Medical Laboratory Tests

Tang Ping
First Teaching Hospital
Zhengzhou university
 Contents
 Haematology
 Urine analysis
 CSF and other body fluids analysis
 Stool examination
 Clinical enzymology
 Liver function tests
 Evaluation of renal function tests
 …
 The Blood
 Composition and Function of blood
 RBC, Hb, Hct, Ret, MCV, MCH,MCHC.
 WBC, DC.
 Anemias, homeostasis
 Bone marrow examination
 ESR
 …
Composition & Function
of blood
 Blood Components
 Hematocyte  Plasma

 Erythrocytes (red  55% of blood volume

blood cells)  Water
 Carry oxygen  Electrolytes
 Plasma proteins
 Leukocytes (white
 Albumin
blood cells)
 Fibrinogen
 Protect against  Globulins
infection and cancer
 Substances
 Platelets (cell transported by blood
fragments)  Nutrients
 Blood clotting  Waste products
 Respiratory gases
 Hormones
 Hematocyte
 Red blood cells (erythrocytes)
 White blood cells (leukocytes)
» Granulocytes
– Neutrophils
– Eosinophils
– Basophils
» Agranulocytes
– Lymphocytes
– Monocytes
 Platelets (thrombocytes)
Plasma Composition
Transports organic and
inorganic molecules,
hematocytes, and heat

 Water 90%
 Plasma proteins 7%
 Other solutes 3%
Peripheral blood examination

Red blood cell and hemoglobin

 Red blood cell

Pronormoblast
Basophilic normoblast
Polychromatic normoblast
Orthochromatic normoblast
Marrow reticulocyte
Reticulocyte
erythrocyte
 Red blood cells
 Non-nucleated
 Carriers of oxygen and
nutrients
 Biconcave disc shape
» requires specialized cytoskeleton
» spectrin
 About 8 microns
 Normal values

Men 5.5 ± 1.0 × 1012/l

Women
Infants
(full term cord blood)
Children 3 months
Children 3-6 years
Children 10-12 years
4.8 ± 1.0 ×1012/l
5.0 ± 1.0 ×1012/l
4.4 ± 0.8 ×1012/l
4.8 ± 0.7 ×1012/l
4.7 ±0.7 ×1012/l
 Hemoglobin (Hb)

Fe ion in 
heme group
reversibly
binds O2

How many oxygen

molecules can 1
Hb molecule
carry?


 Hemoglobin Function
 Transport and exchange respiratory gases
» Ease at which hgb binds and releases O2 is
oxygen affinity
» oxyhemoglobin: hgb with O2
» deoxyhemoglobin: hgb without O2
» 2,3 diphosphoglycerate (2,3, DPG) controls hgb
affinity for O2
– TENSE FORM : lower affinity for O2, 2,3 DPG
salt bridges formed (deoxygenated form)
– RELAXED FORM : increased affinity for O2,
molecule shrinks (oxygenated form)
 Hb determination
Sahli’s acid haematin method

Normal Range of Hb

Men 15.5 ±2.5 g/l

Women 14.0 ± 2.5g/l
Infants 16.5 ± 3.0g/l
(full term cord blood)
Children 3 months 11.0 ± 1.5g/l
Children 3-6 years 12.0 ± 1.0g/l
Children 10-12 years 13.0 ± 1.5g/l
Contributors to Hemoglobin Level

 Age
 Gender
 Environment, e.g. altitude
 Pregnancy
 Hydration
 Others, e.g. smoking
 Clinical significances
 RBC increase in  RBC decrease in
 Polythethymia vera  Anemia
 Tabaco abuse  Hemolytic anemia
 High altitude
 Acute hemorrhage
 Renal cell carcinoma
 Marrow failure
 Cardiovascular diseases
 Stress  Chronic renal failure

 Dehydration
 Clinical significances
 Hb increase in  Hb decrease in
 Vigorous exercise
As in RBC
 High altitude
 Anemia
 Dehydration
 Tabaco abuse  Hemolytic anemia
 Polycythemia Vera  Acute hemorrhage
 Renal cell carcinoma  Marrow failure
 Cardiovascular
diseases  Chronic renal
 Stress failure
 Erythrocyte abnormalities
 Osmotic changes
» Renal failure
 Hemoglobin genetic
defects
» Sickle cell anemia
» Thalassemia
 Elliptocytosis and
Spherocytosis
» Deficiency in spectrin of
rbc cell membrane 返回
Morphologic abnormalities
of erythrocytes
 Morphologic abnormalities
of erythrocytes

SIZE
正常红细胞
•Macrocyte( 大红细胞 ), magalocyte( 巨红细胞 ) and
hyperchromic
•Microcyte( 小红细胞 ) and hypochromic
•Anisocytosis ( 红细胞大小不等 )
 Morphologic abnormalities
of erythrocytes

形态变化 MORPHOLOGY
1. Spherocyte (球形红细胞)
2. Elliptocyte (椭圆形红细胞)
3. Target cell (靶形细胞)
4. Sickle cell ( 镰形细胞 )
5. Dacryocyte, teardrop cell (泪滴形红细胞)
6. Acanthocyte （棘形红细胞）
7. Schistocyte or poikilocytosis ( 裂细胞或异形细胞 )
8. Rouleaux formation ( 红细胞缗钱状形成 )
 Morphologic abnormalities
of erythrocytes

血红蛋白含量异常
HEMOGLOBIN CONTENTS
低色素性 hypochromic

高色素性 hyperchromic

嗜多色性 Polychromatic
 Morphologic abnormalities
of erythrocytes

红细胞中出现异常结构 :
Abnormal structure of erythrocyte
点彩红细胞
Basophilic stippling
染色质小体
Howell-Jolly body
卡波氏环
Cabot ring
有核红细胞
Nuckeated erythrocyte
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