Title: Laboratory Diagnosis What is laboratory diagnosis
1 Laboratory Diagnosis
2What is laboratory diagnosis?
- Laboratory diagnosis is such a diagnostic process
in which the samples coming from patients blood
, body fluid , secretion , excretion , tissues
and cells are examined by using various
laboratory methods to get useful data which
may reflects body s functional status ,
pathological changes and etiological hints.
3Why to study laboratory diagnosis?
- Laboratory diagnosis is a very important part in
diagnostics. After we have finished the study of
physical diagnosis and instrument examination ,
we might be able to judge what kind of disease
this patient probably suffer from . For further
diagnosis , it is still not enough if we only
master physical examination . We have to depend
upon some laboratory data to ensure our diagnosis
.
4How to learn laboratory diagnosis?
- First, the methods used in laboratory diagnosis
are more automatic and computerized. - Second , the aim is to train for clinical
application . - For each test, referential values and clinical
significance always should be known very well.
5Chapter 1 Blood Test Blood routine test
(BRT)
- 1. content (items) of BRT
- red blood cell count (RBC)
- hemoglobin(HB)concentration determination
- total white blood cell count (WBC)
- leukocyte differential count (DC)
- platelet count (PC)
6Rferential values of BRT
- Table 1. Deferential values for blood routine
test in different age and sex - ___________________________________
- male female
newborn - ___________________________________
- RBC 4.0-5.5 3.5-5.0 6.0-7.0
- HB 120-160 110-150 170-200
- WBC 4-10 4-10 15-20
- PLT 100-300 100-300
- ___________________________________
7Table 2 Referential values of differential
count
- ___________________________________
- type percent value() absolute value
- ___________________________________
- N st 1-5 0.04-0.5
- N se 50-70 2-7
- LYM 20-40 0.8-4
- Mo 3-8 0.12-0.8
- Eo 0.5-5 0.02-0.5
- Ba 0-1 0-0.1
- ___________________________________
8Morphology of blood cells
- Red blood cell normocyte 6-9um, discocyte-
shape, no nucleus - white blood cell divided in five types
neutrophilic granulocyte neutrophil stab cell
(Nst), neutrophil segmented cell (Nse),
lymphocyte, basophil granulocyte, eosinophil
granulocyte - Platelet smallest cell in peripheral blood
9In automatic blood cell analyzer,25 items are
included together
- WBC 4.010.0x109/L
- LYM 0.8 4.0 x109 /L (2040)
- MID( middle cells) monocyte, eosinocyte,
basocyte , immature cells(rare be seen) - GRAN(granulocyte)2.07.8x109/L(5070)
- RBC4.05.5x1012/L(male),3.55.0x 1012 /L
(female) - HGB 120160 g/L (male), 110150 g /L (femal)
10-
- HCT(hematocrit)0.40.5L/L(male), 0.37 0.48
L/L (female) - MCV ( mean corpuscular volume) 8295 fl
- MCH(mean corpuscular hemoglubin) 2731 pg
- MCHC ( mean corpuscular hemoglubin
concentration) 320360 g/L - RDW ( red cell distribution width ) 11.514.5
- PLT( platelet) 100300x109 /L
- MPV ( mean platelet volume) 8.716.5 fl
- PDW ( platelet distribution width) 15.821.4
11 Clinical significance
- Anomalies of RBC and HB
- 1. decrease of RBC and HB
- Anemia When RBC and HB of individual is lower
than the referential values of the people in same
age , same sex and same area. Usually, if Hb of
adult male and female is lower than 120g/L or
110g/L respectively, they are considered as
anemia.
12According to the level of Hb, anemia is divided
into four degrees in clinic
- mild anemia Hb lt 120g/L(male) or lt
110g/L(female) - medium anemia Hb lt90 g/L
- severe anemia Hb lt60g/L
- extreme severe anemia Hb lt30g/L
13Physiological anemia
- infant and children aged between 3 months to 15
years, - pregnant women in middle or terminal periods of
pregnancy, - elderly people.
14Pathological anemia.
- decrease in synthesis of red blood cell in bone
marrow - increased destroy of red blood cell in peripheral
blood - blood loss
15Decrease in synthesis of red blood cell in bone
marrow
- disorder of hemopoiesis in bone marrow
aplastic anemia - infiltration of bone marrow by tumorous cell
leukemia, multiple myeloma , lymphoma ,
metastatic tumor - deficiency of hemopoietic materials or factors
iron deficiency anemia(IDA), megaloblastic anemia
(folic acid deficiency)
16Destroy of RBC in peripheral blood
-- hemolytic anemia
- Hereditory disease hereditory sphrocytosis
(HS) , G6PD deficiency,
thalassmia , Hb
disease - Acquired anomalies hemolysis by immunological
, physical, chemical , biological and
mechanical factors
17Blood loss --
hemorrhagic anemia
- acute blood loss acute upper digestive tract
bleeding , splenic rupture - chronic blood loss hemorrhoid, hookworm
disease, hypermenorrhea, GI tumor
18- Increase of RBC and Hb
- Comparative increase of RBC and Hb due to the
decrease of volume of plasma--severe dehydration
severe vomoting, diarrhea, severe burn - Absolute increase of RBC and Hbery-throcytosis
polycythemia vera(PV), chronic cardiopulmonary
diseases cor pulmonale, obstructive emphysema,
scarcity of oxygen. -
19- Anomalies of WBC and DC
- In most cases, increase and decrease of WBC is
chiefly depend on the numbers of neutrophil
granuiocyte in the blood. - Leukocytosis WBC is high than 10 x109 /L
- Leukopenia WBC is lower than 4 x109 /L
20- 1. Neutrophil granulocyte
- A. granulocytosis 5 causes leading to
granulocytosis - acute infection or inflammation acute pyogenic
- tonsilitis, acute appendicitis,
hematosepsis - damage or necrosis of tissue severe burn, acute
myocardiac infarction
21- acute blood loss digestive tract bleeding,
- splenic rupture
- Acute poisoning uremia, ketoacidosis
- Malignant blood diseases and tumor
- leukemia, metastatic tumor
22- Granulocytopenia
- leukopenia WBC lt 4 x109 /L
- granulocytopenia
- neutrophil granulocyte lt 1.5 x109 /L
- agranulocytopenia
- neutrophil granulocyte lt 0.5 x109 /L
23- 5 causes for granulocytopenia
- Infection of bacteria and virus typhoid,
influenza, - measles
- some physical and chemical factors drug
- autoimmune diseases systemic lupus
erythematosis (SLE), - malignant blood diseases aplastic
anemia,leukemia - hypersplenism
-
24- Changes of nucleus
- nucleus shift to left
- mild shift to left Nst gt 6 only
- medium shift to left Nst gt 10 with meta-
- myelocyte
- severe shift to left Nst gt 25 with more
- immuture cell (leukemiod reaction )
- nucleus shift to left cab be seen in acute
infection, - acute poisoning, acute hemolysis
25- Nucleus shift to right multi-segmented Nse
gt3 - 3-lobed Nse is normal segmented neutrophil in
BP - nucleus shift to right can be seen
- megaloblastic anemia
- administration of anti-metabolic drugs
-
26- 2. lymphocyte
- A . Lymphocytosis DC Lym gt 40
- Virus infection infectious mononucleosis,
- chickenpox,
- Lymphocytic leukemia ALL, AA, lymphoma
- GVHD or GVHR after BMT
27- B. lymphocytopenia
- administration of anti-tumor drugs, prednision
- radiation x-ray, r-ray , isotope
- 3. monocytosis
- malaria, black fever, TB, subacute bacterial
- endocarditis(SBE)
- monocytic leukemia, malignant histocytosis,
-
-
28- 4. eosinophilia
- allergic diseases, hypersensitive diseases
- parasites infection
- Skin diseases psoriasis
- blood diseases CML, eosinophilic leukemia,
- lymphoma
- Infectious diseas scarlatina
- Hypereosinophilic syndrome
295. Basophil granulocyte bosophilia CML,
basophilic leukemia,
myelofibrosis
30Other tests for red blood cell
- Reticulocyte count (RC)
- 0.05-0.015 (0.5-1.5)
- 24-84 x109 /L
- Reticulocytosis hemolytic anemia
- acute hemorrhagic
anemia - index of therapeutic
effect - IDA, megaloblastic
anemia
31- Reticulocytopenia
- Aplastic anemia
- leukemia
32- 2. Hematocrit(Hct)
- 0.4-0.5L/L(male), 0.37-0.48L/L(female)
- increase of Hct
- blood concentration
- water loss
- polycythemia(PV)
- decreas of Hct anemia
333. Mean values of RBC Mean corpuscular volume
(MCV) MCVHct/RBC
82-95fl Mean corpuscular hemoglubin(MCH)
MCHHb/RBC 27-31pg Mean corpuscular
hemoglubin concentration
MCHCHb/Hct 320-360g/L
34 Morphological classification of
anemia Classification MCV MCH MCHC
diseases Normocytic 82-95 27-31
320-360 AA, HA, leukemia Macrocytic gt100
gt 31 320-360 MA, pernicious
anemia Microcytic lt 80 lt
27 320-260 infection, tumor,
uremia Microcytic lt 80 lt 27
lt 320 IDA, thalassemia Hypochromic
sideroblastic
anemia
35- Erythrocyte sedimentation rate(ESR)
- 0-15mm/h (male), 0-20mm/h (female)
- higher ESR
- infection and inflammation rheumatic
diseases,tuberculosis - malignant tumor
- anemia
- damage or necrosis of tissue
- globulinemia, cholesterolemia
-
36Chapter 2. Bone MarrowExamination
- 1. Clinical application of marrow examination
- Diagnosis for hematopoietic system diseases
- leukemia, myeloma, aplastic anemia, etc
- parasite infectious diseases malaria, black
- fever
- metabolic diseases Gaucher disease. Niemann-Pick
disease
37- Indications
- Fever origin unknown (FOU)
- Cachexia
- Hepatomegaly, splenomegaly, lymphoadenovarix
- Abnormal in quantity and quality in peripheral
- blood cell
38- Contraindication
- Hemophilia
- Pyogenic infection in local skin
- Methods
- bone marrow aspiration
- bone marrow biopsy
39- Development of blood cells
- myeloblast promyelocyte
myelocyte metamyelocyte Nst
Seg - normoblast basophilic normoblast
- polychromatic normoblast
orthochromatic - normoblast erythrocyte
-
40Monoblast promonocyte
monocyte macrophage
histiocyte Megakaryoblast promega
granular Meg thrombocytogenous Meg
platelet B-lymphoblast
B-prolymphoblast B-lymphocyte
plasmablast proplasmacyte
plasmacyte
413. Regulation of blood cell development
- Cytobody from large to small,
- Mega is an exception
- Cytoplasma from less to more,
- color from blue to pink or orange red,
- granules from invisible to visible,
- granules from non-specific to specific
42- Nucleus
- from large to small, Mega is an exception,
- shape of nucleus from round to irregular,
- chromatin patten of nucleus from fine to
- coarse.
- nucleolus from existance to nonexistance
- Ration of nucleus to cytoplasma
- from bigger to smaller
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455.Contene and step of marrow examination
- Myelogram
- Low power(LP)
- Wright stain of marrow film
- plastic degree 5 classification
- Meg count 7-35/1.5x3cm2
- ousspecial cell metastatic tumorous cell
46- Oil immersion
- Nucleated cell count () 200-500
- Ratio of myeloid to erythroid (ME) 2-41
- Morpholigical description of every series
- Special cells and parasite
- Diagnosis
47- Hemogram
- Low power(LP)
- Oil immersion len differential count 100
- leukocyte (DC)
- Immature cell (nucleated cell)
- parasites
486. Normal myelogram and hemogram
- 1. Myelogram
- Normal cellularity erythrocyte nucleated cell
- ME2-41
- Granulocytic series is 40-60 in all nucleated
cells - Erythrocytic series is 20 in all nucleated cells
- Lymphocyte is 20 , monocyte is lt4 in all
nucleated cells - Meg count is 7-35, platelet is normal
- Other cell plasmacyte and histiocyte are rare
- No specific cells and parasite
-
49 Plastic degree of
marrow Plastic degree erythrocyte
nucleated diseases Extreme
hypercellularity 11
leukemia Significant hyper- 101
leukemia, ITP,
Cellularity
plastic anemia Normal
cellularity 201
anemia, normal
myelogram Hypocellularity
501 AA,agranulocy-
topenia Extreme hypocellularity
3001 aplastic anemia
50- 2. Hemogram
- DC is normal
- No nucleated red blood cell
- No immature white cell
- Platelet is normal
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537. Characters of common blood diseases in
microscope
- Iron deficiency anemia(IDA)
- Aplastic anemia(AA)
- Acute leukemia(AL)
- Chronic myelocytic leukemia(CML)
- Idiopathic thrombocytopenia purpura(ITP)
541. Iron Deficiency Anemia(IDA)
- Hemogram
- Hb , RBC , normal RC,
- RBC hypochromia, exaggeration of central
pallor to from rings, anisocytosis - normal WBC and platelet
55- Myelogram
- Significant hypercellularity
- ME
- Erythroid hyperplasia with small normoblast
- Pycnotic nuclei and scanty cytoplasma
- irregular margin
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572. Aplastic Anemia(AA)
- Hemogram
- pancytopenia Hb ,RBC , WBC ,PLT
- RC lt0.005 or absolute value lt 15 x109 /L
- RBC is normocytic
58- Myelogram
- Hypocellularity or extreme hypocellularity,
- Hematopoietic cell decrease erythroid, myeloid
- cells , meg or absent, platelet rarely
be seen - Non-hematoietic cell increase lymphocyte
- Reticular cell , plasmacyte
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603. Acute Leukemia(AL)
- FAB classification
- acute lymphocytic leukemia L1-L3
- acute non-lymphocytic leukemia M0-M7
- Hemogram
- Hb, RBC
- WBC uncertain normal, increase, decreas
- platelet
61- Myelogram
- Extreme or significant hypercellularity
- ME
- Hyperplasia of certain line
- Myeliod(M0,M1-3), monocyte(M4-5), meg(M7),
lymphocyte(L1-3) , erythroid(M6) - Depressed erythroid and meg line
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744. Chronic Myelocytic Leukemia(CML)
- Hemogram
- WBC increase rxtremly
- DC E0, Ba increas, myelocyte,
- metamyelocyte, band cell increase
- normal Hb, RBC or mild decrease
- normal plt
75- Myelogram
- Extreme hypercellularity
- ME increase
- Extreme hyperplasia of granulocyte with increas
of myelocyte, metamyelocyte, band cell, E0, Ba - Normal erythroid and Megakaryocyte
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795. Idiopathic Thrombocytopenic Purpura(ITP)
- Hemogram
- normal Hb, RBC
- normal WBC and DC
- PC decreas with abnormal morphology
80- Myelogram
- Significant hypercellulerity or normal
cellularity - Normal myeloid, erythroid line
- Significant hyperplasia of Meg.
- Impaired maturation of Meg
- Granular Meg or promeg increase
- Platelet producting Meg absent
- Platelet rarely be seen
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