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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
• Ham’s test
• BM aspiration
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CBC
Hb, HCT-anemia-polycythemia
WBC-leukocytosis
-leukopenia
-abnormal cells
Platelet -thrombocytosis-thrombocytopenia
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Criteria for Diagnosis Anemia
Hb.( g/dl)Hb.( g/dl) Hct (%) Hct (%)
Children 11.0 33
Male 13.0 40
Female ( 15-50 ) 12.0 36
Female ( > 50 ) 13.0 40
Pregnant women 11.0 33
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Criteria for diagnosis polycythemia
• Male 18 60
• Female 17.5 55
Hb Hct
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CBC
Hb, HCT-anemia-polycythemia
WBC-leukocytosis
-leukopenia
-abnormal cells
Platelet -thrombocytosis-thrombocytopenia
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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
leukoerythroblastic (myelophthisis)
leukemia
leukocytosis leukopenia
neutrophilia neutropenia
lymphocytosis lymphopenia
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CBC
Hb, HCT-anemia-polycythemia
WBC-leukocytosis
-leukopenia
-abnormal cells
Platelet -thrombocytosis-thrombocytopenia
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CBC and RBC indices
80-96 fl.27-33 pg.33-36 g/dl
12.0-13.6%
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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
- thalassemia
- thalassemia
- hemoglobinopathy
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thalassemia1 trait = _ _ /2 trait = _ /
1 2 = _ _ / _
1 1 = _ _ / _ _
2 2 = _ _
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thalassemia
0
+
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Normal hemoglobin
22= Hb A
22 = Hb F
2 2 = Hb A2
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thalassemia
4 = Hb H
4 = Hb Bart’s
Hb A
Hb A2
Hb F
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thalassemia
Hb A
Hb A2
Hb F
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Heterozygote hemoglob in E
E
22 = Hb A
2 = Hb E
25-35 %
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thalassemia/Hb E
E
Hb A / absent
Hb A2/ Hb E
Hb F
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Father Mother sibling 1 sibling 2
Hct 45% 33 % 42% 36 %
MCV 70 65 82 70%
Hb typing A2A A2ABart’s 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 Bart’s 3.3
Hb H 7.5
Hb CS
genotype
1 trait 122 trait 1 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 Bart’s
Hb H
Hb CS
genotype
trait E trait /E 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:< 20,000
20,000-50,000
50,000-70,000
Spontaneous bleeding
Bleed after minor trauma
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 <5 %
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 < 1.3
INR=
Control PTpatient PT
Control PTpatient PT ISI
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
Normal plasma
PTT
0 hour
2 hour
Correctable PTT Factor deficiency