Haematological tests (Common Blood Tests) and significance

Here I describe the common blood tests that are performed for diagnosing disease. It includes only the routine blood count analysis,

1. HAEMATOLOGICAL TESTS Abel C. Mathew PharmD fourth year Roll no -1

2. Cellular Components of blood derived from pluripotent stem cells in bone marrow. Bone marrow is a hematopoietic and reticuloendothelial organ, normally produces- 200 billions RBCs 1 billion granulocytes daily As reticuloendothelial organ, involved in processing antigens, cellular immune reactions, antibody synthesis, recognition and removal of expired and abnormal cells. Physiology of Blood Cells & Bone Marrow

3. Cell differentiation is differentiation of pluripotent stem cells into any cell line (red blood cells [RBCs], white blood cells [WBCs], and platelets) takes place in bone marrow. Hence, hematopoietic system consists of three primary cell components: Leukocytes, Platelets, and Erythrocytes.

4. Leukocytes encompasses a functionally diverse group of cells that includes Neutrophils,Eosinophils , Basophils , Monocytes /Macrophages, Lymphocytes, and Plasma cells. Platelets ( thrombocytes ) interact to facilitate blood coagulation. provision of a specific receptor site for clotting factors, as well as the necessary phospholipid surface for conversion of prothrombin to thrombin, and protection of thrombin from antithrombin . localization of the thrombus

5. Reticulocyte is the final cell form that precedes development of mature RBC or erythrocyte. During maturation, Hgb is produced and incorporated into the cell. Present in the circulation for 1-2 days before maturation Mature erythrocytes have a 120-day life span.

6. Introduction Complete blood count (CBC) or Complete Blood Examination (CBE) is routinely ordered test   Provides useful information on cellular and non-cellular elements of blood   Helps in diagnosis of multiple haematological disorders

7. Routine tests RBC count WBC count Platelet count Hemoglobin ( Hgb ) Hematocrit ( Hct ) RBC indices ( specifically assess RBCs ) Mean cell volume (MCV) Mean cell hemoglobin (MCH) Mean cell hemoglobin concentration (MCHC) Reticulocyte Count RDW MPV ESR

8. TOTAL RBC COUNT Actual count of red corpuscles in a given amount of blood (cubic millimeter or liter ).The RBC count is interpreted in conjunction with red cell indices, haemoglobin and haematocrit . Normal Range- Male: 4.6 to 6.2 x10 6 cells /mm 3 Female: 4.2 to 5.4 x10 6 cells /mm 3

9. Increased in Certain myeloproliferative neoplasms (example polycythemia vera ), severe dehydration ,RBC counts may be appropriately decreased or increased in certain physiological states. Decreased in Various types of anemia

10. TOTAL LEUCOCYTE COUNT Number of leukocytes in a given amount of blood.  Describe and classify the white cell components neutrophils , lymphocytes, monocytes , eosinophils , basophils Normal Range 4.3-10.3 x 10 ³ cells/ mm³

11. Increased in Monocytes : If a person has high levels of monocytes , it may indicate the presence of chronic infection, an autoimmune or blood disorder, cancer, or other medical conditions. Lymphocytes : If there is an elevation in the level of lymphocytes, the condition is known as lymphocytic leukocytosis . This may occur as a result of a virus, or an infection such as tuberculosis. It may also be linked to specific lymphomas and leukemias . Neutrophils : If a person has heightened levels of neutrophils in their body, the disorder is known as neutrophilic leukocytosis . This condition is a normal physical response to an event, such as infection, injury, inflammation, some medications, and certain types of leukemia.

12. Basophils : Increased levels of basophils may occur in people with a history of underactive thyroid disease, known as hypothyroidism, or in certain other medical conditions. Eosinophils : If a person registers high levels of eosinophils , the body may be reacting to a parasitic or other infection, allergen, or asthma.

13. Decreased in Viral infections that temporarily disrupt the work of bone marrow Certain disorders present at birth (congenital) that involve diminished bone marrow function Canceror other diseases that damage bone marrow Autoimmune disorders that destroy white blood cells or bone marrow cells Severe infections that use up white blood cells faster than they can be produced Medications, such as antibiotics, that destroy white blood cells Sarcoidosis  (collections of inflammatory cells in the body)

14. HEMOGLOBIN ( Hb ) Hemoglobin is the respiratory protein of RBCs, consisting of 3.8 % heme and 96.2 % globin . Hb amount in he given volume(100ml or 1 liter ) of whole blood. Provides a direct indication of the oxygen-transport capacity of the blood. Normal Range Male: 14 to 18g/dl Female: 12 to 16g/dl

15. Decreased in Hb is educed in all anemias , in most cases as a consequence of another underlying disease or a deficiency (iron , folate , vitamin B 12 ) Increased in Hb is higher as a physiologic response to high altitude due to low oxygen tension or in advanced lung or cardiac disease Certain meloproliferative neoplasms (example polycythemia vera )

16. PLATELET COUNTS They are small discoid blood corpuscles, the primary link in achieving hemostasis . Normal Range 150-450 x 1000 cells /mm ³ Increased in Clonal bone marrow disorders such as myeloproliferative neoplasms Reactive: after acute haemorrhage , in malignancies ( about 50 % of patients with ‘ unexpected’ thrombocytosis are found to have a malignancy), after splenectomy , severe trauma, infections, chronic inflammatory disorders, drug reactions, and many miscellaneous conditions

17. Decreased in Immune destruction such as in ITP, reaction to certain drugs, aplastic anemia, leukemias , lymphoproliferative diseases, hypersplenism,DIC , or TTP/HUS and with extracorporeal circulation Following chemotherapy, post-transfusion thrombocytopenia Numerous congenital conditions which may be associated with low platelet counts.

18. HEMATOCRIT (HCT) / PACKED CELL VOLUME (PCV):   It is the percentage volume of blood that is composed of erythrocytes. Hct is usually about 3 times the value of Hgb. Normal Range: Male: 42 to 52 % Female: 37 to 47% Abnormalities in Hct levels parallel those for Hb .

19. Decreased in Hb is educed in all anemias , in most cases as a consequence of another underlying disease or a deficiency (iron , folate , vitamin B12 ) Increased in Hb is higher as a physiologic response to high altitude due to low oxygen tension or in advanced lung or cardiac disease Certain meloproliferative neoplasms (example polycythemia vera )

20. RBCs Indices They are part of the complete blood count ( CBC ) test that provide information about the hemoglobin content and size of red blood . They are used in diagnosis of anemia and it’s causes . Mean corpuscular volume (MCV): is the average size of a red blood cell and is calculated by dividing the hematocrit (Hct) by the red blood cell count. MCV = Hct / RBC Normal range: (78-98) fL (femto- is 10 -15 ) Normal MCV = normocytic anemia Decreased MCV = microcytic anemia Increased MCV = macrocytic anemia

21. Mean corpuscular hemoglobin (MCH): is the average amount of hemoglobin (Hb) per red blood cell and is calculated by dividing the hemoglobin by the red blood cell count . MCH = Hb / RBC Normal range: 27-32 pg/cell (pico- is 10 -12 ) MCH levels over 34 pg are generally considered abnormally high. The most common reason for high MCH is macrocytic anemia, which is a blood disorder in which the body fails to produce enough red blood cells MCH levels below 26 pg are considered abnormally low. Common causes of Low MCH results include blood loss, iron deficiency and microcytic anemia, which is a condition in which red blood cells are abnormally small, carrying less hemoglobin

22. Mean corpuscular hemoglobin concentration (MCHC): is the average concentration of hemoglobin per Packed red blood cells and is calculated by dividing the hemoglobin by the hematocrit . MCHC = Hb / Hct Normal range: 30-35 g/ dL ( deci is 10 -1 ) Generally, if the MCHC level is over 36%, this is considered to be too high. One reason that the MCHC level would be too high is because of spherocytosis . Spherocytosis is the presence of spherocytes in the blood. Spherocytes are types of red blood cells that contain an abnormally high amount of hemoglobin . If the hemoglobin is not stable, this can also cause the MCHC level to be too high . I f the MCHC level is below 28%, this is considered too low . The MCHC level can be too low because of blood loss over time , too little iron in the body, or hypochromic anemia. Hypochromic anemia is a condition in which the red blood cells have a decreased amount of hemoglobin

23. RDW The red cell distribution width (RDW) blood test measures the amount of red blood cell variat . A normal range for red cell distribution width is 11.9 to 15.5 percent in adult females and 11.8 to 15.6 percent in adult males. If you score outside this range, you could have a nutrient deficiency , infection , or other disorder. However, even at normal RDW levels, you may still have a medical condition.

24. MPV One of the tests run during a CBC is a mean platelet volume (MPV) test. An MPV test measures the average size of your platelets. It's closely related to a platelet count test, which measures the number of platelets in your blood. The normal result for MPV for MPV is 7.5-11.5fL for Unisex gender and for All age groups A high MPV means that your platelets are larger than average. This is sometimes a sign that you're producing too many platelets. Platelets are produced in the bone marrow and released into the bloodstream. Larger platelets are usually young and more recently released from the bone marrow. Smaller platelets are more likely to have been in circulation for a few days. low MPV means your platelets are smaller than average. Smaller platelets tend to be older, so a low MPV could mean your bone marrow isn't producing enough new ones. Again, a low MPV on its own doesn't mean anything.ve been in circulation for a few days.

25. ESR Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body. The test actually measures the rate of fall (sedimentation) of erythrocytes (red blood cells) in a sample of blood The normal range is 0-22 mm /hr for men and 0-29 mm /hr for women There are multiple causes of a high ESR test result. Some common conditions associated with high rates include: anemia kidney disease lymphoma multiple myeloma old age pregnancy A low ESR test result may be due to: congestive heart failure hypofibrinogenemia leukocytosis low plasma protein polycythemia sickle cell anemia

26. RETICULOCYTE Reticulocytes are immature red blood cells.,It’s also known as a retic count, corrected reticulocyte count, or reticulocyte index A reticulocyte count can help if your bone marrow is producing enough red blood cells. . The reference range, or healthy range, of the reticulocyte percentage in adults is 0.5 percent to 1.5 percent. High reticulocyte levels could be a sign of: acute bleeding,chronic blood loss, hemolytic anemia , erythroblastosis fetalis , also called hemolytic disease in a newborn, a potentially fatal blood disorder that affects some fetuses and newborns kidney disease Low reticulocyte levels could indicate: iron deficiency anemia aplastic anemia folic acid deficiency vitamin B-12 deficiency bone marrow failure caused by drug toxicity, infection, or cancer kidney disease cirrhosis side effects from radiation therapy

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