MLS 031- HEMATOLOGY 1

BLOOD - Increased RBC count reflecting increased

circulating RBC mass
➢ Average human possesses 5 liters of blood
- Leads to hyperviscosity
➢ Transports oxygen from lungs to tissues
➢ Thoma pipette- used routinely until the
➢ Clears tissues of carbon dioxide
advent of automation
➢ Transports glucose, proteins, and lipids
➢ Hemacytometer- a glass counting
➢ Moves wastes to liver and kidneys
chamber
PLASMA
❖ RBC count in cells per microliter/cubic millimeter,
➢ Liquid portion
milliliter, liter
➢ Provides coagulation enzymes that protect vessels
❖ The first electronic counter, patented in 1953 by
from trauma and maintain the circulation
Joseph and Wallace Coulter of Chicago, Illinois,
➢ Transports and nourishes blood cells
xwas used so widely that today automated cell
3 TYPES OF BLOOD CELLS
counters are often called Coulter counters
➢ RED BLOOD CELLS (RBCs)/ ERYTHROCYTES HEMOGLOBIN, HEMOTOCRIT, AND RED BLOOD CELL INDICES
➢ WHITE BLOOD CELLS (WBCs)/ LEUKOCYTES ➢ Hemoglobin measurement relies on a weak
➢ PLATELETS (PLTs)/ THROMBOCYTES solution of potassium cyanide and potassium
HEMATOLOGY ferricyanide, called Drabkin reagent
- Study of these blood cells by expertly staining, ➢ An aliquot of whole blood is mixed with a
counting, analyzing, and recording appearance, measured volume of Drabkin reagent, hemoglobin
phenotype, and genotype of all 3 types of cells is converted to stable cyanmethemoglobin
- Able to predict, detect, and diagnose blood ➢ Color intensity is measured in spectrophotometer
diseases and many systemic diseases that affect at 540 nm
the blood cells • Hematocrit
HISTORY - Also called Packed cell volume (PCV)
1657 Athanasius Described “worms” in blood - Ratio of the volume of packed RBCs to the
KIrcher volume of whole blood
1674 Anton Van Described RBCs through
- Manually determined by transferring blood
Leeuwenhoek microscope lenses
to a plastic tube w/ uniform bore,
1800s Giulio Described platelets as “petites
centrifuging, measuring column of RBCs
Bizzozero plaques”
1902 James Homer -developed Wright Stain plus plasma.
Wright - opened a new world of visual - Normal ratio= 50%
blood film examination through • Buffy Coat
the microscope - Light colored layer between plasma and
> Wright’s Romanowsky-type RBCs (if separated)
stain - polychromatic, a mixture - Contains WBCs and platelets
of acidic and basic dyes - Excluded from hematocrit determination
➢ In present- day hematology laboratory, RBC, WBC, ❖ Medical laboratory professional may us 3
and Platelet appearance is analyzed through numerical results: RBC count, HGB, and HCT
automation or visually using 500X to 1000X light ➢ MCV (Mean Cell Volume)
microscopy stained with Wright or Wright-Giemsa - size
stain - Recorded in femtoliters (fL)
➢ MORPHOLOGY– scientific term for cell appearance - Reflects RBC diameter on a Wright-stained blood
• Cell color film
• Size ➢ MCH (Mean Cell Hemoglobin)
• Shape - Picograms (pg)
• Cytoplasmic inclusions - Expresses mass of hemoglobin per cell and
• Nuclear condensation parallels MCHC
RED BLOOD CELLS ➢ MCHC (Mean Cell Hemoglobin Concentration)
- Are anucleate, biconcave, discoid cells filled w/ a - percentage
reddish protein, hemoglobin, which transports - Expressed in grams per deciliter (g/dL)
oxygen and carbon dioxide. - Reflects RBC staining intensity and amount of
- Appear salmon pink central pallor
- Measure 7 to 8 nm in diameter ➢ RBC distribution width (RDW)
• Anemia - 4th RBC index
- Loss of oxygen-carrying capacity - Expresses the degree of variation in RBC
- Often reflected in a reduced RBC count or volume
decreased RBC o Anicytosis
• Polycythemia
 - recognize antigens and mount humoral
RETICULOCYTES (antibodies) and cell-mediated antagonistic
- 0.5-0.25% exceed the 7-8 ʮm average diameter responses.
- Stain slightly blue-gray - nearly round, slightly larger than RBCs, and have
- Young RBCs contain RNA and are called Reticulocytes round featureless nuclei and thin rim nongranular
➢ Polychromatic (Polychromatophilic) erythrocytes- cytoplasm
newly released from the RBC production • Lymphocytosis- increase, associated w/ viral
- indicate the ability of the bone marrow to increase infections
RBC production in anemia caused by blood loss or • Lymphopenia/Lymphocytopenia- decreased,
RBC destruction associated w/ drug therapy/immunodeficiency
➢ Methylene blue dyes ➢ Monocytes
- called nucleic acid stains / vital stains - is an immature macrophage passing through the
- used to differentiate and count young RBCs blood from its point of origin, usually the bone
WHITE BLOOD CELLS marrow
- Dedicated to protecting their host from infection and - most abundant cell type (macrophage)
injury - identify and phagocytize
- source: bone marrow or lymphoid tissue - blue-gray cytoplasm w/ fine azure granules, and a
- nearly colorless in an unstained cell suspension nucleus that is usually intended or folded
- visually counted using a microscope and a hemacytometer • Monocytosis- increase, benign monocytosis
• Leukopenia – decreased WBC count may be found in certain infections or in
• Leukocytosis – increased WBC count inflammation
Granulocytes Agranulocytes • Monocytopenia- decreased, seldom used
Neutrophils Lymphocytes • Leukemia- uncontrolled proliferation of a
Bands Monocytes clone of a malignant WBCs
Eosinophils ➢ Acute Myelogenous Leukemia
Basophils - common or children are at risk
➢ Chronic Myelogenous Leukemia
➢ Neutrophils - common or adults are at risk
- also called segmented neutrophils, PLATELETS
Polymorphonuclear neutrophils - or thrombocytes
- phagocytic cells - true blood cells that maintain blood vessel integrity by
- major purpose is to engulf and destroy initiating vessel wall repairs
microorganisms and foreign material - adhere to surfaces of damaged blood vessels, forms
o Segmented- multilobed nuclei aggregates with neighboring platelets to plug the vessels,
-cytoplasm: pink or lavender-staining and secrete proteins and small molecules that trigger
• Neutrophilia- increase, signals bacterial thrombosis or clot formation
infection - major cells that control hemostasis (series of cellular and
• Neutropenia- decrease, caused by certain plasma-based mechanisms that seal wounds, repair vessel
medications or viral infections walls, and maintain vascular patency.
➢ Bands/ Band Neutrophils - only 2-4 ʮm in diameter
- slightly less mature neutrophils - round or oval, anucleate, slightly granular
- non segmented nucleus ❖ MPV- Mean platelet value
- U or S shaped • Thrombocytosis- increased, signal inflammation or
• Left shift- increase in bands, signals bacterial trauma
infection • Essential Thrombocythemia- rare malignant
➢ Eosinophils condition characterize by extremely high platelet
- round, bright orange-red cytoplasmic granules counts and uncontrolled platelet production
filled w/ proteins involved in immune system • Thrombocytopenia- low platelet count,
regulation accompanied by easy bruising and uncontrolled
• Eosinophilia- elevated eosinophil count, signals hemorrhage
response to allergy or parasitic infection COMPLETE BLOOD COUNT
➢ Basophils - performed on an automated blood cell analyzers and
- dark purple, irregular cytoplasmic granules includes the RBC, WBC, and platelet measurements
- contain histamines and various of other proteins RBC WBC parameters Platelet
• Basophilia- elevated basophil count, rare and parameters parameters
often signals a hematologic disease RBC count WBC count PLT COUNT
➢ Lymphocytes HGB NEUT count: % and MPV
HCT absolute
 MCV LYMPH count: % and
MCH absolute
MCHC MONO count: % and
RDW absolute
RETIC EO and BASO countS:
% and absolute

SOURCES OF ERROR
1. wrong order of draw
2. mislabeling
3. hemolysis
4. clotted sample
ORDER OF DRAW
1. YELLOW
- blood culture
- first in order to avoid skin contamination or further
contamination to the sample
2. LIGHT BLUE
- coagulation studies
- sodium citrate
- 4 inversions
- chelates Ca
3. RED
- non additive
- for chemistry tests
- serum, clotted
• GOLD
- gel separator
- used for many samples
4. GREEN
- heparin
- blood gas (acidic/alkali)
5. LAVENDER
- EDTA (ethylenediaminetetraacetic acid)
- 8 inversions
- anticoagulant
- binds calcium