血液一般检查讲稿双语.doc

血液一般检查讲稿双语 First section:Blood routine test(BRT)Has Someonehere everheard of BRT before?Yes!Very goodmany studentshave heardbefore.(NO?maybe youare allvery healthy).when yougo tohospital,doctors alwaysapply fora BRTas areference toyour disease.They canknow about the red blood cells,white blood cells andplatelets et,al.So BRTis themost monexamination in clinical laboratory.Today we will learn the bloodroutiest(the abbreviationis BRT)or pleteblood count(CBC).1Sample collectingfirst,we will learn aboutthe collectionof BRTsample.The bloodcan becollected from finger orvein.But weare alwayscollecting bloodfrom vein,Because theresult efrom avein sampleis moreaurate andstable thanfromfinger.But ifit is very difficultto finda goodvein tocollect,for example,when wemeet witha baby.After wecollected thesample,the bloodmust beanticoagulated withEDTA-K2.Because wewill countcells init.We will learn in the later.Here pleaseremember theanticoagulant-EDTA-K2.OK,lets takea lookof the main contentsofBRT.It concludethree parts,they areRBC,WBC,PLT.Now wewilllearnone byone.2.RBC related parameters At first,willlearnabouttheredblood cells.There areseven parameters related toit.They are1）The number of redblood cells(RBC)2）The amountof hemoglobinin the blood(Hb)3）Hematocrit（Hct）4）mean corpuscularvolume(MCV)5）Mean corpuscularhemoglobin（MCH）6）Mean corpuscularhemoglobin concentration(MCHC)7）Red bloodcell volume distribution width（RDW)1）RBC andHb Now,lets learnabout RBCand hemoglobin.we putthe twoindexes together,because theyhave the same clinicalsignifcance. （1）The normal values Thenormal values of RBC is tomale:the normalnumber of RBC is4.0-5.5,to Female:is3.5-5.0million millionsper liter.so it is different between male and female.Familiar toRBC,the normal value ofhemoglobin is differentbetweenmaleandfemale too.All the values aboveare requiredto remember.The numbers of RBC or the concentrations of Hb is increased,it can be caused by relativefactors orabsolutely factors.For example,when wesickingburning orsweating too much,much watersin ourbody will be lost,the plasmais concentrated,so the RBC numbersis relativelyincreasing.Some diseases,such asheart disease,lung disease,can also cause the number ofRBC increasing.We allknow that the mainfunction ofRBCiscarry oxygen,when peoplegot heartdisease,for example,heart failure,the body will belack ofoxygen,so it will producemore RBCas pensation. （2）Clinical significanceIf the numbersofRBC or theconcentrationsofHbis decreased,we callthis anemia.Certainly itinclude physologic anemia andpathologic anemia.When peopleis pregnantor gettingold,the physologicfactors willcause the number ofRBC decreased,this calledphysologicanemia.It needntto cure.If the iron in the bodyis deficiency,the bonemarrow cantproduce enoughRBC orthe RBCwhich producedare abnormal.These allcan because anemia.Anemia isvery monin clinic.Please turnto page268,lets lookat thetable4-2-2-the classificationof anemia.2）HCT orPCV（P280)Ok,this isall of the numbersofRBCand hemoglobin.Now,wewilllearn anotherindex ofRBCHematocrit orpacked cellvolum(PCV).HCT is the ratiothat thevolumes ofblood cells(mainly RBC)in thewhole blood.So thecalculate formulais Vcell/V wholeblood.Because the cells in the bloodmainly isRBC,which is the reasonwhy theblood isred,so theclinical significanceof HCTis aordwith thechange ofRBC.When the RBCor Hb increasing,HCT will increase too.And when the RBCorHbdecreasing,HCT will decrease too.3）MCV,MCH,MCHC（P280）Now,lets learnthree relatedindexes ofRBC,they areMCV,MCH andMCHC.The MCVis the abbreviation of mean volumeof each RBC,so fromthe definition,we cansee thatit representthe averagesize ofRBC.Patients withIDA(iron deficientanemia),their RBCare smaller than normal people,the MCVis decreased.So wecan judgethe RBCsize fromthis index.MCH istheabbreviation ofmeanhemoglobin of eachRBC,it representthe averagehemoglobin ofRBC.We alsocite IDAas example,we allknow,it isnecessary thattheironin ourbody mustbe adequateinthecourse ofhemoglobin producing,when theiron isdeficiency,the hemoglobininthe RBC willbe reduced,certainly theMCH is decreased.The MCHCisthemean corpuscularhemoglobin concentration,These threeindexes can be calculatedwith the number ofRBC,HCT and hemoglobin.When twoindexes amongthem isknown,the leftindex canbe calculatedtoo.MCV,MCH andMCHC reflectthe sizeandhemoglobinconcentration ofindividual cells.It isuseful inthe diagnosisof varioustypes ofanemia.P281,table4-2-54）RDW Ok,please eback to the slide.Lets learnthe lastindex aboutRBC-RDW.Atfirst lets see the definition:the RDWistheabbreviationof theRBC volumedistributionwidth.It isa measureof thevariation ofRBCvolume.In normalpeople,theRBCvolume ishomogeneous，is about7um,but incertain anemia,some RBC bee larger,some RBCbee smaller,So the size ofRBCbeevariety,the RDWwillbeincreased.Application:P281,table4-2-63.WBC relatedparameters Now lets learnabout WBC,firstlets see theparametersrelatedto WBCThey arethenumber of whiteblood cellsand theponent of WBC,WBC aredivided intofive types:neutrophil,lymphocyte,monocyte,eosinophil andbasophil.Each typecells canbe describedin twoforms:the percentage and theabsolute count.Mostly weuse thepercentage todescribe theponent of WBCS.1）The functionof WBCFight infectionMake antibodies2）Divided intoFive typesaording toits shapeTypes of WBCs normallypresent inblood:-neutrophils(infection-fighters),2types:?polys orsegs=segmented neutrophils(mature)?bands orstabs=banded neutrophils(young)-lymphocytes(immunity)-monocytes(phagocytosis)-eosinophils(allergy,parasites)-basophils(hypersensitivity)In neutropenia,most WBCsare lymphocytes.An earlyindication ofrecovery isthe presenceof monocytes,Non-malignant blastsare sometimesseen duringneutrophil recoveryfollowing chemotherapy,especially inconjunction withGCSF/GMCSF therapy,as aresult ofan overstimulated bonemarrow releasingimmature cellsinto theperipheral circulation.Neutrophil(Ne)make up55-70%of totalWBC countvery tinylight staininggranules the nucleus isfrequently multi-lobed canphagocytizing foreigncells,toxins,and virusesEosinophil(EO)make up0.5-5%of totalWBC countlarge granulesstained pink(or red)the nucleusoften hastwo lobesthe granules contain enzymesattacks parasitesand anyantigen plexesare alsoresponsible forallergic responseBasophil(Ba)less than1%of totalWBC countgranules arelarge,stain deepblue topurple granulesoften numerous,can maskthe nucleusgranulescontainhistamines mediatehypersensitivity reactionslymphocyte(Ly)make up20-40%of totleWBC countit isan agranularcell withvery clearcytoplasm the cytoplasm stains pale blue nucleus isvery large for thesize ofthe cell,stains darkpurple Lymphocyteis muchsmaller thanthe threegranulocytes play an important role in our immune response produceantibodies andprovide secondaryimmunity Thelymphocyte isan agranularcell withvery clearcytoplasm whichstains paleblue.Its nucleusisverylargeforthesizeofthecell andstains darkpurple.(Notice thatthenucleusalmost fillsthecellleaving avery thinrim ofcytoplasm.)This cell is muchsmallerthanthe threegranulocytes(which areall aboutthesamesize).These cellsplayanimportantroleinourimmuneresponse.The T-lymphocytes actagainst virusinfected cellsand tumorcells.The B-lymphocytes produceantibodies.Monocyte(Mo)it is agranular,make up4-10%of totleWBC countIt isthe largestcell amongthe fivetypes thecytoplasm is abundant andstainspalebluenucleusoften shapedU or kidney bean,stains darkpurple develop into large macrophages phagocytizepathogens duringinfection Thiscellisthe largestoftheleukocytes andisagranular.The nucleusis mostoftenUorkidneybean shaped;thecytoplasmisabundantand lightblue.These cellsleave theblood stream(diapedesis)to beemacrophages.As amonocyte ormacrophage,these cellsare phagocyticand defendthe bodyagainst virusesand bacteria.These cellsaount for3-9%of allleukocytes.In peoplewith malaria,endocarditis,typhoid fever,and RockyMountain spottedfever,monocytes increasein number.it candevelopintolargemacrophagesinthebody tissuesthat phagocytizepathogens duringinfection Normalvalues Ok,lets see the normalvaluesof WBCS.To youall,thevaluesin thisslide mustto remember.The numberofWBC is4-10thousand millionsper liter.And mainlyis posedof neutrophil,contain50-70percentage,the secondponent islymphocyte,normally is20-40percentage,and the normalvalueof monocyteis3-8percentage,eosinophil andbasophil arescase tosee innormalpeople,thenormalvalue is0.5-5percentageand0-1percentage respectively.Clinical significanceThe change of eachponent wouldlead tothenumberofWBCincreased ordecreased,but itsclinical significanceisdifferent,so weshould distinguishwhich ponentis changed.Nowletslearntheclinical significanceofeachponent.First,lets seethe neutrophil:Ne ThechangeofWBCismostly changedby the neutrophil.In certainpeople such as pregnant,the neutrophilwill increase,and whenwe eattoo muchor aftersport,itwill increase temporarily.These areall physiologicincreasing.Neutrophil increasingis seenoften inclinic.Many acutedisease can cause the neutrophil increasing,please noticethe acute.Acute disease such asacute infection-mainly causedby bacteria,injury oracute hemolysisand bleeding.These areall acutedisease.Besides acutedisease,in mostleukemia such as CML(chronic myelocyticleukemia)theneutrophilisincreasetoo.Followed with the increasingof neutrophil,thenumberofWBCis alwaysincreasing.The decreasingof neutrophilis oftenoure in some certain infections,such asvirus,typhia andparatyphoid.When people infected withvirus,the lyphocytewill increasing,and when peopleinfected with typhiaor paratyphoid,theneutrophilisdecreased,thenumberofWBCis alsodecreased.Morever,some hematonosissuch asAA,IDA,PNH,and someexternal factorssuch asX ray、medcine canalsocauseneutrophil decreasing.We allknow inthe spleen,blood cells,including RBC,WBC andplatelet,canbe destroyed,so insome desease,the functionof spleenbee toostrong,thebloodcells willbedestroyedtoomuch,cancausetheRBCWBC andplatelets decreasingatthesame time.In autoimmunediseasesuchas SLE,RA,the antibodycan bindwiththebloodcells,and thebodywilldisposal thebloodcellsas externalantigen,send ittotheimmune systemto destroyit.Here letssee twoterms,the firstis leukopenia:it defineswhen thenumberofWBC areless than4.0*109.The otheris neutropenia:it defineswhen thenumberofneutrophil areless than1.5*109.Eo Ok,letsseethe eosinophil.You should remenber intwo diseasesthe eosinophilwill increasing,the twodiseases areallergy andverminosis.The allergycanbecausedbyfood,medicine orpollen.When peopleinfected withparasite wecalled itverminosis.The decreasingof eosinophilhas noimportant significance.So weshouldremenberwhen peoplewith allergyor verminosis,the eosinophiloften increasing.Ba Letsseethebasophil,the increasingof basophilis notoften seeninclinic,it canbe seeninsomecertain hematonosissuchasCML,Bone marrowfibrosis andallergy.It willincreasing fastwhen theCML is activity,so itis importantto observethe diseasewhether itis beeseverity.Ly Letsseethe lymphocyte,the lymphocyteinclude Tlymphocyte andB lymphocyte,they arethemainimmunocyte,so whenthe immunity isactivity,the lymphocytewillincrease.For example,whenpeopleinfectedwithvirus,or hastumors,ortheexclusion oftransplant isourred,the lymphocytewillincrease.In theother side,whentheimmunityisdeficient,thelymphocytewilldecrease.If peoplecured withcortin,do youknow cortin?It isa hormoneproduced inkidney,it canrestrain theimmune system.Certain diseasesuchasSLE,RA orpeople hastransplant,itismonly used.Mo increasingcertaininfections(endocarditis）,certain hematonosis(M5)decreasing nosignificance PLTrelatedparametersThe numberof platelets（PLT)normalvalue:(100-300)109/L Meanplatelet volume（MPV)Platelet distributionwidth（PDW)MPV Similarwith MCV,PDW similarwith 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测定血红蛋白及分析皱缩态的WBC血红蛋白测定原理与手工测定的氰化高铁血红蛋白转化法不同氰化高铁血红蛋白转化法测血红蛋白为ICSH推荐的参考方法2.分类原理1）.三分类经过溶血剂处理后的白细胞可以根据体积大小初步确认其相应的细胞群第一群是小细胞区（35-90