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lecture notes on hematology I, Lecture notes of Clinical chemistry

it covers the tests associated with hct, hgb, procedures and their normal values

Typology: Lecture notes

2022/2023

Uploaded on 01/26/2023

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HEMATOCRIT, ESR, & EOFT
Hematology I
BS Medical Laborator
y
Science | SEM 1 2022
Hematocrit
test that is performed based on
the principle of separating
cellular elements of blood from
the liquid part plasma
“packed cell volume”
defined as the percentage of
PCV to the total amount of blood
provides useful information
about the size and content of
rbc when correlated with other
information i.e. rbc ct, hgb conc
the numbers generated by true
tests enable to calculate rbc
indices
Methods of Hematocrit Determination
1. Macrohematocrit method
known as the wintrobe method
Wintrobe tube-special thick
walled hematocrit tube is used
a long pasteur pipet is used to fill
its contents
time consuming (seldom used)
formula:
hct % = prbc / total blood height x 100
ex. 42 / 95 x 100
= 44.2 or 44 %
44. 2 / 100 = 0.442 x 100 = 44
2. Microhematocrit method
simple procedure: requiring 2-3
drops of blood wc makes an ideal
test to follow the prognosis of
anemic px or bleeding px
special glass capillary tube is
used 1 mm in diameter & 7cm
long
capillary blood/anticoagulated
venous blood
if capillary blood- heparinized
ex. 42 % = 42 % or 42 / 100
= 0. 42
nv CU units SI units
male 41. 5-50. 4 % 0.4150.504
female 35. 9–44. 6% 0.3590.446
plasma: water, proteins, glucose,
hormones
buffy coat: leukocytes & platelets
hematocrit: red blood cells
note: the results are read at the top of
packed cell column
Hemoglobinometry
Hemoglobin
- main oxygen carrying
pigment distributed in the
body
heme- oxygen binding
pigment packed in protein
envelopeglobin
heme portion- consists of
porphyrin structure into which
Fe++ is suspended
- 98% iron exists in the
form of hemoglobin
1gm of hgb = 3.47 mg of Fe++
globin portion- protein consists
of two pairs of AA chains
- contributes about 35% of
rbc, the rest is water
hgb nv:
male-14-17.5g/
dL
female- 12.3-15.
3 g/dL
SI: 140-175 g/L
123-153 g/L
pf3
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Hematology I

BS Medical Laboratory Science | SEM 1 2022

Hematocrit ● test that is performed based on the principle of separating cellular elements of blood from the liquid part → plasma ● “packed cell volume” ● defined as the percentage of PCV to the total amount of blood ● provides useful information about the size and content of rbc when correlated with other information i.e. rbc ct, hgb conc ● the numbers generated by true tests enable to calculate rbc indices

Methods of Hematocrit Determination

  1. Macrohematocrit method ● known as the wintrobe method Wintrobe tube - special thick walled hematocrit tube is used ● a long pasteur pipet is used to fill its contents ● time consuming (seldom used) formula: hct % = prbc / total blood height x 100 ex. 42 / 95 x 100 = 44.2 or 44 %
  2. 2 / 100 = 0.442 x 100 = 44
  3. Microhematocrit method ● simple procedure: requiring 2- drops of blood wc makes an ideal test to follow the prognosis of anemic px or bleeding px ● special glass capillary tube is used 1 mm in diameter & 7cm long

● capillary blood/anticoagulated venous blood ● if capillary blood- heparinized ex. 42 % = 42 % or 42 / 100 = 0. 42 nv CU units SI units male 41. 5-50. 4 % 0.415–0. female 35. 9–44. 6% 0.359–0.

plasma : water, proteins, glucose, hormones buffy coat : leukocytes & platelets hematocrit : red blood cells

note: the results are read at the top of packed cell column

Hemoglobinometry ● Hemoglobin

  • main oxygen carrying pigment distributed in the body ● heme - oxygen binding pigment packed in protein envelope→ globinheme portion - consists of porphyrin structure into which Fe++ is suspended
  • 98% iron exists in the form of hemoglobin 1gm of hgb = 3.47 mg of Fe++ ● globin portion - protein consists of two pairs of AA chains
  • contributes about 35% of rbc, the rest is water

hgb nv: male-14-17.5g/ dL female- 12.3-15. 3 g/dL SI: 140-175 g/L 123-153 g/L

Hematology I

BS Medical Laboratory Science | SEM 1 2022

● test for hgb is performed on a free flowing capillary blood or from venous blood in EDTA ● reported as g/100 ml of blood or g/dl ● hgb can also be estimated from its oxygen combining power of the blood: 1gm hgb = 1.34 ml O ● Sahli pipet- used to contain whole blood to be diluted chemicals to lyse rbc to release hgb into the sol’n for determination (20uL)

Hemoglobin derivatives ● Methemoglobin

  • iron is in Ferric state
  • incapable of reversibly combining with oxygen
  • dark brown
  • normal conc: 1-2% ● Sulfhemoglobin
  • formed when sulfur combines with the heme of hemoglobin
  • green
  • cannot carry oxygen
  • the only hgb not measured by cyanmethemoglobin mtd
  • formed by the action of drugs i.e. sulfonamides, and presence of sulphur air
  • irreversible = remains in the carrier rbc ● Carboxyhemoglobin- formed by the exposure of normal hgb to

CO2 and CO

  • in high conc, it imparts a cherry red color to blood and skin
  • affinity of hgb for CO is more than for O2 ( times) hence, it readily combine CO even when present in low conc
  • reversible
  • normal person: 0.16 % smokers/mine workers: 1-10%

Methods of hgb determination 1.Colorimetric Method a. Direct visual colorimetric ● Tallqvist- lithographed colors correspond the hgb values ranging from 10-100 %

  • finger puncture blood placed on a piece of absorbent paper→color is matched against the color chart
  • corresponding reading is taken ● Dare- undiluted blood is spread in thin films between glass discs for direct matching
  • small glass chamber is filled with whole capillary blood→ glass chamber is illuminated by battery bulb→ color of the blood is matched with standard
  • no longer use, gives 50% error

Hematology I

BS Medical Laboratory Science | SEM 1 2022

  • drop rises to top its spec. gravity = less than the given spec. gravity 3. Gasometric Method - hgb determination based on oxygen content of blood
  • used for research purposes and for preparation of standard sol’n
  • indirect method of estimation of hgb using Van Slyke apparatus Van Slyke formula: 1 gm hgb = 1.34 ml O gm hgb= given O2 in mmHG / 1. = gm/100ml 4. Chemical Method - determines the iron content of blood a. Wong b. Kennedy formula: 1 gm hgb = 3. 47 mg Fe++ gm hgb = given mg Fe++ / 100 ml / 3. = gm/100ml 5. Hemoglobin estimation in Autoanalyzers Principle: electrical impedance principle
  • blood is diluted using reagent diluent→sodium lauryl sulphate hgb reagent is added
  • SLS : has surfactant which lyse rbc and release hgb; also reduces the turbidity developing from plasma lipids and cell membrane
  • SLS converts Ferrous (Fe+2) to Ferric (Fe+3) → forming methemoglobin→ methgb combines with SLS→ forming

SLS hemichrome molecule- absorbance of this molecule is measured at 555nm to determine haemoglobin

  • advantage: free hgb is rapidly converted to detectable chromagen decreasing the measurement time; reagent is cyanide free
  • disadvantage: false elevation is noted when there is high wbc ct (30,000/uL) 6. Portable Hemoglobinometer
  • consists of precalibrated portable battery operated spectrometer
  • no dilution is required
  • blood is run by capillary action directly into cuvette containing sodium nitrate and sodium azide which convert hgb to azide methemoglobin
  • absorbance is measured at wavelength of 565nm

Sources of error in estimation of hgb

  1. errors of sampling including presence of micro-clots in EDTA/oxalated blood due to inadequate mixing
  2. presence of excess of tissue fluid diluting the capillary blood due to squeezing in finger prick method
  3. error while diluting the blood
  4. error in estimation of color intensity
  5. improperly lysed red cells, nucleated red cells, paraproteins, lipids may give erroneous high results.

Hematology I

BS Medical Laboratory Science | SEM 1 2022

Quality control

  1. use of appropriate anticoagulant (citrate samples should not be used)
  2. sample should be checked for clots
  3. use of standards and controls in analyzers
  4. storage and stability of standard solutions should be maintained
  5. blood samples and controls must be brought to room temperature before testing samples.

Conditions with variation in hgb level

  1. Conditions where hemoglobin are raised ● Chronic obstructive pulmonary disease ● Congenital cyanotic disease of heart ● Smokers polycythemia ● Renal cell carcinoma – due to ectopic secretion of erythropoietin ● Pheochromocytoma ● Polycythemia vera ● People living in high altitude
  2. Conditions where hemoglobin is falsely raised ● Burns ● Severe dehydration ● Immediately after acute hemorrhage ● Blood taken during the intravenous infusion of iron containing drugs 3. Conditions with false anemia ● Pregnancy – due to increase in plasma volume leading to fall of 1 to 2 g/dl ● Hypervolemia – due to disproportionate increase in plasma volume and rbc vol 4. Causes for decreased hgb conc. Anemia due to: ● Blood loss ● Parasitic infection ● Drugs and lead poisoning ● Dietary deficiency (iron, copper, vitamins) ● Malabsorption of nutrients ● Chronic disease (diseases of liver, kidney and cancer) Physiological variations ● Strenuous physical exercise ● Diurnal variation – highest in morning and lowest in evening ● High altitude – increase with increase in altitude

Erythrocyte Sedimentation Rate ● measures the degree of settling of erythrocytes in plasma during a specified period of time ● useful diagnostic for hidden diseases like cancer, tb, but not specific for any particular disease ● increased in cases of TB, acute and chronic infections, acute viral hepatitis, CA, multiple myeloma, LE, pregnancy and rheumatic fever

Hematology I

BS Medical Laboratory Science | SEM 1 2022

zetacrit percent at the knee of curve (hct reader) → compute for ZSR %

- 65% markedly increased

formula: zsr % = hct / zetacrit % x 100 nv: 40-50% male & female

Erythrocyte Osmotic Fragility Test ● tests the strength of rbc of changes in the content, membrane composition or shape and withstand hemolysis in various hypotonic sol’n of NaCl ● when placed in a hypotonic sol’n , rbc tends to take in water and begin to swell; upon reaching a max. capacity of water absorption, rbc will then burst (hemolysis) ● in hypertonic sol’n , they loose fluid thereby shrink and crenate ● normal rbcs withstand dilutions of about 0.5% NaCl before they hemolyse; more fragile cells hemolyse at 0.75% NaCL ● in isotonic sol’n of 0.85% NaCl, no lysis of rbc will occur ● this test is associated with certain anemias ● increased rbc fragility (IH= tube 24, CH= tube 20) seen in hemolytic jaundice, hereditary spherocytic anemia, hereditary ovalocytic anemia and other hemolytic anemias

● decreased osmotic fragility (IH= tube 19, CH= tube 16) is associated with obstructive jaundice, iron deficiency anemia, sickle cell anemia, thalassemia, esp when many target cells are present

  1. Sanford method
  • 0.5 NaCl in 12 tubes (numbered from 25-14) → distilled water→ drop of blood each tube
  • percent salt sol’n: multiplye the tube no. by 0. ex. 25 x 0.02 = 0.50 %

first pink tinge = initial hemolysis no sediment of cells = complete hemolysis

nv: (hemolysis)

tube no. percent sol’n

IH tube 22 0. CH tube 17 0.