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Lecture 01 - Clinical Laboratory Hematology

Lecture 01 - Clinical Laboratory Hematology - o Clinical...

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Clinical Laboratory Hematology - Automate complete blood counts (CBC) - Automated and manual leukocyte differential (Diff) - Marrow examination o Smears (how to collect and make smears) o Tissue biopsy and clot - Blood sample (anticoagulated with EDTA) o At top = serum plasma o Middle = WBC o Bottom = RBC o Hematocrit = mass cell volume (packed cell volume) Do not measure directly we just calculate Hematocrit = RBC concentration*MCV - Currently we measure the hemoglobin and the mean cell volume (volume of each red blood) - Validation of CBC o Blood counts often critical for diagnosis (most frequently ordered tests) o Automated counts are accurate and reliable, but they have limitations o Medical technologists and physicians validate automated blood counts by: Comparing with previous results Delta check; easier to detect rapid change Determining if they are physiologically possible Does it make sense logically or is there something wrong with the sample Correlate with scatterplots, histograms, blood smears, and clinical history Correlate the blood count with the blood smears To help determine what is going on - Physiologic variation o physiologic variation due to age, sex, altitude, pregnancy, time of day, posture There is variation between normal blood count between age/sex/altitude/ preg (usually lower hemogloblin count)/time of day (can vary up to 8%)/ posture (lying down & first stand up = more concentrated) o Hgb and cell counts are highest in the morning, lowest in the evening with a mean difference of 8-9% o Cell counts increase several % upon standing from a recumbent position - Normal Values Birth 1 Month 2 Years Adult Hgb gm/d L 14-24 10-14 11-14 14-17(M) 12-16(F) MCV fL 100-115 72-88 76-90 82-98 WBC K/ul 9-29 6-14 4-12 4-11 % Neuts 40-60 20-40 20-45 45-70 % Lymphs 20-40 40-70 40-60 20-40 - - There is very dramatic changes from birth to adolescent o Hemoglobin starts high at birth drops as child comes up again M/F different happens at puberty o MCV start out high drops to lower levels then comes back to normal levels o WBC starts out at high drops to normal in children – children have higher lymphocytes than adults and they have different immune system - Typical Automated Cell Counter Operation o Sample is aspirated and split into three segments to measure: White blood count (WBC) and differential after lysis of red cells (get rid of all the red cells to look at the white cells) Hemoglobin by spectrophotometry (lysis all the
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