HEMATOLOGY
Jane Finley, BS MT (ASCP)
Nov 1, 2004
HEMATOLOGY AND LAB LANGUAGE
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Blood
Serum
Plasma
Erythrocytes (RBC)
Granulocytes (WBC)
Platelets (Plt)
Lab Language: Hematology Testing
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Complete Blood Count (CBC)
Erythrocyte Sedimentation Rate (ESR)
Sickle Cell Screening
Hemoglobin Electrophoresis
Ferritin
Iron
Total Iron Binding Capacity (TIBC)
Transferrin
Lab Language : CBC
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Hemoglobin
Hematocrit
RBC
WBC
Plt ct
RDW
MCV
MCH
MCHC
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Segmented Neutrophil
Lymphocyte
Monocyte
Eosinophil
Basophil
Reticulocyte
Reticulcyte Production
Index (RPI)
Complete Blood Count
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White Blood Count (WBC)
Red Blood Cell Count (RBC)
Platelet Count (Plt)
Hemoglobin (Hb or Hgb)
Hematocrit (Hct)
Red Cell Indices (MCV,MCHC,MCH)
Red Cell Distribution Width (RDW)
Differential Count (Diff)
CBC Differential -WBC
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Segs
Lymphs/Atypical
Mono’s
Eo’s
Baso’s
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Bands
Metamyelocyte
Myelocyte
Promyelocyte
Blast
CBC Differential-RBC
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Anisocytosis
Microcytes
Macrocytes
Nucleated RBC
Howell Jolly Bodies
Basophilic Stippling
Hypochromia
Riticulocytes
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Poikilocytosis
Teardrop
Ovalocytes
Helmet cells
Sickle Cells
Cell Counts:
Number of cells per liter of whole
blood
WBC
4.5-11.0 x 109/L
RBC
Males: 4.3-5.7 x1012/L
Females: 3.8-5.1 “
Plt
150-400 x109/L
Terms
Leukocytosis
Erythrocytosis
Erythropenia
Thrombocytosis
Thrombopenia
Hemoglobin
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Heme + protein (globulin)
Main purpose is to carry O2
Three main types
Variants result in identifiable disorders
Normal ranges are age and gender
related
Hematocrit
• Packed Cell Volume
• Measures what percentage of whole
blood is represented by RBC
• Compares RBC and hemoglobin
• Normal ranges are age and gender
related
Lab Language: Red Cell Indices
• MCV- Mean Corpuscular Volume
• MCH-Mean Corpuscular Hemoglobin
• MCHC-Mean Corpuscular Hemoglobin
Concentration
• RDW-Red Cell Distribution Width
Mean Corpuscular Volume (MCV)
The average size (volume) of an RBC.
 MCV (in fL) = (hematocrit x 10)
(rbc count [in millions/µL])
 Normal values:
80-100 fL
The MCV is a useful tool in the differential
diagnosis of anemia
Mean Corpuscular hemoglobin (MCH)
 The average hemoglobin content of a RBC.
 Normal values: 26-34 pg.
 MCH (in pg) = hemoglobin x 10
rbc count
Mean Corpuscular Hemoglobin
Concentration (MCHC)
 The percentage of a RBC's volume which
contains hemoglobin.
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Normal values: Usually between 31-37%.
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MCHC may be decreased with severe iron
deficiency anemia.
 MCHC [in g/dL] = hemoglobin [in g/dL]
hematocrit [in L/L]
RED CELL DISTRIBUTION WIDTH
(RDW)
• Degree of Red Cell size variability in a
blood sample
• Coefficient of variation of the size of the
RBCs
• Expressed as %
• Derived from automated instruments
that can directly measure the MVC
• Normal: 11-15 %
Using the RBC Indices
• MCV reveals the average size of the
RBCs
• RDW reveals a variation in size among
the RBCs
• MCHC reveals how much of the cell is
being taken up by hemoglobin
• Together can reveal anemia or
physiologic disorders that affect quality
of life
Lab Language: Indices
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Anemia
Microcytic
Macrocytic
Hypochromic
normochromic
ERYTHROCYTOSIS
• Polycythemia vera
• Secondary Polycythemia
-COPD
-Inappropriate stimulation of
erythropoietin, such as tumors
• Relative Polycythemia
-dehydration,
-severe burns
ERYTHROPENIA (ANEMIA)
• Anemias - may result from:
– chronic or acute blood loss
– decreased synthesis
– increased destruction or
decreased survival
• dilutional effect:
– postural (lower in
recumbent position)
– overhydration
Anemia Classifications
• Microcytic, hypochromic
• Microcytic, normochromic
• Normocytic, normochromic
• Macrocytic, normochromic
NORMOCYTIC, NORMOCHROMIC ANEMIA
• MCV normal
• MCHC normal
• Examples:
– acute blood loss
– aplastic anemia
– most leukemia's
– bone marrow infiltration
MICROCYTIC, HYPOCHROMIC ANEMIA
• MCV decreased
• MCHC decreased
• Examples:
– iron deficiency
– thalassemia
– lead poisoning
– anemia of chronic disease
MICROCYTIC, NORMOCHROMIC ANEMIA
• MCV decreased
• MCHC normal
• Examples:
–mid-stage iron deficiency
–thalassemia
MACROCYTIC, NORMOCHROMIC ANEMIA
• MCV increased
• MCHC normal
• Examples:
– folate deficiency
– vitamin B12 deficiency
– pernicious anemia
Hemoglobin & Hematocrit
Normal Ranges
• Cord blood:
- Hb - 16.5 ± 3 g/dl
- Hct - 51 ± 9 %
• 0.5-2 years:
- Hb: 12.0 ± 1.5g /dl
- Hct - 36 ± 3 %
• 12-16 yrs:
Female:
-Hb 14.0 ± 2 g/dl
-Hct 41 ± 4%
Male:
-Hb 14.5 ± 1 g/dl
- Hct 43 ± 6%
Hemoglobin & Hematocrit
Adult Normal Ranges
– Male:
Hb 15.5 ± 2 g/dl
Hct 47 ± 6%
–Female: Hb 14.0 ± 2 g/dl
Hct 41 ± 5%
RULES OF THREE
• Used for quality control
• Hb X 3 = Hct ± 3%
• RBC X 3 = Hb
• Hct X 100,000 = RBC
Complete Blood Count
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White Blood Count (WBC)
Red Blood Cell Count (RBC)
Platelet Count (Plt)
Hemoglobin (Hb or Hgb)
Hematocrit (Hct)
Red Cell Indices (MCV,MCHC,MCH)
Red Cell Distribution Width (RDW)
Differential Count (Diff)
CBC 1
RBC
5.25 x 10[12]/L
HGB
15.4 g/dL
HCT
46.1 %
MCV
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MCH
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MCHC ______
RDW
_____
CBC 1
RBC
5.25 x 10[12]/L
HGB
15.4 g/dL
HCT
46.1 %
MCV
87.9 fL
MCH
29.3 pg
MCHC 33.4 g/dL
RDW
12.2
CBC 1
CBC 2
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
3.71 x 10[12]/L
5.9 g/dL
20.9 %
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CBC 2
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
3.71 x 10[12]/L
5.9 g/dL
20.9 %
56.2 fL
15.9 pg
28.3 g/dL
20.2
CBC 2
CBC 3
RBC
HGB
HCT
MCV
MCH
3.36 x 10[12]/L
10.9 g/dL
31.2 %
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MCHC
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CBC 3
RBC
HGB
HCT
MCV
MCH
MCHC
3.36 x 10[12]/L
10.9 g/dL
31.2 %
92.8 fL
32.4 pg
34.9 g/dL
CBC 3
CBC 4
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
1.26 x 10[12]/L
5.7 g/dL
16.3 %
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18.1
CBC 4
RBC
HGB
HCT
MCV
MCH
MCHC
1.26 x 10[12]/L
5.7 g/dL
16.3 %
130 fL
45.2 pg
34.9 g/dL
CBC 4