Principles And Practice Of Clinical Haematology Report : 698814

Question:

Discuss about the Principles And Practice Of Clinical Haematology Report.

Answer:

ABSTRACT

This report documents the tests and results done on three family members on their blood to determine the amount of their blood cells and as a result find out the disease the patients are suffering from if any. FBC (full blood count test) is performed on the three patients, besides a Gel hemoglobin electrophoresis test is done on them. The results indicate that the patients may be suffering from anemia, since they have abnormal levels of red blood cells also the absence of Hb S, D, G in the Romano family may be a pointer that they have not undergone genetic mutations. The Anemia in Huyen may be acute blood loss, sickle cell or Hemolytic anemia while in Vincent and Hai-Anh it may be iron deficiency, sideroblastic or Thalassemia.

 

INTRODUCTION

Background

Full Blood Count (FBC) is a repetitive blood test that assesses the three main types of cells in the blood which are platelets, red blood cells and white blood cells. It checks for disorders such as Haemato-oncological, anemia and other infections while Gel hemoglobin electrophoresis test is a blood test used to measure and identify the different types of hemoglobin in the bloodstream. In this scenario we have three patients who have undergone the FBC test and act as our case studies, the results displayed and discussed in detail.

 

Case Studies

There are three case studies in this scenario:

The first patient Huyen Romano, UR#685475, 13.02.2003 (F) a 13-year-old female who has been referred for further investigation. Huyen’s father is an Italian diplomat and her family recently moved to Brisbane from Hanoi. Last week Huyen’s family went to the doctor for a health check and Huyen returned an abnormal FBC. Physical examination revealed jaundice.
The second patient Hai-Anh Romano, UR#685476, 16.08.1977 (F) a 41-year-old female and is Huyen’s mother and currently 12/40 weeks pregnant with her second child. Hai-Anh also had a slightly abnormal FBC results last week but other than starting to tire easily and require more rest/sleep, reports she is feeling well. Physical examination revealed no abnormalities.
The third patient is Vincent Romano, UR#685477, 19.01.1975 (M) a 43-year-old male who has recently arrived in Australia with his family (Hai-Anh and Huyen) to start a new job. Vincent also returned mildly abnormal FBC results last week but reports he is in good health, feels normal and exercises regularly. Physical examination revealed no abnormalities.

 

Objectives

The objective of this test is to:

  • Find out the diseases the patients are suffering from if any.
  • To asses the blood cells of the patients
  • Hemoglobin check

 

 

MATERIALS AND METHODS

Vessels Used

Purple EDTA 4.5 ml.

 

Techniques performed

We use Full Blood Count, blood film to counting White Cell Count (WCC) under light microscope to calculate %100 of WCC. The WBC (white blood count) estimate is done at x10 – count 1 field of view and divide by 5. PLT estimate is done at x100 – count 5 fields of view and times by 2. Using Equation To correct the WCC Corrected WBC count = (WCC/100 +nRBC) x 100 and using this equation when we have nRBC ≥5 nRBC. Haemoglobin Electrophoresis.

 

Preparation

Run the acid gel for 23 min @ 140voHs and run Alkaline gel for 30 min @300 voHs. Following venipuncture, mix the sample well to prevent clot formation within .Clotted EDTA samples will not be processed.

 

Sample Requirements

Storage time – the MCV level will increase slightly (< 5 fl) if the sample is not tested within 24 hours. Refrigeration exacerbates this increase, store all FBC samples at room temperature (out of direct sunlight)

Precautions

Do not expose the blood samples to extreme temperatures. Ensure sample is well mixed following venipuncture and also it is not clotted.

 

RESULTS

Patient 1

 

 

11

 

 

Parameter      Result

WCC             19.4            ×109/L

Hb                 60                g/L

RCC               2.30            ×1012/L

Hct                0.19            L/L

MCV              82               fL

MCH              26.1           Pg

MCHC            316            g/L

RDW              22.4           %

PLT                 313            ×109/L

 

Cell Type % ×109/L
Neurophilis 72 5.6
Band Forms    
Lymphocytes 20 1.6
Monocytes 3 0.2
Eosinophils 4 0.3
Basophils 1 0.1
Metamyelocytes    
Myelocytes    
Promyelocytes    
Blast Cells    
nRBC    

 

WBC Comment:
WCC are normal in number and distribution
RBC Comment:
The blood film showing Echinocytess cells, Target cell, Schistocytes cells, Microcyte and Hypochromic
PLT Comment:
PLTs are normal in number and morphology

 

Patient 2

 

 

 

12

 

Parameter      Result

WCC             6.6            ×109/L

Hb                 120              g/L

RCC               5.00            ×1012/L

Hct                0.37            L/L

MCV              74               fL

MCH              24.0           Pg

MCHC            324            g/L

RDW              14.5           %

PLT                 314            ×109/L

 

Cell Type % ×109/L
Neurophilis 57 3.8
Band Forms    
Lymphocytes 37 2.4
Monocytes 4 0.26
Eosinophils 2 0.13
Basophils    
Metamyelocytes    
Myelocytes    
Promyelocytes    
Blast Cells    
nRBC    

 

WBC Comment:
WCC are normal in number and distribution
RBC Comment:
The blood film showing Echinocytess cells, Target cell, Schistocytes cells, Microcyte and Hypochromic
PLT Comment:
PLTs are normal in number and morphology

 

 

 

 

Patient 3

 

 

 

 

 

Parameter      Result

WCC             6.5           ×109/L

Hb                 123               g/L

RCC               5.55            ×1012/L

Hct                0.38           L/L

MCV              69              fL

MCH              22.2           Pg

MCHC            324            g/L

RDW              16.5          %

PLT                 185            ×109/L

 

Cell Type % ×109/L
Neurophilis 59 4.3
Band Forms    
Lymphocytes 35 1.7
Monocytes 2 0.5
Eosinophils 2 0.13
Basophils    
Metamyelocytes    
Myelocytes    
Promyelocytes    
Blast Cells    
nRBC    

 

WBC Comment:
WCC are normal in number and distribution
RBC Comment:
The blood film showing Echinocytess cells, Target cell, Schistocytes cells, Microcyte and Hypochromic
PLT Comment:
PLTs are normal in number and morphology

 

 

 

The Result of Electrophoresis

Acid gel

Lane

  1. AFSC Ct1 Exp 12/12/18
  2. ROMANO Vincet 19/01/1975
  3. ROMANO Hai-Anh 16/08/1977
  4. ROMANO Huyen 13/02/2003
  5. Patient Y Adult male
  6. Patient Y Adult female
  7. Carol Blood
  8. Normal Ctl Exp 12/12/18

 

 

AFSC CT1

 

Alkaline gel

  1. Vincent Romano
  2. Hai- Anh Romano
  3. Huyen Romano
  4. AFSC Control
  5. Normal Control
  6. Cord blood
  7. Patient X
  8. Patient Y

DISCUSSION

 

Reference Range: White Cell Count (WBC) 4.0 – 11.0 x109/L
Red Cell Count (RBC):
Male: 4.5 – 6.5 x 1012/L
Female: 3.8 – 5.8 x 1012/L
Hemoglobin:
Male: 130 – 180 g/L
Female: 115 – 165 g/L

Hematocrit (Hct, PCV):
Male: 0.40 – 0.52
Female: 0.37 – 0.47

Mean cell volume (MCV):
75 – 100 fl

Mean cell hemoglobin (MCH):
26 – 35 pg

Platelets:
150 – 500 x 109/L

Differential WBC:
Neutrophils – 2.0 – 7.5 x 109/l
Eosinophils – 0.04 – 0.40 x 109/l
Basophils – 0 – 0.1 x 109/l
Lymphocytes – 1.5 – 4.0 x 109/l
Monocytes – 0.2 – 1.5 x 109/l

Reference Text:

Red blood Cells

Normal
The normal hemoglobin content of red blood cells is 115–150 grams per liter. This equates to approximately 27–34 picograms per red blood cell in one liter of blood (Morrissey, C. 2013).

 

White blood Cells

Normal
The combined white cell count is normally 4–10 billion cells per litre of blood (Nguyen, D. 2009).
Platelets

Normal
The normal platelet count is 150–400 billion platelets per litre of blood (or 150-400 x 109/L) (Bareford, A. 2007).
 

White Blood Cell Count Reference:

Components Low High
Neutrophil count Bone marrow failure

Post chemotherapy

Viral infection

Hypersplenism

 

Corticosteroids

Bacterial infection

Inflammation

Necrosis

Malignancy

Lymphocyte count Viral infection

Post chemotherapy

Bone marrow failure

 

CLL/ lymphoma

Viral infection

Chronic infections

 

Monocyte count Leukaemia

Acute infection

Corticosteroids

 

Leukaemia

Bacterial infection

Autoimmune diseases

 

Eosinophil count   Hypereosinophilic syndrome

Skin diseases

Parasite infection

Drug reactions

Malignancy

Allergy

 

 

 

 

Patient 1

Based on Huyen Romano’s history having returned an abnormal FBC she is not in good health subject to further scrutiny.

WCC is normal
RCC is low
Hct low
Mcv is in the line and this called normocytic
MCH is low
MCHC normal
RDW high
PLTs are normal

Low RCC, Hct and MCH indicate that the patient may be suffering from anemia, as a result of diet problems or internal bleeding conditions.

Mcv being normocytic may be as a result of acute blood loss, sickle cell or Hemolytic anemia.

 

Patient 2

Considering Hai-Anh Romano ‘s history, having returned a slightly abnormal FBC the results will determine whether she is sick or not.

WCC is normal
RCC is normal
Hct normal
Mcv is low in the line and this called microcytic
MCH is low
MCHC normal
RDW high
PLTs are normal

Low MCH and MCV can be caused by different types of anemia. This indicate that the patient may be anemic.

Mcv being microcytic may be as a result of iron deficiency, Thalassemia or sideroblastic.

 

 

 

 

 

Patient 3

Referring to Vincent Romano’s past FBC results which were mildly abnormal and a physical examination indicating no abnormalities. The test results will give a clear sign on whether is sick or not (Wells, C. 2006, 12).

WCC is normal
RCC is normal

Hct normal (determines percentage of red blood cells in blood)
Mcv is low in the line and this called microcytic

Formula for calculating MCV fl = (Hct [in L/L]/RBC [in x10 12/L]) x 1000.
MCH is low
MCHC normal
RDW high
PLTs are normal

The result indicates that the MCH (mean cell hemoglobin) is low this indicates a possibility of the patient suffering from anemia, perhaps from conditions causing internal bleeding or from diet problems.

Mcv being microcytic may be as a result of iron deficiency, Thalassemia or sideroblastic.

 

 

Acid gel

Lane

  1. AFSC Ct1 Exp 12/12/18
  2. ROMANO Vincet 19/01/1975
  3. ROMANO Hai-Anh 16/08/1977
  4. ROMANO Huyen 13/02/2003
  5. Patient Y Adult male
  6. Patient Y Adult female
  7. Carol Blood
  8. Normal Ctl Exp 12/12/18

 

 

This result indicates that none of the patients had Hb C since there are no bands where Hb C runs in any of the test lanes.

Hb S is not visible for any of the patients in our case study

Hb A, A2, D, G, E is visible for Vincent and Hai-Anh

The acid gel is faint on the Romano family

The absence of hemoglobin S in the Romano family indicates they have not undergone genetic mutation (Peleg, C. 2009, 12).

The adult hemoglobin Hb A is visible for Vincent and Hai-Anh

 

Alkaline gel

1.Vincent Romano

  1. Hai- Anh Romano
  2. Huyen Romano
  3. AFSC Control
  4. Normal Control
  5. Cord blood
  6. Patient X
  7. Patient Y

 

This result indicates that none of the patients had Hb C, Hb A2, E, O since there are no bands where they run in any of the test lanes.

Hb S, D, G is not visible for any of the patients in our case study

Hb F is visible for Huyen (Fetal Hemoglobin)

Hb A (Adult Hemoglobin) is visible for Vincent and Huyen.

The alkaline gel is faint on the Romano family

The absence of Hb S, D, G in the romano family indicates they have not undergone genetic mutations.

The Hb electrophoresis is done because sickle cell/ Thalassemia is suspected.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES

Alberti, C., Bouakline, A., Ribaud, P., Lacroix, C., Rousselot, P., Leblanc, T. and Derouin, F., 2001. Relationship between environmental fungal contamination and the incidence of invasive aspergillosis in haematology patients. Journal of Hospital Infection, 48(3), pp.198-206.

 

Morrissey, C.O., Chen, S.C., Sorrell, T.C., Milliken, S., Bardy, P.G., Bradstock, K.F., Szer, J., Halliday, C.L., Gilroy, N.M., Moore, J. and Schwarer, A.P., 2013. Galactomannan and PCR versus culture and histology for directing use of antifungal treatment for invasive aspergillosis in high-risk haematology patients: a randomised controlled trial. The Lancet Infectious Diseases, 13(6), pp.519-528.

 

Nguyen, D.T., Amess, J.A., Doughty, H., Hendry, L. and Diamond, L.W., 2009. IDEC‐C2B8 anti‐CD20 (Rituximab) immunotherapy in patients with low‐grade non‐Hodgkin’s lymphoma and lymphoproliferative disorders: evaluation of response on 48 patients. European journal of haematology, 62(2), pp.76-82.

 

Bareford, D. and Hayling, A., 2007. Inappropriate use of laboratory services: long term combined approach to modify request patterns. Bmj, 301(6764), pp.1305-1307.

 

Sanders, Joanne, Alan Pithie, Peter Ganly, Lois Surgenor, Rachel Wilson, Eileen Merriman, Gail Loudon, Rhonda Judkins, and Stephen Chambers. “A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients.” Journal of antimicrobial chemotherapy 62, no. 4 (2008): 809-815.

 

Peleg, A.Y. and Woods, M.L., 2004. Continuous and 4 h infusion of amphotericin B: a comparative study involving high-risk haematology patients. Journal of Antimicrobial Chemotherapy, 54(4), pp.803-808.

 

Sanz, Miguel A., Javier López, Juan J. Lahuerta, Montserrat Rovira, Montserrat Batlle, Cristina Pérez, Lourdes Vázquez et al. “Cefepime plus amikacin versus piperacillin–tazobactam plus amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia: results of an open, randomized, multicentre trial.” Journal of antimicrobial chemotherapy 50, no. 1 (2008): 79-88.

 

Wells, Sara. “Venous access in oncology and haematology patients: part one.” Nursing Standard (through 2013) 22, no. 52 (2008): 39.

 

Darmon, Michael, François Vincent, Laurent Camous, Emmanuel Canet, Caroline Bonmati, Thorsten Braun, Denis Caillot et al. “Tumour lysis syndrome and acute kidney injury in high‐risk haematology patients in the rasburicase era. A prospective multicentre study from the Groupe de Recherche en Réanimation Respiratoire et Onco‐Hématologique.” British journal of haematology 162, no. 4 (2013): 489-497.

 

Estcourt, L.J., Birchall, J., Lowe, D., Grant‐Casey, J., Rowley, M. and Murphy, M.F., 2012. Platelet transfusions in haematology patients: are we using them appropriately?. Vox sanguinis, 103(4), pp.284-293.

 

Dacie, J.V. and Lewis, S.M., 2002. Practical haematology.

 

Zeng, J., Ge, Z., Wang, L., Li, Q., Wang, N., Björkholm, M., Jia, J. and Xu, D., 2010. The histone demethylase RBP2 Is overexpressed in gastric cancer and its inhibition triggers senescence of cancer cells. Gastroenterology, 138(3), pp.981-992.

 

DE WITTE, T., 1998. Quantitation of minimal residual disease in Philadelphia chromosome positive chronic myeloid leukaemia patients using real-time quantitative RT-PCR. British journal of haematology, 102, pp.768-774.

 

Berning, H. and Stilbo, I., 1982. Pseudothrombocytopenia and the haematology laboratory. The Lancet, 320(8313), pp.1469-1470.

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