Introduction to the course

Chang Gung UniversityDepartment of Medical Biotechnology

Clinical HematologySpring, 2012

Course Coordinator: Dr. Daniel Tsun-Yee Chiu

Participating Instructors: Drs. ML Cheng, CP Tseng , HY Ho, SJ Lin, CR Shen and DC Chu; vice chief Technologists: Ms. CC Tsao and PY Chang.

Laboratory Coordinatior: Dr. Ching-Ping Tseng and Mr, Gen-Hung Lee, MT, MS.

Technical Specialist: Ms. Yu-Han Chen, MT, MS

Text required1. Hoffbrand AV, Pettit JE. "Essential haematology" 5th

edition.Blackwell Science, 2006 (6th edition may come out later on this semester)

1. Dacie JV, Lewis SM. "Practical Haematology" 10th ed.,Churchill Livingstone, 2006

2. McDonald GA, et al. "Atlas of Haematology" 5th ed.,Church Livingstone, 1988(Highly recommended but not mandated)

Additional references 1. Jandl J. "Blood: Text book of Hematology". Little Brown, 1991.

2. Hoffman et al. "Hematololgy". churchill Livingstone, 1991

3. Williams et al. "Hematology". McGrqw and Hill, 1991

4. Stamatoyannopoulos et al. "The molecular basis of blood diseases". 2nd ed., W.B. Sanders Co., 1994.

5. Wintrobe MM et al. "Clinical Hematology" 9th ed. Lea & Febiger, 1992

6. Rapaport S. "Introduction to Hematology" 2nd ed.,J. B. Lippincott Co., 1987

Course Format This course is a team-teaching course and officially schedules 2

hours of lecture per week on Tuesday from 1:10-2:00PM & on Thursday from 1:10–2:00 PM. In addition, 2 laboratory sessions per week with 3 hours each has been officially scheduled on Tuesday. 2:10AM-5:00 PM and on Thursday from 2:10-5:00 PM. However, some of the officially scheduled lab. hours may be used for lecture and vise versa.

Subject matter covered The four major components of blood, namely, red cells, white cells,

platelets and plasma, will be discussed. Major emphasis include:

1. Nomenclature (terminology)2. Morphology of formed elements3. Hematologic theories and techniques

In addition, the molecular basis, biochemistry and pathophysiology of blood diseases will be discussed with a major emphasis on the laboratory aspects of differential diagnosis of these diseases.

Clinical Hematology 2012 Course Coordinator: Ching-Ping TsengLecture-------Tuesday, 1:10-2:00PM & Thursday, 1:10-2:00PMLaboratory---Tuesday, 2:10-5:00PM & Thursday, 2:10-5:00PM

Basis of Grading

Office hours: Drop-in or by appointment. Ext. 5097

Chang Gung UniversityDepartment of Medical Biotechnology Clinical Hematology

RBC 1－ RBC function and RBC Indices

RBC function and Red cell indicesI. Function of RBC : To transport oxygen and CO2

II. Morphology : Biconcave donut shape or biconcave discIII. Hematocrit and Red cell countIV. Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration (MCHC)V. Red Cell distribution Width (RDW)

VI. Required Reading:"Essential Haematology " by Hoffbrand & Pettit . pp 1-11" Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp 49-51 and pp 72-74.

RBC Morphology

• Biconcave disc• Diameter : 7 ~ 8 μm

RBC function and Red cell indicesI. Function of RBC : To transport oxygen and CO2

II. Morphology : Biconcave donut shape or biconcave discIII. Hematocrit and Red cell countIV. Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration

(MCHC)V. Red Cell distribution Width (RDW)VI. Required Reading:

"Essential Haematology " by Hoffbrand & Pettit . pp 1-11" Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp 49-51 and pp 72-74.

Hematocrit (Hct)• When anticoagulated whole blood is centrifuged, the

space occupied by the packed red blood cells.

• Normal range : 42~52% for men 36~46% for women

Plasma

Buffy coat

Red blood cells

Capillary tube

Red blood cell count• The red blood cells count (RBC) is the number of red

blood cells in 1 μl of whole blood.

• Normal range : 4.2~5.4 million / μl for men 3.6~5.0 million / μl for women

RBC function and Red cell indicesI. Function of RBC : To transport oxygen and CO2

II. Morphology : Biconcave donut shape or biconcave discIII. Hematocrit and Red cell countIV. Red Cell Indices 1. Mean Corpuscular Volume (MCV) 2. Mean Corpuscular Hemoglobin (MCH) 3. Mean Corpuscular Hemoglobin Concentration

(MCHC)V. Red Cell distribution Width (RDW)VI. Required Reading:

"Essential Haematology " by Hoffbrand & Pettit . pp 1-11" Hematology: Principle & Procedures" by B Brown. (Lea and Fegiger) pp 49-51 and pp 72-74.

Mean Corpuscular Volume (MCV)

• The MCV indicates the average volume of the red blood cells.

• MCV =

= (fl)

• Normal value for the MCV : 80~97 fl• If the MCV is less than 80 fl, the RBCs are microcytic. If the MCV is greater

than 97 fl, the RBCs are macrocytic. If the MCV is within the normal range, the RBCs are normocytic.

Volume of RBC in femtoliters (fl) / μl of blood

RBC / μl of blood

Hematocrit * 10RBC count in millions

1 μl = 109 fl

Mean Corpuscular Hemoglobin Concentration (MCHC)

• The MCHC is an expression of the average concentration of hemoglobin in the red blood cells. It gives the ratio of the weight of hemoglobin to the volume of the red blood cells.

• MCHC =

=

• Normal value for the MCHC : 32~36 %

Hemoglobin in g/dlHematocrit /dl

* 100 (to convert to %)

Hemoglobin * 100Hematocrit

%

Mean Corpuscular Hemoglobin Concentration (MCHC)

An MCHC below 32% indicates hypochromia, an MCHC above 36% indicates hyperchromia, and red blood cells with a normal MCHC are termed normochromic. Please note that an MCHC above 38% should not occur.

Mean Corpuscular Hemoglobin (MCH)

• The MCH indicates the average weight of hemoglobin in the red blood cells.

• MCH =

=

• Normal value for the MCH : 27~31 pg

• An MCH lower than 27 pg is found in microcytic anemia and also with normocytic, hypochromic RBCs. An elevated MCH occurs in macrocytic anemia and in some cases of spherocytosis in which hyperchromia may be present.

Weight of hemoglobin in 1 μl of bloodNumber of red blood cells in 1 μl of blood

Hemoglobin * 10Red blood cell count in millions

(pg)

1 g = 1012 pg

1 ml = 103 μl

Red cell distribution width (RDW)• RDW is an index of the variation of red cell size (volume) in a specimen of blood

• RDW=

• RDW=

Size at 80% tile – size zt 20% tile

Size at 80% tile + size zt 20% tileNormal range : 10 ± 1.5 %

S.D. of size distribution

MEAN size

Normal range : 13 ± 1.5 %

• Advantages of having RDW 1. Recognize RBC abnormality from CBC 2. Assist in differential diagnosis 3. Following the course of a disease

•An example of Complete Blood Count (CBC)