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% |
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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 |
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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:
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· the XII-th factor level is equal to 20-70% from adult level (up to the 9-14th 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 3rd and the 6th days of life (they come to norm up to the 14th 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 6th month;
· protein C and S contents are reduced significantly;
· plasminogen level is lowered up to 40-50% (up to the 6th month);
· plasminogen activator level is increased during the 1st 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 1st day of life (in mature babies – during the 3rd-5th 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 1st 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.-8th Ed.-McGrawHill, 2004.-P.367-378, 444-476.
6. Seeley R.R., Stephens T.D., Tate P. Essentials of Anatomy and Physiology.-The 3rd Ed.-McGraw Hill, 1999.-P. 286-304, 372-392.
LESSON 40
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