Blood Routine

Examination
 Blood tests are used to determine
physiological and biochemical states
such as disease, mineral content,
drug effectiveness, and organ
function.
 Cellular evaluation
 Full blood count (or "complete blood count")
 Hematocrit and MCV ("mean corpuscular volume")
 Erythrocyte sedimentation rate (ESR)
 Cross-matching. Determination of blood type for
blood transfusion or transplants
 Blood cultures are commonly taken if infection is
suspected. Positive cultures and resulting sensitivity
results are often useful in guiding medical treatment
 Complete Blood Count
 The complete blood count is the calculation
of the cellular (formed elements) of blood

 These calculations are generally

determined by specially designed
machines that analyze the different
components of blood in less than a minute

 The complete blood count (also called CBC)

is generated by testing a simple blood
sample.
 Components of CBC

White blood cell count (WBC)

 The number of white blood cells in a volume

of blood
 Normal range varies between 4,300 and
10,800 cells per cubic millimeter (cmm)
 This can also be referred to as the leukocyte
count and can be expressed in international
units as 4.3 - 10.8 x 109 cells per liter
Automated white cell differential

A machine generated percentage of the different types of white

blood cells, usually split into granulocytes, lymphocytes,
monocytes, eosinophils, and basophils

Neutrophil 27.5x109/L 45-54 — 62-74 % of WBC

Lymphocytes 1.34x109/L 16-25 ---- 33-45 % of WBC
Monocytes 0.20.8x109/L 3-4 -----7-10  % of WBC
Eosinophil 0.040.4x109/L 13-7 % of WBC
Basophil 0.010.1x109/L 0.00.75-2 % of WBC
Red cell count (RBC)

 The number of red blood cells in a

volume of blood
 Normal range varies between 4.2 - 5.9
million cells/cmm
 This can also be referred to as the
erythrocyte count and can be expressed
in international units as 4.2 - 5.9 x 1012
cells per liter
Hemoglobin (Hb)

 The amount of hemoglobin in a volume of blood

 Hemoglobin is the protein molecule within red blood cells
that carries oxygen and gives blood its red color
 Normal range for hemoglobin is different between the
sexes and is approximately 13 - 18 grams per deciliter
for men and 12 - 16 for women (international units 8.1 -
11.2 millimoles/liter for men, 7.4 - 9.9 for women)
Hematocrit (Hct)
 The ratio of the volume of red cells to
the volume of whole blood
 Normal range for hematocrit is
different between the sexes and is
approximately 45 - 52% for men and
37 - 48% for women
 Mean cell volume (MCV)

 The average volume of a red cell

 This is a calculated value derived
from the hematocrit and red cell
count
 Normal range is 86 - 98 femtoliters
Mean cell hemoglobin (MCH)

 The average amount of hemoglobin in

the average red cell
 This is a calculated value derived from
the measurement of hemoglobin and the
red cell count
 Normal range is 27 - 32 picograms
Mean cell hemoglobin concentration
(MCHC)

 The average concentration of

hemoglobin in a given volume of red
cells
 This is a calculated volume derived from
the hemoglobin measurement and the
hematocrit
 Normal range is 32 – 36 g/dl.
Red cell distribution width (RDW)

 A measurement of the variability of red cell

size
 Higher numbers indicate greater variation in
size
 Normal range is 11 – 15%
Platelet count

 The number of platelets in a volume blood

 Platelets play a vital role in blood clotting
 Normal range varies slightly between laboratories
but is in the range of 150,000 - 400,000/ cmm
(150 - 400 x 109/liter)
Indication for CBC

 The complete blood count (CBC) is a screening test,

used to diagnose and manage numerous diseases

 It can reflect problems with fluid volume (such as

dehydration) or loss of blood

 It can show abnormalities in the production, life span,

and destruction of blood cells

 It can reflect acute or chronic infection, allergies, and

problems with clotting.

 The CBC test isolates and counts the six types of cells
found in the blood: eosinophil, neutrophil, band cell,
red blood cell, lymphocyte, and monocyte
Procedure

 A CBC requires a simple blood drawing

 Blood is drawn from a vein, usually from the inside of the

elbow or the back of the hand
 When the needle is inserted to draw blood, some people
feel moderate pain, while others feel only a prick or
stinging sensation
 After the blood is drawn, there may be some throbbing

 There are a few slight risks associated with a CBC:

1. Excessive bleeding
2. Fainting or feeling lightheaded
3. Hematoma (blood accumulating under the skin)
4. Infection (a slight risk any time the skin is broken)
5. Multiple punctures to locate veins
Results:
 Normal values vary with altitude and gender.

Low numbers of red blood cells may indicate:

 Blood loss
 Anemia (various types)
 Hemorrhage
 Bone marrow failure (for example, from radiation, toxin,
fibrosis, tumor)
 Erythropoietin deficiency (secondary to renal disease)
 Hemolysis (RBC destruction) from transfusion reaction
 Leukemia
 Multiple myeloma
 Malnutrition (nutritional deficiencies of iron, folate,
vitamin B12, vitamin B6)
 Over hydration
High numbers of red blood cells
may indicate:

 Low oxygen tension in the blood

 Congenital heart disease
 Cor pulmonale
 Pulmonary fibrosis
 Polycythemia vera
 Dehydration (such as from severe diarrhea)
 Renal (kidney) disease with high
erythropoietin production
Low numbers of white blood cells
(leukopenia) may indicate:

 Bone marrow failure (for example, due to

granuloma (granular tumor), tumor, or
fibrosis)
 Presence of cytotoxic substance
 Collagen-vascular diseases (such as lupus
erythematosus)
 Disease of the liver or spleen
 Radiation exposure
High numbers of white blood cells
(leukocytosis) may indicate:

 Infectious diseases
 Inflammatory disease (such as
rheumatoid arthritis or allergy)
 Leukemia
 Severe emotional or physical stress
 Tissue damage (for example, burns)
A low hematocrit may indicate:

 Anemia (various types)

 Blood loss (hemorrhage)
 Bone marrow failure (for example, due to
radiation, toxin, fibrosis, tumor)
 Hemolysis (RBC destruction) related to
transfusion reaction
 Leukemia
 Malnutrition or specific nutritional
deficiency
 Multiple myeloma
 Over hydration
 Rheumatoid arthritis
A high hematocrit may indicate:

 Dehydration
 Burns
 Diarrhea
 Eclampsia
 Erythrocytosis
 Polycythemia vera
 Shock

Low hemoglobin values may indicate:

 Anemia (various types)
 Blood loss
 ESR
 The erythrocyte sedimentation rate (ESR), also called a
sedimentation rate is the rate at which red blood cells precipitate
in a period of 1 hour

 It's a common haematology test which is a non-specific measure of

inflammation

 To perform the test, anticoagulated blood is placed in an upright

tube, known as a Westergren tube and the rate at which the red
blood cells fall is measured and reported in mm/h.

 The red cells form stacks called 'rouleaux' which settle faster

 The ESR is increased by any cause or focus of inflammation. The ESR

is decreased in sickle cell anemia, polycythemia, and congestive
heart failure. The basal ESR is slightly higher in females
 ESR Age (years) 20 55 90
Men 10 14 19
Women 15 21 23
 Cross-matching
 A blood type (also called a blood group) is a
classification of blood based on the presence or absence of
inherited antigenic substances on the surface of red blood
cells (RBCs)

ABO and Rh blood grouping
 Cross-matching, refers to the testing that is
performed to determine the compatibility of a
donated unit of blood with its intended recipient

 Cross-matching is done by a qualified

laboratory technologist in a blood bank, and can
be done electronically, with a computer
database, or serologically
 Blood culture
 Blood culture is microbiological culture of blood

 It is employed to detect infections that are spreading

through the bloodstream (bacteremia, septicemia)

 Microbial organisms multiply and reproduce in

predetermined culture media under controlled
laboratory conditions

 Blood culture are used to determine the type of

organism, its abundance in the sample being tested,
or both
 Biochemical analysis

 A basic metabolic panel measures

sodium, potassium, chloride,
bicarbonate, blood urea nitrogen
(BUN), magnesium, creatinine, and
glucose. It also sometimes includes
calcium
Normal Ranges

 Sodium (Na) 136-145mmol/L

 Potassium (K) 3.5-4.5mmol/L
 Urea 2.5-6.4 mmol/L BUN - blood urea nitrogen
 Urea 7-18mg/dL
 Creatinine – male 62-115μmol/L or 0.7-1.3mg/dL
 Creatinine – female 53-97μmol/L or 0.6-1.1mg/dL
 Glucose (fasting) 3.9-5.8mmol/L
 Glucose (fasting) 70- 105mg/dL
 Some blood tests, such as measuring glucose, cholesterol
or for STD screening require fasting (or no food
consumption) eight to twelve hours prior to the blood test

 While the regular glucose test is taken at a certain point in

time, the glucose tolerance test involves repeated testing
to determine the rate at which glucose is processed by the
body

 For the majority of blood tests, blood is usually obtained

from the patient's vein. However, other specialized blood
tests, such as the Arterial blood gas, require blood
extracted from an artery
Arterial blood gas analysis

 Blood gas analysis of arterial blood

is primarily used to monitor carbon
dioxide and oxygen levels related to
pulmonary function. But, it is also
used to measure blood pH and
bicarbonate levels for certain
metabolic conditions.
 Molecular profiles
 Protein electrophoresis (general technique -- not a
specific test)
 Western blot (general technique -- not a specific test)
 Liver function tests
 Polymerase chain reaction (DNA). DNA testing is today
possible with even very small quantities of blood: this is
commonly used in forensic science, but is now also part
of the diagnostic process of many disorders.
 Northern blot (RNA)
 Sexually transmitted diseases