clinical interpret at ing data power point

8/14/2019 Clinical Interpret at Ing Data Power Point

1/36

Clinical Interpretating data

HEMATOLOGIC SYSTEM
http://images.google.co.id/imgres?imgurl=http://www.sandhurstjoggers.org.uk/3-HealthAdvice/blood_cells.jpg&imgrefurl=http://www.sandhurstjoggers.org.uk/3-HealthAdvice/Bloodtransfusion.htm&h=734&w=974&sz=110&hl=en&start=3&um=1&tbnid=7kZx5RgnozglvM:&tbnh=112&tbnw=149&prev=/images%3Fq%3Dblood%26um%3D1%26hl%3Den%26sa%3DG


2/36

Hematologic System

Blood consists of : Plasma and cells

suspended in plasma

Plasma c.o. : water, dissolved protein,electrolytes, organic and inorganic

substances

Blood cells c.o. : Erythrocyte (RBC),

Leucocyte (WBC) and Thrombocyte


3/36


4/36


5/36

Pluripotent stem cell

Thrombocyte RBC WBC

Granulocyte MonocyteLymphocyte

Basophil

EosinophilNeutrophil

Myeloblast, Promyelocyte,

Myelocyte, Metamyelocyte,

Band neutrophils,

Polymorphonuclear cells


6/36


7/36
http://upload.wikimedia.org/wikipedia/commons/2/20/Illu_blood_cell_lineage.jpg


8/36

Laboratory test


9/36

1. Coagulation test

a. Bleeding time : duration of bleeding

b. Prothrombine time (PT) : evaluate the extrinsic factor andcommon clothing pathways ( II, V, VII, X, fibrinogen).

Evaluate warfarin therapy and hepatic function.

c. Activated Partial Thromboplastin Time (APTT) : to evaluate

intrinsic factor ( VIII, IX, XI) and to monitor heparin therapy.d. Thrombin Time : used to evaluate the heparin therapy and

thrombolytic drug, coagulation abnormalities.


10/36


11/36


12/36

2. Complete Blood Count/ Full

blood count

a. Haemoglobine (Oxygen carrying

RBC protein)

b. Hematocrite /PCV/EVF (RBC in 100

ml blood)

c. RBC count (RBC in 1 ml blood)

d. WBC counte. Platelet
http://en.wikipedia.org/wiki/Image:Platelets.jpghttp://www.abc.net.au/science/photos/whatis/answer4.htm


13/36

a red blood cell (rbc)

b white blood cell (lymphocyte)c white blood cell (neutrophil)

d white blood cell (eosinophil)

e plasma (matrix)
http://www.abc.net.au/science/photos/whatis/answer4.htm


14/36

Lab Test by specific

cell types


15/36

Fibrinogen

Serum protein electrophoresis (albumin, Globulin)

Platelets

Carboxyhemoglobine (CO Hb)

Coombs test

Erythrocyte sedimentation rateFolate serum

Iron metabolism (Ferritin, Iron, TIBC, Transferrin)

MCH, MCHC, MCV , RCDW (RBC)

Reticulocytes (immature RBC contain RNA recidual)

Vit B 12Eosino, Baso, Neutro (WBC)

Lymphocyte

Monocyte


16/36

Disease with haematologic lab

Anemia
http://en.wikipedia.org/wiki/Image:1GZX_Haemoglobin.png


17/36

Erythrocytes (RBC)

Erythropoesis

Erythropoetin

Producted on kidneyIncreased RBC poduction on BM

Use Nutrients;Iron, B 12, Folate.


18/36

Anemia

Definition : Hb, symptom of an

underlying disease

Anemia Causes :Iron deficiency,

Folate def, Vit B 12 def, haemolysis

Due to decreased production

Loss of erythrocytes Pregnancy


19/36

Hows the lab?

A decrease in level of hemoglobin

How to evaluate?- Hemaglobin (ethnic, age, altitude)- Hematocrit,- Mean cell Hemoglobin (Hb/RBC)

- Mean cell hemoglobin concentration (Hb concentrationaverage in 100 ml RBC

- Mean cell volume (Average volume of single red cells)- Red cell distribution width (histogram of the distribution of

RBC vol)- Peripheral Blood smear (anisocytosis, poikilocytosis)- specific causa


20/36

Micrositic anemia

Iron deficiency anemia (Low Iron,Low

ferritin,High TIBC )

MCHC and MCH

MCV < 80 m 3

Hb, Htc


21/36

Megaloblastic anemia

Folate deficiency, B 12 deficiency

Htc

Increased of homocystein and

methylmalonic.

MCHC normal/fall

MCH

MCV >80 m 3


22/36

Anemia of chronic disease

Chronic infections, inflammation and

malignancy

COPD, CHF,DM,Hypertension

Impairment in the delivery of iron to thedeveloping rbc.

DD : liver disease, connective tissue

disease (SLE, RA), infection, malignancy,endocrine disorders (PTH,TH)

Low Iron, Low TIBC,High Ferritin


23/36

Spesific disease with anemia

Thalassemia : chain of the globin molecule is affected:in thalassemia, the production of globin isdeficient, while in thalassemia the production of globin is defective. (Micro Hypo, low MCV, low RBC)

Sickle Cell anemiaAplastic anemia :is a condition where bone marrowdoes not produce sufficient new cells to replenishblood cells (low rbc, wbc and platelet)

PRCA (anemia characterized by absence of red cellprecursors in the bone marrow )

Hereditary anemia

Hemolytic anemia
http://../wiki/Human_%CE%B2-globin_locushttp://../wiki/Bone_marrowhttp://../wiki/Cell_(biology)http://../wiki/Bloodhttp://../wiki/Bloodhttp://../wiki/Cell_(biology)http://../wiki/Bone_marrowhttp://../wiki/Human_%CE%B2-globin_locus


24/36

Disease with Platelet
http://en.wikipedia.org/wiki/Image:Platelet_blood_bag.jpg


25/36

Disorders with Platelet count

1. Thrombocytopenia :- Viral inf- Immunologic (CLL, Lymphoma Hodgkins ,

Non Hodgkins- ITP

2. Thrombocytosis

-Physiologic (exercise, stress, epinephrine)

-Essential (CML, agnogenic myeloidmetaplasia, polycythemia vera)

-Reactive (blood loss, hemolytic anemia,infectious disease, RA, IBD, lymphoma)
http://en.wikipedia.org/wiki/Image:Platelet_blood_bag.jpg


26/36

Disorders with Coagulation

cascade


27/36

Prolonged PTT

With normal PT : Heparin,Def.

Intrinsic Pathway factor (prekallikrein,

XII, Xi, IX, VIII), Inhibitor factor,

Willebrand disease, Lupusanticoagulant


28/36

Prolonged PT

With normal PTT : Factor VIII def, Liver

disease, Vit K def, warfarin therapy

INR estimation :

PT patient

PT control

What is INR for?- Adjustmen anticoagulant dose

- Give therapy


29/36

Prolonged PT and PTT

Fac I, II, V, X def

Heparin therapy

Warfarin therapyVit K def

Liver disease

DIC


30/36

Disease with WBC


31/36

WBC

Neutrophils

Monocytes

LymphocitesEosinophil

Basophil


32/36

Disease with eosinophil

Contain numerous inflammatorymediators

Parasitic inf ( helmintic) ,

Protozoa inf ( Isospora belii, Dientamoeba fragilis),

Other inf ( aspergillosis, coccidioidomycosis),

allergic reactions,

skin disorders,

neoplastic disease


33/36

Disease with Basophilia

Form heparin therapy

Hypersensitive, Infection,

malignancies, RA, DM, Fe deficiency.


34/36

Disease with Neutrophil

Refers to mature and band neutrophilsIncrease in (neutrophilia): infections,necrosis, inflammatory disease, leukemias,metabolic disorders, gout, smoker

Increased by : corticosteroids, ephinefrine,oral contraceptive

Decrease in (neutropenia): Some bacterialinfection, viral inf, protozoa inf, liver disease,

marrow depressant.Decreased by : anticonvulsants, antithyroid,NSAID


35/36

Disease with Lymphocyte

T,B,NK

Increase in : Viral infection ( hepatitis,

MMR, HIV), corticosteroids,

malignancies, SLE, bacterial disease,

chronic inflammation

Decrease in : immunodeficiency

syndromes, severe illness, lymphatic

circulatory system


36/36

Diseasse with Monocyte

Increase in : Infectious, collagen

vascular disease,

Infection (TB, Typhoid, endocarditis),

Malaria, Syphillis, Fungal

clinical interpret at ing data power point

Documents