Hematology Review : Hematology Review By
Felicia Magee Tardy, M.S.,
Department of Clinical Pathology
University of Mississippi Medical Center
Jackson, Mississippi Introduction : Introduction Hematology: the study of blood and blood forming tissues.
Blood consists of 55% plasma and 45% formed elements.
Formed elements include erythrocytes, leukocytes, and thrombocytes. Erythrocytes : Erythrocytes Normal range 4.2-5.5 million per mm3 in adults.
Diameter 7 microns.
Cells for transport of O2 and CO2.
Life span 120 days. Leukocytes : Leukocytes Normal range 4 - 11 thousand per mm3 in adults.
Size 8-20 microns.
Involved in fighting infection, combatting allergic reactions, and immune responses. Thrombocytes : Thrombocytes Smallest cells in the blood.
Normal range 130,000-400,000.
Active role in coagulation and hemostasis. Routine Hematology : Routine Hematology Anticoagulant of choice: EDTA
Complete Blood Counts (CBCs)
Manual WBC Differentials
Erythrocyte Sedimentation Rates (ESRs)
Reticulocyte Counts Automated Counting : Automated Counting Coulter Principle
Electrical impedance: resistance or change in current when cell passes between two electrodes in NaCl solution. Automated Counting : Automated Counting Flow Cytometry
Uses lasers to measure both forward and side scatter.
Forward scatter measures size.
Side scatter measures granularity. Sources of Error : Sources of Error Inadequate mixing of specimen.
Platelet clumps or platelet satellitosis.
Diluted specimens. Know Normal Ranges!!! : Know Normal Ranges!!! WBC
BASOPHILS Erythrocytic Maturation Series : Erythrocytic Maturation Series Rubriblast
Erythrocyte RBC Morphology : RBC Morphology Elliptocytes Target Cells : Elliptocytes Target Cells Tear Drops Stomatocytes : Tear Drops Stomatocytes Sickle Cells Schistocytes : Sickle Cells Schistocytes RBC Inclusions : RBC Inclusions Howell-Jolly Bodies : Howell-Jolly Bodies Round, purple inclusions in RBCs.
Composed of DNA.
Commonly seen in in patients with hypofunctioning spleens.
Splenectomy. Basophilic Stippling : Basophilic Stippling Numerous, small purple inclusions in RBCs.
Aggregates of ribosomal RNA.
Most commonly seen in lead poisoning. Pappenheimer Bodies : Pappenheimer Bodies Clusters of dark blue granules, irregular in size and shape.
Composed of iron and ribosomal RNA.
Seen in sideroblastic and hemolytic anemias. Classifications of Anemias : Classifications of Anemias Microcytic, Hypochromic
Chronic disease, Inflammation
Thalassemia trait Microcytic, Hypochromic : Microcytic, Hypochromic Many RBCs smaller than
nucleus of normal
lymphocytes, increased central pallor.
Iron deficiency, thalassemias, anemia of chronic disease. Classifications of Anemias : Classifications of Anemias Normochromic
Acute blood loss Classifications of Anemias : Classifications of Anemias Macrocytic
Vitamin B12 deficiency
Liver disease Macrocytic RBCs : Macrocytic RBCs Most RBCs larger than nucleus of normal
lymphocytes, increased MCV.
Folate or Vitamin B12 deficiencies, alcoholism, and liver disease. Reticulocytes : Reticulocytes Immature RBCs.
Reticulum stains blue using a supravital stain (new methylene blue).
Counted and expressed as % of total red cells. Reticulocyte Count : Reticulocyte Count Uses supravital stain which stains cells in the living state.
Retic % = # retics per 1000 RBCs
Corrected retic= % retics x pt. HCT
45 Hemoglobinopathies : Hemoglobinopathies Beta Chain Substitutions
Hgb S: Valine for glutamic acid
(6th position, beta chain)
Hgb C: Lysine for glutamic acid
(6th position, beta chain) Hemoglobinopathies : Hemoglobinopathies Alkaline Electrophoresis
- C S F A +
E G O WBCEvaluation : WBCEvaluation MyelocyticMaturation Series : MyelocyticMaturation Series Myeloblast
Segmented Neutrophil Toxic Granulation : Toxic Granulation Increased basophilic granules
Seen in severe infections, burns, malignancies, and pregnancy.
Distinguish from basophils. Dohle Bodies : Dohle Bodies Sky blue inclusions in cytoplasm of neutrophils.
Seen in infections, burns, myleproliferative disorders, and pregnancy.
Composed of RER and glycogen granules. Pelger-Huet Anomaly : Pelger-Huet Anomaly Special Stains : Special Stains PAS: ALL, Erytrholeukemia
LAP: CML v. Leukomoid Reaction
Myeloperoxidase: AML, AMMoL (weak+)
Sudan Black: AML, AMMoL (weak+)
Specific Esterase: AML, AMMoL
Non-specific Esterase: AMML, AMoL
TRAP: Hairy Cell Leukemia
Prussian Blue: Sideroblastic Anemia CML versusLeukomoid Reaction : CML versusLeukomoid Reaction Characteristic CML Leukomoid
LAP score Decreased Increased
Toxic gran. Decreased Increased
Dohle bodies Absent Present
Philadelphia May be present Absent
chromosome WBC Disorders : WBC Disorders Alder-Reilly: Large azurophilic granules, increased mucopolysaccharides
Chediak-Higashi: Membrane defect of lysosomes, large primary granules in segs
May-Hegglin: Familial disorder with large platelets and Dohle bodies
Pelger-Huet: Hyposegmented neutrophils FAB Classifications : FAB Classifications M1: Myeloblastic without maturation
M2: Myeloblastic with maturation
M5a: Monocytic, poorly differentiated
M5b: Monocytic, well differentiated
M6: Erythroleukemia, DiGuglielmo’s
M7: Megakaryoblastic Acute Myeblastic Leukemia (M1) : Acute Myeblastic Leukemia (M1) Chronic MyelogenousLeukemia : Chronic MyelogenousLeukemia FAB Classifications : FAB Classifications L1: Small, uniform lymphoblasts
L2: Large, pleomorhphic lymphoblasts
L3: Burkitt’s type (vacuolated and
deeply basophilic cytoplasm) Acute Lymphoblastic Leukemia : Acute Lymphoblastic Leukemia Chronic Lymphocytic Leukemia : Chronic Lymphocytic Leukemia Body Fluids : Body Fluids Types of Body Fluids : Types of Body Fluids Cerebrospinal Fluid (CSF)
Miscellaneous Fluids Body Fluids Testing : Body Fluids Testing Physical examination
RBC and WBC counts
*Refers to synovial fluids only. Cerebrospinal Fluid (CSF) : Cerebrospinal Fluid (CSF) Examined to determine the presence of meningitis or intracranial hemorrhage.
Multiple tubes drawn (4).
Differentiate between traumatic tap and intracranial hemorrhage.
Xanthochromia is indicative of intracranial hemorrhage. Quick Review : Quick Review Differentiate between traumatic tap and intracranial hemorrhage.
Differentiate between transudate and exudate.
Crystal identification and associated conditions. Traumatic Tap v. Intracranial Hemorrhage : Traumatic Tap v. Intracranial Hemorrhage Traumatic Tap
Decreasing amounts of blood with each tube drawn
May contain clots
Supernatant clear Intracranial Hemorrhage
Blood evenly distributed throughout collection tubes
Hemosiderin, hematoidin crystals Transudates v. Exudates : Transudates v. Exudates Characteristic Transudate Exudate
Appearance Clear, colorless Yellow, turbid, purulent, bloody
Specific gravity <1.015 >1.015
Protein <3 g/dL >3 g/dL
LD <200 IU >200 IU
Cell count <1000/uL >1000/uL
Conditions Congestive Infections,
Heart failure Malignancies Crystal Identification : Crystal Identification Monosodium urate (uric acid)
Yellow when parallel to the compensator, and blue when perpendicular.
Seen in gout.
Blue when parallel to the compensator, and yellow when perpendicular.
Seen in pseudogout. Crystal Identification : Crystal Identification Good Luck!!!! : Good Luck!!!!