MT-HEMA 1.

1 (Hematology) LEC milliosmoles per kilogram for adults

and older adults; 275 to 290 mOsm/kg
Historical Developments and General for children
Characteristics of Blood  Increased or decreased osmolality calls
for evaluation of the patient’s fluid
Hematology and electrolyte balance.
 Branch of medical science concerned with the  The normal range for serum osmolality
diseases of blood and blood- forming tissues is 280-300 mOsm/kg.
Blood  Above normal values may indicate
 Vital, life-sustaining fluid circulating in a closed conditions such as dehydration,
system of blood vessel and the heart hyperglycemia, diabetes insipidus,
 It is composed of different kinds of cells hypernatremia, uremia and renal
(occasionally called corpuscles): these formed tubular necrosis
elements of the blood constitute about 45% of 6. Specific gravity – ratio of the density of
the whole blood and the other 55% is blood a substance to that of a standard
plasma, the blood’s liquid medium which substance (water)
appears yellow in color.  Whole blood – 1.052-1.061
 The systemic circulation provides the  Plasma – 1.022-1.026
functional blood supply to all body tissue. It  The specific gravity (relative density)
carries oxygen and nutrients to the cells and of human whole blood and plasma from
picks up carbon dioxide and waste products. 25 healthy volunteers was determined
 It carries oxygenated blood from the left gravimetrically. For whole blood it was
ventricle through the arteries to the capillaries found to be 1.0621 (95% confidence
in the tissues of the body interval; 1.0652-1.0590) at 4°C and
1.0506 (95% confidence interval:
1.0537-1.0475) at 37°C).
7. Volume/amount
 Blood volume is the volume of blood
(red blood cells and plasma) in the
circulatory system of any individual
and is regulated by kidney.
 20% of the extracellular fluid
amounting to 8% of the total body
mass
 Blood volume is 5L to 6L (1.5 gal) in
an average sized adult male and 4L
to 5L (1.2 gal) in an average sized
adult female
 Newborn’s blood volume in 250-
350mL of the total blood volume

 Characteristics of Blood  Normovolemia – normal blood volume

1. Color  Hypervolemia – increased blood
 Arterial – bright red or bright scarlet volume
red color (high oxygen content) o Excessive fluid intake
 Venous – very dark red (low oxygen o Blood transfusion
content) o IV injection of fluids
2. Reaction  Hypovolemia – decreased blood
 Alkaline pH 7.35-7.45, average 7.4 volume
 pH is controlled by the buffer system o Loss of blood (bleeding or
of the blood hemorrhage)
3. Viscosity o Loss of erythrocytes (hemolytic
 Whole blood – 4.5 to 5.5 times as anemias)
viscous as water, more resistant to o Loss of plasma (severe burns)
flow than water o Loss of body fluids (diarrhea,
4. Temperature - 37°C (98.6°F) LBM, excessive sweating)
5. Osmolality
 Measure of how much one substance  Functions
has dissolved in another substance. 1. Transportation
The greater the concentration of the  Respiration
substance dissolved, the higher the  Nutrient carrier from GIT
osmolality  Transportation of hormones from
 Very salty water has higher osmolality endocrine glands
than water with just a tint of salt.  Transports metabolic wastes
 A normal result is typically 275 to 295 2. Regulation
  Regulates pH
 Adjusts and maintains body
temperature
 Maintains water content of cells 1. Blood Plasma
3. Protection  When the formed elements are
 WBC protects against disease by removed from the blood, straw-
phagocytosis colored liquid called plasma is left.
 Reservoir for substances like water, Plasma 91.5% water and 8.5% solutes,
electrolyte etc. much of which (7%) are proteins.
 Performs haemostasis  Some of the proteins in plasma are
 Blood Composition also found elsewhere in the body but
1. Whole blood includes those confined to the blood are called
erythrocytes, leukocytes, plasma proteins.
platelets, and plasma.  These proteins play a role in
When a specimen is maintaining proper blood osmotic
centrifuges, leukocytes pressure which is important in total
and platelets make up body fluid balance.
the buffy coat (small  Most plasma proteins are synthesized
layer of cells lying by the liver, including the albumins
between the packed (54% of plasma proteins), globulins
RBCs and the plasma) (38%) and fibrinogen (7%).
2. Plasma is the liquid portion of unclotted 2. Formed elements
blood that has been treated with  They are so named because they are
anticoagulants. Serum is the fluid that enclosed in a plasma membrane and
remains after coagulation, therefore have a definite structure and shape.
devoid of clotting factors such as  All formed elements are cells, broadly
fibrinogen. classified as RBCs, WBCs, except for
platelets, which are tiny fragments of
bone marrow cells.
Red blood cells (erythrocytes)
 Anucleate, biconcave, discoid cells filled with a
reddish protein, hemoglobin, which transports
oxygen and carbon dioxide
 Appear pink to red and measure 6-8µm in
diameter
 They have a zone of pallor (whites in RBCs)
that occupies one-third of their center
 RBCs counted in measured volumes can detect
anemia or polycythemia
 Anemia – loss of oxygen-carrying capacity and
is often reflected in a reduced RBC count or
decreased RBC hemoglobin concentration.
 Polycythemia – increased RBC count
reflecting increased circulating RBC mass, a
condition that leads to hyperviscosity.
 RBC indices
- For the computation of RBC indices, three
numerical results—RBC count, Hgb and Hct
(packed cell volume) may be used.
- Part of the complete blood count (CBC) test.
They are used to help diagnose the cause of
anemia, a condition in which there are too
few RBCs.
 units) is 32-37 g/dL (SI units) 320-
370 g/dL
o A measure of the average
concentration of Hgb in g/dL
o Reflects RBC staining intensity and
amount of central pallor
o Calculate using Hgb and Hct values

o MCHC (g/dL) =
H gb ( dLg ) x 10 0
Hct
a. 32-37 g/dL MCHC indicates normochromic
RBCs
b. Lesser than (<) 32 g/dL MCHC indicates
hypochromic RBC, which is seen in
iron deficiency anemia
- MCV (Mean Corpuscular Volume)
c. Greater than (>) 37 g/dL MCHC indicates
o Reference range (SI/Conventional possible error in RBC or Hgb
units) is 80-95 femtoliters (fL), measurement, or the presence of
newborn 96-180 fL spherocytes
o An indicator of the average/mean
 Other RBC parameters
volume of RBCs
1. RDW (RBC distribution width)
o Reflects RBC diameter on a Wright-
 A measurement of the range in the
Stained blood film
volume and size of the RBCs
o Calculate using the hematocrit (Hct)
 A normal range for RDW is 12.2-
and RBC count
16.1& in adult females and 11.8-14.5
Hct ( % ) x 10 in adult males. If you score outside
o MCV (fl) =
RBC count ( x 10 12/ L) this range, you could have a nutrient
- Low MCV indicates microcytic (small deficiency, infection, or other
average RBC size) normal MCV indicates disorder. However, even at normal
normocytic (normal average RBC size), and RDW levels, you may still have a
high MCV indicates macrocytic (large medical condition
average RBC size)  Determined from RBC histogram (a
o Increased MCV can be seen in graphic representation of particle size
distribution).
megaloblastic anemia, hemolytic
 High RDW: it could be an indication
anemia with reticulocytosis, liver
of nutrient deficiency of iron, folate or
disease and normal newborn.
vitamin B12. These results could also
o Decreased MCV can be seen in
indicate macrocytic anemia when your
iron deficiency anemia, thalassemia,
body doesn’t produce enough red blood
sideroblastic anemia and lead
cells.
poisoning.
 A person may have high RDW and
- MCH (Mean Corpuscular Hemoglobin)
normal MCV. This suggests a
o Reference range (SI/conventional
deficiency of iron, B12 or folate. It
units) is 26-34 picograms (pg) may also indicate chronic liver
o An indicator of the average weight disease. High RDW and low MCV.
of hemoglobin in individual  A low RDW means your RBCs are all
RBCs (hemoglobin amount per RBC) about the same size
o Expresses the mass of hemoglobin 
and parallels the MCHC
o Calculate using the hemoglobin 2.
(Hgb) and RBC count 2.
2.

o MCH (pg)
H gb ( dLg ) x 10 2.
2.
1012 2.
RBC count x
L( ) 2.
2.
o 2.
o Increased MCH can be seen in 2.
macrocytic anemia 2.
o Decreased MCH can be seen in 2.
microcytic, hypochromic anemia 2.
- MCHC (Mean Corpuscular H
Hemoglobin Concentration) ematocrit
o Reference range (SI/conventional  Reference range for males
 (conventional units is 41-53 L/L) (SI  WBCs are so named because they are nearly
units is 0.41-0.53 L/L), for females colorless in an unstained cell suspension
(conventional units is 36-46%) (SI units  Leukopenia – decreased WBC count (fewer
0.36-0.46 L/L). Reference range is age than 4500µL)
and sex dependent.  Leukocytosis – increased WBC count (more
 The percentage of RBCs in a given volume than 11,500µL)
of whole blood.
 The buffy coat layer of leukocytes and
platelets, not included in the
measurement, can be seen between
plasma (upper) and RBC (lower) layers
 Calculate by many automated cell
counters using the MCV and RBC count
 Hct % =
1012
MCV ( fL ) x RBC count ( x )
L
10
3. Hemoglobin
 A protein in RBCs that carries oxygen.
 Reference range for males
(conventional units is 13.5-17.5 g/dL)
(SI unita 135-175 g/L); for females
(conventional units – 12.0-
16.0 g/dL) (SI units – 120-160 g/dL)
 Reference range for hemoglobin is age
and sex dependent.
 High levels could be indicative of
the rare blood diseases,
polycythemia. It causes the body
to make too many RBCs, causing the
blood to be thicker than usual.
 This can lead to clots, heart attacks,
and strokes. It is a serious, lifelong
condition that can be fatal if it’s not
treated
 Parameters
1. All these parameters—RBC count, Hgb,
Hct, indices and RBC morphology—are
employed to detect, diagnose, assess
the severity and monitor the treatment
of anemia, polycythemia and the
numerous systemic conditions that
affect RBCs.
2. Automated hematology profiling
instruments are used in nearly all
laboratories to generate these data,
although visual examination of the
Wright- stained blood film is still
essential to verify abnormal results
 Reticulocytes
1. Polychromatic(polychromatophilic)
erythrocytes, newly released from the
RBC production site: the bone marrow
2. Indicate the ability of the bone
marrow to increase RBC
production in anemia due to blood
loss or excessive RBC destruction

White Blood Cells (Leukocytes)

 Leukocytes protect their host from infection
and injury.
 They are transported in the blood from their
source, usually bone marrow or body cavity
destination.
Platelets (Thrombocytes) - Relative polycythemia – an apparent rise
 Thrombocytes are true blood cells that of the erythrocyte level in the blood,
maintain blood vessel integrity by initiating however the underlying cause is reduced
vessel wall repairs. plasma volume
 They are only 2-4µm in diameter, round or  Absolute count – actual number of each
oval, anucleate “cell fragments” cell type without respect to other blood
 They appear insignificant (small size), but components
they are essential to life and are extensively - Absolute polycythemia – true increase in
studied for their complex physiology. red cell mass from any cause
 Thrombocytosis – elevated platelet count  Complete Blood Count – CBC is performed
 Thrombocytopenia – low platelet count on automated hematology profiling
 Thrombocythemia – life-threatening instruments and includes the RBC, WBC and
hematologic disorder platelet measurements
 PLT (platelets) - RBC parameters
1. Reference range  RBC count
 (SI units – 150-450x109/L)  Hgb
 (conventional units – 150,000-  Hct
450,000/µL)  MCV
 MPV (Mean Platelet Volume)  MCH
1. Reference range  MCHC
 RDW
 (SI/conventional units – 6.8-10.2 fL)
 Retic
 Analogous to MCV for erythrocytes
- Platelet parameters
 PLT count
 MPV
- WBC parameters
 WBC count
 Neutrophil count: % and absolute
 Lymphocyte count; % and absolute
Basic Homeostasis
 Eosinophil and Basophil counts:
 Homeostasis – body’s tendency to move
% and absolute
toward physiological stability. In vitro
Basic Hematology Terminology
testing of blood and other body fluids must
 a- – without
replicate exact environmental body
conditions. These conditions should include  -blast – youngest/nucleated
the following:  -chromic – colored
1. Osmotic concentration – the  -cyte – cell
body/cellular water concentration,  dys- – abnormal
composed of 0.85% sodium chloride.  -emia – in the blood
This normal osmotic concentration is  ferro- – iron
termed isotonic  hyper- – increased
2. Hypotonic solution – greater amount  hypo- – decreased
of water in relationship to lesser  iso- – equal
amount of solutes—water enters the  macro- – large
cell; the cell swells and may lyse  mega- – very large, huge
3. Hypertonic solution – lesser amount  micro- – small
of water in relationship to greater  myelo- – marrow
amount of solutes – water leaves the  normo- – normal
cell; cell may crenate  -oid – like
 -osis – increased
 pan- – all
 -penia – decreased
 -plasia – formation
 -poiesis – cell production
 poly- – many
 pro- – before
 thrombo- – clot
Formed Elements and Sizes

Relative and Absolute Blood Cell Counts

 Relative count – amount of a cell type in
relation to other blood components