LABORATORY PICTURE OF PATIENT

WITH BLOOD CELL DISORDER

Dr. dr. Sianny Herawati, Sp.PK

SMF Patologi Klinik FK UNUD / RSUP Sanglah
 Introduction

• Laboratory test support diagnosis of blood

cell disorder

• Many kind of laboratory test:

• p - complete blood count (CBC)
- reticulocyte count
- blood smear evaluation
- bone marrow examination
 Introduction

- Iron status (SI, TIBC, ferritin)

- hemoglobin electrophoresis
- Coomb’s test
• p - folic acid, B12 serum
- G6PD serum
- malaria (thick and thin smear)
 Introduction

- Erythrocyte sedimentation rate (ESR)

- ABO Blood group
- Hemostasis (screening test  PT, APTT,
• p confirmation test  coagulation factors
assay)
- D-dimer
 Complete Blood Count (CBC)

• CBC support diagnosis of hematology and non

hematology disorder

• p
• CBC → parameter, cytogram and histogram

• Hematology analyzer, manual method

 Complete Blood Count (CBC)

• p
 Complete Blood Count (CBC)

• Reference range: depend on method/

instrument, age, sex, ethnicity, altitude.

• p
• Interpretation of CBC: patient condition,
praanalytic and analytic laboratory
 CBC parameter

CBC parameter divided into:

1. Erythrocyte group
2. Leucocyte group
3. Thrombocyte group
4. Histogram
 Erythrocyte group

1. RBC count (RBC)

2. Hemoglobin (HGB)
3. Hematocrite (HCT)
4. Mean cell volume (MCV)
5. Mean cell hemoglobin (MCH )
6. Mean cell hemoglobin concentration (MCHC)
7. Red cell distribution width (RDW)
 Leucocyte group

1. WBC count
2. Differential count, (%) and (#):
- neutrophil
- eosinophil
- basophil
- lymphocyte
- monocyte
 Thrombocyte group

1. Platelet/thrombocyte count (PLT)

2. Platelet distribution width (PDW)
3. Mean platelet volume (MPV)
4. Plateletcrit (PCT)
Eri: N
Hb: menurun
Hct: menurun

Anemia

Indeks eritrosit:
MCV: <
MCH: <
MCHC: <
RDW CV: ↑
NRBC: -

Hipokromik
mikrositer,
anisositosis

Suggest:
Reticulocyte count
Blood smear
Iron studies
Hb electrophoresis
 Anemia

Based on erythrocyte index, anemia divided into:

1. Microcytic anemia
2. Normocytic anemia
3. Macrocytic anemia
 Microcytic anemia

Differential diagnosis:

1. Iron deficiency anemia

2. Anemia of chronic disease
3. Thalassemia
4. Sideroblastic anemia
 Iron deficiency anemia

Laboratory picture:

1. Microcytic anemia (sometimes normocytic anemia

in early stage)
2. Anisocytosis
3. Low SI (serum iron)
4. TIBC increased
5. Low ferritin
6. Thrombocytosis
7. Iron in marrow negative
 Anemia of chronic disease

Laboratory picture:

1. Normocytic anemia/mild microcytic

2. Normal RDW
3. SI decrease
4. TIBC decrease
5. Feritin normal/increase
6. Iron in marrow normal
 Thalassemia

Laboratory picture:

1. Microcytic anemia
2. RBC increase (> 5juta/mm3)

3. Mentzer index: MCV/RBC

Index > 13: suspect iron deficiency anemia
Index < 13: thalassemia minor

4. SI, TIBC, ferritin normal

 Normocytic anemia

Differential diagnosis:

1. Iron deficiency anemia in early stage

2. Anemia of chronic disease
3. Acute bleeding
4. Aplastic Anemia
5. Myelodysplastic syndrome (MDS)
 Macrocytic Anemia

Differential diagnosis:

1. Megaloblastic Anemia (B12 and folic acid

deficiency)
2. Alcoholism
3. Drug
4. Liver disease
5. Hypothyroid
6. Bone marrow disorder
 Eri: menurun
Hb: menurun
Hct: menurun
MCV: normal
MCH: sedikit ↓
MCHC: sedikit ↓
RDW CV: ↑
NRBC: +

Anemia Hipokromik
normositer,
anisositosis

Leukosit:↑↑
netropenia,
limfositosis,
monositosis
8 th, ♂

Platelet: ↓
 Eri: menurun
Hb: menurun
Hct: menurun
MCV: sedikit ↑
MCH: sedikit ↓
MCHC: sedikit ↓
RDW CV: ↑
NRBC: +

Anemia normokromik
normositer,
anisositosis

Leukosit:↑↑
netropenia,
limfopenia,
monositosis, blast +
31 th,
Platelet: ↑ ↑
♂
 Eri: normal
Hb: normal
Hct: normal
MCV: normal
MCH: normal
MCHC: normal
RDW CV: normal
NRBC: -

Leukosit: sedikit ↑
Netrofilia, limfopenia

Platelet: ↑
69 th,
♀
 Hemostasis examination

A brief background

Dr. Rudolph Virchow

1821-1902
 Hemostasis examination

• Homeostatic Haemostasis – is the physiologic

mechanism that maintains blood in the fluid
state. It is a fine balance between bleeding and
clotting.
 Hemostasis examination

PT (Prothrombin Time)

• Measure of the extrinsic pathway

• It is used in the evaluation of any suspected

bleeding tendency due to Factor deficiency,
acquired coagulopathies or in monitoring patient in
long term oral anticoagulation (warfarin
treatment).
 Hemostasis examination

PT (Prothrombin Time)

• Normal value: 10 – 12 second (depend on each

laboratory)
difference between control dan sample
< 2 second
 Hemostasis examination

INR (International Normalised Ratio): represents the

PT Ratio that would have been obtained for the
particular patient if the primary WHO Reference
Thromboplastin (human-derived with ISI=1.0) been
used in the PT determination.
Patient PT ISI
INR =
Mean normal PT

Nilai normal : 0,8 – 1,2 (± 1)

 Hemostasis examination
Optimal level for anticoagulant
therapy
INR 2,0 – 3,0
Therapy & prophylaxis
post myocard infarct

• p • INR 2,5 – 3,5 (high risk of clot formation) :

mechanical heart valves & recurrent MI
• INR < 2 no adequate protection for
thrombosis
• INR >3-4 risk of uncontrolled bleeding
 Hemostasis examination

aPTT (activated Partial Thromboplastin Time)

• Measure of the intrinsic pathway

• Normal value: 26– 40 second (depend on each laboratory)

difference between control dan
sample < 7 second
• p

Thank you