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Южно-Уральский государственный медицинский университет Министерства здравоохранения РФ (бывш. ЧелГМА)
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5. Literature recommended:

1. Lecture course.

2. Mistchenko V.P., Tkachenko E.V. Methodical instructions for dental students (short lecture course).-Poltava, 2005.-P.44-47.

3. Mistchenko V.P., Tkachenko E.V. Methodical instructions for medical students (short lecture course).-Poltava, 2005.-P. 75-80.

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.375-377.

6. Seeley R.R., Stephens T.D., Tate P. Essentials of Anatomy and Physiology.-The 3rd Ed.-McGraw Hill, 1999.-P.295.

6. Materials for self-control:

Control questions

  1. Fibrinolytic system factors.

  2. Plasminogen external and internal activators.

  3. Fibrinolysis scheme.

  4. Fibrinolysis assessment methods.

  5. Oral cavity role in fibrinolysis process.

                  1. Lesson 39

                  2. Total blood

1. The topic studied actuality. Blood analyze is non-specific, universal, still judiciousely used diagnostic method. It gives significant information at different physiological and pathological conditions.

2. Study aims:

To know: physiological limits of main blood indexes; major age peculiarities.

To be able to: interpret total blood (to see indexes abnorm, to say what conditions it can testify to).

3. Pre-auditory self-work materials.

3.1.Basic knowledge, skills, experiences, necessary for study the topic:

Subject

                  1. To know

To be able to

Pathophysiology

Main blood indexes norm

Interpret total blood and to tell about main mechanisms and probable reasons of the changes observed

Pediatry with Neonatology

Blood peculiarities in different-aged children in part about the first and the second crossings

Interpret total blood changes

Internal Diseases

Total blood main indexes norm

To tell about probable reasons of the changes observed in internal diseases clinics

Surgery

Total blood main indexes norm

To tell about probable reasons of the changes observed in surgical clinics

Dentistry

                  1. Total blood main indexes norm

                  1. To tell about probable reasons of the changes observed in stomatological patients

3.2. Topic content

Color index characterizes erythrocytes satiation degree with haemoglobin. It is calculated on formula:

                  1. C.I.= (X haemoglob. x 5,0 x 1012/l) : (167 g/l x X erythroc.)

where:

X haemoglob. – found haemoglobin amount (g/l);

X erythroc.- found erythrocytes amount in 1 l of blood.

The second formula: Hb (g/l) x 3 : RBC (3 first ziphras). It is evaluated in conditional units.

At English-speaking countries all these indexes are automatically determined practically in every clinic. Especially they are of great importance for anemias differentiated diagnostics.

1. MCV (Mean Corpuscular Volume) – average erythrocytic volume. MCV=HCT (%) : RBC (x 1012/l) x 10, where: HCT- haematocrit; RBC- erythrocytic amount.

MCV (normocytes) - adults: 78-94 mcm3 or fl (femptolitres)

new-borns: 95-105 mcm3;

children: 76-90 mcm3.

MCV↑ (macrocytosis):

  • pregnancy;

  • megaloblastic anaemia;

  • myelodysplastic syndrome;

  • liver diseases;

  • hypothyreoidism;

  • alcoholism;

  • treatment with estrogens;

  • treatment with barbiturates et al.

MCV↓ (microcytosis):

  1. anaemias:

  • hereditary microspherocytic;

  • iron-deficient;

  • sideroblastic;

  • chronic anaemias;

  • thalassaemia (hereditary haemoglobinopathy);

  1. hypohydration;

  2. aluminium intoxication.

2. MCH (Mean Corpuscular Haemoglobine) – haemoglobine average content in erythrocytes.

MCH=Hb (g/l):RBC (x 1012/l)

MCH (erythrocytic normochromy)- adults: 27-33 pg (picogram)

children: 24-30 pg

MCH↑(hyperchromy):

  • new-borns;

  • megaloblastic anaemia;

  • liver cirrhosis.

MCH↓ (hypochromy):

  • iron-deficient anaemia;

  • thalassaemia;

  • sideroblastic anaemia.

3. MCHC – Mean Corpuscular Haemoglobine Concentration – Mean haemoglobine concentration in erythrocyte – Hb (g/decaliter): Ht or HCT (l/l) x 100

MCHC (norma): 32-36 g/dl (320-360 g/l).

MCHC↑:

  • new-borns;

  • hereditary spherocytosis;

  • long-termed hypohydration.

MCHC↓ (absolute hypochromy):

  • iron-deficient anaemia;

  • thalassaemia;

  • sideroblastic anaemia;

  • hydraemia.

4. Reticulocytes amount in blood volume unit - Norm:

adults and children: 0,2-2,0 % or 25-85 x 109/l;

new-borns : 2-6% or 85-250 x 109/l.

Reticulocytosis (increasing):

  • anaemias (haemolytic, acute posthaemorrhagic),

  • in initial period (6-10th days) of effective anaemias treatment, caused by iron and folic acid, cyancobalamine and pyridoxine insufficiency;

  • in course of exit from bone marrow hypoplasy after therapy with cytostatics;

  • after splenectomy;

  • at malaria.

Reticulopenia (decreasing):

  • hypo- and aplastic anaemias;

  • megaloblastic anaemias;

  • acute leukemias;

  • radiation disease;

  • in course of cytostatic therapy;

  • pre-regenerative crisises at haemolytic anaemias;

  • kidney diseases;

  • radiation disease anaemia.

5. Reticulocytic index (RI)= R (%) x Ht (of patient) : Ht (normal). It is used for more adequate bone marrow erythropoietic activity assessment with the haematocrit taking into account.

Norm: 1%

RI ↑:

  • haematocrit decreasing;

  • haemolytic anaemias (due to erythropoiesis activation);

  • initial stage of effective anaemias treatment (due to the same reason).

6. Reticulocytes formation index – RFI=RI:t (reticulocytes maturation time in perypheral blood) x 10.

RFI (norm)=1 cond. un.

RFI (at anaemia)>3 indicates to erythropoietic cells prolipheration and maturation activating.

RFI (at anaemia)<3 indicates to erythropoiesis inhibition.

7. RDW – erythrocytes distribution dispersion by volume – standard inclination correlation to MCV.

It is estimated by erythrocytometric curve (of Price-Jons’) variation co-efficient and is expressed in percentage.

Anisocytosis (this index increasing) – different-sized Er presence in one blood smear. It is characteristic for anemias (hemolytic, Fe-deficient, megaloblastic) as well as osteomyelofibrosis.

Table 6. Erythrocytes distribution by their size

                  1. Term

  1. Er average diameter (mcm)

  1. MCV (fl)

                  1. Normocytic

  1. 6,8-8,5

  1. 78-94

                  1. Microcytic

  1. <6,8

  1. <75

                  1. Macrocytic

  1. >8,5

  1. >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, %

                  1. Years

                  1. Segm

                  1. Rods

                  1. Lymph

                  1. Mon

                  1. Eos

                  1. 2

                  1. 1-3

                  1. 28-48

                  1. 37-61

                  1. 5-9

                  1. 1-7

                  1. 3

                  1. 1-3

                  1. 32-54

                  1. 34-56

                  1. 4-8

                  1. 1-7

                  1. 4

                  1. 2-4

                  1. 34-54

                  1. 33-53

                  1. 4-8

                  1. 2-6

                  1. 5

                  1. 1-3

                  1. 35-55

                  1. 33-53

                  1. 3-9

                  1. 2-6

                  1. 6

                  1. 1-3

                  1. 38-58

                  1. 30-50

                  1. 3-9

                  1. 2-6

                  1. 7

                  1. 1-3

                  1. 39-57

                  1. 32-50

                  1. 4-8

                  1. 1-5

                  1. 8

                  1. 1-3

                  1. 41-59

                  1. 29-49

                  1. 4-8

                  1. 1-5

                  1. 9

                  1. 1-3

                  1. 43-59

                  1. 30-46

                  1. 4-8

                  1. 1,5-4,5

                  1. 10

                  1. 1-3

                  1. 43-59

                  1. 30-46

                  1. 4-8

                  1. 1-5

                  1. 11

                  1. 1-3

                  1. 45-57

                  1. 30-46

                  1. 3-9

                  1. 1,5-4,5

                  1. 12

                  1. 1-3

                  1. 44-60

                  1. 29-45

                  1. 4-8

                  1. 1-5

                  1. 13

                  1. 1-3

                  1. 45-59

                  1. 30-44

                  1. 4-8

                  1. 1-5

                  1. 14

                  1. 1-3

                  1. 46-60

                  1. 28-44

                  1. 4-8

                  1. 1-5

                  1. 15

                  1. 1-3

                  1. 45-61

                  1. 29-45

                  1. 3-9

                  1. 1-5

PLATELETS FUNCTIONS ASSESSMENT CRITERIA

  • platelets absolute quantity;

  • capillary bleeding time;

  • platelets aggregational activity;

  • blood clot retraction;

  • prostaglandines (thromboxanes, prostacyclines) metabolism.

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