2013/09/05

OVERVIEW of Third Year

Haematology

Plus

Full/Complete Blood Count
Third years

2013-2014

OVERVIEW OF THIRD YEAR

HAEMATOLOGY

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# ...... GOOD NEWS, BAD NEWS

DATE

TOPIC
PRETEST

LECTURER

SEPTEMBER 5, 2013

PLUS
INTRODUCTION AND OVERVIEW
PLUS
CBC INTERPRETATION and FOLLOW UP

DR. S. VUMA

SEPTEMBER 12, 2013

Approach to MICROCYTIC ANAEMIAS 1:

DR. S. VUMA

PLUS
1: IRON DEFICIENCY ANAEMIA
2: ANAEMIA of CHRONIC DISEASE

(Dr K. JAIME)

SEPTEMBER 19, 2013

MICROCYTIC ANAEMIAS 2:
THALASSAEMIAS

DR. K. CHARLES

SEPTEMBER 26, 2013

MACROCYTIC ANAEMIAS
1: MEGALOBLASTIC ANAEMIA

DR. K. CHARLES

OCTOBER 3, 2013

APPROACH TO HAEMOLYTIC ANAEMIAS

DR. S. VUMA

OCTOBER 10, 2013

MACROANGIOPATHIC HAEMOLYTIC ANAEMIAS

(NB: RESEARCH DAY?)

DR K. CHARLES

OCTOBER 17, 2013

SICKLE CELL DISORDERS

DR. K. CHARLES

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# FIRST YEAR.
WHAT IS HAEMATOLOGY.!!!....???
Basics ..

# THIRD YEAR
APPLICATION of basic knowledge

Omg.How much am
I supposed to know
about this topic?

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# My job
# IS
very Simple
To simply help you to focus
To simply help with praccal applicaon

# THIRD YEAR haematology is to HELP you

FUNCTION as an INTERN!

Quizz 1 : Problem

# As discussed in class

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Making a diagnosis.
# 1-History (70%)

# (Relevant quesons, labs)

# Perform 1-2-3 to

# 2-Examinaon

A-Make the diagnosis

# 3- APROPRIATE
Laboratory invesgaons

B- Complicaons

# Conrm/refute diagnosis

C- Stage the condion

Main emphasis of Year 3!
D- Plan Therapy

Making a diagnosis
# Ability to
synthesize informaon from history, physical examinaon and
preliminary blood tests
# Provisional diagnosis

plan further invesgaons and come up with a treatment plan

# recognize clinically urgent condions

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Remember: peripheral blood components

MDSC 1002
#

(Buffy
coat)

Blood composion

Fluid component
# Plasma: contains clong factors
# Serum: no clong factors
# Proteins, electrolytes, gases,
hormones, lipids
CELLULAR component
# Red cells
# Platelets
# White cells

Granulocytes
Neutrophil
Eosinophil
Basophil
Agranulocytes
Lymphocytes
(B, T, NK cells)
Monocytes

Formed elements (cells)

# FIRST YEAR
# Described in terms of 5S
# (CBC/FILM)
NumberS

# THIRD YEAR
Special stains
Cell markers

Size
Shape
IncluSions
Staining
# Simple stains - Giemsa

# Deviaon from normal

Specic disease

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OVERVIEW OF 3rd YEAR: HAEM

(Buffy
coat)

MDSC 3311

MDSC 3312

MDSC 3313

MDSC 3314

Red blood cell disorders

Anaemias

Haemostasis/thrombosis
Transfusion medicine

Haematologic malignancies

Exposure to clinical/laboratory aspects

Covering ALL components

# MDSC3311 / 3312/ 3313
# CLERKSHIP WILL CLARIFY A LOT!!

PREREQUISITES! You have to remember material covered in MDSC 1002

Full/Complete Blood Count

Interpretaon
And
FOLLOW up invesgaons

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OBJECTIVES:
# Write down THREE things you KNOW about
CBC/FBC
# Write down THREE things you want to learn
about the CBC/FBC

# 1: Prerequisites

Objecves

# Review Peripheral blood cells/haemopoiesis (MDSC 1002)

# 2: Discuss indicaons for a CBC/FBC

# 3: Discuss blood collecon and manual and automated methods of
blood cell counng
# 4: Describe the dierent CBC parameters and recognize
abnormalies in a CBC
# 5: Interpret a CBC/FBC print out
# 6: Suggest appropriate follow up invesgaons
# 7: PLUS praccal applicaon: Clinical scenarios and correlates..!
ALWAYS
# THIRD YEAR is to HELP you FUNCTION as an INTERN!

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Objecves cont.
# PBL

# References

90
91
92

ESSENTIAL HAEMATOLOGY
# AV Horand
# JE Pet
# PAH Moss

Dr Vumas CLERKSHIP NOTES

CBC/FBC: Objecve 2
# Helps in diagnosis of
# What?
# When?
# Why?

Haematologic condions
Haematologic manifestaons of systemic
disease
# Haematology is very CENTRAL in medicine in
general

# USUALLY the FIRST POINT of CALL and

DIRECTS what FOLLOW UP invesgaons

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Blood cell counts

# In health

# In disease

# Physiological dierences

# Erroneous..!
# (pre analycal/analycal/post analycal)

Normal adult
Neonate
Older child

Age
Male/female
Pregnancy
Race/ethnic dierences

Transient
#
#
#
#

Infecon
Malignancy
Etc

Collecon technique
Ancoagulant : blood rao
Age of specimen
# (doctor control)

Exercise
Posture
Diurnal variaons
Altude

Objecve 3: Blood collecon

# EDTA specimen

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Objecve 3: The haemocytometer

Objecve 3: Automated counters

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Principles of blood counters

# Known volume of blood plus dilluent
# Lyse red blood cells
# 1) Hb (converted to HbNC)

spectrophotometrically- (Cyanhaemoglobin)

# 2) WCC

Impedance
Light scaering technology

# 3) Platelets- thresholds for platelets,

Red blood cells
White blood cells (size)
# Dierenal count

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# OBJECTIVE 2: CBC/FBC parameters

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Reference ranges (Hg g/dl)

Cord blood

13.5 20.5

First day of life

15.0 - 23.5

Chn 6months-6years

11.0 14.5

Chn 6-14years

12.0 - 15.5

Adult males

13.0 17.0

Adult females (non pregnant)

12.0 - 15.5

Females (pregnant)

11.0 14.0

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Objecve 4: FBC/CBC parameters

# Measured

Haemoglobin
Red cell count
MCV
White cell count

# Haematocrit
Measured automacally

# Packed cell volume

Measured by centrifuging the blood and
manually measuring the proporons

Platelets

# Calculated
MCH
MCHC
Hct

# RDW
# MPV and PDW
# HOW DO THESE PARAMETERS
HELP US MAKE A DIAGNOSIS?

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HCT

MCV

MCH

MCHC

F 0.32 0.48 / L

Average size of rbc

80-95

Hb content per rbc

27.5 30.5pg

Average Hb content/rbc


32-36g/dl

HCT = MCV x RCC

MCV = PCV RCC HB divided by RCC

M 0.37 0.53 / L
37 - 53 %

32 48 %

MCV-90

RCC- 5x 1012

MCV-90
RCC- 5 x 1012

HB - 15g/dL
RCC - 5 x 1012

HCT=90 x (5 x 1012 ) MCV=45 (5 x 1012 ) MCH =15g/dL

= 90
= 45%
(5x1012)

= 30pg

Hb (MCV x RCC)

HB- 1 5g/dL,
MCV- 90,
RCC - 5 x 1012 / L
MCHC =15(90x5x 1012)
= 33g/dL

Morphologic
classicaon of
anaemias

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Quizz 3

# As discussed in class: Review

Film/smear

See video on my-elearning : MDSC 3314: preparation of slides

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Quizz 4: Name the dierent cells.

Platelet
Eosinophil

Neutrophil (Band Cell)

Mature
Neutrophil
Basophil

Monocyte
Lymphocyte

Red Blood Cell

(Mature Erythrocyte)

FILM: Diagnosis ?
# (numberS)
#
#
#
#

Size
Shape
Staining
inclusionS

# SPECIAL STAINS?

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# OBJECTIVE 5 : CBC interpretaon

# OBJECTIVE 6 : Follow up invesgaons

How to interpret a CBC/FBC

# Understand the dierent parameters
# Explain normal range/reference range
# Recognize abnormal levels of the parameters
# Explain the dierent terminologies to explain abnormalies
WHAT FOLLOW UP INVESTIGATIONS TO BE PERFORMED??

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CBC interpretaon
# Quanty
Too many/much
Normal
Too few/lile

# Quality

# Appearance
Morphology
Film

# Funcon

Size
# Too big
# Normal
# Too small

# 23year old female: CBC / FBC-

Hb 6g/dl
MCV 67
Wcc- 5.9 x 109 /L
Platelets 709 x 109 /L

# Comment? Diagnosis?

Quizz 5
# Follow up invesgaons?
# Comment ?
# Film.
Abnormal red blood cell
Size - microcytosis
Shape anisocytosis, pencil cells
Staining - hypochromia

# Further invesgaons?

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Microcyc Anemia (IDA)

# 78year old man

# Lemon yellow jaundice
# FBC
Hb - 4.3g/dl
MCV - 123
Platelet 70 x 109 /L
Wcc 3 x 109 /L
# Comment?
# Diagnosis?

Quizz 6
# Comment?
# Film
RBC: Abnormal shape, size
Macrocytes
Ovalocytes
Hypersegmented neutrophils
Tear drop cells
Fragments
# Further invesgaons?

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Macrocyc Anemia (Meg.):

Quizz 7
# CBC
Hb- 21g/dL

# Comment ?

# 2day old neonate?

# 50 year old male?
Dierenal Diagnosis?
Clinical features?

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Peripheral blood components

#

Blood composion

Fluid component
# Plasma: contains clong factors
# Serum: no clong factors
# Proteins, electrolytes, gases,
hormones, lipids
CELLULAR component
# Red cells
# Platelets

(Buffy
coat)

# White cells

Granulocytes
Neutrophil
Eosinophil
Basophil
Agranulocytes
Lymphocytes
(B, T, NK cells)
Monocytes

Increased rcc / Hb :
Erythrocytosis / Polycythaemia
#

Types/causes
Relave

# (decreased uid component)

Absolute-

# Primary

Polycythaemia Rubra Vera

# Secondary-

high altude,
chronic heart/lung disease
renal tumours, etc

Eects

Hyperviscosity

# Sluggish ow
# Thrombosis

Decreased oxygen delivery

#
#
#
#

Tiredness
Weakness
Headaches
Dizziness

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Control of erythropoiesis : EPO

(Negave feedback model)
O2 detection
in kidneys

RBCs in blood

EPO

Erythropoiesis
in bone marrow

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Quizz 8
#

# 6 year old boy

Chronic diarrhoea
Anal itching

# Wcc-16 x 109/L

N-47%L-19%E-43%M-2

# Eosinophillia

Reacve or malignant
Reacve
#
#
#
#
#

Parasite infestaon
Drugs
Allergies
Skin diseases
Autoimmune diseases

Malignant
#
#
#
#

Hodgkin lymphoma
Acute leukemia
Chronic eosinophil leukemia
HES

# Further invesgaons?

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2013/09/05

Quizz 9
# 57 year old man
# Cough

Purulent, yellow sputum

# CBC

Hb 13g/dL
MCV -80
Platelet 499 x 109/L
Wbc- 31 x 109 /L

# FILM

FEATURES?

Review MDSC 1002: Haemopoiesis

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Wcc maturaon

Cell type

Growth
factors

Regulation

Function

Life span

Too much

Too few

Neutrophil

Eosinophil

Lymphocyte

Red blood
cell

Platelet

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Infecons
Bacterial

Viral

Parasites
worms

CBC

Leucocytosis

Leucocytosis

Leucocytosis

DIFF

Neutrophillia

Lymphocytosis

Eosinophillia

Left shift

Reactive
lymphocytes

Film

Toxic
granulation

Atypical
lymphocytes

Quizz 10
# CBC

HB-14g/dl
Mcv- 85
Wcc 5.7 x 109/L
Platelet 21 x 109/L

# COMMENT?

# Thrombocytopenia
1: Producon
# Bone marrow problem

2: Destrucon
# Peripheral problem

3: Distribuon
# sequestraon

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Quizz 11 cont.
# 6 year old boy
# FBC

Hb-5,3
MCV- 90
Wcc- 1,3 x 109/L
Pl- 34 x 109/L

# COMMENT?
# Producon/destrucon/distribuon..?

# As discussed in class

Follow up invesgaons?

# FILM?
# Follow up invesgaons?

Indicaons for bone marrow aspirate and trephine biopsy

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Quizz 13
# 27year old male
# CBC

HB-14g/dl
Mcv- 85
Wcc 5.7 x 109/L
Platelet 21 x 109/L

Basketball player
Previously well
No bleeding
Pre-op bloods for elecve le knee
arthroscopy

# TREATMENT/MANAGEMENT?
# EXPLAIN.!

Does the result look like the paent!!??

# We do NOT treat RESULTS.. We Treat paents!!
# Errors
Pre-analycal
Analycal
Post-analycal

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Quizz 14
#
#
#
#
#

Known sickle cell anaemia

Chest pain,
Jaundiced
Temp 390 C
FBC
Hb- 6g/dl
MCV- 95
Wcc 37 x 109/L
Platelet 372 x 109/L

# EXPLAIN.!

Take home

# Does the result look like the paent!

# Remember the principles of the CBC/FBC machine!

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Quizz 14: Follow up invesgaons

# 65 year old man
# Chronic backache

# Painful le forearm
No trauma
Fracture humerus

# CBC

Hb 8g/dL MCV 83

# FILM..?
# Follow up invesgaons..?

Mechanism of ESR?

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Invesgaons
#
#
#
#

# Bone marrow aspirate/

trephine biopsy

CBC/DIFF
Film
Rec count
ESR

Flow cytometry
Cytochemistry
Cytogenecs

# Lymph node biopsy

# Iron studies
# Folate/B12

# PT
# APTT
# BT

# X-rays, USS, CT, MRI

(Staging)

High ESR
# Inammatory condions

# Other tests?

# Collagen disease

# Eg CRP

SLE, RA

# Malignancies
Haem-

# MM, Lymphoma

Non-haematological

# Infecons
TB

# Etc etc etc

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SUMMARY

CELL TYPE

TOO FEW

TOO MUCH

ABNORMAL

Anaemia
--microcytic
--normocytic
--macrocytic

Polycythemia
Erythrocytosis

Sickle
Spherocyte
Target
Bite

WHITE

Leucopenia
--neutropenia
--lymphopenia

Leucocytosis
--neutrophillia
--lymphocytosis
--eosinophillia

Left shift
Immature
Blasts
Leucoerythroblastic

PLATELET

Thrombocytopenia

Thrombocytosis

Thrombasthenia

RED

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# Abnormal results : Disease states

THAT IS WHAT THIRD YEAR IS ABOUT!
You have to understand normal FIRST!

Assignment
# On my e-learning:
# Assignment 2
Case B, Case C, Case D

# Video: making blood lms

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