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HEMATOLOGY

Deals with the clinical, morphologic, and laboratory disorders of the blood and the blood
forming organs
Study includes the analysis of the concentration, structure and function of cells in the
blood; their precursors in the bone marrow; chemical constituents of plasma or serum
function of platelets and proteins involved in the hemostasis and blood coagulation.
BLOOD: Heart
Arteries
Capillaries
Veins
Heart.

Historical review:

Aristotle and Plato- study of Hemostasis.


2nd century AD- moises Maimonides describes 2 male children who died in excessive
bleeding after circumcision.
1658: Swammerdam: discovered erythrocytes.
1674: Anton van Leeuwenhook: discovered microscopes.
1803: Scholein: Hemophilia: love of Hemorrahage
1842: platelets were described
1846: Wharton Jones: distinguished PMN from leukocytes.
1879: Ehrlich: completely classified the leukocytes (basophil, Neutrophils, Monocytes,
Lymphocytes).
1905: paul Morawitz: Blood coagulation theory
1930: Quick prothrombin time determination (Coagulation test)

Functions of the Blood:


1. Respiratory
It transports oxygen from the lungs to the tissues and eliminates carbon dioxide from the
body tissues to the lungs.
2. Nutritional
It serves as a vehicle for transport of blood materials absorbed from the gastrointestinal
tract to the different tissues of the body.
3. Excretion
It pick up metabolic end products of the tissues
4. Buffering action
Through the presence of buffer system, it helps to maintain the acid base equilibrium.
- The maintenance of a normal water balance and fluid distribution throughout the body.
- Assists in the preservation of an almost neutral reactions in the tissue and selective
secretion of soluble substances.
5. Maintenance of constant body temperature

-it distributes the heat produced in active muscles and thus aids in the regulation of body
temperature
6. Transportation of hormones and other endocrine secretions
It transports hormones from the glands in which they are produced to the target organs.
7. Body defense mechanism
It promotes body defense against bacterial invasion and disease through the activities of
certain leukocytes and immune bodies in the blood stream.
Physical characteristics of Blood
1. In vivo, it is fluid because of a naturally circulating anticoagulants ( heparin)
2. In vitro, it coagulates within 5-10 mins
3. It is red in color due to hemoglobin
4. Volume: 6-8% of the total body weight
Adults: 5-6 or 60-85ml/kg body weight
Neonates: 250-350ml
Terms:
Normovolemia= normal blood volume
Hypovolemia= decreased blood volume
Due to:

Loss of whole blood


Loss of rbc
Loss of plasma
Loss of body water

Hypervolemia: increased blood volume


During excessive fluid intake
During blood transfusion
During IV injection of fluids
Oligemia: total reduction of blood volume (severely loss of blood)

5. Viscosity:
Resistance to flow; stickiness in comparison to distilled water
It is thick and viscous; 3.5-4.5 times thicker than water.

6. Specific gravity
This refers to the density of blood compared with distilled water
Average: 1.055

Whole blood (men)

1.055-1.064

Whole blood (women)

1.052-1.060

Plasma

1.025-1.029

Serum

1.024-1.028

7. Reaction or pH
Slightly alkaline (7.35-7.45)

8. Osmolality
-

This depends to the number of osmotic particles in the blood


With an approximately 20gm solid/ 100ml of blood
Serum- 281 to 291 mosm/kg H2O

Composition of Blood
-plasma

Liquid portion of unclotted blood


Protein fibrinogen
Pale yellow plasma

Serum

Liquid portion of clotted blood


Without fibrinogen, clotting factors II, V and VIII
Straw colored fluid
With high serotonin content due to breakdown of platelets during clotting

The following can be found in both plasma and serum:


a. 10% chemicals
NPN (Non protein Nitrogen)
Proteins (albumin and globulin)
Carbohydrates ( sugars)
Lipids (cholesterol, triglycerides)
Enzymes
Electrolytes (inorganic/organic constituents)

Minerals
Antibodies and antigens
Others: hormones, gases
b. 90%water
II cellular/ hemocytes/solids- 45%
a.
-

Redblood cells (RBC)


Erythrocytes
Akaryocytes
Erythroplastids
Normocytes
Discoytes

-contains haemoglobin which binds oxygen


b. white blood cells (WBC)
- leukocytes
-leucoplastids
Defend the body against foreign substances
Types:
a. Granular WBC
= Neutrophil, Eosinophil and Basophils
b. Aggranular WBC
= lymphocytes, monocytes
c. Platelets
=thrombocytes
Thromboplastids
-primarily function in the stoppage of bleeding
d. hemoconia or blood dust of muller

III. Gaseous portion


-exchange between oxygen and carbon dioxide o2, co2 and N2
BLOOD COLLECTION:
-

Correct patient identification


Various collection techniques with precise methodology

Source of blood: Capillary/ Peripheral Blood and venous Blood


Collected in sterile containers

Microsampling

collection of blood from puncture made on skin


blood obtained :
a. capillary blood
b. peripheral blood
c. arteriolar blood
a. Infants <6 months of age
b. Young children
c. Adults
CAPILLARY OR PERIPHERAL BLOOD

It is liable to give discrepant result and should be used only:


a. When venipuncture is impractical
b. When small quantities of blood are required in the examination
c. When patient is bed ridden and the operator feels that the skin or capillary puncture is
easier to perform.
d. Requires free flowing capillary blood as in clotting time and bleeding time
determinations.

Sites of skin puncture:


Adults
a. Palmar surface of the tip of a finger 3rd or 4th finger of the left hand or none which is less
used
b. Free margins of the earlobe
Infants/neonates
a. Plantar surface of the heel
b. Great toe
c. Thumb
Advantage of the finger puncture
1. The finger could be easily manipulated.
2. Skin at the site is elastic, and wound tends to close easily
3. It is preferably employed for preparing blood films but the blood must flow freely to
avoid altered distribution of leukocytes.
Advantage of earlobe puncture

1. Skin is thin and puncture is less painful because of a few nerve endings.
2. Post puncture tenderness is avoided.
3. Less tissue juice because there is less amount of tissues.
Disadvantage of skin or capillary puncture in general
1. Small amount of blood is obtained and the examination cannot be repeated
2. Capillary or peripheral blood frequently hemolyzes.
3. Precision is poorer in capillary blood than venous blood because of the variation in the
flow and dilution with insterstitial fluid.
Collection techniques:
puncture

2-3mm depth

1st drop(blood) wipe away because presence of tissue juices.

2nd blood = use for examination.

Things to remember in doing skin puncture:


1. An edematous or congested part should not be used since results will be inaccurate
2. Cold and cyanotic skin is not advisable to use it gives false high cell count.
3. Disposable lancets should be used.
4. Whichever is site is used, make sure it is warm, to guarantee dilated vessels and thus
ensure free flow of blood.
5. For earlobe puncture, the ear must be rubbed with lint until warm and pink. When the
heel is used, it must be made warm by immersion in warm water or by use of hot water
compress. Otherwise values significantly higher than in venous blood may be obtained,
especially in newborn.
6. Vigorous squeezing after puncture should be avoided because it causes the add mixture of
tissue juices.

Venous blood:
Venipuncture
Three factors are involved in good venipuncture:

Venipuncturist
Patient and his vein
Equipment

Venipuncturist

Also called phlebotomist


Old phrase: primum non nocere
Or the first thing is not to inflict damage
Hematomas or ecchymoses are evidence of phlebotomist poor technique or judgement

Venous blood is most preferred:


1. Easier and more convenient and an adequate volume of suitable for variety of test is
obtained
2. Offers the fastest method of collecting samples from a large number of patients.
3. It reduces the amount and variety of apparatus to be carried in the hospital wards.
4. It reduces the possibility of error resulting from dilution with tissue juices or constriction
of skin vessels by cold or emotion that may occur in taking blood by finger puncture.
General methods of venous collection
1. Syringe method
2. Vacuum method
3. Butterly infusion method
Sites of venipuncture:
Years old up to adult life:
1. Veins of the antecubital fossa
a. Median cephalic vein (most preferred)
Well anchored in tissue and does not roll when punctured.
b. Cephalic vein
Is located on the outer part of the arm where the outside skin tends to be a little
tougher
c. Median cephalic vein is located on the outer part of the arm where the outside skin
tends to roll in many patients.
2. Veins on the dorsal surface of the hand and fingers
3. . veins on the ankle and wrist
Newborn infants up to 18 months:
4. External and jugular vein
5. Temporal vein (scalp vein)
6. Superior longitudinal sinus (fontanel)
Older children: 18 months -3 years old
7. Long saphenous vein

8. Femoral vein
9. Popliteal vein
10. Ankle vein
Equipment:

Tourniquet may be:


a. Soft rubber tubing at least 2-5mm in diameter and 18 inc in length
b. Blood pressure cuffed inflated to 40-60mm/hg
c. Band-quet tourniquet=1 inch wide rubber band
Needles
a. Needles gauge number: express the diameter of the needle
Diameter or gauge:
0.5mm (g25)

1.2mm (G18)

0.6mm (G23)

1.625mm (G14)

0.9mm (G20)

1.1/1.0mm (G19)

*the smaller the gauge number, the larger the diameter of the needle.
Recommended: adults= gauge 19 or 20
Children= gauge 23 or 25
B. needles length: used depends on the depth of the vein
Usual length: 30-40 mm

Hemolysis
-

Is the destruction of RBC


A process to be prevented during blood collection that will affect the various
haematological examinations.

Things to remember in venipuncture:


1. All materials should be dry and sterile because wetness causes hemolysis.
2. Tourniquet must be applied at least 3 inch above the site of puncture

3. It should be tied not too tightly as it will constrict the artery as well as the veins. It should
be tied in a half bow manner.
4. It should be released first before withdrawing the needle from the vein.
5. Needle should be removed from the adapter of the syringe and blood allowed to flow
gently down the sides of the tube.
6. Containers are stoppered and those with anticoagulants are inverted several times (not
shaken)
7. Dont freeze blood because RBC will hemolyze.
Complications of venipuncture and suggestion for their prevention:
1. Immediate local complications
a. Hemoconcentration- increased amount of cellular elements in the blood due to
prolonged application of the tourniquet
b. Failure of the blood to enter the syringe. This may be due to the following:
A. Excessive pull of the plunger
Move back and forth slowly to reduce the force of aspiration.
B. Piercing the outercoat of the vein without entering the lumen
Withdraw the needle slightly and reenter the vein.
C. Transfixation of veins- piercing through the walls of the veins
Withdraw the needle slightly and gently aspirate to see if the blood enters. If this
fails, the puncture may have to be repeated.
c. Hematoma- subcutaneous effusion of blood resulting in discoloration, pain, swelling
and tumor like mass
o Repeat puncture on another site.
d. Circulatory failure- failure of the blood to flow due to nervousness and other
emotional factors.
o Call a physician
e. Syncope- fainting due to sudden insufficiency of blood supply to the brain.
o Let the patient lie flat on the bed and call a physician.
f. Continued bleeding- occurs in patient with hemorrhagic tendency.
o Apply slight pressure
II Late local Complications:
a. Thrombosis- clotting of blood inside the vessel due to trauma and repeated
infections
b. Thrombophlebitis: inflammation of the vein in which a thrombus (blood clot)
is present
III. Late general complications
Hepatitis B and HIV may be transmitted by contaminated needle or syringe. Needles
must be disposed properly.