1、 Laboratory Diagnostics (Blood Examinations) Mei Huang(黄梅黄梅), M.D., PhD. Dept. of Hematology, Tongji HospitalDefinition: Clinical practice to collect the laboratory information for the purpose of prevention, diagnosis, treatment and prognosis evaluation Laboratory diagnostics and clinical ecsomatics
2、(检验学检验学)Progress of laboratory diagnostics and imaging are two major driving forces for the modern medicineImportance of laboratory diagnostics: Evidence Based Medicine (循证医学循证医学)Blood = Blood cells + PlasmaBlood = Blood cells + Plasma ContentsContents Examination of blood cells and Examination of b
3、lood cells and clinical relevance clinical relevanceCompositionThe average person has about 5 liters of blood that may be separatedInto 3 liters of plasma and 2 liters of cellsThe normal adults blood volume is estimated at 1/19 of his total bodyWeight or about 80mililiters per kilogram BW The plasma
4、 is a liquid derived from the intestines and organsOf the bodyMajor components: proteins and peptides, lipids, glucose, enzymes, bioactiveSubstances, salts, trace elements and H2OYolk sacFetal liver Bone marrowSpleen Blood cells are produced in bone marrowThe bone marrow, located in the medullary ca
5、vity of bone, is the sole sites for effective hematopoiesis. HSCL-progenitorcM-progenitorPre-BPre-TLymphoidMyeloidDCTBPlasma CellNKCFU-GMCFU-MEGBFU-ECFU-EMegERYGRANMONOGRANMONOMegTMENRBCPlateletB?Stem cells/progenitor cellsstromal cells, hematopoietic growth factors and hematopoietic cells Erythrocy
6、tes (red blood cells, RBC)Leukocytes (white blood cells,WBC)1.Granulocytes(granular leukocytes) Neutrophil Eosinophil Basophils2. Mononuclear Cells(MNC, or agranulocytes) Lymphocytes MonocytesThrombocytes or plateletsRBC:Platelet:WBC= 500:30:1NeutrophilBasophilEosinophilMonocytes/MacrophageComponent
7、s of blood cells BNEMQuantity of the blood cells or percentageQuality of the blood cellsMale adult 120-160g/L 4.0-5.5x10/LFemale adult 110-150g/L 3.5-5.0 xNeoborn: 170-200g/L 6.0-7.0 x10Red blood cellsIncrease of RBC(erythrocytosis) Polycythemia1. Concentrated blood (plasma): dehydration caused by d
8、iarrhea, burn or diabetic keto-acidosis2. Secondary polycythemia: Hypoxia in COPD, congenital heart diseases; elevation of blood erythropoitin (EPO) in renal disorders or in certain tumours3. Polycythemia vera: A myeloproliferative disease, may progress to leukemia or myelofibrosis.Red blood cellsRe
9、duction of RBC (Anemia)RBC, Hemoglobin (Hb), Hematocrit (Hct)Mean corpuscular volume (MCV)Mean corpuscular hemoglobin (MCH)Red blood cell volume distribution width,RDWEvidences for hypoproliferative anemia1 RBC,Hb2 Reticulocyte2 Hypocellularity in BM3 Hemopoietic tissueEvidences for DNA/Hb synthesis
10、 disturbance1 RBC, Hb2 RBC size and chromatic change3 Underlying disease4 Morphology of BM cells5 Biochemical parametersEvidences for RBC destructionEvidences for RBC destruction1 RBC, Hb1 RBC, Hb2 Ret2 Ret3 Erythroid3 Erythroid hyperplasia in BM hyperplasia in BM5 Jaundice (unconjugated Bilirubin5
11、Jaundice (unconjugated Bilirubin) )6 Free bilirubin6 Free bilirubin in plasma in plasma血红蛋白异常血红蛋白异常珠蛋白链质的异常量的异常Hemolysis caused by hemoglobinopathy 1 Hemoglobin electrolysis 2 HbA2, HbF quantitation assay 3 Heinz test Hemolysis by RBC membrane or enzyme abnormality 1 RBC osmotic fragility 2 Self hem
12、olysis and incubation 3 HAM test 4 Coombs testChanges in RBC size & morphologyMicrocyticMacrocyticNormocyticAnisocytosisReticulocyte0.5%-1.5%Or 24-84x109/LWBC Count & DifferentialWBC 4000-10000Neu 50-70%Eosin 0.5-5%Baso 0-1%Mono 3-8%Lymph 20-40% Neutrophilia1 Infection or inflammation2 Stress reacti
13、on3 Myeloproliferative disorderes4 Non-hemopoietic malignancy原粒早幼粒中幼粒晚幼粒杆状 二叶 三叶 四叶 五叶未成熟过渡型成熟型1:13 正常 核左移 核右移 Nuclear shift Toxic granulesDifferential of leukemoid reaction with CML 类白 慢粒病因 有 无临床表现 原发病 脾大WBC 中 特高BASO/EOSIN 正常 高骨髓 感染 粒系NAP 高 低Ph1 染色体 阴性 阳性 Neutropenia1 Viral infection2 Typhoid fever
14、3 Severe bacterial infection, sepsis4 Hemopoietic disease 5 Physic/chemical6 Hypersplenism7 Immune-mediatedEosinophilia1 Allergy & hypersensitivity2 Lymphoma3 Other malignancy4 Parasite infection5 Idiopathic eosinophiliaBasophilia1 Chronic myelogenous Leukemia(CML)2 Myelofibrosis3 Chronic hemolysis4
15、 SplenoectomyLymphocytosis1 Physiological2 Infections3 Lymphoblastic leukemia & lymphoma4 Graft rejection5 Recovery period of acute infectionLymphocytopenia1 Drugs: cytostatic, steroids, anti-lymphocyte antibody or ATG2 Radiation3 Immune deficiency: AIDSMonocyteMacrophage Monocytosis1 Infections wit
16、h cellular immune2 Blood disorders3 Recovery period of myelosuppressionPlateletMorphologyPlatelet countThrombocytosisThrombocytopeniaFunctionThrombocytosisThrombocytosisMPD,post-operation, bleedingThrombocytopeniaThrombocytopenia1 Marrow failure2 infection3. Chemical/radiation3 Folic acid/VitB12 deficiency4 Consumptive: DIC, TTP5 Destruction: ITPCan you interpret the blood routine report?
