Praktikum Hematologi Blok 254 FK UNSWAGATI

Anemia Made Easy

Anemia Trigger Words

Microcytic: Target cells - thalassemia Basophilic stippling - lead poising Halo/ringed - sideroblastic Koilonychia - iron deficiency Normocytic: AA male, sulfa - G6PD def osmotic fragility test - spherocytosis Chloramphenicol, carbamazipine, phenytoin - aplastic Severe chest pain AA kid - sickle cell Pigmented gall stones, elevated LDH, shistocytes - autoimmune

Macrocytic: Diphyllobothriasis, Crohn's - Vit B12 def Neurologic disorder - Vit B12 def Palmar erythema, caput medusa, EtOH abuse - cirrhosis AIDS on HAART - azidothymidine

EOSINOFIL

BASOFIL

Netrofil segmen

LIMFOSIT

Netrofil batang

Acute Myelocytic Leukemia/AML

AML

Rouleaux, normoblast

metamielosit

mielosit

mielosit

metamielosit

metamielosit

metamielosit

Promielosit

ALL

AML

Hipersegmentasi netrofil

Smudge cell/CLL

Giant thrombocyte

Vakuolisasi netrofil

Granular toxic

Drumstick/ barr bodies leucocyte

Lekosit dengan Dohles bodies

Netrofil dengan inti sel piknotik/degenerasi

Pelger-Huet Anomaly pada lekosit dengan bilobar (dua lobus)

Auer Rod pada lekosit (AML)

Whitney is Sick
A 2 year old African-American boy is brought to the emergency room because of 2 hours of left-sided abdominal pain and shortness of breath. The patient is hypotensive and tachycardic. Physical exam demonstrated a palpable spleen 8 cm below the costal margin. Labs: Hemoglobin 5.1 Hematocrit 16 WBC 4500 Platelets 85000

Whitney is Sick
What is most likely causing the presenting signs and symptoms? A. Splenic sequestration B. Salmonella sepsis C. Congestive heart failure D. Autoimmune hemolytic anemia E. Aplastic anemia

Unit #5B Clinical Laboratory Testing Basic Hematology

Platelets / Thrombocytes Pieces of a bone marrow cell known as a megakaryocyte Function to stop bleeding by forming a plug and also release coagulation factors Platelets on blood smear (very small dots among RBC)

ASH Teaching Slides: Blood Cells

The appearance of normal circulating blood is relatively uniform with little variation in size and shape. Red blood cells will have an area of paleness in the center, which is approximately one-third the diameter of the cell.
Maslak, P. ASH Image Bank 2008;2008:8-00044. Copyright 2008 American Society of Hematology.

ASH Teaching Slides: Blood Cells

Normal blood smear. The four larger cells shown are called granulocytes, a type of white blood cell.

Maslak, P. ASH Image Bank 2008;2008:8-00067. Copyright 2008 American Society of Hematology.

ASH Teaching Slides: Blood Cells

Iron-deficiency anemia is indicated by red blood cells that are paler and of a smaller size than normal.

Schrier, S. ASH Image Bank 202;2002:100345. Copyright 2002 American Society of Hematology.

ASH Teaching Slides: Blood Cells

Chronic myelogenous leukemia. The blood smear shows an increased number of neutrophils, a type of white blood cell.
Maslak, P. ASH Image Bank 2001;2001:100202. Copyright 2001 American Society of

ASH Teaching Slides: Blood Cells

Blood smear; arrows indicate sickled cells.

Schrier, S. ASH Image Bank 2001;2001:100248. Copyright 2001 American Society of Hematology.

ASH Teaching Slides: Blood Cells

Hairy-cell leukemia. The characteristic cell of this type of leukemia has projections uniformly distributed around its border that give it a hairy appearance.
Maslak, P. ASH Image Bank 2007;2007:7-00011. Copyright 2007 American Society of Hematology.

ASH Teaching Slides: Blood Cells

Hodgkin lymphoma. The large cells with an owl-like appearance are called Reed-Sternberg cells and are a sign of Hodgkin lymphoma.

Kadin, M. ASH Image Bank 2002;2002:100484. Copyright 2002 American Society of

Anaemia Classification

Morphology
Microcytic Macrocytic Normocytic

Red cell distribution width - RDW

Measure of RBC size

variation (anisocytosis) Increased in iron deficiency Normal in thalassaemia trait Normal/raised in anaemia of ch. Disease Can be very high in megaloblastic anaemias ?practical value

Haemolysis blood films Sickle cell Spherocytes

Macrocytosis Common
Less common
B12/folate deficiency Chronic liver disease Excess alcohol Myelodysplasia

Haemolysis Myeloma Other bone marrow disorders Hypothroidism

Iron Deficiency
Always confirm with

ferritin May be falsely normal with active acute/chronic disease If >50 makes iron deficiency less likely In early deficiency or with mixed deficiencies MCV may be normal

Causes Diet Young and old Malabsorption Coeliac (tTG) Chronic blood loss GIT Uterine UGT

Failure to respond to iron

Inadequate treatment
Dose and/or duration Avoid slow release preparations

Continued cause
Bleeding

Malabsorption Poor compliance Intolerance due to side effects Incorrect diagnosis

Increased Ferritin

Infection/inflammation Chronic liver disease; esp. alcohol related Malignancy Repeated transfusions Hereditary haemochromatosis
>1000 is risk of organ damage

Porphyria Cutanea Tarda Prolonged iron therapy without iron deficiency

Tests for haemolysis

Initial evaluation
LFTs Inc. bilirubin only Retics - increased LDH - increased Haptoglobin - decreased

Additional tests
Blood film Polychromasia Spherocytes Sickle cells Hb electrophoresis Direct Antiglobulin

(Coombs) test

Tests for haemolysis

Initial evaluation
LFTs Inc. bilirubin only Retics - increased LDH - increased Haptoglobin - decreased

Additional tests
Blood film Polychromasia Spherocytes Sickle cells Hb electrophoresis Direct Antiglobulin

(Coombs) test

ERITROPOEISIS & TROMBOPOEISIS

ERITROPOIESIS

Pronormoblast

Normoblast Basofil
Normoblast Polikromatofil

Pronormoblast

Normoblast basofil

Normoblast polikromatofil

Normoblast asidofil

ERITROPOIESIS

Normoblast Asidofil

Eritrosit

Retikulosit (Pewarnaan BCB)

1 1

1
2 1 1 2 2 2

2
1

1. Eritrosit normal sediaan apus darah tepi 2. Trombosit

TROMBOPOIESIS

A. Megakarioblast B. Promegakariosit

C. & D. Megakariosit E. Nukleus Megakariosit

F. Trombosit

Megakarioblast

Promegakariosit

Megakariosit dgn trombosit