 4. Microscope with Miller ocular eye disc 1. One EDTA tube or EDTA Microtainer 2. Specimens can be stored at room temperature for 8 hours or refrigerated at 2 to 8 C for 24 hours. Commercially prepared controls are...

Thrombotic Disorders

Inherited thrombotic disorders are associated with genetic mutations that result in deficiencies of one or more of the naturally occurring inhibitors such as AT, heparin cofactor II, protein C, and protein S. Increased procoagulant factor such as in prothrombin G20210A mutation is associated with thrombosis. Other causes for inherited thrombotic disorders are AT, proteins C and S deficiencies, factor V Leiden, or an inherited form of hyperhomocysteinemia caused by an enzyme deficiency (see...

I

Figure 3.9 Anaerobic breakdown of glucose in red cell metabolism. third microcytic mechanism occurs in red cells from individuals who have iron overload disorders like hereditary hemochromatosis. These individuals will show a dimorphic blood smear, some microcytes mixed with macrocytes, some red cells exhibiting normal hemoglobin levels, and some showing hypochromia. The final microcytic mechanism is from those individuals who have the anemia of inflammation. Approxi mately 10 of these...

Case Study

A 60-year-old woman complained of gastric pain and vomiting for 2 weeks. She had no fever, but a CAT scan was ordered and showed a slightly enlarged spleen. An enlarged lymph node was also discovered. The patient complained of severe itching, redness and scaling of the skin, and pitting edema. A bone marrow showed a hypocellular architecture with increased fat. Laboratory findings are as follows WBC 39.0 X 109 L Differential RBC 4.25 X 1012 L Segs 29 MCV 89 fL Platelets normal MCH 27.5 pg...

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Figure 7.2 Three mechanisms of spherocyte formation. 100 Part II Red Cell Disorders mune process are the result of an antibody being attached to the red cell and then removed or sheared as the coated red cell passes through the spleen. As this occurs, the exterior membrane of the red cell is sheared and a spherocyte produced. A more moderated spherocyte-producing process is senescence, or natural red cell death. As the cell ages, it progressively loses membrane, leading to the production of...

Tall

*These are example of chromosome abnormalities the list is not intended to be comprehensive. Figure 11.2 Acute myeloid leukemia with t(8 21) (q22 q22). Note Auer rod in myeloblast. *These are example of chromosome abnormalities the list is not intended to be comprehensive. ence texts for an in-depth discussion of immunophe-notypes and genetics that are characteristic for each disorder. Acute Myeloid Leukemia With t(8 21)(q22 q22) This leukemia occurs most often in children or young adults and...

Essential Thrombocythemia

ET, or primary thrombocythemia, is a chronic MPD characterized by a clonal proliferation of megakary-ocytes in the bone marrow. The peripheral blood platelet counts exceed 600,000 pL and can be greater than 1 million. This disease is characterized by an Table 12.11 O Key Facts for Essential Thrombocythemia Marked thrombocytosis (platelet count > 600 X 109 L) Neurological manifestations Megakaryocyte fragments in both peripheral blood and bone marrow Absent Philadelphia chromosome increased...

Acute Myeloid Leukemia

AML is malignant, clonal disease that involves proliferation of blasts in bone marrow, blood, or other tissue. The blasts most often show myeloid or monocytic differentiation. Almost 80 of patients with AML will demonstrate chromosome abnormalities, usually a mutation resulting from a chromosomal translocation (the transfer of one portion of the chromosome to another).9 The translocation causes abnormal oncogene or tumor suppression gene expression, and this results in unregulated cellular...

Lap

Marked neutrophilia with a shift to the left Basophilia and eosinophilia Normal Few nRBCs Normal increased Enlarged and fragments myeloblasts (occ) Basophilia and eosinophilia increased Giant and abnormal megakaryocytes present Normal increased Leukocytosis with neutrophilia and basophilia Normal morphology as disease progresses iron deficient morphology Increased Normal increased Leukocytosis usually mild > 600,000 pL Giant size Bizarre shapes Micromegakaryocytes and megakaryocytic fragments...

Lipid Storage Diseases Briefly

The lipid storage diseases are a group of diseases in which a strategic metabolic enzyme is missing or inactive, usually as a result of a single gene deletion (see Table 10.5). Because of this missing enzyme, undigested metabolic products accumulate in cells and cell integrity is affected. Cells of the reticuloendothelial system (RES) are most often affected. The RES is a network of cells seen throughout the circulation and tissues that provide the phagocytic defense system. Histiocytes,...

Table 202 O Platelet Estimate From Peripheral Smear

Platelets per X100 Field Platelet Count Estimate Figure 20.7 Three zones of wedge preparation. 1. WBCs should contain a blue nucleus along with a lighter staining cytoplasm. 2. RBCs should have good quality of color ranging from buff pink to orange. 3. Platelets should be blue with granules and no nucleus. 1. Place a well-stained slide on the stage of the microscope, smear side up, and focus using the low-power objective (X10). 2. Check to see if there are good counting areas available free of...

Pyruvate Kinase Deficiency

Pyruvate kinase deficiency (PK) is a rare enzyme disorder of the Embden-Meyerhof pathways. Red cells lacking this enzyme are unable to generate adenosine triphosphate (ATP) from adenosine diphosphate (ADP) for red cell membrane function. The result is rigid, inflexible cells that are sequestered by the spleen and hemolyzed. Both sexes are affected in this autosomal recessive disorder. There is a high incidence in individuals of northern European origin and in the close-knit Amish population of...

Review Questions fl

Which of the following are defects of platelet adhesion 2. Which one of the conditions will produce a thrombocytopenia due to an altered distribution of platelets 3. One of the main differences between TTP and HUS is d. microangiopathic hemolytic anemia. 4. Nose bleeding, deep bruising, and gum bleeding are usually manifestations of which type of coagulation disorder 5. The presence of thrombocytopenia and giant platelets best describes a. classic von Willebrand's disease. 6. Chronic idiopathic...

Anticoagulant Therapy

Thromboembolic diseases are treated by antithrom-botic drugs. Antithrombotic agents include antiplatelet drugs, anticoagulant drugs, and thrombolytic drugs. Antiplatelet drugs prevent platelet activation and aggregation and are most effective in the treatment of the arterial diseases. Anticoagulant drugs inhibit thrombin and fibrin formation and are used commonly for the treatment of venous thrombosis. Thrombolytic drugs are used to break down fibrin clots, to restore vascular function, and to...

Sickle Cell Anemia

Genetics and Incidence of Sickle Cell Anemia The genetics of sickle cell anemia are not complicated. Sickle cell anemia is a beta chain variant and inheritance of the beta chains is located on chromosome 11. Chromosome 11 has one location on each chromosome for the inheritance of a normal beta chain or an abnormal beta chain therefore, the sickle cell anemia is autosomal codominant, inherited in simple Mendelian fashion (Fig. 8.1). At present, there are 80,000 Americans who have sickle cell...

Myelofibrosis With Myeloid Metaplasia

Myelofibrosis with myeloid metaplasia (MMM) is a CMPD characterized by bone marrow fibrosis, proliferation of megakaryocytic and granulocytic cells, and extramedullary hematopoiesis. MMM presents with an elevated WBC, teardrop RBCs, normocellular or hyper-cellular bone marrow, leukoerythroblastic anemia, splenomegaly, and the absence of the Philadelphia chromosome.28,29 MMM is a clonal hematopoietic stem cell expansion in the bone marrow with the production of reticulin and bone marrow...

Vii

Figure 19.4 Activated protein C resistance pathway. Reference ranges vary from lab to lab but in general the normal ratio is 2 or greater. A range of < 2 is diagnostic. aPTT is decreased when is APC is added to the normal plasma. Plasma from patients with APCR has a lower ratio than the reference ranges established for normal patients. A DNA test is available to confirm the specific point mutation in patients with factor V Leiden. Prothrombin mutation (G20210A) is the second most prevalent...

History Of Blood Coagulation

The study of blood coagulation can be traced back to about 400 bc and the father of medicine, Hippocrates. He observed that the blood of a wounded soldier congealed as it cooled. Additionally, he noticed that bleeding from a small wound stopped as skin covered the blood. If the skin was removed, bleeding started again. Aristotle noted that blood cooled when removed from the body and that cooled blood initiated decay resulting in the congealing of the blood. If fibers were removed, there was no...

Disorders Of Fibrinogen

Appropriate levels of fibrinogen are necessary to maintain hemostasis and to cause platelets to aggregate. The reference range for fibrinogen is 200 to 400 mg dL. Fibrinogen is an acute-phase reactant, meaning that there will be a transient increase in fibrinogen during inflammation, pregnancy, stress, and diabetes and when taking oral contraceptives. Therefore, a careful patient history is necessary when evaluating a problem involving fibrinogen. For the most part, decreases in fibrino-gen...

Red Blood Cell Membrane Development And Function

The mature red blood cell is a magnificently designed instrument for hemoglobin delivery. As a hemoglobin-filled sac, the red cell travels more than 300 miles through the peripheral circulation, submitting itself to the swift waters of the circulatory system, squeezing itself through the threadlike splenic sinuses, and bathing itself in the plasma microenvironment. Cellular and environmental factors contribute to red cell survival. In order for the red cell to survive for its 120-day life...

Criteria for the Diagnosis of Lupus Anticoagulant

Prolongation of at least one phospholipid-dependent tests Lack of correction of mixing studies Correction of the abnormal result with the addition Lack of any other specific inhibitor apy. About 36 to 50 of patients with HIT develop life-threatening thrombosis. The thrombotic tendency can last for at least 30 days.1 Venous thrombosis (extremity venous thrombosis) is more common than arterial thrombosis. Other complications of HIT include thrombocytopenia, heparin-induced skin lesions (10 to 20...

Lymphoid Malignancies

Chronic lymphocytic leukemia (CLL) is caused by a clonal proliferation of B lymphocytes. It is the most common chronic leukemia with a predilection for men over women. Most patients are older, over 50 years of age.1 Small lymphocytes begin to accumulate in the spleen, lymph nodes, and bone marrow to a high degree and eventually spill into the peripheral blood. These malignant lymphocytes will show CD15, CD19, CD20, and CD22 antigen markers as well as exhibit a low level of surface...

Hereditary White Cell Disorders

Pseudo Pelger Huet Anomaly

This inherited disorder is associated with thrombocytopenia and giant platelets. Abnormal bleeding may be seen in a small number of affected individuals. Dohle bodies are seen in the cytoplasm of neutrophils and are larger than the Dohle bodies seen in neutrophils responding to infections or inflammation. Alder's Anomaly (Alder-Reilly Anomaly) This rare genetic disorder is associated with the presence of coarse dark granules in neutrophils, lymphocytes, monocytes, eosinophils, and basophils...

Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation

The mere mention of the words the patient has DIC usually strikes fear into the hearts of attending physicians, laboratorians, and nursing staff. The acute DIC event is almost always unanticipated and dramatic. Fatal outcomes do occur. DIC is triggered by an underlying pathological circumstance occurring in the body (Fig. 18.4). As a result, the hemostatic system becomes unbal anced, hyperactivating the coagulation and or the fibrinolytic system. This process is systemic, leading to excessive...

Ineffective Erythropoiesis In Megaloblastic Anemia

The bone marrow is hypercellular in the megaloblastic conditions and the white cell precursor cells are large, especially the metamyelocytes. The myeloid-to-erythroid (M E) ratio is 1 1 or 1 3, reflecting erythroid hyperplasia as you would see in the bone marrow Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Figure 6.2 Normoblastic erythropoiesis with a polychro-matophilic normoblast (arrow). Bone marrow destruction of erythroid precursors Lack of...

Wo R D

Anticoagulant Agent that prevents or delays blood coagulation Pathophysiology Study of how normal processes are Protocols Formal ideas, plan, or scheme concerning patient care, bench work, administration, or research 1. Wintrobe M. Milestones on the path of progress. In Wintrobe M, ed. Blood, Pure and Eloquent. New York McGraw-Hill, 1980 1-27. 2. Abramowitz M. Microscope Basic and Beyond. Vol. 1. Melville, NY Olympus America Inc, 2003 1.25. 3. Wallace MA. Care and use of the microscope. In...

Acute Lymphoblastic Leukemia

Macrophage Peritoneal Fluid

Acute lymphoblastic leukemia (ALL) is a malignant disease that evolves as a result of mutation of lymphoid precursor cells that have their origin in the marrow or thymus, at a particular stage of maturation. The immunophenotype reflects the antigen expression of the stage of differentiation of the dominant clone. The leukemic cells persistently accumulate in intrame- dullary and extramedullary sites, constantly competing with normal hematopoietic cell production and function. This results in...

Hereditary Elliptocytosis

Hereditary elliptocytosis (HE) is a highly variable red cell membrane disorder with many clinical subtypes. Its occurrence is 1 4000 in the population, affecting all racial and ethnic groups.10 The inheritance is usually autosomal dominant. At the heart of this membrane defect is a disordered or deficient spectrin and proteins commonly associated with the alpha and beta spectrin regions. A decreased thermal stability occurs in each of the clinical subtypes. Elliptocytes are present to varying...

Miscellaneous Red Cell Disorders

Aplastic anemia is one of a group of hypoproliferative disorders in which there is cellular depletion and a reduced production of all blood cells, pancytopenia. Discovered in 1888 by Dr. Paul Ehrlich, this syndrome is usually idiopathic but thought to be a result of two possible mechanisms an antibody directed against an antigen on stem cells or an immune mechanism that is at play, in which T lymphocytes suppress stem cell pro-liferation.23 Several situations seem to predispose an individual to...

Hereditary Spherocytosis

The Genetics and Pathophysiology of Hereditary Spherocytosis Hereditary spherocytosis (HS) is a well-studied disorder and fairly common among individuals of northern Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. Figure 7.1 Spherocyte. Note the density of the cell with respect to the other red cells in the background. European origin, with an incidence of 1 5000.1 The mode of inheritance in 75 of individuals is autosomal dominant,...

The Spleen As An Indicator Organ Of Hematopoietic Health

Few organs can match the versatility of the spleen. This small but forgotten organ is a powerhouse of prominent red cell activity such as filtration, production, and cellular immunity. Under normal circumstances, the organ cannot be felt or palpated on physical examination. This fist-shaped organ, located on the left side of the body under the rib cage, weighs about 8 ounces, is soft in texture, and receives 5 of the cardiac output per minute. The spleen, a blood-filled organ, consists of red...

An Approach To Interpreting Automated Hematology Data

Electrical Impedance Hematology

Automated hematology has totally changed the landscape of the hematology laboratory. Fewer manual techniques are required, as more operations become automated. Work patterns have shifted as hematology professionals are expected to maintain quality and morphologic acuity and adjust to increasingly complex instrumentation. Operators of automated instruments (technologists) are expected to have a variety of interpretive skills. Additionally, most of the white cell differentials that are reviewed...

Physiological And Pathological Thrombosis

Normal hemostasis refers to the body's physiological response to vascular injury. Normal clot formation and clot dissolution is accomplished by interaction among five major components vascular system, platelets, coagulation system, fibrinolytic system, and inhibitors. These components must be in the functional state for normal hemostasis to occur. Imbalance in any of the above components will tilt the hemostatic scale in favor of bleeding or thrombosis. There are two systems of hemostasis the...

The Microcytic Anemias

Iron Intake and Iron Absorption Iron Storage and Recycled Iron Pathophysiology and Symptoms Tests Used to Diagnose Iron Deficiency Causes of Iron Deficiency Treatment for Iron Deficiency Anemia of Chronic Disease and Inflammation Pathophysiology, Diagnosis, and Treatment Anemias Related to Iron Overload Conditions, the Sideroblastic Anemias Brief History and Demographics The Pathophysiology of the Thalassemias The Alpha Thalassemias Beta Thalassemia Major Cooley's Anemia, Mediterranean Fever...

The Complete Blood Count

The complete blood count (CBC) is one of the most frequently ordered and most time-honored laboratory tests in the hematology laboratory. This evaluation consists of nine components and offers the clinician a variety of hematological data to interpret and review that directly relate to the health of the bone marrow, represented by the numbers and types of cells in the peripheral circulation. The nine components of the CBC (Fig. 2.6) are the white blood cell count (WBC), red blood cell count...

Reactive Lymphocytosis In Common Disease States

Lymphocytosis Photo

It is normal for young children between the ages of 1 and 4 to have a relative lymphocytosis. The white cell differential in this age group will show a reversal in the number of lymphocytes to segmented neutrophils from the adult reference range. The lymphocytes, however, will have normal morphology (Fig. 10.11). By far the most common disease entity displaying variation in lymphocytes is infectious mononucleosis. This is viral illness caused by the Epstein-Barr virus (EBV), a member of the...

Pernicious Anemia As A Subset Of Megaloblastic Anemias

Intrinsic factor is the single most important ingredient to the absorption of vitamin B12 and subsequent delivery of vitamin B12 to the circulation. When problems with intrinsic factor develop, the condition is called pernicious anemia. Drs. George Minot and William Murphy of Boston were awarded the Nobel Prize in 1934 for their discovery that ingestion of liver successfully treated patients with pernicious anemia. Several factors may account for the lack of intrinsic factor in the stomach,...

Hematology in Practice

Faculty, Medical Technology Program Morgan State University Baltimore, Maryland Assistant Professor Villa Julie College Stevenson, Maryland F. A. DAVIS COMPANY Philadelphia F A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright 2007 by F. A. Davis Company Copyright 2007 by F A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,...

Iron Intake And Iron Absorption

Iron is one of the most abundant metals in the world, yet IDA continues to be one the most prominent nutritional disorders worldwide.1 Many factors contribute to this situation and they need to be understood to have a fuller appreciation of iron balance. Iron balance is regulated by several conditions a the amount of iron ingested, b the amount of iron absorbed, c red blood cell formation using recycled and new iron, d iron stores, and e iron loss through blood loss or other sources Fig. 5.1 ....

Polycythemia Vera

Red Panda Overproduction

PV polycythemia rubra vera is a clonal disorder characterized by the overproduction of mature RBCs, WBCs, and platelets.19,20 With the increased production of red cells, there is an increase in hemoglobin, hematocrit, and red cell mass RCM . Erythrocytosis is the most prominent clinical manifestation of this disorder. The bone marrow is usually hypercellular with hyperplasia of all three bone marrow elements. This disorder usually occurs in the sixth or seventh decade of life. All causes of...

The Hemolytic Process

Insulin Resistance Images

Red cell senescence or death is a natural process for red cells at the end of their 120-day life span. As a natural byproduct, the contents of the red cell are released and returned to various parts of the circulation to be recycled in the process of red cell regeneration. When red cell death occurs in an orderly fashion, the hematologi-cal balance is maintained. Hemoglobin is kept at normal levels, and the bone marrow maintains a steady production of red cells. If premature red cell death or...

O Troubleshooting

What Do I Do to Correct the CBC When the White Count Is Out of Linearity Range WBC 194.1 X 109 L WBC beyond reportable range, upper RBC 3.89 X 1012 L linearity limit is 99.9 X 109 L Hgb 11.3 g dL RL, R, RH, flags WBC diff NE, LY, MO, EO, BA all have R flags The entire CBC and differential was flagged and considered nonreportable. 1. Which of these CBC results are unacceptable to report out to the clinician without further workup ALL WBC out-of-range, inaccurate RBC HCT RBC indices, questionable...

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Figure 5.4 Microcytic and hypochromic red cells. There are many populations that are vulnerable to IDA. Infants and pregnant women may suffer from nutritional deficiency, young children may develop IDA when their growth and development rate outstrip their iron intake, and young women who have increased iron need due to menstruation or pregnancy may develop IDA see Table 5.6 . But the primary cause of iron deficiency in the Western world is GI bleeding for males and excessive menses for females....

V

Figure 13.3 Hairy cell leukemia, showing hair-like projections in large mononuclear cells. data in an attempt to project disease prognosis and risk factors. Hairy cell leukemia HCL is a rare B-cell malignancy in which the key morphological entity is a fragile appearing mononuclear cell with hair-like or ruffled projections of the cytoplasm Fig. 13.3 . The nuclear material in these cells is round or dumbbell shaped with a spongy appearance of the chromatin. Hairy cells represent approximately 50...

The Role Of The Spleen In Red Cell Membrane Disorders

The spleen plays a vital role in red cell health and longevity. Because 5 of cardiac output per minute is filtered through the spleen, this organ has ample opportunity to survey red blood cells for imperfections. Only those red cells that are deemed flawless are conducted through the rest of the red cell journey. The four functions of the spleen have been explained in Chapter 2, but when considering red cell membrane defects, it is the splenic filtration function that is the most relevant. As...

Quantitative Disorders Of Platelets

A normal platelet count is 150 to 450 X 109 L. In this range, an individual will have properly functioning platelets that assist in the coagulation process by creating a platelet plug and stimulating the formation of a solid fibrin clot. A decrease in platelet count will cause bleeding from the mucous membranes such as gum bleeding gingival bleeding , nose bleeding epistaxis , extensive bruising ecchymoses , or petechiae pinpoint hemorrhages . A patient with a platelet count of 60,000 will...

Glucose6phosphate Dehydrogenase Deficiency

Nonspherocytic Hemolytic Anemia

There are a limited number of inherited disorders of red cells related to biochemical deficiencies. Glucoses-phosphate dehydrogenase G6PD deficiency represents a fascinating and far-reaching disorder that has at its core a metabolic misstep. G6PD is the catalyst in the first stages of the oxidative portion of the red cell's metabolism and a key player is the phosphogluconate pathway, whose role it is to keep glutathione in the reduced state. Glutathione is the chief red cell antioxidant and...

Hemoglobin Structure And Synthesis

Hemoglobin Molecule

Hemoglobin is the life-giving substance of every red cell, the oxygen-carrying component of the red cell. Each red blood cell is nothing more than a fluid-filled sac, with the fluid being hemoglobin. In 4 months, or 120 days, red cells with normal hemoglobin content submit to the rigors of circulation. Red cells are stretched, twisted, pummeled, and squeezed as they make their way through the circulatory watershed. Each major organ in the human body depends on oxygenation for growth and...

Wbc

16.9 X 109 L 9.3 g dL 26.5 104 X 109 L 12.5 X 109 L 8.4 g dL 24.2 97 X 109 L Hemoglobin and hematocrit were the only two tests ordered and both results seem totally verifiable. Since the technologist had access to the complete CBC on the computer screen, she noticed the disparity in white counts. The change in white count, however, is troubling and alerted the technologist to the possible problems with the sample. She considered these possibilities 1. Is the specimen clotted or contaminated 2....

Rdw

In this sample, the Hgb and Hct have failed the correlation check, and the red cell indices in this individual are astronomically high and have been flagged by the automated instrument. The most likely explanation for these results is the development of a strong cold agglutinin in the patient's sample. Cold agglutinins or cold antibodies were first described by Landsteiner in 1903 and are usually IgM in origin. These agglutinins may occur as a primary anemia or a secondary development to a...

N

Red cells form stacks of coins as a reaction to excess protein. laboratory abnormalities such as rouleaux may also be seen. Red cells circulating in abnormal proteins like fibrinogen and globulin may cause rouleaux formation Fig. 13.12 , where red cells look like stacks of coins even in the thinner areas of the smear. Unlike red cell agglutination, where red cells are attracted to an specific antibody and appear in clumps, rouleaux is nonspecific binding of red cells...

Liver Parenchymal Cell

Hepatic Parenchymal Cells

Figure 4.5 Extravascular hemolysis increased bilirubin and decreased haptoglobin. Under conditions of extravascular lysis, these conditions are present Hemoglobin, hematocrit, and red cell count are low. Serum bilirubin is elevated. Reticulocyte count is elevated. Hepatosplenomegaly may be seen. Distinguishing between intravascular and extravascular hemolysis can be accomplished by paying careful atten- tion to laboratory data. Yet, it is imperative for a student to understand why each of these...

Hemoglobin Function and Principles of Hemolysis

Extravascular Hemolysis

Types of Hemoglobin Hemoglobin Function Abnormal Hemoglobins Types of Hemolysis Laboratory Evidence of Hemolysis The Physiology of Hemolysis Terminology Relevant to the Hemolytic Anemias After completing this chapter, the student will be able to 1. Identify the components of hemoglobin. 2. Define the normal structural elements related to hemoglobin synthesis. 3. Describe hemoglobin function. 4. Describe the origin of hemoglobin synthesis in erythroid precursors. 5. List the normal adult...

A

Revised Coagulation Cascade In Vivo Vessel injury Insoluble monomer cross-linked fibrin Figure 15.5 In vivo coagulation cascade. Insoluble monomer cross-linked fibrin Laboratory testing looks at the in vitro effect of the coagulation process which is measured by the prothrombin time PT , activated partial thromboplastin time aPTT , thrombin time TT , fibrin degradation products FDPs , and D-dimer. This section will focus on PT and a PTT, while Chapter 20 will concentrate on the other routine...

The Morphological Classification Of The Anemias

Generally, anemias are classified either morphologically or according to pathophysiological cause. The pathophysiological approach refers to the cause of anemias whether the anemia is caused by excessive destruction or diminished production of red cells. Although this is certainly a respected approach, more clinicians are familiar with the morphological classification of anemias that relies on the red blood cell indices. This classification is readily available using CBC data and can be acted...

X5050

Release the tension clip and remove the sample chamber and filter card. Remove the slide from the clip and allow to fully air-dry. 9. Stain the slides in the stainer and allow to completely dry. 10. Perform a differential count on the stained smear. See Table 20.10 for normal results. a. Identify the cells as segmented neutrophils, lymphocytes, monocytes, eosinophils, and others. The others include mesothelial, macrophages, and tumor cells. For a chart including abnormal cells in CSF, see...

How To Cure Insulin Resistance Naturally

Autoimmune hemolytic anemia Process by which cells fail to recognize self and consequently make antibodies that destroy selected red cells Direct antiglobulin test Laboratory test for the presence of complement or antibodies bound to a patient's red blood cells Erythroderma Abnormal widespread redness and scaling of the skin, sometimes involving the entire body Monosomy Condition of having only one of a pair of chromosomes, as in Turner's syndrome, where there is only one X chromosome instead...

Laboratory Diagnosis For Thrombotic Disorders

The availability of a wide range of assays to evaluate the hypercoagulable state has enhanced the diagnosis of inherited and acquired thrombotic events. However, the assays are expensive and time consuming. These laboratory tests should be considered for patients in whom the test results will impact the choice, intensity, and duration of anticoagulant therapy, family planning, and prognosis.1 The clinical events that justify laboratory evaluation of hypercoagulable states are listed in Table...

Word Key

Acidosis Increase in the acidity of blood as in diabetic acidosis due to an excessive loss of bicarbonate as in renal disease Alkalosis Increase in blood alkalinity due to an accumulation of alkaline or reduction in acid Allosteric Shape change Amino acid One of a large group of organic compounds marked by the presence of both an amino group NH2 and a carboxyl group COOH the building blocks of protein and the end products of protein digestion Complement Group of proteins in the blood that play...

The Thalassemia Syndromes

Over 2 million Americans carry the gene for thalassemia,14 yet most have never heard of the word thalassemia, which comes from the Greek word thalassa, meaning from the sea. Relatively few individuals develop severe forms of thalassemia, but for those who do, there is a lifetime of transfusions and medical management of multiorgan problems. The thalassemic gene is ubiquitous, yet it has a particular penetration in Mediterranean areas and in Middle Eastern, Northern African, Indian, Asian, and...

Hematological Features Of Megaloblastic Anemias

Megaloblastic Anemia Peripheral Smear

The CBC shows a pancytopenia low white count, low red count, and low platelet count , although the platelet count may be only borderline low see normal values on the front cover of this textbook . Pancytopenia in the CBC combined with macrocytosis should raise the index of suspicion toward a megaloblastic process because few other conditions aplastic anemia, hyper-splenism show this pattern.4 Red cell inclusions such as basophilic stippling and Howell-Jolly bodies may be observed. Howell-Jolly...

LEjCl

Note Page numbers followed by f and t indicate figures and tables, respectively. Acanthocytes, 307 Accuracy precision clarification of, 9, 10f Activated partial thromboplastin time aPTT , 238 automated procedure for, 315-318 in hemophilia A diagnosis, 260 Activated protein C resistance Factor V Leiden , 285 laboratory diagnosis, 285-286 pathway, 285f Acute basophilic leukemia, 175 Acute erythroid leukemia, 173-174, 173f Acute hemolytic anemia, 103-104 Acute lymphoblastic leukemia ALL , 175...

Lip

A 44-year-old woman went to her physician as part of a physical examination for life insurance. Her medical history was unremarkable, but she did complain of loss of appetite with a full feeling in her upper abdomen. She appeared to be in good physical condition but her spleen was palpable. Her physician ordered a complete CBC. What condition could cause an enlarged spleen An enlarged spleen can occur primarily as a result of hemolysis and sequestered cells or as a result of extramedullary...

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Figure 5.16 Microcytic hypochromic blood smear in thalassemia minor. often been confused with IDA Fig. 5.16 , but a close examination of the CBC will show an individual with an increased red count. Above all other values, the increased RBC is significant in this condition because it represents that the bone marrow is compensating for having only one half the complement of beta chains. This change, although subtle, is often unrecognized by clinicians, and for this reason, many beta thalassemia...

Qualitative Defects Of White Cells

Qualitative changes of the white cell take place either in the cytoplasm or the nucleus. These changes are classified as either inherited or acquired. Acquired defects are seen with much greater frequency than inherited abnormalities. Once a patient has developed an increased white count, toxic changes of the white cells usually occur due to stress during maturation and as a result of activity in the circulation or tissue. A 146 Part III White Cell Disorders Neutrophilia Increase in segmented...

Acquired Defects Of Platelet Function

Pathophysiology Chemical Ingestion

Included in this category of platelet defects are those factors that are external to the platelet and that are nonimmune, such as drug-related platelet abnormalities, extrinsic platelet abnormalities, or as a sequel to an underlying disorder. Of all the drugs that affect platelet function, aspirin is the most popular. Ingestion of aspirin irreversibly inhibits cyclooxygenase COX-1 inhibitors by inhibiting the formation of prostaglandin synthesis. Both of these chemicals are necessary for the...

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Acute inflammation Early viral meningitis Bacterial meningitis see Fig. 20.13 meningitis Alzheimer's disease Multiple sclerosis Tumors lymphomas Reactive lymphocytes to include plasma cells in most of the above diseases, particularly in multiple sclerosis and viral meningitis Increased eosinophils Tumor malignant cells Others Newborn infants Recovery phase of meningitis Siderophages present, indicating a CNS hemorrhage in past 48 hours Erythrophages present, indicating an active CNS bleed and...

Pathophysiology

The MDSs are a clonal stem cell disorder, resulting from a lesion in the stem cell that leads to the formation of an abnormal clone of cells, a neoplasm. There are two types of MDS de novo new cases unrelated to any other treatment and secondary cases related to prior therapy, usually alkylating therapy or radiation. Certain populations are at risk for MDS those individuals exposed to benzene, radiation petrochemical employees, cigarette smokers, and patients with Fanconi's anemia.2 Secondary...

Chronic Eosinophilic Leukemia

CEL is a chronic myeloproliferative disease characterized by an elevation and proliferation of the eosinophil.1 The eosinophil is increased in the peripheral blood, bone marrow, and peripheral tissue. There is tissue and organ damage from the overproduction of eosinophils. The diagnosis of CEL is made if the blood eosinophil count is greater than 1500 pL, there are no other causes of increased eosinophils, and there are clinical signs and symptoms of organ damage. There is no Ph chromosome or...

Abnormal Red Cell Morphology

Automated instrumentation in hematology has redefined the level of practice in most hematology laboratories. Along with the complete blood count CBC , most instruments offer an automated differential count. When values from the differential or CBC are out of the reference range, results are flagged. If a result is flagged, the operator or technologist must make a decision to perform reflex testing or pull a peripheral smear for review or complete differential in order to resolve the abnormal...

Laboratory Diagnosis Of Megaloblastic Anemias

The megaloblastic anemias show striking similarities in their clinical and hematological presentations. Common features of the megaloblastic anemias include Hypersegmented neutrophils five lobes or more in segmented neutrophils Hyperplasia in the bone marrow The differential diagnosis of these disorders depends on a more sophisticated battery of laboratory tests that can help determine if the patient is lacking vitamin B12, folic acid, or intrinsic factor. Several tests are used to distinguish...

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Red Blood Cell Production, Function, and Relevant Red Cell Morphology Basic Red Cell Production Red Cell Maturation Red Cell Terminology Orthochromic Normoblast-Nucleated nRBC Red Blood Cell Membrane Development and Function Composition of Lipids in the Interior and Exterior Layers Composition of Proteins in the Lipid Bilayers The Cytoskeleton Variations in Red Cell Size Variations in Red Cell Color Variations in Red Cell Shape After completing this chapter, the student will be able to 1....

Performing A Manual Differential And Assessing Red Blood Cell Morphology

Blood Smear Slide Feathered Edge

When blood samples are evaluated by the use of automated hematology analyzers, this analysis includes automated differentials. Specific criteria pertaining to normal, abnormal, and critical values have been programmed into the analyzers by the institution, and if the differentials do not meet these criteria, verification is necessary. This is done by performing manual differentials and further evaluating the peripheral smear. First, a differential white blood cell WBC count is performed to...

Basic Red Cell Production

Red blood cell production is a dynamic process that originates from pluripotent stem cells, a phenomenal structure whose cells can give rise to many tissues, including skin, bone, and nerve cells. Next to the mapping of the human genome, the use of stem cells as agents of therapy is one of the paramount discoveries of the 20 th century. What makes stem cells so appealing is their versatility. They will respond to a programmed chemical environment in bone marrow or in cell culture, replicating...

Clinical Features Of Patients With Megaloblastic Anemia

Megaloblastic anemia is usually a disease of middle-aged to older age with a high predilection for women. Severe anemia, in which the hemoglobin drops to 7 to 8 g dL, is accompanied by symptoms of anemias such as shortness of breath, light-headedness, extreme weakness, and pallor. Patients may experience glossitis sore or enlarged tongue , dyspepsia, or diarrhea. Evidence of neurological involvement may be seen with patients experiencing numbness, vibratory loss paresthesias , difficulties in...

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Figure 4.4 Intravascular hemolysis increased bilirubin, decreased haptoglobin, but free hemoglobin present. Figure 4.4 Intravascular hemolysis increased bilirubin, decreased haptoglobin, but free hemoglobin present. Ten percent of hemolysis is intravascular, and it occurs as hemoglobin is lysed directly in the blood. Intravascular lysis takes place directly inside the vessel, and hemoglobin is released into the plasma Fig. 4.5 . Hemoglobinemia, red-tinged hemoglobin seen directly in the plasma...

Bone Marrow Report

Bone Marrow Aspiration Needle Parts

Once the slides from the biopsy and or aspirate material are stained, the physician will evaluate the bone marrow for overall cellularity, M E ratio 300 to 500 cells are scanned , maturation of each cell line, marrow-to-fat ratio, and presence of abnormal or tumor cells. The 22 Part I Basic Hematology Principles bone marrow iron store will be evaluated by the use of Prussian blue stain, and the marrow architecture will be observed for abnormalities in the stromal structure necrosis, fibrosis,...

Leukopoiesis

White cells are a remarkably versatile group of cells whose primary purpose is to defend against bacteria, viruses, fungi, or other foreign substances. To this end, most white cells are granulated and these granules contain enzymes used for digestion and destruction of the invading organisms. In the bone marrow there is a 4 1 ratio, the M E ratio indicating that four myeloid, or white cells are produced for one erythroid cell. Daily production of white cells is 1.5 billion. Transit from the...

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Normal serum Normal serum Patient serum Patient cells Dilute acid Dilute acid Trace hemolysis 3 Hemolysis 2 Hemolysis Heat inactivated serum Dilute acid Patient cells Figure 7.11 Ham's test. Note varying degrees of hemolysis in tubes 1, 2, and 3. Hemolysis occurs in tubes containing patient cells, patient serum, and acidified serum. Hemolysis does not occur in tubes with heat-inactivated serum and control cells, because heat inactivates complement. Heat inactivated serum Dilute acid Patient...

Donna Castellone

History of Blood Coagulation Overview of Coagulation Platelets An Introduction Platelet Development Platelet Structure and Biochemistry Platelet Function and Kinetics Platelet Aggregation Principle Classification of Coagulation Factors Physiological Coagulation In Vivo Laboratory Model of Coagulation Extrinsic Pathway Intrinsic System Activated Partial Thromboplastin Time