HEMATOLOGY  Carboxyhemoglobin

- The relatively stable combination of

1658 - Discovery of erythrocytes by Swammerdam carbon monoxide (CO) and Hb
1674 - Human erythrocytes described by - Act as asphyxiant because it will not
Van Leuwenhoek release oxygen to the tissue
1842 - Platelets were described - Can result a cherry red face

1846 - PMN (Polymorphonuclear leukocytes)  Coumadin

distinguished from other leukocytes by - trade mark for warfarin sodium
Wharton Jones - used in anticoagulant therapy
 Echinocyte
1879 - First complete classification of the leukocytes - a burr-shaped RBC
by Ehrlich - seen in RBC with metabolic depletion
1905 - Paul Morawitz - theory on blood coagulation
was accepted Abbreviations
1913 - Lee and White - whole blood coagulation time dl Decilitre
was performed DNA Deoxyribonucleic acid
1920 - Hematology was considered a separate FBC Full blood count
science from clinical pathology Fl Femtolitre
1930 - Prothrombin time determination was G6PD Glucose-6-phosphate dehydrogenase
introduced by Quick Hb Hemoglobin concentration
Hct Hematocrit
1940 - Other test for evaluating hemostatic
HH + PC/Plt
mechanism like platelet count bleeding time
HH(Hb and Hct); PC / Plt (Platelet Count)
were introduced
HDW Hemoglobin distribution width
1964 - “Cascade and Waterfall” theory was MCH Mean cell hemoglobin
introduced MCHC Mean cell hemoglobin concentration
Present - Automation has considerably improved MCV Mean cell volume
the precision and accuracy of testing MGG May-Grünwald- Giemsa
 stain for differential count
Definition of Terms HPLC High performance liquid
 Acanthocytes chromatography
- red cells resembling echinocytes with NRBC Nucleated red blood cell
pseudopods PCV Packed cell volume/ Hematocrit
- abnormal RBC pertaining to the abnormal Pg Picogram  unit of MCH
shape of RBC RBC Red blood cell count
 Anemia – a condition characterized by a RDW Red cell distribution width
deficiency in the quantity RBC and Hb RNA Ribonucleic acid
WBC White blood cell count
 Anisocytosis – abnormal variation in size of
erythrocytes Blood indices
Size of RBC 1) Mean cell hemoglobin
 Normolytic  6 – 8 m 2) Mean cell hemoglobin concentration
 Macrocytic  >8 m 3) Mean cell volume
 Microcytic  <6 m
 Aplasia – reduced cellularity in the BM with
diminished production of RBC, platelets and
PMNs
 Cabot ring
- ring or figure of eight artifact (Schleicher)
within certain ertyhrocytes
- Formerly considered remnants of the
nuclear membrane
Hematology includes the study of blood cells and
coagulation
 It encompasses analyses of the concentration,
structure, and function of cells in blood; their
precursors in the bone marrow; chemical
constituents of plasma or serum intimately
linked with blood cell structure and function;
and function of platelets and proteins involved
in coagulation
3 Major Functions of Blood
 Blood is a life-sustaining fluid which circulates
through the heart and blood vessels 1. Transport (1,3,4)
 It carries oxygen and nutrients to the tissues
and waste products to the lungs, liver and
kidneys, where they can be removed from the
body.
Characteristics of Blood
A. Volume
- This is about 6-8% of the total body weight. It
varies with the size of the person.
 Adults: 5-6 L or 60-80 ml/kg body weight
 Neonates: 250-350 ml
2. Protection (5)
B. Viscosity
- This refers to resistance to flow, stickiness in
comparison to distilled water.
- Much more dense than pure water
C. Specific Gravity
- Refers to the density of blood compared with
distilled water
 Whole blood (Men): 1.055 – 1.064
 Whole blood (Women): 1.052 – 1.060 3. Regulation (2,6,7)
 Plasma (unclotted) : 1.025 – 1.029
 Serum (clotted) : 1.024 – 1.028
D. Reaction or pH
- Slightly alkaline with pH range of 7.35 to 7.45
E. Osmolality
- This depends on the number of osmotic
particles in the blood
- Serum: 281 to 297 mosm./kg H20
Functions of Blood Composition of Blood
1. Respiratory
2. Homeostasis
3. Nutritive
4. Excretory
5. Immunity
6. Water balance regulation
7. Regulation of body temperature
8. Transportation
 Blood transport the following substances:
o Gases, namely oxygen (O2) and
carbon dioxide (CO2), between the
lungs and the rest of the body
o Nutrients from the digestive tract and
storage sites to the rest of the body
o Waste products to be detoxified or
removed by the liver and kidneys
o Hormones from the glands which
they are produced to their target cells
o Heat to the skin so as to help
regulate body temperature
 Blood has several roles in inflammation:
o Leukocytes or WBC – destroy
invading microorganisms and cancer
cell
o Antibodies and other proteins –
destroy pathogenic substances
o Platelet factors – initiate blood
clotting and help minimize blood loss
 Blood helps regulate:
o pH by interacting with acids and
bases
o Water balance by transferring water
to and from tissues
o Blood is also a good heat regulator
 Blood is classified as a connective tissue and
consists of two main components:
- Plasma, which is clear extracellular fluid
- Formed elements, which are made up of
the blood cells and platelets
Formed Elements
1. RBC / Erythrocytes
 Anucleate, biconcave, discoid cells filled
with a reddish protein, hemoglobin, which
transports oxygen and carbon dioxide
 Appear pink to red
 Measure 6 to 8 µm in diameter with a zone
of pallor that occupies one third of their
center, reflecting their biconcavity
 Anemia – means loss of oxygen-carrying
capacity and is often reflected in a reduced
RBC count or decreased RBC Hb
concentration
 Polycythemia – an increased RBC count
reflecting increased circulating RBC mass, a
condition that leads to hyperviscosity
 RBC counting – pipetting a tiny aliquot of
whole blood and mixing it with 0.85%
normal saline (matches the osmolality of
blood)
 1:200 dilution – typical for RBC counts and
a glass pipette designed to provide this
diutionThoma pipette
 Hemacytometer – glass counting chamber
where the diluted blood was transferred
2. WBC/ Leukocytes
 Dedicated to protecting their host from
infection and injury
 Nearly colorless in an unstained cell
suspension
 Same as RBC counting but the typical
dilution 1:20 and the diluent is a dilute acid
solution (causes RBC to lyse or rupture
 WBC count ranges 4500 to 11 500/ µL
 Leukopenia – decreased WBC count (fewer
than 4500/ µL)
 Leukocytosis – increased WBC count (more
than 11 500/ µL)
 Granulocytes – NEB
 Agranulocytes– Lymphocytes and
Monocytes
Types of WBCs:
a. Neutrophil
- Phagocytic cell whose major purpose is
to engulf and destroy microorganisms
and foreign material, either directly or
after they have been labeled for
destruction by the immune system
- Segmented – refers to multilobed
nuclei
- Neutrophilia– increase in neutrophil
and often signals for bacterial infection
- Neutropenia – decrease in neutrophil
and often caused by certain
medications or viral infection
b. Eosinophil
- Cells with bright orange-red, regular
cytoplasmic granules filled with
proteins involved in the immune
system regulation
- Eosinophilia – elevated eosinophil
count and often signals a response to
allergy or parasitic infection
 The distribution of eosinophils and
basophils in blood is so small compared
with neutrophil that the terms eosinopenia
and basopenia are theoretical and not
used
c. Basophil
- Cells with dark purple, irregular
cytoplasmic granules that obscure the
nucleus
- Basophil granules contains Histamine
and various other protein
- Basophilia– elevated basophil count; a
rare condition and often signals a
hematologic disease
d. Lymphocytes
- Comprise a complex system of cells
that provide for host immunity
- Recognize foreign antigens and mount
humoral (antibodies) and cell-
mediated antagonistic responses
- Nearly round, are slightly larger than
RBCs, and have round featureless
nuclei and a thin rim of nongranular
cytoplasm
- Lymphocytosis – increase in the
lymphocyte count and is associated
with viral infection
- Lymphopenia/Lymphocytopenia–
abnormally low lymphocyte count and
often associated with drug therapy or
immunodeficiency
- Also implicated in leukemia
- Chronic lymphocytic leukemia – more
prevalent in people older than 65
years
Acute lymphoblastic leukemia– most
common form of leukemia
 e. Monocyte
- An immature macrophage passing
through the blood from its point of
origin, usually in BM, to a targeted
tissue location
- Slightly larger diameter than other
WBCs, blue-gray cytoplasm with fine
azure granules, and a nucleus that is
usually indented or folded
- Monocytosis– increase in the number
of monocytes and may be found in a
certain infections, collagen-vascular
diseases or in acute or chronic
leukemias
- Macrophage
 Most abundant cell type in the
body
 More abundant than RBCs or
skin cells although monocytes
comprise a minor peripheral
blood WBCs
 Occupy every body cavity
 Some are motile and some are
immobilized
 Their tasks is to engulf and
phagocytose (engulf and
consume) foreign particles
 Assist the lymphocytes in
mounting an immune
response through the
assembly and presentation of
immunogenic epitopes
 Uncontrolled platelet and hemostatic
activation is responsible for:
o Deep vein thrombosis
o Pulmonary emboli
o Acute myocardial infarctions (heart
attacks)
o Cerebrovascular accidents (stroke)
o Peripheral artery disease
o Repeated spontaneous abortions
(miscarriages)
 Thrombocytosis – elevated platelet counts
and signals inflammation or trauma but
convey modest intrinsic significance
 Essential thrombocythemia– rare
malignant condition characterized by
extremely high platelet counts and
uncontrolled platelet production; life-
threatening hematologic disorder
 Thrombocytopenia – low platelet count and
is a common consequence of drug
treatment and may be life threatening
o Accompanied by easy bruising and
uncontrolled hemorrhage

3. Platelets / Thrombocytes
 True blood cells that maintain the blood
vessel by initiating vessel wall repairs
 Rapidly adhere to the surfaces of damaged
blood vessels
 Form aggregates with neighboring platelets
to plug the vessels
 Secrete proteins and small molecules that
trigger thrombosisor clot formation
 The major cells that control hemostasis, a
series of cellular and plasma based
mechanisms that seal the wounds, repairs
vessel walls and maintain vascular patency
(unimpeded blood flow)
 2-4 µm in diameter, round or oval,
anucleate and slightly granular