血液一般检查讲稿双语.doc

First section: Blood routine test (BRT) Has Someone here ever heard of BRT before? Yes! Very good many students have heard before. (NO? maybe you are all very healthy ).when you go to hospital, doctors always apply for a BRT as a reference to your disease. They can know about the red blood cells ,white blood cells and platelets et,al.So BRT is the most common examination in clinical laboratory. Today we will learn the blood routine test (the abbreviation is BRT) or complete blood count (CBC). 1Sample collectingfirst, we will learn about the collection of BRT sample. The blood can be collected from finger or vein. But we are always collecting blood from vein, Because the result come from a vein sample is more accurate and stable than from finger.But if it is very difficult to find a good vein to collect, for example ,when we meet with a baby. After we collected the sample, the blood must be anticoagulated with EDTA-K 2. Because we will count cells in it. We will learn in the later. Here please remember the anticoagulant-EDTA-K2.OK, lets take a look of the main contents of BRT. It conclude three parts, they are RBC,WBC,PLT.Now we will learn one by one. 2. RBC related parametersAt first, will learn about the red blood cells. There are seven parameters related to it. They are：1） The number of red blood cells (RBC) 2） The amount of hemoglobin in the blood (Hb)3） Hematocrit （Hct）4） mean corpuscular volume (MCV) 5） Mean corpuscular hemoglobin（MCH）6） Mean corpuscular hemoglobin concentration (MCHC)7） Red blood cell volume distribution width（RDW) 1） RBC and HbNow ,lets learn about RBC and hemoglobin. we put the two indexes together ,because they have the same clinical signifcance.（1）The normal values The normal values of RBC is to male :the normal number of RBC is 4.0-5.5,to Female: is 3.5-5.0 million millions per liter . so it is different between male and female. Familiar to RBC, the normal value of hemoglobin is different between male and female too. All the values above are required to remember.The numbers of RBC or the concentrations of Hb is increased, it can be caused by relative factors or absolutely factors.For example , when we sicking burning or sweating too much ,much waters in our body will be lost, the plasma is concentrated, so the RBC numbers is relatively increasing.Some diseases, such as heart disease , lung disease, can also cause the number of RBC increasing. We all know that the main function of RBC is carry oxygen, when people got heart disease, for example, heart failure, the body will be lack of oxygen, so it will produce more RBC as compensation.（2）Clinical significanceIf the numbers of RBC or the concentrations of Hb is decreased, we call this anemia. Certainly it include physologic anemia and pathologic anemia. When people is pregnant or getting old , the physologic factors will cause the number of RBC decreased, this called physologic anemia. It neednt to cure.If the iron in the body is deficiency , the bone marrow cant produce enough RBC or the RBC which produced are abnormal. These all can be cause anemia. Anemia is very common in clinic. Please turn to page 268 , lets look at the table 4-2-2-the classification of anemia.2）HCT or PCV（P280)Ok, this is all of the numbers of RBC and hemoglobin.Now , we will learn another index of RBC Hematocrit or packed cell volum (PCV).HCT is the ratio that the volumes of blood cells (mainly RBC) in the whole blood. So the calculate formula is V cell / V whole blood.Because the cells in the blood mainly is RBC, which is the reason why the blood is red, so the clinical significance of HCT is accord with the change of RBC. When the RBC or Hb increasing, HCT will increase too. And when the RBC or Hb decreasing ,HCT will decrease too.3）MCV,MCH,MCHC（P280）Now, lets learn three related indexes of RBC, they are MCV, MCH and MCHC.The MCV is the abbreviation of mean volume of each RBC, so from the definition, we can see that it represent the average size of RBC.Patients with IDA (iron deficient anemia) , their RBC are smaller than normal people, the MCV is decreased. So we can judge the RBC size from this index.MCH is the abbreviation of mean hemoglobin of each RBC, it represent the average hemoglobin of RBC. We also cite IDA as example, we all know, it is necessary that the iron in our body must be adequate in the course of hemoglobin producing, when the iron is deficiency, the hemoglobin in the RBC will be reduced, certainly the MCH is decreased.The MCHC is the mean corpuscular hemoglobin concentration, These three indexes can be calculated with the number of RBC, HCT and hemoglobin. When two indexes among them is known, the left index can be calculated too. MCV,MCH and MCHC reflect the size and hemoglobin concentration of individual cells. It is useful in the diagnosis of various types of anemia. P281,table 4-2-54）RDWOk, please come back to the slide.Lets learn the last index about RBC-RDW.At first lets see the definition: the RDW is the abbreviation of the RBC volume distribution width.It is a measure of the variation of RBC volume.In normal people, the RBC volume is homogeneous，is about 7um, but in certain anemia, some RBC become larger, some RBC become smaller, So the size of RBC become variety, the RDW will be increased. Application: P281,table 4-2-63.WBC related parametersNow lets learn about WBC, first lets see the parameters related to WBCThey are the number of white blood cells and the component of WBC, WBC are divided into five types: neutrophil, lymphocyte, monocyte, eosinophil and basophil. Each type cells can be described in two forms: the percentage and the absolute count. Mostly we use the percentage to describe the component of WBCS.1）The function of WBCFight infectionMake antibodies2）Divided into Five types according to its shapeTypes of WBCs normally present in blood:- neutrophils (infection-fighters), 2 types: polys or segs = segmented neutrophils (mature) bands or stabs = banded neutrophils (young)- lymphocytes (immunity)- monocytes (phagocytosis)- eosinophils (allergy, parasites)- basophils (hypersensitivity)In neutropenia, most WBCs are lymphocytes. An early indication of recovery is the presence of monocytes,Non-malignant blasts are sometimes seen during neutrophil recovery following chemotherapy, especially in conjunction with GCSF/GMCSF therapy, as a result of an over stimulated bone marrow releasing immature cells into the peripheral circulation.Neutrophil (Ne)make up 55-70% of total WBC count very tiny light staining granulesthe nucleus is frequently multi-lobedcan phagocytizing foreign cells, toxins, and virusesEosinophil (EO) make up 0.5-5% of total WBC countlarge granules stained pink (or red) the nucleus often has two lobes the granules contain enzymes attacks parasites and any antigen complexes are also responsible for allergic responseBasophil (Ba)less than 1% of total WBC countgranules are large, stain deep blue to purplegranules often numerous ,can mask the nucleusgranules contain histaminesmediate hypersensitivity reactions lymphocyte (Ly)make up 20-40% of totle WBC countit is an agranular cell with very clear cytoplasm the cytoplasm stains pale bluenucleus is very large for the size of the cell , stains dark purpleLymphocyte is much smaller than the three granulocytesplay an important role in our immune responseproduce antibodies and provide secondary immunity The lymphocyte is an agranular cell with very clear cytoplasm which stains pale blue. Its nucleus is very large for the size of the cell and stains dark purple. (Notice that the nucleus almost fills the cell leaving a very thin rim of cytoplasm.) This cell is much smaller than the three granulocytes (which are all about the same size). These cells play an important role in our immune response. The T-lymphocytes act against virus infected cells and tumor cells. The B-lymphocytes produce antibodies.Monocyte (Mo)it is agranular, make up 4-10% of totle WBC countIt is the largest cell among the five types the cytoplasm is abundant and stains pale bluenucleus often shaped U or kidney bean , stains dark purpledevelop into large macrophagesphagocytize pathogens during infection This cell is the largest of the leukocytes and is agranular. The nucleus is most often U or kidney bean shaped; the cytoplasm is abundant and light blue. These cells leave the blood stream (diapedesis) to become macrophages. As a monocyte or macrophage, these cells are phagocytic and defend the body against viruses and bacteria.These cells account for 3-9% of all leukocytes. In people with malaria, endocarditis, typhoid fever, and Rocky Mountain spotted fever, monocytes increase in number. it can develop into large macrophages in the body tissues that phagocytize pathogens during infection Normal valuesOk ,lets see the normal values of WBCS.To you all, the values in this slide must to remember.The number of WBC is 4-10 thousand millions per liter. And mainly is composed of neutrophil, contain 50-70 percentage, the second component is lymphocyte , normally is 20-40 percentage, and the normal value of monocyte is 3-8 percentage , eosinophil and basophil are scase to see in normal people, the normal value is 0.5-5 percentage and 0-1percentage respectively.Clinical significanceThe change of each component would lead to the number of WBC increased or decreased , but its clinical significance is different ,so we should distinguish which component is changed.Now lets learn the clinical significance of each component.First ,lets see the neutrophil:NeThe change of WBC is mostly changed by the neutrophil.In certain people such as pregnant ,the neutrophil will increase, and when we eat too much or after sport , it will increase temporarily. These are all physiologic increasing.Neutrophil increasing is seen often in clinic. Many acute disease can cause the neutrophil increasing, please notice the acute. Acute disease such as acute infection-mainly caused by bacteria, injury or acute hemolysis and bleeding. These are all acute disease. Besides acute disease , in most leukemia such as CML(chronic myelocytic leukemia) the neutrophil is increase too. Followed with the increasing of neutrophil , the number of WBC is always increasing.The decreasing of neutrophil is often occure in some certain infections, such as virus, typhia and paratyphoid. When people infected with virus, the lyphocyte will increasing, and when people infected with typhia or paratyphoid , the neutrophil is decreased, the number of WBC is also decreased.Morever, some hematonosis such as AA, IDA, PNH, and some external factors such as X ray、medcine can also cause neutrophil decreasing.We all know in the spleen , blood cells, including RBC, WBC and platelet, can be destroyed, so in some desease , the function of spleen become too strong, the blood cells will be destroyed too much , can cause the RBC WBC and platelets decreasing at the same time.In autoimmune disease such as SLE , RA, the antibody can bind with the blood cells , and the body will disposal the blood cells as external antigen, send it to the immune system to destroy it.Here lets see two terms, the first is leukopenia: it defines when the number of WBC are less than 4.0*109.The other is neutropenia: it defines when the number of neutrophil are less than 1.5*109.EoOk, lets see the eosinophil.You should remenber in two diseases the eosinophil will increasing , the two diseases are allergy and verminosis. The allergy can be caused by food , medicine or pollen. When people infected with parasite we called it verminosis.The decreasing of eosinophil has no important significance.So we should remenber when people with allergy or verminosis ,the eosinophil often increasing.BaLets see the basophil, the increasing of basophil is not often seen in clinic, it can be seen in some certain hematonosis such as CML, Bone marrow fibrosis and allergy. It will increasing fast when the CML is activity, so it is important to observe the disease whether it is become severity. LyLets see the lymphocyte, the lymphocyte include T lymphocyte and B lymphocyte, they are the main immunocyte, so when the immunity is activity ,the lymphocyte will increase. For example , when people infected with virus , or has tumors , or the exclusion of transplant is occurred, the lymphocyte will increase.In the other side, when the immunity is deficient , the lymphocyte will decrease. If people cured with cortin, do you know cortin? It is a hormone produced in kidney, it can restrain the immune system. Certain disease such as SLE , RA or people has transplant, it is commonly used. Moincreasing：certain infections(endocarditis）,certain hematonosis( M5 ) decreasing：no significancePLT related parametersThe number of platelets（PLT) normal value: (100-300)109/LMean platelet volume（MPV)Platelet distribution width（PDW)MPV Similar with MCV , PDW similar with RDW.第二节 血细胞自动化分析及临床应用1.血细胞自动化分析原理：1）三分类：电阻法原理（coulter原理）50年代初，库尔特（Coulter）发明并申请了粒子计数技术的设计专利，其原理是由于电解质是导体，血细胞是不良导体，当血细胞通过小孔时，会引起一个瞬间的电阻变化，将电阻的变化量转换成脉冲，脉冲的数量代表血细胞的数量，脉冲的大小反映血细胞的大小，血细胞类型根据细胞大小来判定。这种方法称为电阻抗法，也称为库尔特原理 仪器在检测时，有两个带有小孔的计数池同时工作：一个称红细胞计数池：分析生理状态下的RBC和PLT2-20fl认定为PLT36-360fl认定为RBC(其中混有的白细胞因数量比例十分微小而被忽略）一个称白细胞计数池