1Greek work “haima” and “logos” which means study of blood
- Defined as the discipline that studies the development of cells and
diseases present in blood
Hematology
21657
Athanasius Kircher - Described worms in blood
31658
Swammerdam - Discovered erythrocytes (RBCs)
41674
Anton van Leeuwenhoek - Described size and shape of human RBCs
51842HemoglobinFocuses on regulatory enzymes and cofactors
Guilio Bizzozero - Described platelets as “petites plaques”
61846
Wharton James - Distinguished Polymorphonuclear Neutrophil (PMN) from other leukocytes
71879
Paul Elrich - Established the first complete classification of leukocytes
81902
James Homer Wright - Development of Wright Stain for cell staining
91920
Hematology was considered separate science from clinical
pathology
10Present
Automated analyzers are now able to differentiate and enumerate
cells from one another
111. Foundation in blood cell formation identification through the practice
of preparing a peripheral blood smear
2. Has the ability in serving morphology of cells
WRIGHT STAIN
12- A specialized connective tissue
- Average volume is 5 Liters (adult)
Blood
1355%
-Serum (Clotted)
-Plasma (Unclotted)
Liquid Portion
1445%
-Erythrocytes
-Leukocytes
-Thrombocytes
Cellular Portion
15Normal pH Value
pH of 7.35 – 7.45 (average of 7.40) – slightly basic
16Normal Blood Color
Arterial Blood (Oxygenated)
-Bright red (due to O2 and more alkaline or neutral/higher pH)
Venous Blood (Deoxygenated)
-Dark purplish red (due to CO2 and more acidic/lower pH
17Viscosity
3.5 – 4.5x more viscous and thicker than water
18Specific Gravity
1.0555 (due to solutes found in blood)
19Weight of Blood
78 – 85 mL of blood contributes to the per kilogram of
body weight
20Normal Blood Volume
-Male 5 – 6 L
-Female 4 – 5 L
-Newborn 250 – 350 mL
-Average blood volume in adults is 5L
21FUNCTIONS OF BLOOD
-Respiration → Oxygen and CO2
-Nutrition
-Excretory → waste products
-Buffering Action → pH (acid base balance)
-Antibodies and Endocrine Glands
-Clotting Factors (Platelets)
-Immune substances
22LAYERS OF CENTRIFUGED BLOOD
1st Layer - Fatty Layer (Not Visible)
2nd Layer - 55% Plasma/Serum (Fluid portion - Proteins)
3rd Layer - <1% Buffy Coat (Contains WBCs and platelets)
4th Layer - 45% Packed RBCs/Erythrocytes (Heaviest and most abundant)
23TWO FORMS OF LIQUID PORTION
Plasma - From unclotted blood, contain fibrinogen
Serum - From clotted blood, no presence of fibrinogen
-Fluid remains after coagulation has occurred
24COLOR CHART
Pale Yellow - Normal
Pink Slightly - hemolysis (destruction of RBCs) due to release of hemoglobin
Red - Gross hemolysis due to damage of RBCs and hemoglobin
Yellow Brown - Icteric plasma due to increased bilirubin (Bilirubinemia) – a
form of hemolysis (subject for recollection or re-extraction)
25TRANSPARENCY
Clear - Normal
Milky/Turbid: Lipemic – due to increased triglycerides (lipids, fats, and
sugars)
26- Most abundant cells in blood tissue
• Biconcave (Discoid or Discocyte)
• Anucleated in shape
• salmon pink in color
• Average 6 – 8 um in size (approx. 7.2 um)
Erythrocytes
27- Main component of RBCs; Responsible for its salmon pink or red color
Hemoglobin
28Hemoglobin is responsible for:
ponsible for:
1. Oxygen-carrying capacity of RBCs (transport and release of
gases)
2. Transport Oxygen (Oxyhemoglobin) and Carbon Dioxide
(Deoxyhemoglobin)
29- Lighter region – Shallow Depression – Area of Depression
-HgB Concentration is “Inversely Proportional” with
CENTRAL PALLOR
30Normal: 1/3 of the diameter of RBC
• Hypochromic → >1/3 (↑ central pallor; ↓ HgB)
• Hyperchromic → <1/3 (↓ central pallor; ↑ Hgb)
31RBCs loss of oxygen-carrying capacity
• (↓ RBC count, ↓ HgB level)
When HgB is low, Oxygen is low
Anemia
32an increased RBC count reflecting increased circulating
RBC mass, a condition that leads to hyperviscosity
• (↑ RBC Count)
Polycythemia
33RBC PARAMETERS
A. RBC Count
B. Hemoglobin Determination
C. Hematocrit Determination
D. RBC Indices
E. RBC Morphology
34Manual RBC Counting
-RBC Thoma Pipet
-Hematocytometer or Counting Chamber (Reported in uL or L)
-RBC Diluting Fluid (Isotonic Solution)
35Automated Cell Counters
Coulter Counter
36Method is called as the “Cyanmethemoglobin Method” (HiCN)
Hemoglobin Determination
37
o Gold standard for Hgb Determination
o Relies on a weak solution of potassium cyanide and potassium
ferricyanide, called “Drabkin’s Reagent”
o Automated Analyzers – Ionic surfactant (Detergent) sodium
lauryl sulfate to reduce environmental cyanide
Cyanmethemoglobin Method (HiCN)
38Components of Drabkin’s Reagent
1. Potassium Ferricyanide
2. Potassium Cyanide
3. Sodium Carbonate or Dihydrogen phosphate
4. Surfactant or Detergent
39- Measure parameters of a single RBC for the assessment of anemia
- Helps in determining cases of anemia
RBC Indices
404 types of RBC Indices
1. MCV
2. MCH
3. MCHC
4. RDW
41- Indicates average volume of RBCs in femtoliter (fL)
- Focuses on size of RBC
Mean Cell/Corpuscular Volume (MCV)
42- Average weight/mass of HgB in picograms (pg)
- Focuses on HgB content (pallor and color)
Mean Cell/Corpuscular Hemoglobin (MCH)
43- Average HgB concentration in RBC (% or g/dL)
- More on hemoglobin concentration (pallor and color)
- Measure HgB concentration in a single RBC; Staining
capacity of RBCs and Amount of Central Pallor (g/dL)
Mean Cell/Corpuscular Hemoglobin Concentration
(MCHC)
44- Measure of degree of variation in cell size
- Quantifies normal and abnormal RBCs
- Based on the Standard Deviation of RBC Volume/size
and is routinely reported by automated blood cell analyzers
- Measure degree of anisocytosis
Red Cell Distribution Width (RDW)
45Increased variation in RBC size (↑ RDW)
Anisocytosis
46Mature erythrocytes that have a shape other than the normal
round, biconcave appearance
• Variation in cell shape
Poikilocytosis
47Abnormal RBC shape
Poikilocyte
48- Immature form of RBC (young RBC from bone marrow) – contains RNA remnants
• In a wright stain blood film, 0.5% to 2.5% of RBCs exceed the 7 – 8
um average diameter and stain slightly (blue-gray)
Reticulocytes
49• Newly released from the bone marrow → subject to maturation in the
blood stream
“Polychromatic (Polychromatophilic) Erythrocytes”
50➔ Also called as “Supravital Stains”
➔ Are dyes absorbed by live cells (stained on its living state)
➔ Young RBCs (Retics) contain remnants
of ribonucleic acid (RNA) – Cytoplasmic RNA Remnants – in its cytoplasm
Vital Stains
51Examples of Supravital Stains
1. NMB → New Methylene Blue
2. BCB → Brilliant Cresyl Blue
3. Crystal Violet → Used for detection of Heinz bodies
52No level of oxygen in tissue that can lead to death
Tissue Hypoxia
53- Loosely related category of cell types dedicated to protecting their host
from infection and injury
- Responsible for the protection and provides immunity against infection
and/or injury
- Either transported from bone marrow or lymphoid tissue in response to
infection
Leukocytes
54PATHOLOGIC CONDITIONS
Leukocytosis - High WBC count in blood
Leukopenia - Low WBC count in blood
Leukemia - Uncontrolled proliferation of WBC
55DIFFERENT TYPES OF WBC
– SI (GA-BEN) NAGLARO NG (ML)
Granulocytes - Basophils, Eosinophils, Neutrophils
Agranulocytes - Monocytes, Lymphocytes
56- Phagocytic; contains heparin and histamines
• Release of histamines lead to inflammation
response to allergies
Basophils
57- Phagocytic; for immune system and regulation
• For parasitic infections and allergies
Eosinophils
➔ “EO” means Red
➔ “Phil” means Love
➔ Are cells with bright orange-red
58Also called as “Polymorphonuclear Nuetrophils” (PMN)
- Phagocytic; major purpose is to engulf and destroy
microorganisms and foreign materials, either directly or after they have
been labeled for destruction by the immune system
- For bacterial infection
Neutrophils
59➔ A phagocytic cells whose major purpose is to
engulf and destroy microorganisms and foreign materials
o Neutrophils (NEUTs)
o Segmented Neutrophils (SEGs)
o Polymorphonuclear Nuetrophils (PMN)
60- Slightly less mature neutrophils with a nonsegmented nucleus in a U
or S shape
Band Cells
61- Phagocytic; has the ability to identify antigens
• Matures into macrophages in tissue
Monocytes
62- Non – phagocytic; has the ability to release antibody
➔ Found in specific tissues
Lymphocytes
63- Also called as “Platelets”
- Major cells that controls hemostasis, balance between hemorrhage (bleeding) and thrombosis (clotting)
- Smallest cell in PBS with 2 – 4 um, round to oval in shape
Thrombocytes
64- Quantitative assessment of all cells in blood
Complete Blood Count
65- Assess function of platelets and clotting factors in response to injury
- Test regulatory proteins that play in coagulation
- Qualitative assessment of platelets
Coagulation Assay
66Focuses on vascular integrity and platelet response
➔ Refers to the role of blood vessels and platelets
in response to a vascular injury
Primary
Hemostasis
67Focuses on coagulation proteins in plasma
➔ Activation of a series of coagulation proteins in
the plasma
Secondary Hemostasis or
Coagulation pathway
68Focuses on regulatory enzymes and cofactors
➔ Final stage of coagulation; third system of
enzymes and cofactors digests clots to restore
vessel patency
Tertiary Hemostasis or Fibrinolysis
69TEST FOR HEMOSTASIS
1. Platelet count
2. Mean Platelet Volume (MPV) – fL
3. Prothrombin Time (PT)
4. Activated Partial Prothrombin Time (APTT)
5. Thrombin Time
6. Fibrinogen Assay
7. D-Dimer Assays