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1、第二章 血液一般检测,（Complete Blood Count),School of Medical Laboratory Science HuXin 胡 昕,(Blood Routine Test),Contents and Learning Objectives,The measurements in a CBCCriteria for collection of proper specimensReference value for human and blood clinical significance-Be able to interpret CBC information sh
2、eets,What does a complete blood count measure?,What does a complete blood count measure?,How to collect a complete blood count sample?,Sample collection-Site-Strict aseptic technique-？,Blood Service Clinical Laboratory the First Affiliated Hospital,EDTA-K2,CBC：不凝固的人血,How to interpret complete blood
3、count results?,Reference value RBC Hb成年男性(4.0 5.5)1012/L 120 160 g/L 成年女性(3.5 5.0)1012/L 110 150 g/L 新生儿(6.0 7.0)1012/L 170 200 g/L,1.RBC&Hb,贫血(anemia),Thalassemia,1）Hematocrit，Hct(packed cell volume，PCV）,2.Other Red cell indices,Elevated or lowered Hct is accord with the change of RBC,so the clinic
4、al significance of HCT can refer to the RBC and Hb,*Remember Plasma,在某些病理情况下,Hb和RBC的浓度不一定能正确反映全身红细胞总容量的多少。1 大量失血（主要是血容量的缩小，血浓度变化很 少，从Hb等数值上很难反映出贫血）2 水潴留（血浆容量大，红细胞容量正常，但红细 胞浓度低，表面看有贫血）3 失水（血浆容量小，浓度偏高，有贫血也看 不出）,Hb对贫血程度的判断上优于RBC计数。,2)Mean RBC indices,useful in diagnosing the type of anemia,g/L,3)RBC Di
5、stribution Width，RDW,These cells exhibit a large variation in size.The RDW is a numerical indication of this morphologic abnormality.,This value indicates the degree of red cell size variation or how much difference exists between the largest and smallest red cells.,2）TOTAL LEUKOCYTE COUNT(TLC),法国AB
6、X血球计数仪Micros60,Normal values:4 10109/L,Neutrophil(Ne)Lymphocyte(Ly)Eosinophil(Eo)Basophil(Ba)Monocyte(Mo),DIFFERENTIAL LEUKOCYTE COUNT,Clinical Significance,Ne：a增多：如急性感染或炎症、急性溶血、失血、粒 细胞白血病等。b减少：感染性疾病如病毒感染及伤寒、血液系统 疾病如再障、物理化学因素如接受射线、单核巨噬细胞功能亢进等。Ly：a增多：感染性疾病如病毒感染、肿瘤性疾病、及移植排斥反应等。b减少：应用肾上腺皮质激素、免疫缺陷性疾病等。,
7、(50 70),(20 40),M：a.增多：某些感染如感染性心内膜炎等、血液病如单核细胞白血病等。b.减少：无重要临床意义。,Eo：a.增多：变态反应性疾病、寄生虫病、皮 肤病、某些恶性肿瘤及传染病等。b.减少：无重要临床意义。Ba：a.增多：见于慢性粒细胞白血病、骨髓 纤维化、变态反应性疾病等。b.减少：无临床意义。,(3 8%),(0.5 5%),(0 1%),4）Platelet,Causes of thrombocytopenia:Viral infection Idiopathic thrombocytopenic purpura(ITP)Medications DIC Liver
8、 disease Autoimmune disease Hypersplenism Pregnancy Bone marrow causes,Partially clotted sample Platelet clumping in the blood collection tube,High Platelet Count(Thrombocytosis)Malignant tumorPolycythemia veraSplenectomy,Normal platelet counts are not a guarantee of adequate function.,How to perfor
9、m a complete blood count test?,阴性结果,阳性结果,向临床报告,WBC分类,全部手工操作,20-40%,60-80%,太多的工作量!,工作量少 报告迅速,simplified the practice of haematology,made possiblesome additional parameters to be determined withoutmuch efforts.,Comparing Manual and Automated cell counters,1.血细胞自动化分析原理：1）三分类：电阻法原理（Coulter Counter.）,Wal
10、lace Henry Coulter(1913-1998),2）五分类技术：为基于流式通道的三维分析技术,COULTER PRINCIPLE,2.Cell histogram：,-X轴：体积（fL）-Y轴：相对数量,1）WBC/BASO histogram,2）Red cell histogram,Gaussian distributionMCV&RDW,下面介绍几种贫血时图形变化：,（4）叶酸及维生素B12缺乏引起的巨幼细胞性贫血（D）：直方图波峰右移，峰底增宽，显示明显的大细胞不均一性。给予叶酸或维生素B12后，正常红细胞逐步释放入血液，而病理细胞并未完全消亡，检测时即再出现双峰形，说明治
11、疗有效。,（3）铁粒幼细胞性贫血（B）：直方图显示红细胞呈典型的“双形”性改变（即同时存在着两类型的红细胞，一种是小细胞低色素性红细胞，另一种是正常形态的红细胞），故出现波峰左移、峰底增宽的双峰。在缺铁性贫血经治疗有效时，也可出现类似的图形，但峰底要更宽些。,（2）轻型-珠蛋白生成障碍性贫血（C）：直方图图形表现为小峰左移，峰底变窄，典型的小细胞均一性贫血。,（1）缺铁性贫血（A）：典型呈小细胞性贫血，其特点为曲线波峰左移（MCV降低），峰底变宽（RDW增高），显示小细胞不均一性。,不同类型贫血红细胞体积分布直方图,Vocabulary,venipuncturesyringeiodineper
12、spirepicahydration therapyerythropoietinaplastic anemiahaemolysismegaloblastic anemiasideroblastic anemiarheumatic disease steroidtyphoid,malariatuberculosisdengue infectionslupusneutrophilia leukemia neutropeniahematonosiscortinendocarditischronic myelocytic leukemiabone marrow fibrosis,bone marrow fibrosisblood transfusiondisseminated intravascular coagulationAspirintestosteronesplenomegalysideroblastic anemia,References,http:/http:/,
