02血液的特殊检查（02specialexaminationofblood）

1、02 血液的特殊检查(02 special examination of blood)clinical laboratory manualthe second chapter: special examination of bloodindex: section 1: laboratory examination of hemolytic anemia (second): laboratory examination of low pigmented anemiasection 1: laboratory examination of hemolytic anemiafirst, the ex

2、amination of excessive red blood cell destruction1. peripheral blood routine red blood cell count, hemoglobin content decreased, blood smear showed broken red blood cells, abnormal red blood cells and so on. a typical abnormal red blood cell or self agglutination phenomenon may provide clues to the

3、cause of hemolysis2. plasma free hemoglobin determination significa.nee of normal plasma only a trace of free hemoglobin, >40mg/l is especially important index of hemolysis intravascular hemolysis, such as paroxysmal nocturnal hemoglobinuria, incompatible bloodtransfusion reaction. extravascular

4、hemolysis, such as hereditary polycythemia, generally does not increase3. significance of serum haptoglobin determination (hp)serum haptoglobin decreased in 1:a variety of hemolytic anemia, including intravascular or extravascular hemolysis;the liver cell damage, infectious mononucleosis, congenital

5、 absence of haptoglobin in.infection, tissue damage,malignant tumors and so on.2. serum haptoglobin increased in extrahepatic obstructive jaundice,to identify intravascular or extravascular positive expression of severe intravascularin the case of paroxysmal nocturnal hemoglobinuria, high concentrat

6、ion of the red blood albumin band,4. . the significance of plasma hemin albumin test this test is helpful hemolysis, hemolysis there is a but there is no zone in the presence of extravascular hemolysis.5. urine testthe urobilinogen excretion increased;the occult blood test positive, this is because

7、when the plasma free hemoglobin was significantly higher than that of haptoglobin and tubular reabsorption function, the hemoglobin urine;the rous test is positive, is a reflection of chronic hemolysis, especially intravascular hemolysis6. red cell life test is a reliable index to detect hemolysis,

8、commonly used 51cr, 3p-dfp or two isopropyl phosphate labeling red blood cell method, can reflect the index of red blood cell life this assay showed shortened red blood cell lifespan indicating hemolysistwo. examination of compensatory proliferation of red blood cells1. reticulocyte count increased

9、from 5% to 20%2. peripheral blood showed red blood cells, mainly late red blood cells. due to the appearance of reticulocytes and erythrocytes, the increase of red blood cell count can be seen.3. the bone marrow red blood cells proliferated significantly, mainly in young and late red blood cells, an

10、d the proportion of red blood cells often reversedthree examination of erythrocyte membrane defect1. significance of erythrocyte osmotic fragility test1. the increase of erythrocyte osmotic fragility is found in hereditary globular histiocytosis, autoimmune hemolytic anemia and subsequent serve cell

11、 increase2. the decrease of erythrocyte osmotic fragility is found in iron deficiency anemia and thalassemia2. red cell incubation osmotic fragility test this test is sensitive to the detection of light hereditary mononucleosis, also found in enzyme deficient hemolytic anemia such as pyruvate kinase

12、 deficiency.3. hemolysis test and the significance of correction test in 1., hereditary hemolysis increased significantly in hypotonic saline, and hemolysis was corrected after adding glucose, and hemolysis was corrected after adding atp2. congenital non spherical cell hemolytic anemia type i (g-6-p

13、d deficiency), slightly increased in normal saline or hemolysis in hypotonic saline, partial hemolysis corrected after glucose, and partial hemolysis corrected after atp3. congenital non spherical cell hemolytic anemia type ii (pk deficiency), hemolysis in hypotonic saline was significantly enhanced

14、, hemolysis after glucose addition could not be corrected, and hemolysis was corrected after adding atpfour, erythrocyte enzyme defect inspection1. methemoglobin reduction test significance, when the normal activity of g-6-pd cells, the reduction rate of >75%; such as g-6-pd defects, formation of

15、 methemoglobin, reduction rate is much slower than the normal red blood cells,the reduction rate was significantly reduced the test showed that red blood cells had the ability of reducing methemoglobin, and the specificity was low it could be used as a screening test for g-6-pd deficiency.2. . the s

16、ignificance of denatured globin body examination. when g-6-pd deficiency, the degeneration of globin corpuscle is easy to be detected, and the increase of denatured globin corpuscle can be seen in some drug poisoning, unstable hemoglobin disease and splenectomy.3. red blood cell g6-pd activity deter

17、mination, g-6-pd deficiency, often delayed or no fluorescence point, can be used as a specific screening test for g-6-pd the activity of g-6-pd can be quantitatively determined by ultraviolet spectrophotometry.4. erythrocyte pyruvate kinase assay, pyruvate kinase deficiency, often delayed disappeara

18、nce or 60min still does not disappear, can be used as pyruvate kinase specific screening test the activity of pyruvate kinase can be quantitatively determined by ultraviolet spectrophotometry.five the abnormal synthesis of globin1. significance of hemoglobin electrophoresis1. , such as hba, hba2, hb

19、f reduction, is seen in alpha - globin 一 producing anemia;2., such as hba reduction, hbf increased significantly, seen in beta 一 globin 一 producing anemia;3. iron deficiency anemia often reduce hba2, megaloblastic anemia hba2 can be increased;4. if the new zone may be abnormal hemoglobin, it should

20、be further examined.2. fetal hemoglobin (hbf) determinationsignificance of 1. anti alkali hemoglobin determinationthe alkali resistant hemoglobin was significantly higher in:beta globin producing anemia. mild increase except in:beta thalassemia is also found in normal pregnant women, aplastic anemia

21、, hereditary globular histiocytosis, paroxysmal nocturnal hemoglobinuria, leukemia, and bone marrow metastatic carcinomadetermination of the significance of 2. hbf acid washing and alkali resistance hemoglobin determination3. hbh inclusion body staining increased significantly in patients with globi

22、n - producing anemia (alpha - marine anemia), hbh disease and some hemoglobin diseases4. the significance of red cell degeneration test showed that the number of sickle cells was related to the content of hbs except for hbs disease, sickle cells could also be found in some cases of hemoglobin diseas

23、e5. unstable hemoglobin test1. isopropyl alcohol precipitation test significance, unstable hemoglobin disease added isopropanol solvent can precipitate after 5min, 20min can become flocculent hb比 hbf or methemoglobin may also be positive when elevated.2. significance of thermal denaturation test wit

24、h isopropanol precipitation testsix. examination of immune hemolysissignificance of 1. anti human globulin test1. direct test was positive:autoimmune hemolytic anemia (aiha), besides primary aiha, can also be secondary to cormective tissue disease, malignant lymphoma, leukemia, certain infections, d

25、rugs and other aiha;hemolytic disease of the newborn(3) a few cold resistant forms of immune hemolytic anemia2. indirect tests were chronic in pregnant women with rh and abo blood group immune hemolysis, and incomplete antibodies in maternal serumthe significance of the 2. acid hemolysis test was po

26、sitive, which supported the diagnosis of pnh severe aiha, marked spherical hyperplasia may even be positive3. sucrose water hemolysis test significance, this test is often positive in patients with pnh, and more sensitive than acid hemolysis test, but the specificity is not strong. aplastic anemia,

27、autoimmune hemolytic anemia, hereditary spherical cell hyperplasia can also be slightly positive reaction.4. the significance of cold and hot hemolysis test, this test is positive to support the diagnosis of pch. some viral infections, such as infectious mononucleosis and mumps, are occasionally pos

28、itivethe second section: laboratory examination of low pigment anemiathe significance of serum iron (si) determination1. : the reduction of serum iron in total body iron reduction. iron deficiency anemia is the most common cause of iron deficiency anemiathe iron loss increased, such as the various c

29、auses of chronic blood losswe need to increase the amount of iron, such as pregnancy, lactation and infant growth periodthe iron transport barriers, such as severe infection, malignant tumor, liver cirrhosis2. increased serum iron level was observed:the excessive destruction of red blood cells, such

30、 as hemolytic anemia;the use of iron reduction, such as aplastic anemia;the increase in iron absorption, iron treatment, such as long-term blood transfusion, the storage of hemachromatosis; iron release increased, such as acute hepatitistwo. determination of serum total iron binding capacity (tibc)1

31、. the decrease of serum total iron binding capacity was observed:the transferrin loss, such as kidney disease, uremiathe transferrin synthesis is reduced, such as hereditary transferrin deficiency;the ferritin decreased, such as cirrhosis;the other, such as infection, tumor and hemolytic anemia2. th

32、e increase of serum total iron binding capacity was observed:the transferrin synthesis increases, such as the various causes of iron deficiency anemia;the excessive iron absorption, such as long-term blood transfusion, iron injection treatment;the increased release of ferritin, such as acute hepatit

33、is, liver cell necrosis 3 as tibc increased, mainly in iron deficiency anemia serum iron decreased; tibc decreased, serum iron increased showed disorder of hemoglobin synthesis, such as thalassemia; both were increased, suggesting that chronic infection, liver cirrhosis, nephropathy etcthree the sig

34、nificance of determination of serum unsaturated iron binding capacity (uibc) see serum iron and tibc items uibc increases in iron deficiency anemiafour. the significance of transferrin (tf) determination is the same as that of tibc. see tibcfive. the significance of serum ferritin (sf) determination

35、1. decreased serum ferritin was observed:the iron deficiency anemia, with early diagnosis valuethe malnutrition, severe chronic disease of body iron stores leads to the reduction of secondary anemia2. increased serum ferritin was found in patients:the iron storage in the body too much, such as long-

36、term blood transfusion and inappropriate treatment of iron;the malignant tumor;the acute infection and inflammation;the liver diseases such as cirrhosis, hepatic necrosis and myocardial infarction.significance of 0 red blood cell volume distribution width (rdw)1. according to mcv, rdw value can be d

37、ivided into 6 kinds of anemia:the small cell anemia were: mcv decreased, rdw normal, such as light thalassemiasmall cell heterogeneity anemia: mcv decreased, rdw increased, such as iron deficiency anemiathe positive cell anemia: mcv and rdw were all normal, such as anemia caused by chronic diseasesthe positive cell heterogeneity of anemia with normal mcv and rdw increase, as early as iro