Haematology - the basics

Function of blood

Transport oxygen around the body Transport nutrients to the cells of the body Remove waste products from the body Defend the body from infection

Constituents of blood

A typical adult body contains 5 litres of blood. 3 litres is plasma the rest is cells Plasma

90% is water 10% is proteins, electrolytes, glucose, lipoprotiens (LDL + HDLs), hormones and vitamins Red Blood Cells White Blood Cells Platelets

Cells

How blood cells are made

Cells are formed by a process called haemopoiesis In the fetus cells are formed in the liver and spleen In neonates cells are formed in all the bones In adults cells are formed in the large flat bones, sternum and ribs and at the end of long bones, femur

Red blood cells

Red blood cells (RBCs) are also known as erythrocytes In an adult male there are about 5,200,000 per microlitre of blood RBCs make up about 40-45% of the blood this number is known as the hematocrit The ratio of RBCs/WBCs/platelets 600/1/40 During formation the RBC loses its nucleus and leaves the bone marrow as a reticulocyte in then matures into an erythrocyte. At this point hemoglobin production stops In humans the life of the RBC is about 120 days. They are removed in the liver and spleen

Red blood cells

RBCs are structurally the the simplest cells in the body Their primary function is to transport oxygen through the body. To do this they use hemoglobin. In addition they remove CO2 from the cells

White Blood Cells

White blood cell (WBCs) are also known as leucocytes In an adult there are about 7000 per microlitre of blood. Their numbers increase in response to infection. There are 5 main types of leucocyte
Neutrophils Eosinophils Basophils (granolocyte) Lymphocytes Monocytes 40-75% 1-6% 0-1% 20-45% 2-10%

Neutrophils

Neutrophils attack bacteria by ingesting it (phagocytosis). They can attack 5 20 bacteria in their lifetime They are present in the pus of wounds Increasing numbers of neutrophils mean a bacterial infection is present

Eosinophils

Eosinophils attack parasites and They play a role in allergy reactions and phagocytise antigen complexes

Eosinophils

Eosinophils attack parasites and They play a role in allergy reactions and phagocytise antigen complexes

Basophils

Basophils function in allergic reactions They release histamine which makes blood vessels leak are attarct WBCs They release heparin to stop clotting and allow WBCs to reach bacteria

Lymphocytes

Lymphocytes are group complex cells that direct the immune system They include

B lymphocytes produce antibodies Helper T cells interact with macrophages NK, Natural killer attach viruses

Monocytes

After maturation in the bone marrow they enter the blood stream for about 24 hours. They then enter the connective tissue where they become macrophages. They move to areas of inflammation and phagocytosize damaged, old and dead cells They also secrete interferon and other substances which function in the immune system.

Platelets

They are not true cells but cellular fragments of a large cell called a megakaryocyte In an adult there are about 250,000 per microlitre of blood. Platelets stick together to form a platelet plug to help in the clotting process. They contain many chemicals to assist in clotting.

Blood cell indicies

Examination of number and distribution of blood cells provides information about the patient condition. Conditions known as anaemis result in low numbers of RBCs High numbers of white cells indicates infection or serious disease The patients blood cell counted is compared against normal ranges. Blood cell counts are presented in the form of standardised parameters or indicies

RBC (millions/l)
Hb - Haemoglobin concentration (g/dl) MCV - Mean Cell Volume (fl) MCH - Mean Cell Hb (pg)

Calculated (Hb x 10)/RBC Calculated Hb/PCV x 100

MCHC - Mean Cell Hb Concentration

Hct - hematocrit , PCV (%)

Proportion of blood made up of red cells

Calculated RBC x MCV

RDW Red cell distribution width

WBC (thousands/l)

Neutrophils Eosinophils Basophils Lymphocytes Monocytes

(thousands/l) (thousands/l) (thousands/l) (thousands/l) (thousands/l)

% % % % %

Platelet count - (thousands/l) MPV - Mean Platelet Volume (fl)

A CBC is requested for

Diagnostic evaluation of disease states

Diagnose various cancer conditions Diagnose and classify anemia Detect parasitic infections Identify bleeding disorders Detect allergic conditions Recognize specific nutritional deficiencies Confirm a diagnosisand Identify a definitive course of treatment

Pre-operative screening General health screening Measure the effect of drug treatment

Monitor therapy