More Related Content Similar to Investigation in hematology Similar to Investigation in hematology (20) Investigation in hematology3. Investigation in patient with anemia
Specific
Initial
• Inclusion body
• CBC, blood smear
• Osmotic fragility
• Red cell indicies • Saline agglutination
• Coombs’ test
• Reticulocyte count
• Hb typing
• Ham’s test
• BM aspiration
4. CBC
-anemia
Hb, HCT
-polycythemia
-leukocytosis
WBC
-leukopenia
-abnormal cells
-thrombocytosis
Platelet
-thrombocytopenia
5. Criteria for Diagnosis Anemia
Hb.( g/dl) 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
7. CBC
-anemia
Hb, HCT
-polycythemia
-leukocytosis
WBC
-leukopenia
-abnormal cells
-thrombocytosis
Platelet
-thrombocytopenia
9. Leukocyte disorders
leukocytosis leukopenia
neutrophilia neutropenia
lymphocytosis lymphopenia
eosinophilia
basophilia
monocytosis
leukemoid reaction
leukemia
leukoerythroblastic (myelophthisis)
15. CBC
-anemia
Hb, HCT
-polycythemia
-leukocytosis
WBC
-leukopenia
-abnormal cells
-thrombocytosis
Platelet
-thrombocytopenia
17. CBC and RBC indices
80-96 fl.
27-33 pg.
33-36 g/dl
12.0-13.6%
18. Reticulocyte count
Normal = 0.2-2 %
Corrected reticulocyte = Pt HCT X Reti.
Normal HCT
26. α thalassemia
Hb A
β Hb A2
Hb F
α γ
δ
β4 = Hb H
γ4 = Hb Bart’s
30. 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
α 1 trait α 1α 2 α 2 trait α 1 trait
genotype
31. 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
β trait E trait β /E normal
genotype
34. CBC and platelet
Platelet: < 20,000 Spontaneous bleeding
20,000-50,000 Bleed after minor trauma
50,000-70,000 Bleed after major trauma
44. Venous clotting time
Normal: 5-20 minute
Prolong if clotting factor is <5 %
Small clot - hypofribinogenemia
Clot retraction time (plt function)
Clot lysis time
45. Prothrombin time (PT)
Normal: 11.6-14.4 sec
PT ratio = patient PT Normal < 1.3
Control PT
ISI
INR = patient PT
Control PT
ISI = international sensitivity index
46. Partial thromboplastin time (PTT)
Normal = 34-48 sec
Isolated PTT prolong:
•F VIII, IX, XI, XII deficiency
•F VIII, IX, XI inhibitor
•Antiphospholipid syndrome