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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. CBC. &. ESR. دكتر آزر م. C. A. D. A. اندازة گلبولها و تعيين نوع آنها در دستگاههاي كولتر 30 - 90 uL RBC 90- 150 uL Lymph 150-180 uL Mix 180-350 uL Poly. Dr.Azarm. C. 6.4 x10 3 WBC

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم

  2. CBC & ESR دكتر آزرم

  3. C A D

  4. A

  5. اندازةگلبولها و تعيين نوع آنها در دستگاههاي كولتر 30 - 90 uL RBC 90- 150 uL Lymph 150-180 uL Mix 180-350 uL Poly Dr.Azarm

  6. C

  7. 6.4 x10 3 WBC • 5.2 x103 RBC • 14.3 g/100 Hb • % HCT • fl MCV • pg MCH • g/100 MCHC • 14 % RDW • 2.4 g/100 HDW • 280 x103/ul PLT

  8. Diff White blood cell differential Range Segmented Neutrophils 56% 1800-78000 Band 3% 0-700 Eosinophils 2.7% 0-450 Basophils 0.3 0-200 Lymphocytes 34% 1000-4800 Monocytes 4% 0-800 Plt …………………………………………. 150.000-400.000

  9. Platlet مl=

  10. Neutopenia: Normal …………….. 5500-2500 Mild N.……………. 2500-1500 Modurate N. …. 1500-1000 Severe N. …… 1000- 500 Very severe N. 500- 200 Critical Neutropenia< 200

  11. Neutropenia: Count below 2500/ul 1- Drug induced: colchicine, antithyroidphenothiaziness, sulfonamides, antibiotics, anticonvulsants, thiazides , gold salts…….. 2- Idiosyncratic 3- Megaloblastic anemia 4- Hypersplenism 5- Chemotherapy 6- Irradiation

  12. LEKOMOID RECTION : • MYLOID LEUKOMOID REACTION : • LITTLE IMATURITY • -WITH LEFT SHIFT ( SIMULATE CML) • TUMOR & INFECTION • -SIMULATING AML • TB , ALCOHOLISM , MEGALOBLASTIC ANEMIA • LYMPHOID LEUKOMOID REACTION : • -MATURE CELL • PERTOSIS , DERMATITIS HERPETIFORM , VARICCELLA MELLANOMA , BREAST Ca , TB MILLIARY • -IMMATURE CELL • IM , HEPATITIS , TB , SYPHILIS

  13. Neutrophilia 1-Severe exercise 2- hypoxia 3- Estress 4- Injection Epinephrine 5- Corticosteroids 6- Acute infection 7- Tissue damage 8- Hemolysis 9- Druge:ACTH, lead, benzene 10- Hemorrhage 11- Hodgkin’s Lymphoma 12- Neoplasm

  14. Lymphocytosis (More then 4000/ul) 1- Viral infection 2- infectious mononucleosis 3- Chronic lymphocytic leukemia 4- HTLV1 5- Radiation 6- Lead intoxication 7- Stress 8- Leukemia & Lymphoma 9- Phenytoin (Dilantin) 10-Syphilis

  15. Lymphopenia (Less then 1500/uL 1- Immune deficiency syndrome 2- Adernocortical hormones 3- Chemotherapy 4- Irradiation 5- Hodgkin’s Lymphoma 6- Terminal phase of Carcinoma 7- AIDS ( HIV )

  16. Monocytosis Above 1000/ul 1-Acute Infection 2-Agranulocytosis 3-Tuberclosis 4-sub acute bacterial endocarditis 5- Viral Infection:Inf.Mono 6-Mycotic,Rickettsial ,&Protozoal Infec 6-Lymphoma (HD)

  17. Monocytopenia: Corticosteroides Therapy Hairy Cell Leukemia

  18. Basophilia Increased above 150/ul 1-Allergic reaction 2-Chronic Myeloid Leukemia 3-Myeloid Metaplasia 4-Poly Cythemia Vera 5-Irradiation 6-Hypothyroidism 7-Chronic Hemolytic Anemia 8-Post Splenoctomy

  19. Basopenia Less then 10/ul 1- in the Morning 2-Glucocorticoids 4- Acute infection 5-Stress 6- Hyperthyroidism

  20. Hbg/100 (13-17) Hemoglubin concentration in 100cc blood HCT 38-49% Hematecrit : Cell / Wholeblood RBC 4-6 milion / uL

  21. Red Cell Distribution Width (RDW) RDW is an estimate of Erythrocyte ansiocytosis 13.1 + - 1.5 % (11.6-14.6) Id-A Thalassemia

  22. Reticulocytosis • Bleeding • Hemolysis • Sudden Hypoxia • Marrow Infiltration • Hematinic therapy

  23. CALCULATION USED FOR INTERPRETING RBC INDEX IN MICROCYTIC ANEMIA

  24. Labortory test for anemia RETICULOCYTE PRUDUCTION INDEX (R P I) RPI = RET%*PHCT /NHCT/ SI

  25. CR= Hctp/ HctN*R RPI = CR/ SI EXAMPLE FOR RPI CALCULATION 35 YEARS AGED MALE WITH : HB=8 G/DL MCV=105 fl RET%=3% cRc=24 / 45 X 3 =1.6 RPI=1.6 / 2 = 0.8

  26. HEMOGLOBIN ELECTEROPHORESIS HB A 2< 3 R/O B THAL MINORHB A2 = 3- 3.5 SUSPICIUOS HB A2 > 3.5 B MinThalssemia HEMOGLOBIN ELECTEROPHORESIS DON’T R/O a THAL SYNDROMS

  27. MCVmean corposcular Volume ( 80-100fl ) MCHmean Corposcular Hemoglobin ( 30-40 pg ) MCHCmean Corposcular HemoglobinConcetration ( 30-35 mg/100 )

  28. Heinz Bodies • Enzymopathies • ( G6PD deficiency) • Oxidants (Sulphamides) • Unstable Hemoglubins • (Hb Leiden) • post Splenectomy

  29. Target Cells • - Liver disease • Thalassemia • Post Splenectomy • Iron deficiency • Sickle cell anemia • Hemoglobinopathy C

  30. Spherocytosis • Autoimmune H.A. • Hereditary Spherocytosis • Micro-angiopathic H.A. • Disseminated I.C. • Post Splenectomy

  31. Howell jolly Body *Splenoctomy *Non Function spleen

  32. Normochrome N Acute inflamation Hypochrome Mic ID-A ,Thalassemia S. Sidroblastic A. , Chronic Inflamation Macrocytic Folat & vit B12 deficiency Target cell Thalassemia , Hb C, E & S Post splenoctomy Abetalipoproteinemia Basophilic Hemolytic A. , ID –A. stippling Thalassemia , lead Poisoning

  33. Heinz body ……G6PD d. Unstable Hb . post Splenectomy Hawell-Jolly….. Post Splenectomy bodies Megaloblastic A. Tear drop ……. Myelofibrosis Spherocyte ……Hereditery Sph. Imune H.A. Hypophosphatemia ,G6PD d. Schistocyte …...DIC , Thalassemia S. NRBC …………Acute blood lose , Methaplasia

  34. Platlet

  35. Platelet defects 1- Quantity Platelet disorders : Thrombocytopenia ( ITP) Thrombocytosis 2- Quality Platelet disorders: Acquired (drugs) Congenital

  36. Causes of reactive thrombocytosis: -Hemorrage - Surgery - Trauma - Iron deficiency anemia - Splenoctomy - Infection - Malignant disease - Inflamatory disease

  37. Drugs Affecting Platelet Strong Inhibitors Moderate Inhibitors Weak Inhibitors Alcohol Hitroglycerin Nitroprusside Aspirin Abciximab (anti gpIIb/IIIa) Ticlopidine (anti ADP) NSAFD Antibiotics Penicillins cepholosporins nitrofurantoin Dextran Fibrinolytics Heparin Hetastrach

  38. ESR

  39. Erythrocyte sedimentation rate ( ESR ) هنگامي كه خون كامل ( ضد انعقاد دار) مدت زمان معيني بحال خود رها شود گلبولهاي قرمز از پلاسما جدا شده و رسوب ميكنند . فاصلة بين سطح گلبولها و سطح پلاسما را سرعت رسوب ميگويند.

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