Investigation in hematology

1. Investigation in hematology
Chittima Sirijerachai

2. Investigation in hematology
•Anemia
•Bleeding
•Malignancy

3. Investigation in patient with anemia
Initial
•CBC, blood smear
•Red cell indicies
•Reticulocyte count
Specific
•Inclusion body
•Osmotic fragility
•Saline agglutination
•Coombs’ test
•Hb typing
•Ham’s test
•BM aspiration

4. CBC
Hb, HCT
-anemia
-polycythemia
WBC
-leukocytosis
-leukopenia
-abnormal cells
Platelet
-thrombocytosis
-thrombocytopenia

5. Criteria for Diagnosis Anemia
Hb.( g/dl)Hb.( g/dl) Hct (%) Hct (%)
Children 11.0 33
Male 13.0 40
Female ( 15-50 ) 12.0 36
Female ( > 50 ) 13.0 40
Pregnant women 11.0 33

6. Criteria for diagnosis polycythemia
•Male 18 60
•Female 17.5 55
Hb Hct

7. CBC
Hb, HCT
-anemia
-polycythemia
WBC
-leukocytosis
-leukopenia
-abnormal cells
Platelet
-thrombocytosis
-thrombocytopenia

8. Normal value
WBC 5,000 – 10,000 /cu.mm.
PMN 40-75 %
L 20-50 %
Eo 1-6 %
B 1 %

9. Leukocyte disorders
eosinophilia
basophilia
monocytosis
leukemoid reaction
leukoerythroblastic (myelophthisis)
leukemia
leukocytosis leukopenia
neutrophilia neutropenia
lymphocytosis
lymphopenia

15. CBC
Hb, HCT
-anemia
-polycythemia
WBC
-leukocytosis
-leukopenia
-abnormal cells
Platelet
-thrombocytosis
-thrombocytopenia

17. CBC and RBC indices
80-96 fl.
27-33 pg.
33-36 g/dl
12.0-13.6%

18. Reticulocyte count
Normal = 0.2-2 %
Corrected reticulocyte =Pt HCT X Reti.
Normal HCT

19. Inclusion body
Heinz body

20. Osmotic fragility (OF)
•Red cell + 0.33 % NSS
•One tube OF – screening for thalassemia
•Hereditary spherocytosis

21. Bone marrow aspiration
Indication :-
•Cytopenia
•Myelophthisis anemia
•Leukemia
•Lymphoma staging
•Myeloproliferative disorders
•Fever of unknown origin

22. Thalassemia
- a thalassemia
- b thalassemia
- hemoglobinopathy

23. a thalassemia
a
1
trait=_ _ /aa
a
2
trait=_ a/aa
a
1
a
2
= _ _ / _ a
a
1
a
1
= _ _ / _ _
a
2
a
2
= _ a/ _ a

24. b thalassemia
b
0
b
+

25. Normal hemoglobin
a
b
g
d
a
2
b
2
= Hb A
a
2
g
2
= Hb F
a
2
d
2
= Hb A
2

26. a thalassemia
a
b
g
d
b
4
=Hb H
g
4
=Hb Bart’s
Hb A
Hb A
2
Hb F

27. b thalassemia
ab
g
d
Hb A
Hb A
2
Hb F

28. Heterozygote hemoglobin E
a
b
E
g
d
b
A
a
2b
2= Hb A
a
2
b
E
2
=Hb E
25-35 %

29. b thalassemia/Hb E
a
b
E
g
d
Hb A / absent
Hb A
2
/ Hb E
Hb F

30. Father Mother sibling 1sibling 2
Hct 45% 33 % 42% 36 %
MCV 70 65 82 70%
Hb typingA
2
A A
2
ABart’s HA
2
A A
2
A
Hb A %96 91 97 98
Hb A
2
2.2 1.4 1.1 1.5
Hb F 1.3
Hb E
Hb Bart’s 3.3
Hb H 7.5
Hb CS
genotype
a
1
traita
1a
2
a
2
traita
1
trait

31. Fathermother sibling 1sibling 2
Hct 40 % 40% 25 45%
MCV 72 84 65 85
Hb typingA
2
A EA EF A
2
A
Hb A %94 98
Hb A
2
5.5 1.5
Hb F 32
Hb E 30 65
Hb Bart’s
Hb H
Hb CS
genotype
b traitE traitb /E normal

32. Investigation in patient with
bleeding disorders

33. Investigation
CBC, platelet count
Bleeding time
Platelet function test
Venous clotting time
Prothrombin time (PT)
Partial thromboplastin time (PTT)

34. CBC and platelet
Platelet:< 20,000
20,000-50,000
50,000-70,000
Spontaneous bleeding
Bleed after minor trauma
Bleed after major trauma

36. CBC and platelet

37. Giant platelet

39. Bleeding time
•Platelet function
•Normal: 2-7 minute

41. PTT

42. PT

43. TT

44. Venous clotting time
Normal: 5-20 minute
Prolong if clotting factor is <5 %
Small clot - hypofribinogenemia
Clot retraction time (plt function)
Clot lysis time

45. Prothrombin time (PT)
Normal:11.6-14.4sec
PT ratio=
Normal < 1.3
INR =
Control PT
patient PT
Control PT
patient PT
ISI
ISI = international sensitivity index

46. Partial thromboplastin time (PTT)
Normal = 34-48 sec
Isolated PTT prolong:
•F VIII, IX, XI, XII deficiency
•F VIII, IX, XI inhibitor
•Antiphospholipid syndrome

47. Mixing test
Patient plasma
Normal plasma
PTT
0 hour
2 hour
Correctable PTT Factor deficiency