ABOUT HAEMATOLOGICAL TESTS

1. HAEMATOLOGICAL TESTS
INTRODUCTION:
 Hematology mainly involves study of blood .
 Hematology tests are performed to diagnosis many health and disease
conditions.
 Hematology tests include tests on blood, blood protein and blood
producing organs.
 The tests can evaluate a variety of blood conditions including infections,
anaemia, blood clotting disorders and leukemia.
Parameters measured:
1. Haemoglobin concentration.
2. Red blood cell count.
3. MCV ( Mean cell volume).
4. MCH ( Mean cell Haemoglobin).
5. MCHC ( Mean cell Haemoglobin concentration).
6. PCV (Packed cell volume) or Haematocrit.
7. Platelet count.
8. white blood cell count.
9. Differential white blood cell count.
10. Erythrocyte sedimentation rate.
11. C- reactive protein.
12. APTT.
13. D- Dimer
14. Total Iron binding capacity.
15. Serum B12 .

2. Haemoglobin concentration:
 Haemoglobin is the protein molecule in red blood cell that carries oxygen
from the lungs to the body tissues and return carbon dioxide from tissue
back to lungs.

3.  Haemoglobin concentration is normally greater in men than in women.
 Haemoglobin is most commonly measures to detect anemia.
Normal range : .
 Hb -11. 5 - 16.5 g/ dL
 Males : 14 - 18g/ dL .
 Females : 12 - 16g/dL At birth : 25 g/dL.
Decreased :
1. Hb is decreased in all anemias.
2. Deficiency of iron, folate, vitamin B12 .
Increased :
1.Hb is higher as a physiological response to high altitude due to low oxygen
tension.
2. Lung and cardiac disease.
3. Meloproliferative neoplasm ( polycythemia vera)
4.Medication - Ivermectin.
5. In rare genetic disease the haemoglobinopathies are detected. These
haemoglobinopathies are abnormal structure of haemoglobin.
6. Abnormal haemoglobins can be detected as Hbs (sickle haemoglobin) in
sickle cell disease.
7. And as HbA2 in beta thalassemia.
RBC count :
 RBC are produced in the bone marrow by process of erythropoiesis.
 Life span of matured RBC is 120 days.
 They are removed by reticuloendothelial system.
Normal range:
 Adults males : 4.5 - 6 million/ cumm.
 Adults female: 4-5.5 million/cumm.

4.  At birth : 6.7 million/ cumm.
Increased :
 RBC count increased in certain meloproliferative neoplasm example
polycythemia.
 At Sever dehydration RBC count decrease or increased.
 Hypoxia condition.
 Chronic airway diseases.
Decreased:
 RBC count decreased in various types of anaemia.
Variation in shapes:
 Crenation: Shrinkage in hyper tonic conditions.
 Spherocytosis: Globuylar form in hypotonic conditions.
 Elliptocytosis: Crescent shape
 Poikilocytosis: Flask, hammer shape.
Variations in size :
1. Microcytes : smaller cells.
2. Macrocytes : Larger cells.
3.Anisocytes : cells of different sizes.
Reticulocytes :
 Reticulocytes are non nucleated cells.
 Reticulocytes normally represent between 0.5 -1 percentage of total
RBC.
 Reticulocytes count may be useful in assessing the response of the bone
marrow to iron, folate or vitamin B12 therapy.
Normal value :
0.5 - 1.0 %
High reticulocytes level:

5.  Acute bleeding, chronic blood loss, haemocytic anemia, Erythroblostosis.
Low reticulocytes level:
 Iron deficiency anemia, Aplastic anemia, Folic acid deficiency, Bone
marrow failure caused by drug toxicity, cancer, kidney disease, cirrhosis,
and side- affects from radiation therapy.
Mean cell volume :
 The MCV is the average volume of a single red cell.
 Measured in femtolitres.
 Microcytic and macrocytic are indicated low and high MCV.
Normal range : ( 78-98) fL
 Normal MCV = Normocytic Anemia
 Decreased MCV = microcytic anemia
 Increased MCV = macrocytic anemia
 MCV is useful in the process of identification of various types of
anaemias such as caused by iron deficiency ( microcytic).
 Vitamin B12 Or folic acid deficiency ( Megaloblastic Or macrocytic).
Packed cell volume ( PCV) :
 The PCV also called as the Haematocrit. It is the ratio of the volume
occupied by the red cell to the total volume of blood.
 The PCV is calculated as product of MCV and RBC.
 Decreased in any sort of anemia.
 It will be raised in polycythaemia.
 Haematocrit ( HCt) is usually about 3 times the value of Hgb.
Normal range :
 males : 42 to 52 %
 Females : 37 to 47 %
Decreased :
 Decreased in all anemia
Increased :

6.  Increased in polycythaemia vera.
 Hgb is low and Hct is low in hemorrhage and anemia condition.
 Hgb is normal and Hct is low in pregnancy and overhydration.
 Hgb is normal and Hct high in dehydration.
 Hgb is high and Hct high at certain conditions like Higher altitudes,
COPD, smokers with fibrosis.
 Medication increase Hct levels clozapine, Atropine.
Mean Cell Haemoglobin:
 The MCH is the average weight of Haemoglobin contained in a red cell.
 It is measured in picograms and calculate : MCH = Haemoglobin / RBC.
 The MCH depends on the size of red cells as well as concentration of
Haemoglobin in cells.
Normal range: 27 - 32 pg/cell
 MCH levels over 34 pg are generally considered abnormally high.
 The most common reason for high MCH is the macrocytic anemia.
 MCH levels below 26 pg are considered low.
Increased:
 Increased in macrocytic anemia.
Decreased :
 MCH decreased in blood loss, Iron deficiency, Microcytic anemia.
Mean Cell Haemoglobin Concentration:
 MCHC is the measure of average concentration of haemoglobin in 100
ml of red cells.
Normal range : 30-35 g/dL
 MCHC level over 36 % considered to be high.
 MCHC below 28% considered to low.
Increased:
 Sever dehydration, spherocytosis.

7. Decreased:
 Iron deficiency
 Hypochromic anemia.
Note :
 MCHC is low called hypochromic .
 MCHC is normal called normochromic.
 MCHC in macrocytic anaemia is normal (or) only slightly reduced
because large red cells may contain more haemoglobin.
Red cell Distribution Width: (RDW)
 It measures the difference in the volume and size of RBC.
Normal range: 11- 15%.
 Used with MCV to determine types of anemia.
 High RDW and low MCV indicates iron - deficiency anemia.
 High RDW and High MCV indicates folate and vitamin B12
deficiency anemia.
WBC : .
 White blood cells are part of immune system that protects our body from
infection.

8. Normal range: 4500-10,000 cells/ml. .
 Increased White blood cells called as leukocytosis.
 Decreased white blood cells called as leukopenia.
 Increased WBC in infections and malignant disorders such as leukemia.
 Leukopenia in immune suppression condition.
Normal ranges:
 Total WBC count : 4.0-11.0 X 109
/L
 Neutrophils : 30-75% ( 1.5-4.0X109
/L)
 Lymphocytes :5-15 % (1.5-4.0X109
/L)
 Monocytes :2-10% ( 0.2-0.8X109
/L)
 Basophils : <1%
 Eosinophils : 1-6%
Neutrophils :
 Neutrophils are most abundant type of white cell. They have phagocytic
function and formed in the bone marrow from stem cell.
 Life span 10-20 days .
 Increase in presence of infection, tissue damage, and inflammation
example rheumatoid arthritis.
 Neutropenia also described as agranulocytosis .
Basophilia:
 Basophils normally constitutes small portion of white cell count.
 Basophilia occurs in various malignant and premalignant disorder such
as leukaemia and myelofibrosis.
Eosinophils :
 Eosinophils constitute normally less than 6 % of white cells.
 Their function concerned with inactivation of the mediators released
from mast cells.
 Eosinophilia occurs in many allergic conditions such as asthma, fever,
drug sensitivity reaction and some malignant disease.

9. Lymphocytes :
 Lymphocytes are second most abundant white cells in circulating blood.
 Formed in bone marrow.
 Increased in lymphocytes number occurs in viral infection such as
rubella, mumps , infectious hepatitis and infectious mononucleosis.
Monocytes :
 Monocytes are macrophages. Their number increased in some infections
such as typhoid, sub acute bacterial endocarditis, tuberculosis.
 Basophilia:Increased basophils.
 Basopenia: Decreased basophils.
 Neutropenia: Decreased neutrophils.
 Neutrophilia:Increased neutrophils.
 Lymphocytosis: Increased lymphocytes.
 Lymphocytopenia:Decreased lymphocytes.
 Agranulocytosis: lack of granulocytes.
 Aplastic: Depression of synthesis of all cell types in bone marrow.
 Eosinophilia:Increased eosinophils.
 Thrombocytosis: Increased platelets count.
 Thrombocytopenia: Decreased platelets count.
Platelet count :
 They are small discoid blood corpuscles.
Normal range : 150-450X1000 cells /mm3
Increased :
 Clonal bone marrow disorders such as myeloproliferative neoplasm.
 thrombocytosis occurs in malignancy, informatory disease and in
response to blood loss.
 Chronic inflammatory disorders, drug reaction.
Decreased :
 Pregnancy
 Viral infection

10.  Aplastic anemia, hemorrhage
 Thrombocytopenia results in spontaneous bleeding.
 Leukemia and lymphoproliferative diseases.
ESR:
Erythrocyte sedimentation rate (ESR) is a type of blood test that measures how
quickly erythrocytes (red blood cells) settle at the bottom of a test tube that
contains a blood sample. Normally, red blood cells settle relatively slowly. A
faster-than-normal rate may indicate inflammation in the body. Inflammation is
part of your immune response system. It can be a reaction to an infection or
injury. Inflammation may also be a sign of a chronic disease, an immune
disorder, or other medical condition.
If your ESR is high, it may be related to an inflammatory condition, such
as:
 Infection
 Rheumatoid arthritis
 Rheumatic fever
 Vascular disease
 Inflammatory bowel disease
 Heart disease
 Kidney disease
Sometimes the ESR can be slower than normal. A slow ESR may indicate a
blood disorder, such as:
 Polycythemia.
 Sickle cell anemia.
 Leukocytosis, an abnormal increase in white blood cells.
Normal range:
0-22mm/hr. in men
0-29mm/hr. in women
C- reactive protein:
c-reactive protein test measures the level of c-reactive protein (CRP) in a
sample of your blood. CRP is a protein that your liver makes. Normally, you

11. have low levels of c-reactive protein in your blood. Your liver releases more
CRP into your bloodstream if you have inflammation in your body. High levels
of CRP may mean you have a serious health condition that causes
inflammation.
Normal range: less than 10 mg/L
CRP test may be used to help find or monitor inflammation in acute or
chronic conditions, including:
 Infections from bacteria or viruses
 Inflammatory bowel disease, disorders of the intestines that include
Crohn's disease and ulcerative colitis
 Autoimmune disorders, such as lupus, rheumatoid arthritis, and vasculitis
 Lung diseases, such as asthma.
D-dimer test :
 D-dimer test looks for D-dimer in blood. D-dimer is a protein fragment
(small piece) that's made when a blood clot dissolves in your body.
 Blood clotting is an important process that prevents you from losing too
much blood when you are injured. Normally, your body will dissolve the
clot once your injury has healed.
 A D-dimer test is used to find out if you have a blood clotting disorder.
These disorders include:
 Deep vein thrombosis (DVT), a blood clot that's deep inside a vein.
These clots usually affect the lower legs, but they can also happen in
other parts of the body.
 Pulmonary embolism (PE), a blockage in an artery in the lungs. It usually
happens when a blood clot in another part of the body breaks loose and
travels to the lungs. DVT clots are a common cause of PE.
 Disseminated intravascular coagulation (DIC), a condition that causes
too many blood clots to form.
 Having a high D-dimer level in your blood can be a sign of a blood
clotting disorder since the level of D-dimer can rise greatly when there’s
significant formation and breakdown of blood clots in your body.