Table 6. Erythrocytes distribution by their size

Term	Er average diameter (mcm)	MCV (fl)
Normocytic	6,8-8,5	78-94
Microcytic	<6,8	<75
Macrocytic	>8,5	>94

 

OTHER HEMATOLOGIC INDEXES WIDELY USED IN MODERN CLINICS AND LABORATORIES

· NRBC/100 WBC - Er amount on 100 L;

· TOXIC GRAN – irritation granules (appearing in blood at intoxications);

· Dohle Body – specific granules (Dohle bodies);

· RPI – Reticulocytic-Platelet Index;

· Aniso – anisocytosis ; 

· Мacro – macrocytosis;

· Micro – microcytosis;

· Poikilo - poikylocytosis;

· Ovalocyte – ovalocytosis;

· Elliptocyte – elliptocytosis;

· Target cells – targeted Er;

· Shistocyte – shictocytes (“hedgehogs”);

· Acanthocyte – “hedgehogs”, but “needles” amount is less, they are thicker and located more seldom;

· Tear drop – dacryocytes (Er like tears);

· Spherocyte;

· Sickle Cell – drepanocyte, sickle-shaped Er (it contains Hb S, badly attaching and giving oxygen, it possesses increased ability to sedimentation and vessels obstruction and is observed at sickle-celled anemia;

· Hypochromia;

· Polychrom – polychromatophilia – sensitivity to many stains;

· Howel-Jolly (bodies) - (leucocytes granules);

· Burr Cell or bodies – sexual chromatin (is detected in neutrophils).

TOTAL BLOOD EXAMPLE

40-YEARED MAN

(it is performed on automatized counter MS9)

· WBC 6180 /ul (norm 4000-11000) or 6,18 x 10⁹/l

· RBC 4,57 Mil/ul (norm 4,20-5,40) or x 10¹²/l

· RDW 11,2

· Hemoglobin 9,5 g/dl (norm 12-16)

· Hematocrit 32,1 % (norm 36-46)

· MCV 70,2 fl (norm 80-100)

· MCH 20,8 pg (norm 27-32)

· MCHC 29,6% (norm 33-38)

· ESR 8 ihr (mm/hr) (norm up to 15)

· ANISO 2+

· MICRO +

· MACRO +

· HYPOCHROMIA +

· POIKILO –

· Neutrophils 72%

· Lymphocyte 27%

· Monocyte 1%

 

Result: Anemia Hypochromic Microcavitary

Table 7: Main indexes of blood:

RBC	Red Blood Cells	М 4,5-5,5х 1012/l W 3,7-4,5 х 1012/l	Newborns 4,0-7,0 х 1012/l babies, children 3,7-5,3 х 1012/l	After 75 years –physiological anemia
HB	Hemoglobin	М 130-180 g/l W 120-160 g/l	Newborns 200-240 g/l; babies 110-140 g/l	After 75 years –physiological hypochromy
Ht or HCT	Hematocrit	М 40-48% W 36-44%	Newborns 44-64% children 35-45%	Reduced after 60 years
RDW	Red Сells Distribution Width	11,5-14,5%
MCV	Mean Corpuscle (Corpuscular) Volume	83-98 mcm3	Newborns 128 fl 7 days 100-112 fl 6 months 78 fl 12 months 77-79 fl 4-5 months 80 fl	Increasing after 50 years (especially in smoking people) at physiological age iron-deficient ane-mia - microcytosis
МСН	Mean Corpuscular Hemoglobin	27-33 pg	24-30 pg	Less than norm after 60 years (as anemia result)
MCHC	Mean Corpuscular Hemoglobin Сoncentration	32-36 g/dl 320-360 g/l	More than norm in newborns	Less than norm at Fe-deficiency
VSR or ESR	Velocity sedimentation rate or erythrocytes sedimentation rate	М 6-12 mm/h W 8-15 mm/h (at pregnancy up to 20 mm/h as hyperfibrino-genemia result, 15-20 mm/h at menstruation as erythropenia result)	Newborns 1-2 mm/h Up to 1 month 2-6 mm/h 6-12 months 4-14 mm/h 2-10 years 4-12 mm/h	1-2 mm/h
ER	Erythrocytic resistance (the most often osmotic one)	Min 0,42-0,48% NaCl (hemolysis beginning), max – 0,30-0,34% (complete hemolysis)	Newborns: min 0,48-0,52%, max – 0,24-0,30%; babies: min 0,46-0,50%, max – 0,24-0,32%; 1-7 years min 0,46-0,48%, max – 0,26-0,36%; 7-15 years min - 0,44-0,48%, max – 0,28-0,36%	In the old – both min and max boarders get decreased but minimal one – more significant
WBC	White Blood Cells	4,5-9,0 x 109/l	Newborns 11,6-20,6 2 weeks 8,4-14,1 1 months 7,6 – 12,4 2 months 7,2-11,6 6 months 6,7-11,3 1 year 6,8-11,0 7 years 5,9-9,3 15 years 5,5-8,5	In the old – like in the adult; leucopeny – at purulent-septic diseases, in exhausted people, at alimentary tract diseases
WBC Differen-tial	White Blood Cells Differential
GRA	Granulocytes (#) – absolute numerals; % - percentage correlation in leucocytic formule		Other tables	Often segmented-nucleated (degenerative) shift to the right, it is a sign of blood getting old
Neut:	Neutrophils	50-70%
1) Stabs or stab neutro-phils, rods or rod neutrophils	Rod-nucleated neutrophils	1-4%
2) Bands	Segment-nucleated neutrophils	50-65%
Eos	Eosinophils	1-4%
Bas (Baso)	Basophils	0-1%
AGRA	Agranulo-cytes			In deep old people there can be monocytopeny and lymphocyte-peny
Lymph	Lymphocytes	20-40%: T – 40-70%; B – 20-30%; 0 (zero) or T- and B- lymphocytes predecessors – 20-30%
Mon (Mono)	Monocytes	2-10%

 

Table 8

NEW-BORNS LEUCOCYTE FORMULE

Day	Mye-locytes	Meta- myelo-cytes	Rods	Segm	Lymph	Mon	Eos	Bas
1-st hour	0-4	0-4	0,5-11,3	51,4-72,0	16,1-33,3	3,1-9,5	1,0-5,0	0-1
1 day	0-1,5	0-4	0,8-12,4	49,6-72,8	15,5-31,7	4,1-10,5	0,7-3,5	0-1
2 day	0-2,5	0-5	0,5-11,3	46,9-69,1	18,6-34,8	4,7-12,1	0,8-5,0	0-1
3 day	0-1	0-4	1,0-6,6	41,5-63,5	21,9-40,3	5,9-14,3	1,7-5,7	0-1
4 day	0-0,5	0-3	1,2-5,4	36,0-59,0	26,1-47,1	5,6-15,0	1,6-6,2	0-1
5 day	0-2	0-4	1,3-5,1	32,4-54,0	30,7-49,9	6,4-14,4	1,8-6,0	0-1
6 day	0-2	0-3	1,1-4,5	40,5-54,5	31,5-53,7	6,8-14,2	1,5-6,3	0-1
7 day	0-1	0-4	1,4-4,6	29,0-47,0	36,5-55,1	6,1-14,9	1,7-5,7	0-1
8 day	0-1	0-4	1,2-4,6	29,5-48,4	37,0-55,4	6,0-14,2	1,5-5,7	0-1
9-15 days	0-0,5	0-4	0,9-4,1	26,3-47,5	38,0-57,8	6,2-14,8	1,9-6,3	0-1

Table 9

BABIES LEUCOCYTIC FORMULE, %

Months	Rods	Segm	Lymph	Mon	Eos
1	0,9-3,1	17-39	46-70	4,2-11,8	1,8-6,2
2	0,9-3,1	16-34	52-72	4,4-11,6	1-5
3	0,8-3,2	18-36	51-71	4-10	1-5
4	1,0-3,0	19-39	48-68	3,7-10,3	1-5
5	0.9-3,1	21-39	48-68	3,7-10,3	1-5
6	0,8-3,2	20-40	47-69	3,9-10,1	1-5
7	0,9-3,1	20-40	48-68	4-10	1,9-5,1
8	0,8-3,2	21-43	45-67	3,8-10,2	1-5
9	0,8-3,2	22-42	46-66	4-10	1-5
10	0,8-3,2	24-44	44-64	4-10	1,2-4,8
11	0,8-3,2	25-43	43-65	4-10	0,9-5,1
12	0,8-3,2	23-43	44-66	4-10	0,8-5,2

 

Table 10

DIFFERENTIATED LEUCOCYTES OF 2-15-YEARED CHILDREN, %

 

Years	Segm	Rods	Lymph	Mon	Eos
2	1-3	28-48	37-61	5-9	1-7
3	1-3	32-54	34-56	4-8	1-7
4	2-4	34-54	33-53	4-8	2-6
5	1-3	35-55	33-53	3-9	2-6
6	1-3	38-58	30-50	3-9	2-6
7	1-3	39-57	32-50	4-8	1-5
8	1-3	41-59	29-49	4-8	1-5
9	1-3	43-59	30-46	4-8	1,5-4,5
10	1-3	43-59	30-46	4-8	1-5
11	1-3	45-57	30-46	3-9	1,5-4,5
12	1-3	44-60	29-45	4-8	1-5
13	1-3	45-59	30-44	4-8	1-5
14	1-3	46-60	28-44	4-8	1-5
15	1-3	45-61	29-45	3-9	1-5

PLATELETS FUNCTIONS ASSESSMENT CRITERIA

· platelets absolute quantity;

· capillary bleeding time;

· platelets aggregational activity;

· blood clot retraction;

· prostaglandines (thromboxanes, prostacyclines) metabolism.

 

COAGULOGRAM CHANGES IN CHILDREN

In mature new-borned

Vascular-platelet hemostasis:

· platelet amount is like in bigger children and even in the adult;

· bleeding duration is like in the adult;

· platelet clot retraction is like in the adult;

· platelets morphology is like in the adult;

· adhesive function is like in the adult;

· aggregation activity is reduced to ADP, collagen, epinephrine (due to weakened releasing reaction, proaggregants decreasing in part thromboxan and prostaglandins).

Coagulation hemostasis:

· the XII-th factor level is equal to 20-70% from adult level (up to the 9-14^th days of life);

· prekallikrein level is reduced up to 20-50%;

· highly-molecular kininogen is lowered up to 40-80% of the adult level;

· thus, both blood coagulation and fibrinolysis are retarded;

· but even deep hypocoagulation is not accompanied by bleedings;

· this period distinguishing feature is vit K-dependent factors (II, VII, IX and X) lowering especially on the 3^rd and the 6^th days of life (they come to norm up to the 14^th day of life);

· early cutting of cord before so-called “placenta autotransfusion” id est blood pumping from placenta vessels into the child blood stream leads to bigger lowering in these vit K-dependent factors content;

· similarly, maternal breast early giving (during 2 first hours after birth) lowers significantly mentioned factors depression after birth comparatively to breast later giving (in 6-8 hours);

· antithrombin III level in plasma is lowered up to 50-69% and reaches its normal level up to the 6^th month;

· protein C and S contents are reduced significantly;

· plasminogen level is lowered up to 40-50% (up to the 6^th month);

· plasminogen activator level is increased during the 1^st 7 days;

· fibrinolysis activation is especially observed at cord cutting in 3-5 min (if right after birth – in less extent);

· if coagulation factors level is less than 10% than the child can be determined to the risk group on hemorrhagies;

· if coagulation factors content is more than 60% than the child can be determined to the risk group on thrombosis.

But one should remember that all mentioned features are physiological norm sign but not pathological one.

In immature new-borned:

· hemostasis bigger depression than in mature babies;

· lowering all procoagulants except fibrinogen and fibrinase;

· maximal hypocoagulative shift is observed during the 1^st day of life (in mature babies – during the 3^rd-5^th days);

· early hypocoagulation reason – physiological jaundice, factors deficient synthesis in liver;

· bigger deficiency of the XII-th;

· bigger deficiency of antithrombin III, protein C;

· bigger deficiency of fibrinolytic system components;

· all mentioned changes determine bigger rate both of hemorrhagic and thrombotic changes, more often DIC-syndrome development;

· increase up to the adult norm appears in different terms.

Yeared children

· blood coagulation time reaches adult numbers up to an end of the 1^st year of life;

· platelets number – is like in the adult;

· but many junior thrombocytes (8-17%, in the adult – 4-5%);

· 7-8% - old platelets;

· 10-11% - atypic forms;

· prothrombin content is fluctuated more both in the side of increase and decrease;

· the V-th and VII-th factors level is reduced comparatively to the adults;

· thus, there is big variety in indexes and they do not reach adult norms.

 

The biggest varieties –during puberty.

TOTAL BLOOD

Name_________________________________________

Sex________________

Age_______________

Special conditions (in part, pregnancy)________________

Er number________________________________

Hb level__________________________________

Color index_______________________________

VSR (ESR)_______________________________

Hematocrit_______________________________

MCV ____________________________________

MCH ____________________________________

MCHC__________________________________

Reticulocytes_____________________________

Leucocytes number( L)______________________

Junior (JUN) or bands ______________________

Stabs or rods_____________________________

Segments (SEGM) ________________________

Basophils (BAS) __________________________

Eosinophils (EOS) ________________________

Lymphocytes (LYMPH) _____________________

Monocytes (MON)__________________________

Platelets (PLT) ____________________________

4. Literature recommended:

1. Lecture course.

2. Mistchenko V.P., Tkachenko E.V. Methodical instructions for dental students (short lecture course).-Poltava, 2005.-P.38-47.

3. Mistchenko V.P., Tkachenko E.V. Methodical instructions for medical students (short lecture course).-Poltava, 2005.-P. 60-81.

4. Mistchenko V.P., Tkachenko E.V. Blood system Physiology //Methodical recommendations to practical classes for students of medical and dental departments.-Poltava, 2005.-20p.

5. Stuart Ira Fox. Human Physiology.-8^th Ed.-McGrawHill, 2004.-P.367-378, 444-476.

6. Seeley R.R., Stephens T.D., Tate P. Essentials of Anatomy and Physiology.-The 3^rd Ed.-McGraw Hill, 1999.-P. 286-304, 372-392. 

 

LESSON 40

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