Investigation in hematology

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Investigation in hematology

• Chittima Sirijerachai

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Investigation in hematology

• Anemia
• Bleeding
• Malignancy

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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
• Hams test
• BM aspiration

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CBC
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Criteria for Diagnosis Anemia
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Criteria for diagnosis polycythemia
Hb Hct

• Male 18 60
• Female 17.5 55

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CBC
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Normal value
WBC 5,000 10,000 /cu.mm.
PMN 40-75
L 20-50
Eo 1-6
B 1
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Leukocyte disorders

• eosinophilia

• basophilia

• monocytosis

• leukemoid reaction

• leukemia

• leukoerythroblastic (myelophthisis)

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CBC
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CBC and RBC indices
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Reticulocyte count
Normal 0.2-2
Corrected reticulocyte Pt HCT X Reti.
Normal HCT
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Inclusion body
Heinz body
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Osmotic fragility (OF)

• Red cell 0.33 NSS
• One tube OF screening for thalassemia
• Hereditary spherocytosis

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Bone marrow aspiration

• Indication -
• Cytopenia
• Myelophthisis anemia
• Leukemia
• Lymphoma staging
• Myeloproliferative disorders
• Fever of unknown origin

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Thalassemia

• - a thalassemia
• - b thalassemia
• - hemoglobinopathy

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a thalassemia
a1 trait _ _ /aa
a2 trait _ a/aa
a1 a2 _ _ / _ a
a1 a1 _ _ / _ _
a2 a2 _ a/ _ a
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b thalassemia
b0
b
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Normal hemoglobin
a2b2 Hb A
a2g2 Hb F
a2 d2 Hb A2
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a thalassemia
b4 Hb H
g4 Hb Barts
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b thalassemia
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Heterozygote hemoglobin E
a2b2 Hb A
a2bE2 Hb E
25-35
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b thalassemia/Hb E
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Father Mother sibling 1 sibling 2
Hct 45 33 42 36
MCV 70 65 82 70
Hb typing A2A A2ABarts H A2A A2A
Hb A 96 91 97 98
Hb A2 2.2 1.4 1.1 1.5
Hb F 1.3
Hb E
Hb Barts 3.3
Hb H 7.5
Hb CS
genotype
a2 trait
a1 trait
a1a2
a1 trait
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Father mother sibling 1 sibling 2
Hct 40 40 25 45
MCV 72 84 65 85
Hb typing A2A EA EF A2A
Hb A 94 98
Hb A2 5.5 1.5
Hb F 32
Hb E 30 65
Hb Barts
Hb H
Hb CS
genotype
b trait
b /E
E trait
normal
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Investigation in patient with bleeding disorders
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Investigation

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

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CBC and platelet
Platelet
lt 20,000
Spontaneous bleeding
Bleed after minor trauma
20,000-50,000
50,000-70,000
Bleed after major trauma
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CBC and platelet
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Giant platelet
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Bleeding time

• Platelet function

• Normal 2-7 minute

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PTT
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PT
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TT
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Venous clotting time

• Normal 5-20 minute
• Prolong if clotting factor is lt5
• Small clot - hypofribinogenemia

• Clot retraction time (plt function)

• Clot lysis time

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Prothrombin time (PT)
Normal 11.6-14.4 sec
PT ratio
Normal lt 1.3
INR
ISI international sensitivity index
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Partial thromboplastin time (PTT)
Normal 34-48 sec

• Isolated PTT prolong
• F VIII, IX, XI, XII deficiency
• F VIII, IX, XI inhibitor
• Antiphospholipid syndrome

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