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    Add as FriendHaematological Function Test

    by: Gaurav

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    1 : Hematological Function Tests Red and white blood cell tests
    2 : Introduction Functions and disorders of – Erythrocytes Leucocytes Anemias Interpretation & application in diagnosing and monitoring various blood disorders.
    3 : Physiology of blood cells & Bone Marrow Blood cells- pluripotential stem cells – bone marow Bone marrow- hematopoetic & reticuloendothelial organ Hematopoetic: Produces— 2.5 billion RBCs 1 billion granulocytes 2.5 billion platelets/kg B.W daily.
    4 : Hematopoiesis the proteins that stimulate hematopoesis are- hematopoietins or colony stimulating factors granulocyte macrophage csf megakaryocyte csf interleukin 2 erythropoietin thrombopoietin Inhibitors of hematopoietin are— interferons and lymphotoxins
    5 : Reticuloendothelial: processing antigens cellular immune reactions antibody synthesis recognition & removal of aging abnormal cells and particulate matter
    6 : Reticulocyte is the final cell form- development of mature RBCs- during maturation process Hb is produced and incorporated in the cell Reticulocytes persists in circulation for 1-2 days before maturing into erythrocytes
    7 : Complete Blood Count Difft cellular and non cellular components- RBC Count WBC Count Hb Hct RBC indices- MCV, MCH,MCHC Reticulocyte count RBC distribution width Platelet count and mean platelet volume CBC wth differential order- diff WBCs
    8 : Red Blood Cell Count 4.5-6.5 million cells/mm3 4.6-6.2 m/mm3 males 4.2-5.4m/mm3 Actual count of RBCs Higher in males than females— after puberty, androgen- erythropoietic stimulant Significance- below the normal range in anemias Proportionate decrease in Hb
    9 : White Blood Cell Count 4000-10,000 cells/mm3 Actual count of Leucocytes Unlike RBCs, WBCs develop in to several mature forms Various percentages of mature and immature WBCs- Differential Leucocyte count
    10 : Hemoglobin 14-18g/dL- males 12-16g/dL- females Hb indicates the oxygen carrying capacity of the blood Significance- low in anemia
    11 : Hematocrit (Packed cell volume) 42-52% males 37-47% females Hct is percentage volume of blood that is composed of erythrocytes Hct- 3times the value of Hb Disproportion can occur if cells abnormal in size or shape Significance- low in anemias
    12 : Red Blood Cell indices These tests assess the RBCs Useful in evaluation of anemias, polycythemia and nutritional disorder They assess the size and Hb content of RBC They are not measured but calculated from Hb, RBC Count, Hct using predetermined formulas
    13 : Mean Cell Volume 80-96fL-males 82-98fL- females Estimate the average vol of RBCs Derived by dividing Hct by RBC count Abnormal large cells have increased MCV- Macrocytic Vit B12 & folate defficiency cause macrocytic ery and increased MCV Increase in reticulocytes cause false increase in MCV Abnormal small cells- microcytic- iron defficiency Decrease in MCV- abnormality in Hb synthesis
    14 : Mean cell Hemoglobin 27-33pg/cell Percent value of Hb per RBC Calculated by dividing Hb/RBC Increased in folate defficiency False increase in patients with hyperlipidemia Decreased in iron defficiency anemia Low MCH corresponds with hypochromic RBCs (pale) RBCs
    15 : Mean Cell Hemoglobin Concentration 31-35g/dL or 310-350g/L MCHC is Hb divided by Hematocrit (Hct) Falsely elevated in hyperlipidemia due to specimen turbidity Low in iron deficiency anemia Low in disorders of Hb synthesis
    16 : Reticulocyte Count 0.5-2.5% of RBCs Indirect measurement of RBC production 1% of circulating RBCs is replaced daily In anemia- reticulocyte count reflects level of bone marrow production & decline in total no. of mature erythrocytes that dilute the reticulocytes
    17 : A corrected reticulocyte count- is the one , adjusted to normal Hct to eliminate the increase the count In blood loss or hemolysis- even corrected R.C is increased Untreated anemia- secondary to iron, folateor VitB12- R.C is decreased
    18 : Uses of reticulocyte count Identifying drug induced bone marrow suppression Monitor an anemic patient’s response to iron or vitamin therapy- in such cases, supplementation of lacking factor causes rapid elevation of reticulocyte count.
    19 : Red Blood Cell Distribution Width 11-16% RDW is an indication of variation in red cell volume Increase in RDW- increase in variability in (width) size of RBCs Used with other tests- diagnose iron def anemia- (early) increased RDW Not specific for iron def anemia In patients with high RDW- sugests mixed anemia - micro, macrocytic anemia.
    20 : Laboratory assessment of Anemia Anemia- decrease in either the RBC count or Hb conc. Causes- decreased prod ery increased destruction ery acute blood loss Iron,folic acid, Vit B12- normal dev of ery
    21 : Iron Metabolism - Distribution Iron-containing compounds Transport (transferrin) or storage (ferritin) Total iron concentration = 40-50 mg/kg B.W (60-75% in hemoglobin) Hemoglobin from degrading RBC is degraded in liver, spleen – iron is released. 85% of this iron is recycled – delivered to bone marrow bound to transferrin \
    22 : Iron Metabolism – Absorption Primarily in mucosa of proximal small intestine – Amount absorbed depends on Amount of iron ingested Form of ingested iron - ferric iron not easily absorbed Tissue iron stores – inversely related to amount absorbed
    23 : Iron Metabolism - Transport Major iron transport protein is transferrin. Each gram of transferrin will bind 1.4 mg of iron. Total transferrin present in plasma to bind 253-435 mg of iron/dL of plasma – Total iron-binding capacity (TIBC) Serum iron concentration is 70 – 201 mg/dL – 95% is complexed with transferrin
    24 : Increased Iron Requirements Menstruation – menstruating females have twice the daily requirements as males (2 mg/day) Pregnancy – 3.4 mg/day Infancy/childhood – rapid growth At birth, enough iron stores for 4-5 months- Milk is poor source of iron Iron supplementation recommended AFTER IRON THERPAY- 0.3 g/dL increase/day
    25 : Laboratory Assessment of Iron Serum iron levels 50-150 micro g/dL Total iron binding capacity-250-410micro g/d Serum ferritin >10-20 micro g/dL
    26 : Iron Deficiency Anemia Complete hemogram- Hb estimation: <10g/dL blood smear- micricytosis, hypochromia erythrocyte count- severity MCH: 15-26 pg, decrease MCV-60-80fL, decrease MCHC:20-30%, decrease RWD: >17.5, increase Reticulocyte: >2% after hemorrhage ESR: rare elevation TLC: leucocytopenia, bt leucocytosis after hemorrhage
    27 : Examination of feces: Intestinal blood loss, hence occult blood test Repeat test atleast 3 times on different days examination of urine: Routine exmn- normal Hematuria, kidney disease- cause for iron def anemia
    28 : Gastric juice analysis: Achlorhydria- iron def anemia May help to detect gastric carcinoma, which may lead to iron def anemia Electrophoresis of anemia: Used to rule out other causes of anemia In iron def anemia- electrophoretic pattern of Hb is normal
    29 : Determination of serum bilirubin and SGPT: Rule out cirrhosis of liver, which may lead to iron def anemia
    30 : Additional tests in iron deficiency anemia Serum ferritin: 10-20micro g/L Loss of storage iron-(liver or bonemarow biopsy) Markedly reduced in iron deficiency anemia
    31 : Serum iron 50-150micro g /dL total iron binding capacity 250-410microg/dL Serum iron conc measures iron bound to transferrin this value represents about 1/3rd of the TIBC of transferrin The TIBC measures the iron binding capacity of transferrin protein In iron def anemia,TIBC is increased due to increase in transferrin synthesis
    32 : Megaloblastic Anemia Enlarged erythrocytes Causes Vit B12 & folic acid deficiencies Inadequate dietary intake Defective production of intrinsic factor Defective or deficient absorption of the intrinsic factor- vitamin B12 complex Pernicoius anemia- lack of intrinsic factor
    33 : Laboratory findings for Vit B12 defciency anemia
    34 : Cause of Vit B12 deficiency Schilling test urinary excretion test: 2 stages Regular test: Patient ingests cobalt labl Vit B12- after 1 hr 1000micro g Vit B12 injected, IM- Oral admn Vit B12 excreted in urine- absorption after oral dose thus calculated. Normal conditions 8-40% absorption Inference- if test shows deficient absorption, then test with intrinsic factor
    35 : Stage 2: Determine whether lack of intrinsic factor or defect in ileal absorption Oral Vit B12 is given concomitantly with oral intrinsic factor( usually derived from pork) If absorption difficulty is resolved- lack of intrinsic factor Otherwise different investigations Bacterial overgrowth from small intestine Inflammatory bowel disease
    36 : Folic Acid deficiency Anemia Necessary for DNA synthesis Adult daily req- 50micro g, 400 micro g – food folates Cause– inadequate diet defective absorption
    37 : Laboratory findings of folic acid deficiency anemia
    38 : Hemolytic anemia
    39 : Immune causes of hemolytic anemia Coombs test: direct antiglobulin test (DAT)
    40 : Anemia of chronic disease anemia-accompanies infections– inflammatory traumatic disease- last for 1-2 months Chronic illnesses- T.B, endocarditis, pelvic infl disease, osteomyelitis- associated with anemia Normocytic, normochromic anemia
    41 : Erythrocyte sedimentation rate 1-15mm/hr males 1-20mm/hr females Not used for any specific diagnosis May help in confirming the diagnosis Useful in monitoring inflammatory conditions ESR is higher when disease is active and falls when intensity of disease decreases
    42 : Laboratory findings of anemia
    43 : Conditions that alter ESR
    44 : THANK YOU!@

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