Wondershare EdrawMind
MindMap Gallery Diagnostics·Clinical hematology testing·General blood testing
- 25
Diagnostics·Clinical hematology testing·General blood testing
The knowledge points in the general blood testing section of the clinical hematology testing chapter of diagnostics are summarized. The essence is the change in the number of red blood cells and Hb in unit volume per liter (L) of whole blood.
Edited at 2023-07-09 20:10:54
- bacteria
This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
- Plant asexual reproduction
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
- Reproductive development of animals
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
Diagnostics·Clinical hematology testing·General blood testing
- bacteria
This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
- Plant asexual reproduction
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
- Reproductive development of animals
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
- Recommended to you
- Outline
Red blood cell testing, hemoglobin determination
concept
substance
Unit volume per liter (L) changes in red blood cell number and Hb in whole blood
effect
Reflects the body’s regenerative ability of red blood cells
Aids in the diagnosis of red blood cell-related diseases
Reference
clinical significance
Red blood cell count↑, Hb↑
definition
In unit volume of blood, the number of red blood cells and the amount of hemoglobin are > the upper limit of the reference value
index
Adult male, RBC>6*10^12/L, Hb>170g/L
Adult women, RBC>5.5*10^12/L, Hb>160g/L
Check multiple times
type
relative increase
classic
Severe vomiting, diarrhea, profuse sweating, extensive burns, chronic adrenal insufficiency, diabetes insipidus, hyperthyroid crisis, diabetic ketoacidosis
mechanism
Plasma volume↓→Hemoconcentration→Red blood cell volume relative↑
Absolute increase (polycythemia)
secondary polycythemia
reason
EPO in blood↑
Compensatory increase in EPO
Decreased blood oxygen saturation
Physiological
Fetuses and newborns, residents of plateau areas
pathological
Severe chronic heart and lung disease
Dyshemoglobinopathies (low oxygen-carrying capacity)
Non-compensatory increase in EPO
Tumor or kidney disease
Kidney cancer, hepatocellular carcinoma, ovarian cancer, renal embryonal tumor, adrenocortical adenoma, uterine fibroids, hydronephrosis, polycystic kidney, etc.
primary polycythemia (polycythemia vera)
substance
A myeloproliferative neoplasm (MPN) characterized by an increase in the number of red blood cells.
Performance
Persistent and significant increase in red blood cells
(7~10)*10^12/L, Hb(180~240)g/L
White blood cells↑, platelets↑, total body blood volume↑
Red blood cell count↓, Hb↓
Physiological reduction
Infants and children <15 years old
Red blood cell count, Hb<10~20% of normal adults
The elderly, second and third trimester of pregnancy
Pathological reduction
Various anemias
hypoerythropoiesis anemia
increased red blood cell destruction anemia
excessive red blood cell loss anemia
Red blood cell morphological changes
concept
normal red blood cells
Biconcave disc shape (blood smear is round)
Diameter 6~9µm, average 7.5µm
The edge is about 2µm thick and the center is about 1µm (after dyeing, the surrounding area is light orange-red, and the center is a lightly stained area [central pale area])
Abnormal size
microerythrocytes
Features
Diameter<6μm
The cells become smaller in size and the central light-stained area expands.
microcytic hypochromia
classic
Hypochromic anemia (such as iron deficiency anemia)
large red blood cells
Features
Diameter>10μm
classic
Hemolytic anemia, acute blood loss anemia, megaloblastic anemia
giant red blood cells
Features
Diameter>15μm, oval shape
The Hb content is high and the central light-stained area disappears
classic
Megaloblastic anemia (folic acid, VB12 deficiency)
Uneven size of red blood cells
Features
The size is very different, and the diameter can be more than twice the difference.
classic
Pathological hematopoiesis - reflects the obvious proliferation of red blood cells in the bone marrow
Proliferative anemia, some types of hemolytic anemia, chronic blood loss anemia
Abnormal morphology
spherical cells
Features
Diameter <6µm, thickness increase >2.9µm
Cells are small in size and spherical in shape
Decreased surface area to volume ratio
After dyeing, the color becomes darker and the light dyed area in the center disappears.
classic
Hereditary spherocytosis, autoimmune hemolytic anemia, red blood cell enzyme deficiency hemolytic anemia
oval cells
Features
Transverse diameter/major diameter <0.78, oval or long cylindrical shape with blunt ends
Approximately 1% of oval cells can be found in blood smear, which is normal
classic
Hereditary elliptocytosis, megaloblastic anemia, iron deficiency anemia, myelofibrosis, sickle cell anemia
stoma cells
Features
The central light-stained area is flat and cracked, like a slightly open mouth or fish mouth.
classic
Hereditary oromythocytosis, DIC
target cells
Features
The central lightly stained area expands, and Hb remains in the center and is deeply stained, shaped like a shooting target.
classic
globinogenic anemia, dyshemoglobinopathies, iron deficiency anemia, hemolytic anemia, jaundice, splenectomy
sickle cell
Features
sickle shaped
classic
Sickle cell anemia (Hbs disease)
teardrop shaped cells
Features
Teardrop or hand mirror shape
classic
Myelofibrosis, globinogenic anemia, hemolytic anemia
Spiny cells/ spike cells
Features
Outside the cell membrane, there are spines and spiny protrusions of inconsistent length and unevenly spaced distribution.
classic
Acanthocytosis (congenital abetalipoproteinemia), abnormal lipid metabolism, fat malabsorption, post-splenectomy, retinitis pigmentosa, etc.
zigzag cells
Features
There are short, evenly spaced blunt jagged protrusions on the outside of the cell membrane.
classic
Liver disease, uremia, pyruvate kinase deficiency, peptic ulcer, gastric cancer, heparin treatment, etc.
split cells
substance
Debris from broken red blood cells
Features
The shape changes irregularly
Pear-shaped, crescent-shaped, oblong, dumbbell-shaped, comma-shaped, triangle, helmet-shaped, etc.
reason
Red blood cells, destroyed by mechanical or physical factors
classic
Microangiopathic hemolytic anemia, cardiac valve hemolysis, DIC, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, severe burns
Red blood cells arranged in a coin shape
Features
Red blood cells are connected together in the shape of strings, like strings of ancient copper coins
classic
Multiple myeloma, specific types of lymphoplasmacytic lymphoma (macroglobulinemia)
Irregular red blood cell morphology (increased abnormal red blood cells)
Features
Increased appearance and shape of red blood cells
Blood routine, RDW value (red blood cell volume distribution width) increased
classic
Some anemias associated with changes in red blood cell morphology
Abnormal coloring
Hypochromic
Performance
The orange-red staining is too light and the central pale area is expanded.
substance
Hb content is significantly reduced
classic
Iron deficiency anemia, globinogenic anemia, sideroblastic anemia, certain hemoglobinopathies
hyperpigmentation
Performance
The red coloration is deep and the light staining area in the center disappears
substance
The average Hb content is the highest
classic
megaloblastic anemia
pleochrophilia
Performance
Light gray blue or gray red
Features
For normal people, peripheral blood accounts for 1%
substance
Stained are reticulocytes that have just lost their nuclei - polychromatic erythrocytes or polychromatic erythrocytes
effect
Reflects the active hematopoietic function of bone marrow, vigorous proliferation of red blood cells, and increased release of red blood cells.
classic
proliferative anemia, hemolytic anemia
Structural abnormality
Basophilic stippling
Performance
Tiny blue dots of material, sometimes coexisting with pleochrophobia
Increased quantity, showing coarse granular stippling
lead poisoning
effect
Lead Poisoning Screening
classic
Anemia with strong bone marrow proliferation (such as megaloblastic anemia), lead poisoning
chromatin body
Performance
Round purple-red bodies, about 1~2µm in diameter, varying in number
substance
Remnants of nuclear fragmentation, or fragmentation or loss of chromatin
classic
Physiological
late erythrocytes
pathological
Hemolytic anemia, megaloblastic anemia, pure erythroleukemia, other proliferative anemias
kabo ring
Performance
Inside mature red blood cells, there is a very thin, purple-red thread in the shape of a ring or "8"
substance
remnants of the spindle
classic
Severe anemia, hemolytic anemia, megaloblastic anemia, lead poisoning, leukemia, etc.
nucleated red blood cells
substance
Significant increase in red blood cell demand and release, or damage to the blood marrow barrier
classic
Physiological
newborn
pathological
Various hemolytic anemias
leukemia
Extramedullary hematopoiesis (eg, myelofibrosis)
bone marrow metastasis cancer
After splenectomy (loss of blood filtering and clearance functions)
Testing of white blood cells
White blood cell count
Reference
Adult, (4~10)x10^9/L
Newborn, (15~20)x10^9/L
6 months to 2 years old, (11~12)x10^9/L
clinical significance
Performance
leukocytosis
Adult, 10*10^9/L
Leukopenia
Adult, 4*10^9/L
Mainly affected by the number of neutrophils
type
neutrophils
eosinophils
basophils
Lymphocytes
monocytes
Category count
Neutrophils (N)
concept
type
Neutrophils Nst
The nucleus is bent into a rod shape, coiled into C-shape, S-shape, V-shape, or irregular shape.
Neutral lobulated granulocytes Nsg
Nucleated leaves, 2 to 5 leaves, connected by a thin thread
Features
The cell body is round, with a diameter of 10~13μm.
The cytoplasm is rich, pink-stained, and contains many small, uniform light pink neutral granules.
The nucleus is dark purple-red, and the chromatin is compacted into blocks.
Reference
clinical significance
Neutrophilia
nature
Increased neutrophils, causing an increase in the total number of white blood cells
classic
Physiological increase
cyclical fluctuations
During the day and night, afternoon > morning
temporary increase
Late pregnancy, childbirth
After strenuous exercise or labor
After a big meal or shower
high temperature or severe cold
Pathological increase
acute infection
Pyogenous infections are the most common (Staphylococcus aureus, hemolytic Streptococcus, Streptococcus pneumoniae, etc.)
Severe tissue damage and massive blood cell destruction
12~36 hours after severe trauma, major surgery, extensive burns, acute myocardial infarction, severe intravascular hemolysis
acute massive bleeding
Metabolic poisoning, acute chemical poisoning, biological toxins
acute poisoning
Leukemia, myeloproliferative neoplasms, malignant solid tumors
Chronic myeloid leukemia (mature neutrophils↑)
Myeloproliferative neoplasms (polycythemia vera, essential thrombocythemia, myelofibrosis)
Malignant tumors (malignant tumors of the digestive tract, etc.)
Neutropenia
type
Leukopenia (total number of white blood cells <4*10^9/L)
Granulocytopenia (absolute neutrophil count <1.5*10^9/L)
Agranulocytosis (absolute neutrophil count <0.5*10^9/L)
reason
Infect
G-bacteria infection (typhoid, paratyphoid, etc.)
Viral infectious diseases (influenza, viral hepatitis, chickenpox, rubella, cytomegalovirus infection)
Protozoal infections (malaria, kala-azar)
blood system diseases
Aplastic anemia, hemophagocytic syndrome, partial megaloblastic anemia, severe iron deficiency anemia, paroxysmal nocturnal hemoglobinuria, bone marrow metastasis, etc.
Damage caused by physical and chemical factors
Radioactive substances, heavy metals, chemicals, etc.
Hyperfunction of the monocyte-macrophage system
Splenomegaly and hypersplenism caused by various reasons
autoimmune disease
Nuclear image changes of neutrophils
nuclear left shift
definition
Peripheral blood, the percentage of non-lobulated neutrophils (neutrophils, promyelocytes, mesomyelocytes, promyelocytes) is increased (>5%)
classic
Bacterial infection, acute blood loss, acute poisoning, acute hemolysis, myeloid leukemia, etc.
mechanism
Cell differentiation and maturation disorders
Increased demand for neutrophils and granulocytes
nuclear right shift
definition
Peripheral blood, neutrophil nuclei appear 5 or more lobes, and the percentage is >3%
classic
Megaloblastic anemia, hematopoietic decline, antimetabolite drugs (cytarabine, 6-mercaptopurine)
Inflammation recovery period (transient neutrophil nuclear shift to the right)
Abnormal neutrophil morphology
toxic changes
reason
Severe infectious diseases, various purulent infections, sepsis, malignant tumors, poisoning, large area burns
Performance
Uneven cell size
The cell bodies of some neutrophils are enlarged and vary widely in size.
Purulent inflammation or chronic infection with a long course of disease
Poison particles
Thick, unevenly distributed, dark purple-red or purple-black neutral particles appear in the cytoplasm.
Neutrophil alkaline phosphatase NAP, activity and score are significant ↑
vacuolar denaturation
Single or multiple vacuoles of varying sizes can be seen in the cytoplasm or nucleus.
Cytoplasmic fatty degeneration
Dürer body
Basophilic areas that remain poorly developed locally due to toxic changes in the cytoplasm
Round or pear-shaped, cloud-like, dyed sky blue or blue-black, 1~2 μm in diameter
nuclear degeneration
The nucleus shrinks, dissolves, and fragments
giant multilobulated nucleus
Performance
The cell body is larger, with a diameter of 16~25µm
The nucleus is too lobed, often ≥5 leaves, or even ≥10 leaves
Loose nuclear chromatin
classic
Megaloblastic anemia, after treatment with antimetabolite drugs
Genetically related morphological abnormalities
Pelger-Huet malformation
PseudoPelger-Huet malformation – caused by certain infections, leukemias, myelodysplastic syndromes
nature
Autosomal dominant disorders (familial neutrophil abnormalities)
Performance
Congenital neutrophil nuclear lobulation disorder, nuclear lobulation abnormalities and malformations
Kidney shape, dumbbell shape, pince-nez shape, peanut shape, etc.
Chediak-Higashi malformation
nature
autosomal recessive disorders
Performance
Several to dozens of inclusion bodies with a diameter of 2 to 5 μm, appearing as lavender or blue-purple particles.
Features
Patients are prone to infections, often with albinism
Alder-Reilly deformity
Performance
Huge dark dyed azurophilic particles
classic
Lipochondrodystrophy, hereditary mucopolysaccharide metabolism disorder
May-Hegglin deformity
Performance
Granulocytes contain light blue inclusion bodies throughout their life, similar in shape to Dürer bodies, but larger and rounder
In addition to neutrophils, other granulocytes can also be seen
Eosinophils (E)
concept
Cells are round with a diameter of 13~15µm
The cytoplasm is filled with thick, neat, uniform, and closely arranged orange-yellow or orange-red eosinophilic granules.
The nucleus is mostly two-lobed, spectacle-shaped, and dark purple.
Reference
0.5~5%, absolute value (0.05-0.5)x10^9/L
clinical significance
Eosinophilia
allergic diseases
Bronchial asthma, drug allergy, urticaria, food allergy, angioedema, serum sickness, etc.
Peripheral blood eosinophils ≥10%
parasitic disease
Schistosomiasis, ascariasis, hookworm, etc.
Peripheral blood eosinophils ≥10%
skin disease
Eczema, exfoliative dermatitis, pemphigus, psoriasis, etc.
Mild to moderate increase in peripheral blood eosinophils
blood disease
Chronic myeloid leukemia, chronic eosinophilic leukemia-not otherwise specified, hypereosinophilic syndrome, eosinophilic granuloma, etc.
certain malignant tumors
Certain epithelial tumors, some lymphomas, multiple myeloma
certain infectious diseases
scarlet fever
other
Rheumatic diseases, hypopituitarism, hypoadrenocorticism, allergic interstitial nephritis
eosinophilia
Early stage of typhoid fever and paratyphoid fever
Stressful conditions such as major surgery and burns
After long-term use of adrenocortical hormones
Basophils (B)
concept
Cells are round, 10~12µm in diameter
In the cytoplasm, there are a small number of thick but unevenly sized and irregularly arranged black-blue basophilic granules.
The nuclei are mostly 2 to 3 lobes, and the shape of the lobes is often blurry.
Reference
0~1%, absolute value (0~0.1)*10^9/L
clinical significance
basophilia
allergic diseases
Allergic colitis, drugs, food, inhalant hypersensitivity, erythema, rheumatoid arthritis
blood disease
Chronic myeloid leukemia, basophilic leukemia, myelofibrosis
malignant tumor
Metastatic cancer, etc.
other
Diabetes, infectious diseases (chickenpox, influenza, smallpox, tuberculosis)
basophilia
no clinical significance
Lymphocytes (L)
concept
type
large lymphocytes
Diameter is 10~15µm, accounting for 10%
small lymphocytes
Diameter is 6~10µm, accounting for 90%
Features
Cell body is round or oval
Large lymphocytes, rich cytoplasm, blue color
Small lymphocytes, very little cytoplasm, dark blue
The nucleus is round or oval, occasionally sunken, dark purple, and the color matter is aggregated into blocks.
Reference
20~40%, absolute value (0.8~4) x10^9/L
clinical significance
lymphocytosis
Physiological
When a baby is born, lymphocytes account for 35%; after 4-6 days, it can reach 50% until 4-6 years old.
In childhood, lymphocytes are higher
pathological
Infectious diseases
viral infection
Measles, rubella, chickenpox, mumps, infectious mononucleosis, infectious lymphocytosis, viral hepatitis, epidemic hemorrhagic fever, coxsackie virus, adenovirus, cytomegalovirus
bacterial infection
Bordetella pertussis, Mycobacterium tuberculosis, Brucella, Treponema pallidum, Toxoplasma gondii, etc.
mature lymphocytic neoplasm
recovery period from acute infectious disease
Transplant rejection (GVHR, GVHD)
Diseases with relatively increased lymphocyte ratio
Aplastic anemia, granulocytopenia, agranulocytosis
The proportion of neutrophils ↓ and lymphocytes is relatively ↑, but their absolute values do not increase.
lymphopenia
Apply adrenocortical hormones, alkylating agents, anti-lymphocyte globulin, etc.
Radiation damage, T lymphocyte immunodeficiency disease, agammaglobulin deficiency
reactive lymphocytes (atypical lymphocytes)
substance
Activated lymphocytes (CD8 T lymphocytes are the main component)
type
Type I (foam type)
The cell body is slightly larger than that of lymphocytes and is round or oval in shape.
The nucleus is deviated and appears round, kidney-shaped or irregular; Nuclear chromatin is coarsely reticular or small and has no nucleoli.
The cytoplasm is rich, dark blue, and contains vacuoles of varying sizes (the cytoplasm is foamy, with no or only a few granules)
Type II (irregular/monocytic)
The cell body is larger than type I and often irregular in shape, resembling a monocyte.
The cytoplasm is rich, light blue or light blue-grey, with a few azurophilic granules and mostly no vacuoles.
The nuclear shape is similar to type I, but the nuclear chromatin is more detailed and reticular, and the nucleoli are not obvious.
Type III (naive type)
The cell body is large, 15~18µm in diameter, round or oval in shape
The cells have a lot of mass, are blue or dark blue, mostly without particles, and may have small vacuoles.
The nucleus is round or oval, the nuclear chromatin is finely meshed, and there are 1 to 2 nucleoli.
reason
Infectious diseases
Drug allergy
Blood transfusion, hemodialysis or cardiopulmonary bypass
Other diseases (immune diseases, agranulocytosis, radiation therapy)
Monocytes (M)
concept
The cell body is large, 14~20µm in diameter, round or irregular in shape
There is more cytoplasm, which is stained light blue or gray-blue and contains more small, dust-like purple-red particles.
The cell nucleus is large, irregular in shape, kidney-shaped, horseshoe-shaped, etc., often folded and twisted, lavender red, and the chromatin is fine and loose like a mesh.
Reference
3~8%, absolute value (0.12~0.8)*10^9/L
clinical significance
mononucleosis
Physiological increase
Infants and children, slightly more than adults
Pathological increase
certain infections
Infective endocarditis, malaria, kala-azar, recovery period from acute infection, active tuberculosis, etc.
certain blood diseases
Monocytic leukemia, recovery period from agranulocytosis, myelodysplastic syndrome, chronic myelomonocytic leukemia, etc.
Monocytopenia
no clinical significance
Detection of reticulocytes
concept
substance
The erythrocyte stage after enucleation of late immature erythrocytes
Features
Basophilic substances such as ribosomes and mRNA remain in the cytoplasm.
Bright tar blue or new methylene blue dyeing, showing light blue or dark blue network pattern
The cells are slightly larger than mature red blood cells, with a diameter of 8~9.5µm
Wright-Giemsa stain, polychromatic red blood cells
Reticulocyte determination
Reference
adult
0.05~0.015(0.5~1.5%), absolute number (24~84)x10^9/L
child
0.005~0.015 (0.5~1.5%)
newborn
0.03~0.06 (3~6%)
clinical significance
Increased reticulocytes
Exuberant proliferation of bone marrow red blood cells
Hemolytic anemia, acute blood loss, iron deficiency anemia, megaloblastic anemia, anemia patients after certain treatments
Decreased reticulocytes
Reduced bone marrow hematopoietic function
Aplastic anemia, pure red blood cell aplastic anemia, etc.
Reticulocyte production index PRI
concept
reason
The percentage of reticulocytes is affected by the degree of anemia (hematocrit), reticulocyte maturation time, etc.
effect
Correct various effects on the authenticity of monitoring data when anemic
significance
The production of reticulocytes is multiple times that of normal people
RPI=(Patient reticulocyte%/2)*(Patient HCT/Normal HCT)*100
"2" ——Reticulocyte maturation time (days)
Normal HCT is 0.45 for adult males and 0.4 for adult females.
Reference
Normal person, RPI=2
clinical significance
PRI>3
Hemolytic anemia, acute blood loss anemia
PRI<2
Anemia caused by bone marrow hypoplasia and red blood cell maturation disorder
Platelet testing
platelet countPC/PLT
principle
effect
Counting unit volume (L) The number of platelets in peripheral blood
method
Visual inspection method under microscope, automated blood cell analyzer
Reference
(100~300)*10^9/L
clinical significance
Thrombocytopenia
PC<100x10^9/L
thrombocytosis
PC>400x10^9/L
Primary increase
platelet production disorder
Aplastic anemia, radiation injury, acute leukemia, megaloblastic anemia, advanced myelofibrosis, etc.
Increased platelet destruction or consumption
Immune thrombocytopenia ITP, SLE, lymphoma, upper respiratory tract infection, rubella, neonatal thrombocytopenia, post-transfusion thrombocytopenia, DIC, thrombotic thrombocytopenic purpura TIP, congenital thrombocytopenia
abnormal platelet distribution
Enlarged spleen (cirrhosis, Banti syndrome), blood dilution
Increased reactivity
Acute infection, acute hemolysis, certain cancers
Mild increase, generally <500*10^9/L
Determination of mean platelet volume and platelet distribution width
Reference
MPV, 7~11fl
PDW, 15~17%
clinical significance
mean platelet volume MPV
significance
average volume of individual platelets
Performance
Increase in MPV
Patients with increased platelet destruction and good bone marrow compensatory function
After the suppression of hematopoietic function is relieved, hematopoietic function begins to recover
Increased MPV is the first sign of recovery of hematopoietic function
MPV reduced
Poor bone marrow hematopoiesis and reduced platelet production
leukemia patient
MPV continues to decrease with platelet count
One of the indicators of bone marrow hematopoietic failure
Platelet distribution width PDW
significance
Reflects the dispersion of platelet volume size, expressed by the coefficient of variation CV% of a single platelet volume size
Performance
PDW reduction
Platelets have high homogeneity
Increase in PDW
Platelet size disparity
Acute myeloid leukemia, megaloblastic anemia, chronic myeloid leukemia, splenectomy, giant platelet syndrome, thrombotic diseases, etc.
Peripheral blood platelet morphology
concept
Features
The cell body is round, oval or irregular, with a diameter of 2~3µm.
The cytoplasm is light blue or light red, with small azurophilic granules in the center.
type
Medium platelets, 44.3~49%
Small platelets, 33~47%
Large platelets, 8~16%
Giant, 0.7~2%
size changes
The size of platelets is obviously uneven, and the diameter of large ones can reach 20~50µm or more.
Immune thrombocytopenia ITP, acute myeloid leukemia, chronic myeloid leukemia, certain reactive myeloid hyperproliferative diseases
Morphological changes
normal
Mature platelets account for the vast majority, with a small number of irregular or malformed platelets (<2%), and <7% of platelets with too many or too few granules.
pathology
Abnormal platelet ratio >10%
Normal childish type increases
after acute blood loss
Increased pathological infantile type
Primary, reactive platelet disorders
Lots of blue, giant platelets
Exuberant proliferation of bone marrow megakaryocytes
Distribution
normal
Normally functioning platelets, aggregated into clumps or clusters in peripheral blood smear
pathology
Platelets aggregate into clumps and sheets, occupying the entire field of view of the oil lens
essential thrombocythemia
Significant decrease in platelets
aplastic anemia
No clumping of platelets
Thrombocytopenia
Erythrocyte sedimentation rate measurement ESR/erythrocyte sedimentation rate
concept
definition
The rate at which red blood cells settle under certain conditions, that is, erythrocyte sedimentation rate
factor
Changes in components in plasma
Globulin, fibrinogen↑→Accelerated erythrocyte sedimentation rate
Number and shape of red blood cells
Red blood cells↓→Accelerated erythrocyte sedimentation rate
Spherical red blood cells↑→Slowed erythrocyte sedimentation rate
Reference
Male, 0~15mm/1h
Female, 0~20mm/1h
clinical significance
Increased erythrocyte sedimentation rate
physiological increase
Children <12 years old, senior citizens >60 years old, women during menstrual period, pregnancy >3 months
Physiological anemia, increased fibrinogen content
pathological increase
various inflammatory diseases
Acute bacterial inflammation, rheumatic fever, tuberculosis
tissue damage and necrosis
acute myocardial infarction
malignant tumor
Related to tumor cells secreting glycoprotein products, tumor tissue necrosis, secondary infection, anemia, etc.
Relative or absolute increase in plasma globulin
Nephritis, cirrhosis, multiple myeloma, macroglobulinemia, some B-cell lymphomas, systemic lupus erythematosus, subacute infective endocarditis, kala-azar, etc.
other illnesses
partial anemia
Atherosclerosis, diabetes, nephrotic syndrome, myxedema, etc.
High blood cholesterol and accelerated erythrocyte sedimentation rate
ESR slows down
Less clinical significance
Polycythemia, spherocytosis, severe deficiency of fibrinogen content
Application of Hematocrit Determination and Red Blood Cell Related Parameters
Hematocrit measurement HCT/ Hematocrit PCV
definition
The ratio of blood cells to blood volume
Reference
Micromethod
Male (0.467±0.039)L/L, female (0.421±0.054)L/L
Wen's method
Male, 0.4~0.50L/L (40~50vol%), average 0.45L/L
Female, 0.37~0.48L/L (37~48vol%), average 0.40L/L
clinical significance
effect
Reflects the increase or decrease in red blood cells
factor
Plasma volume, red blood cell volume
Performance
Increased HCT
Hemoconcentration due to various causes
HCT>0.5
Absolute increase in red blood cells caused by various reasons
HCT>0.6
HCT decrease
Various anemias
The decrease in HCT is not necessarily proportional to the decrease in red blood cell count.
Calculation of average red blood cell count
composition
mean corpuscular volumeMCV
definition
Refers to the average volume of each red blood cell, measured in femtoliters (fl)
Reference
Manual method, 82~92fl (82~92µm³)
Blood cell analyzer method, 80~100fl
formula
Mean corpuscular hemoglobin MCH
definition
Refers to the average amount of hemoglobin contained in each red blood cell, measured in picograms (pg).
Reference
Manual method, 27~31pg
Hematology analyzer method, 27~34pg
formula
mean corpuscular hemoglobin concentration MCHC
definition
Refers to the average hemoglobin concentration (grams) per liter of blood, expressed in g/L
Reference
320~360g/L(32~36%)
formula
clinical significance
Classify anemia (depends on the accuracy of red blood cell count, hemoglobin amount, and hematocrit measurement)
Red blood cell volume distribution width RDW determination
definition
Parameters reflecting peripheral blood and red blood cell volume heterogeneity
effect
Diagnose anemia
Reference
RDW-CV (coefficient of variation of red blood cell volume), 11.5~14.5%
clinical significance
Morphological classification of anemia
Diagnosis and differential diagnosis of iron deficiency anemia
iron deficiency anemia
Microcytic hypochromic anemia, increased RDW
Mild beta globin dysgenesis anemia
Microcytic hypochromic anemia, but mostly normal RDW
Dynamic monitoring in the treatment of iron deficiency anemia
Iron deficiency latent period, RDW increased
After treatment, the anemia was corrected, but the RDW did not return to normal levels.
Reflects that the iron stores in the body have not been fully replenished
Clinical applications of blood cell histograms
concept
cell distribution histogram
effect
Display cell population distribution
Features
Abscissa - cell volume
Volume data are in femtoliters (fl)
Vertical coordinate - relative number of cells
White blood cell volume distribution histogram
Classification (35~450fl)
The first group, small cell area (35~90fl)
Lymphocytes are the main components (mature lymphocytes, reactive lymphocytes)
The second group, the middle cell area (90~160fl)
Monocytes, blasts, immature cells, eosinophils, basophils
The third group, large cell area (160~450fl)
Neutral lobulated granulocytes, neutrophilic rod-shaped granulocytes, metamyelocytes
Features
Graphical changes are not specific
There is overlap between cell volumes, and the same group can include multiple types of cells.
An increase in any type of cells in the histogram will produce similar changes in the histogram.
effect
Roughly judge changes in cell proportions or the presence of obvious abnormal cells
Red blood cell volume distribution histogram
effect
Reflects the size of red blood cells in physiological state
Type (24~360fl)
Main group of red blood cells (main peak)
Starting from 50fl and above, there is a normal distribution curve that is approximately symmetrical on both sides and has a narrow base.
Large cell group (toe)
Located on the right side of the main peak, approximately distributed in the 130~185fl area
Some dimer, trimer, multimer cells, small pore residues and reflections of white blood cells
Features
MCV, RDW two parameters
MCV↑——The wave peak moves to the right
RDW-CV↑——wave peak base base broadening
The histogram shows "double peaks" - there are 2 red blood cell populations in peripheral blood
When analyzing histogram graphics, pay attention to the position of the main peak, the base width of the peak, the shape of the peak top, and whether there are double peaks.
Performance
Cell histogram changes in anemia
iron deficiency anemia
microcytic anemia
The MCV decreases and the peak of the main peak curve moves to the left.
Red blood cell size is heterogeneous and RDW is increased
Characteristics of microcytic heterogeneous anemia
Mild beta globin dysgenesis anemia
microcytic homogeneous anemia
The crest moves to the left and the base becomes narrower
sideroblastic anemia
"Dimorphic" changes (microcytic hypochromic red blood cells and normal red blood cells coexist) - double peaks with the peak shifted to the left and the bottom of the peak widened
megaloblastic anemia
large cell heterogeneity
The peak of the histogram moves to the right and the bottom of the peak broadens
mixed nutritional anemia
The pattern changes depending on which cell type is dominant (trophic megaloblastic anemia [MCV↑], iron deficiency anemia [MCV↓])
The severity of both is similar, and the histogram display shows normal (RDW↑, peak base broadening)
platelet histogram
Reference
Histogram volume distribution range, 2~20fl
effect
Reflects PLT, MPV, PDW, PCV and other parameters