1、实验诊断学血液一般检验lectureWhat does a complete blood count measure?What does a complete blood count measure?RBCWBCPltRBC(erythrocyte)=Red blood cell Hb=Hemoglobin Hct=Hematocrit WBC(leukocyte)=White blood cell DC=Differential count Plt(thrombocyte)=Platelet *How to collect a complete blood count sample?Samp
2、le collection -Site -Strict aseptic technique -？Blood Service Clinical Laboratory the First Affiliated Hospital EDTA-K2CBC：不凝固的人血：不凝固的人血How to interpret complete blood count results?Normal values:4 10109/L2 水潴留 （血浆容量大，红细胞容量正常，但红细新生儿 (6.RBC HbIn emotional stress(anxiety)chronic myelocytic leukemia Bo
3、ne marrow causesb减少：应用肾上腺皮质激素、免疫缺陷性疾病等。肤病、某些恶性肿瘤及传染病等。variation or how PregnancyThe RDW is a numerical indication of this morphologic abnormality.Leukopenia Bone marrow causeshematonosisaccord with the change oftuberculosis0)1012/L 110 150 g/Lcertain medicationsRBC(erythrocyte)=Red blood cell Hb=Hem
4、oglobin Hct=HematocritReference value RBC Hb成年男性成年男性 (4.0 5.5)1012/L 120 160 g/L 成年女性成年女性 (3.5 5.0)1012/L 110 150 g/L 新生儿新生儿 (6.0 7.0)1012/L 170 200 g/L 1.RBC&Hb贫血贫血(anemia)Thalassemia1）Hematocrit，Hct(packed cell volume，PCV）2.Other Red cell indices Elevated or lowered Hct is accord with the change o
5、f RBC,so the clinical significance of HCT can refer to the RBC and Hb0.55*Remember Plasma 在某些病理情况下在某些病理情况下,Hb和和RBC的浓度不一定的浓度不一定能正确反映全身红细胞总容量的多少。能正确反映全身红细胞总容量的多少。1 大量失血（主要是血容量的缩小，血浓度变化很大量失血（主要是血容量的缩小，血浓度变化很 少，从少，从Hb等数值上等数值上很难反映出贫血很难反映出贫血）2 水潴留水潴留 （血浆容量大，红细胞容量正常，但红细（血浆容量大，红细胞容量正常，但红细 胞浓度低，胞浓度低，表面看有贫血表面
6、看有贫血）3 失水失水 （血浆容量小，浓度偏高，（血浆容量小，浓度偏高，有贫血也看有贫血也看 不出不出）Hb对贫血程度的判断上优于对贫血程度的判断上优于RBC计数。计数。useful in diagnosing the type of anemia g/Lsideroblastic anemiamuch efforts.肤病、某些恶性肿瘤及传染病等。Thalassemia疾病如再障、物理化学因素如接受射线、血细胞自动化分析原理：Bone marrow causesPolycythemia veravenipunctureHigh Platelet Count(Thrombocytosis)Ga
7、ussian distributionMalignant tumorThalassemia PregnancyHow to interpret complete blood count results?much efforts.2）TOTAL LEUKOCYTE COUNT(TLC)splenomegalyThalassemiaendocarditisuseful in diagnosing the type of anemiaThese cells exhibit a large variation in size.The RDW is a numerical indication of t
8、his morphologic abnormality.This value indicates the degree of red cell size variation or how much difference exists between the largest and smallest red cells.（2）轻型-珠蛋白生成障碍性贫血（C）：直方图图形表现为小峰左移，峰底变窄，典型的小细胞均一性贫血。不同类型贫血红细胞体积分布直方图exists between Bone marrow causesthe First Affiliated Hospital不出）肤病、某些恶性肿瘤
9、及传染病等。How to interpret complete blood count results?useful in diagnosing the type of anemiaEosinophil(Eo)In emotional stress(anxiety)Normal values:4 10109/LThis valuesideroblastic anemia少，从Hb等数值上很难反映出贫血）the largest andOther Red cell indicesThe RDW is a numerical indication of this morphologic abnorm
10、ality.much differencemegaloblastic anemiaCell histogram：2）TOTAL LEUKOCYTE COUNT(TLC)法国法国ABX血球计数仪血球计数仪Micros60 Leukocytosis acute infection certain medications haemolytic diseasesPhysiological high Pregnancy(infant)In the afternoon than in the morning In emotional stress(anxiety)After strenuous exerc
11、iseNormal values:4 10109/LLeukopenia certain infection autoimmune chemotherapy,radiation therapy Neutrophil(Ne)Lymphocyte(Ly)Eosinophil(Eo)Basophil(Ba)Monocyte(Mo)DIFFERENTIAL LEUKOCYTE COUNTClinical Significance Ne：a增多：如增多：如急性感染或炎症急性感染或炎症、急性溶血、失血、粒、急性溶血、失血、粒 细胞白血病等。细胞白血病等。b减少：感染性疾病如病毒感染及伤寒、血液系统减少：感
12、染性疾病如病毒感染及伤寒、血液系统 疾病如再障、物理化学因素如接受射线、疾病如再障、物理化学因素如接受射线、单核巨噬细胞功能亢进等。单核巨噬细胞功能亢进等。Ly：a增多：感染性疾病如增多：感染性疾病如病毒感染病毒感染、肿瘤性疾病、肿瘤性疾病、及移植排斥反应等。及移植排斥反应等。b减少：应用肾上腺皮质激素、免疫缺陷性疾病等。减少：应用肾上腺皮质激素、免疫缺陷性疾病等。(50 70)(20 40)M：a.增多：某些感染如感染性心内膜炎等、增多：某些感染如感染性心内膜炎等、血液病如单核细胞白血病等。血液病如单核细胞白血病等。b.减少：无重要临床意义。减少：无重要临床意义。Eo：a.增多：增多：变态反
13、应性疾病、寄生虫病、皮变态反应性疾病、寄生虫病、皮 肤病、肤病、某些恶性肿瘤及传染病等。某些恶性肿瘤及传染病等。b.减少：无重要临床意义。减少：无重要临床意义。Ba：a.增多：见于慢性粒细胞白血病、骨髓增多：见于慢性粒细胞白血病、骨髓 纤维化、变态反应性疾病等纤维化、变态反应性疾病等。b.减少：无临床意义。减少：无临床意义。(3 8%)(0.5 5%)(0 1%)4）PlateletCauses of thrombocytopenia:Viral infection Idiopathic thrombocytopenic purpura(ITP)Medications DIC Liver di
14、sease Autoimmune disease Hypersplenism Pregnancy Bone marrow causes Partially clotted sample Platelet clumping in the blood collection tubeHigh Platelet Count(Thrombocytosis)Malignant tumor Polycythemia vera SplenectomyHb对贫血程度的判断上优于RBC计数。neutrophilia不同类型贫血红细胞体积分布直方图b减少：感染性疾病如病毒感染及伤寒、血液系统减少：无重要临床意义。O
15、ther Red cell indicesHow to perform a complete blood count test?新生儿 (6.PregnancyNormal values:4 10109/Lbone marrow fibrosisCell histogram：Ne：a增多：如急性感染或炎症、急性溶血、失血、粒（4）叶酸及维生素B12缺乏引起的巨幼细胞性贫血（D）：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。血细胞自动化分析原理：Normal values:4 10109/L增多：见于慢性粒细胞白血病、骨髓What does a complete blood count
16、measure?exists betweenNormal platelet counts are not a guarantee of adequate function.How to perform a complete blood count test?Comparing Manual and Automated cell countersaccord with the change ofuseful in diagnosing the type of anemiavenipuncturePlt(thrombocyte)=Plateletsmallest red cells.（4）叶酸及维
17、生素B12缺乏引起的巨幼细胞性贫血（D）：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。Blood Service Clinical Laboratory纤维化、变态反应性疾病等。Normal values:4 10109/Lindicates the不同类型贫血红细胞体积分布直方图rheumatic disease疾病如再障、物理化学因素如接受射线、Polycythemia vera Bone marrow causesof HCT can refer to the RBC Autoimmune diseaseuseful in diagnosing the type of anemi
18、aThe RDW is a numerical indication of this morphologic abnormality.In the afternoon than in theEosinophil(Eo)Normal values:4 10109/L-Strict aseptic techniqueWBC(leukocyte)=White blood cell DC=Differential countautoimmune细胞白血病等。simplified the practice of haematology,made possible肤病、某些恶性肿瘤及传染病等。不同类型贫血
19、红细胞体积分布直方图Leukopeniaaccord with the change ofSample collection Bone marrow causes（3）铁粒幼细胞性贫血（B）：直方图显示红细胞呈典型的“双形”性改变（即同时存在着两类型的红细胞，一种是小细胞低色素性红细胞，另一种是正常形态的红细胞），故出现波峰左移、峰底增宽的双峰。After strenuous exercise（4）叶酸及维生素B12缺乏引起的巨幼细胞性贫血（D）：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。Other Red cell indicesElevated or lowered Hct is
20、单核巨噬细胞功能亢进等。Ne：a增多：如急性感染或炎症、急性溶血、失血、粒Polycythemia vera阴性结果阴性结果阳性结果阳性结果向临床报告向临床报告WBC分类分类全部手工操作全部手工操作 20-40%60-80%太多的太多的工作量工作量!工作量少工作量少 报告迅速报告迅速simplified the practice of haematology,made possiblesome additional parameters to be determined withoutmuch efforts.1.血细胞自动化分析原理：血细胞自动化分析原理：1）三分类：）三分类：电阻法原理（电
21、阻法原理（Coulter Counter.）Wallace Henry Coulter(1913-1998)2）五分类技术：为基于流式通道的三维分析技术）五分类技术：为基于流式通道的三维分析技术COULTER PRINCIPLE 2.Cell histogram：-X轴：体积（fL）-Y轴：相对数量1）WBC/BASO histogram2）Red cell histogram Gaussian distribution MCV&RDW下面下面介绍介绍几种贫血时图形变化：几种贫血时图形变化：v（4）叶酸及维生素）叶酸及维生素B12缺乏引起的巨幼细胞性贫血（缺乏引起的巨幼细胞性贫血（D）：直方）
22、：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。给予叶酸或图波峰右移，峰底增宽，显示明显的大细胞不均一性。给予叶酸或维生素维生素B12后，正常红细胞逐步释放入血液，而病理细胞并未完全后，正常红细胞逐步释放入血液，而病理细胞并未完全消亡，检测时即再出现双峰形，说明治疗有效。消亡，检测时即再出现双峰形，说明治疗有效。v（3）铁粒幼细胞性贫血（）铁粒幼细胞性贫血（B）：直方图显示红细胞呈典型的）：直方图显示红细胞呈典型的“双双形形”性改变（即同时存在着两类型的红细胞，一种是小细胞低色素性改变（即同时存在着两类型的红细胞，一种是小细胞低色素性红细胞，另一种是正常形态的红细胞），故出现波峰左移、峰
23、底性红细胞，另一种是正常形态的红细胞），故出现波峰左移、峰底增宽的双峰。在缺铁性贫血经治疗有效时，也可出现类似的图形，增宽的双峰。在缺铁性贫血经治疗有效时，也可出现类似的图形，但峰底要更宽些。但峰底要更宽些。v（2）轻型）轻型-珠蛋白生成障碍性贫血（珠蛋白生成障碍性贫血（C）：直方图图形表现为小）：直方图图形表现为小峰左移，峰底变窄，典型的小细胞均一性贫血。峰左移，峰底变窄，典型的小细胞均一性贫血。v（1）缺铁性贫血（）缺铁性贫血（A）：典型呈小细胞性贫血，其特点为曲线波）：典型呈小细胞性贫血，其特点为曲线波峰左移（峰左移（MCV降低），峰底变宽（降低），峰底变宽（RDW增高），显示小细胞不均
24、增高），显示小细胞不均一性。一性。不同类型贫血红细胞体积分布直方图 成年女性 (3.useful in diagnosing the type of anemiaThalassemiaComparing Manual and Automated cell countersPolycythemia verasimplified the practice of haematology,made possible Pregnancyaccord with the change ofmuch efforts.Clinical Significance Basophil(Ba)Blood Service
25、 Clinical Laboratorysideroblastic anemiaHow to perform a complete blood count test?1）三分类：电阻法原理（Coulter Counter.sideroblastic anemiaLymphocyte(Ly)Partially clotted sampledisseminated intravascular coagulation PregnancyEosinophil(Eo)How to perform a complete blood count test?High Platelet Count(Thromb
26、ocytosis)-Strict aseptic techniquesimplified the practice of haematology,made possiblevariation or howPolycythemia veraElevated or lowered Hct istuberculosis5)1012/L 120 160 g/Lcertain medications下面介绍几种贫血时图形变化：1）WBC/BASO histogramchronic myelocytic leukemiasideroblastic anemiaindicates thetuberculos
27、isexists betweenb减少：感染性疾病如病毒感染及伤寒、血液系统增多：某些感染如感染性心内膜炎等、血液病如单核细胞白血病等。Normal values:4 10109/L2）TOTAL LEUKOCYTE COUNT(TLC)Cell histogram：exists between Idiopathic thrombocytopenic purpura(ITP)Eosinophil(Eo)How to perform a complete blood count test?the First Affiliated HospitalOther Red cell indices肤病、
28、某些恶性肿瘤及传染病等。How to interpret complete blood count results?dengue infectionsmuch efforts.成年女性 (3.useful in diagnosing the type of anemiaOther Red cell indices细胞白血病等。新生儿 (6.不同类型贫血红细胞体积分布直方图the largest andMalignant tumor肤病、某些恶性肿瘤及传染病等。useful in diagnosing the type of anemia给予叶酸或维生素B12后，正常红细胞逐步释放入血液，而病理
29、细胞并未完全消亡，检测时即再出现双峰形，说明治疗有效。smallest red cells.Cell histogram：Sample collection2）Red cell histogram增多：见于慢性粒细胞白血病、骨髓aplastic anemiaindicates theautoimmuneHow to perform a complete blood count test?useful in diagnosing the type of anemiaSample collectionendocarditis血细胞自动化分析原理：b减少：感染性疾病如病毒感染及伤寒、血液系统3)RB
30、C Distribution Width，RDW不同类型贫血红细胞体积分布直方图Normal platelet counts are not a guarantee of adequate function.blood transfusionsimplified the practice of haematology,made possible肤病、某些恶性肿瘤及传染病等。Other Red cell indicesuseful in diagnosing the type of anemiab.exists betweenBasophil(Ba)疾病如再障、物理化学因素如接受射线、Thala
31、ssemia PregnancyWBC(leukocyte)=White blood cell DC=Differential count及移植排斥反应等。（4）叶酸及维生素B12缺乏引起的巨幼细胞性贫血（D）：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。2）TOTAL LEUKOCYTE COUNT(TLC)Cell histogram：How to perform a complete blood count test?much efforts.erythropoietinbone marrow fibrosisbone marrow fibrosisrheumatic disea
32、se增多：见于慢性粒细胞白血病、骨髓accord with the change ofVocabulary venipuncture syringe iodine perspire pica hydration therapy erythropoietin aplastic anemia haemolysis megaloblastic anemia sideroblastic anemia rheumatic disease steroid typhoid malaria tuberculosis dengue infections lupus neutrophilia leukemia neutropenia hematonosis cortin endocarditis chronic myelocytic leukemia bone marrow fibrosis bone marrow fibrosis blood transfusion disseminated intravascular coagulation Aspirin testosterone splenomegaly sideroblastic anemia
