TEST BANK
A MANUAL OF LABORATORY AND DIAGNOST
, 2
Blood Studies; Hematology And Coagulation
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
Blood Tests
BLOOD SPECIMEN COLLECTION PROCEDURES
Capillary Puncture (Skin Puncture)
Venipuncture
NOTE
NOTE
Bone Marrow Aspiration
BASIC BLOOD TESTS
Hemogram
Complete Blood Count (CBC)
TESTS OF WHITE BLOOD CELLS
White Blood Cell Count (WBC; Leukocyte Count)
Differential White Blood Cell Count (Diff; Differential Leukocyte Count)
NOTE
Segmented Neutrophils (Polymorphonuclear Neutrophils, Pmns, Segs, Polys)
Eosinophils
Basophils
Monocytes (Monomorphonuclear Monocytes)
Lymphocytes (Monomorphonuclear Lymphocytes); CD4, CD8 Count; Plasma Cells
Lymphocyte Immunophenotyping (T And B Cells)
STAINS FOR LEUKEMIAS
Sudan Black B (SBB) Stain
Periodic Acid–Schiff (PAS) Stain
Terminal Deoxynucleotidyl Transferase (TDT) Stain
Leukocyte Alkaline Phosphatase (LAP) Stain
Tartrate-Resistant Acid Phosphatase (TRAP) Stain
TESTS OF RED BLOOD CELLS
Red Blood Cell Count (RBC; Erythrocyte Count)
Hematocrit (Hct); Packed Cell Volume (PCV)
Hemoglobin (Hb)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Mean Corpuscular Hemoglobin (MCH)
Red Cell Size Distribution Width (RDW)
Stained Red Cell Examination (Film; Stained Erythrocyte Examination)
NOTE
Reticulocyte Count
Sedimentation Rate (Sed Rate); Erythrocyte Sedimentation Rate (ESR)
TESTS FOR PORPHYRIA
Erythropoietic Porphyrins; Free Erythrocyte Protoporphyrin (FEP)
Porphyrins; Fractionation Of Erythrocytes And Of Plasma
ADDITIONAL TESTS FOR HEMOLYTIC ANEMIA
Pyruvate Kinase (PK)
Erythrocyte Fragility (Osmotic Fragility and Autohemolysis)
Glucose-6-Phosphate Dehydrogenase (G6PD)
Heinz Bodies; Heinz Stain; Glutathione Instability
,Hypercoagulability States
Disorders Of Hemostasis
Clinical Alert
Clinical Alert
Tests For Disseminated Intravascular Coagulation (DIC)
Bleeding Time (Ivy Method; Template Bleeding Time)
Platelet Count; Mean Platelet Volume (MPV)
Platelet Aggregation
Thrombin Time (TT); Thrombin Clotting Time (TCT)
Partial Thromboplastin Time (PTT); Activated Partial Thromboplastin Time (APTT)
NOTE
Activated Coagulation Time (ACT)
Prothrombin Time (Pro Time; PT)
Coagulant Factors (Factor Assay)
Plasminogen (Plasmin; Fibrinolysin)
Fibrinolysis (Euglobulin Lysis Time; Diluted Whole Blood Clot Lysis)
Fibrin Split Products (Fsps); Fibrin Degradation Products (Fdps)
D-Dimer
Fibrinopeptide A (FPA)
Prothrombin Fragment (F1 + 2)
Fibrin Monomers (Protamine Sulfate Test; Fibrin Split Products)
Fibrinogen
Protein C (PC Antigen)
NOTE
NOTE
Protein S
Antithrombin III (AT-III; Heparin Cofactor Activity)
BIBLIOGRAPHY
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition Of Blood
The Average Person Circulates About 5 L Of Blood (1/13 Of Body Weight), Of Which 3 L Is Plasma
Plasma Fluid Derives From The Intestines And Lymphatic Systems And Provides A Vehicle For Cel
Cells Are Produced Primarily By Bone Marrow And Account For Blood ―Solids.‖ Blood Cells Are Cla
Cells (Leukocytes), Red Cells (Erythrocytes), And Platelets (Thrombocytes). White Cells Are Furthe
Granulocytes, Lymphocytes, Monocytes, Eosinophils, And Basophils.
Before Birth, Hematopoiesis Occurs In The Liver. In Midfetal Life, The Spleen And Lymph Nodes Pl
Cell Production. Shortly After Birth, Hematopoiesis In The Liver Ceases, And The Bone Marrow Is T
Production Of Erythrocytes, Granulocytes, And Platelets. B Lymphocytes Are Produced In The Mar
Secondary Lymphoid Organs; T Lymphocytes Are Produced In The Thymus.
Blood Tests
Tests In This Chapter Are Basic Screening Tests That Address Disorders Of Hemoglobin (Hb) And
(Hematopoiesis), Synthesis, And Function. Blood And Bone Marrow Examinations Constitute The M
Determining Certain Blood Disorders (Anemias, Leukemia And Porphyrias Disorders, Abnormal Ble
Inflammation, Infection And Inherited Disorders Of Red Blood Cells, White Blood Cells, And Platele
Obtained Through Capillary Skin Punctures (Finger, Toe, Heel), Dried Blood Samples, Arterial Or V
Bone Marrow Aspiration. Specimens May Be Tested By Automated Or Manual Hematology Instrum
Evaluation.
BLOOD SPECIMEN COLLECTION PROCEDURES
, Drop Of Blood.
Clinical Alert
1. Do Not Squeeze The Site To Obtain Blood Because This Alters Blood Composition And Inva
2. Warming The Extremity Or Placing It In A Dependent Position May Facilitate Specimen Colle
Interventions
Pretest Patient Care
1. Instruct Patient About Purpose And Procedure Of Test.
2. Follow Chapter 1 Guidelines For Safe, Effective, Informed Pretest Care.
Posttest Patient Aftercare
1. Apply Small Dressing Or Adhesive Strip To Site.
2. Evaluate Puncture Site For Bleeding Or Oozing.
3. Apply Compression Or Pressure To The Site If It Continues To Bleed.
4. Evaluate Patient's Medication History For Anticoagulation Or Acetylsalicylic Acid (ASA)-Type
5. Follow Chapter 1 Guidelines For safe, effective, informed posttest care.
Clinical Alert
Dried Blood Spot
In This Method, A Lancet Is Used, And The Resulting Droplets Of Blood Are Collected By Blot
Filter Paper Directly. Check The Stability Of Equipment And Integrity Of Supplies When Doing A
Provided, Check The Humidity Indicator Patch On The Filter Paper Card. If The Humidity Circle
Use This Filter Paper Card. The Humidity Indicator Must Be Blue To Ensure Specimen Integrity.
After Wiping The First Drop Of Blood On The Gauze Pad, Fill And Saturate Each Of The Circles In
By Blotting The Blood Droplet With The Filter Paper. Do Not Touch The Patient's Skin To The Filte
Blood Droplet Should Come In Contact With The Filter Paper. If An Adult Has A Cold Hand, Run W
For Approximately 3 Minutes. The Best Flow Occurs When The Arm Is Held Downward, With The
Level, Making Effective Use Of Gravity. If There Is A Problem With Proper Blood Flow, Milk The F
Pressure To Stimulate Blood Flow Or Attempt A Second Finger Stick; Do Not Attempt More Than
Blood Circles Penetrate Through To The Other Side Of The Filter Paper, The Circles Are Fully Sa
Venipuncture
Venipuncture Allows Procurement Of Larger Quantities Of Blood For Testing. Usually, The Antecu
Veins Of Choice Because Of Ease Of Access. Blood Values Remain Constant No Matter Which
Selected, So Long As It Is Venous And Not Arterial Blood.
1. Observe Standard Precautions Appendix A). If latex allergy is suspected, use latex-free s
(See EquipmentAppendix
(See B).
2. Position And Tighten A Tourniquet On The Upper Arm To Produce Venous Congestion.
3. Ask The Patient To Close The Fist In The Designated Arm. Select An Accessible Vein.
4. Cleanse The Puncture Site And Dry It Properly With Sterile Gauze. Povidone-Iodine Must Dry
5. Puncture The Vein According To Accepted Technique. Usually, For An Adult, Anything Smalle
Needle Might Make Blood Withdrawal More Difficult. A Vacutainer System Syringe Or Butterfl
Used.
, 9. Failure To Release Tourniquet Before Needle Withdrawal
c. Posttest Errors
1. Failure To Apply Pressure Immediately To Venipuncture Site
2. Vigorous Shaking Of Anticoagulated Blood Specimens
3. Forcing Blood Through A Syringe Needle Into Tube
4. Mislabeling Of Tubes
5. Failure To Label Specimens With Infectious Disease Precautions As Required
6. Failure To Put Date, Time, And Initials On Requisition
7. Slow Transport Of Specimens To Laboratory
NOTE
A Blood Pressure Cuff Inflated To A Point Between Systolic And Diastolic Pressure Values Can Be
NOTE
The Vacutainer System Consists Of Vacuum Tubes (Vacutainer Tubes), A Tube Holder, And A Dis
Multisample Collecting Needle.
Interventions
Pretest Patient Care
1. Instruct Patient Regarding Sampling Procedure. Assess For Circulation Or Bleeding Problems
2. Reassure Patient That Mild Discomfort May Be Felt When The Needle Is Inserted.
3. Place The Arm In A Fully Extended Position With Palmar Surface Facing Upward (For Antecu
4. If Withdrawal Of The Sample Is Difficult, Warm The Extremity With Warm Towels Or Blankets.
Extremity To Remain In A Dependent Position For Several Minutes Before Venipuncture.
Clinical Alert
In Patients With Leukemia, Agranulocytosis, Or Lowered Resistance, Finger-Stick And Earlobe Pu
Likely To Cause Infection And Bleeding Than Venipunctures. Should A Capillary Sample Be Nece
Cleansing Agent Should Remain In Contact With The Skin For At Least 5 To 10 Minutes. Povidon
Cleansing Agent Of Choice. It Should Be Allowed To Dry. It May Then Be Wiped Off With Alcohol
With Sterile Gauze Before Puncture.
Posttest Patient Aftercare
1. If Oozing Or Bleeding From The Puncture Site Continues For An Unusually Long Time, Eleva
Apply A Pressure Dressing. Observe The Patient Closely. Check For Anticoagulant Or ASA-T
2. Be Aware That The Patient Occasionally Becomes Dizzy, Faint, Or Nauseated During The Ve
Phlebotomist Must Be Constantly Aware Of The Patient's Condition. If A Patient Feels Faint, I
The Tourniquet And Terminate The Procedure. If The Patient Is Sitting, Lower The Head Betw
Instruct The Patient To Breathe Deeply. A Cool, Wet Towel May Be Applied To The Forehead
Neck, And, If Necessary, Ammonia Inhalant May Be Applied Briefly. If The Patient Remains U
Physician Immediately.
3. Prevent Hematomas By Using Proper Technique (Not Sticking The Needle Through The Vein
Tourniquet Before The Needle Is Withdrawn, Applying Sufficient Pressure Over The Puncture
Maintaining An Extended Extremity Until Bleeding Stops.
Clinical Alert
1. Never Draw Blood From The Same Extremity Being Used For IV Medications, Fluids, Or Tra
,Reference Values
Normal See Table 2.1 for normal values
Table 2.1 Normal Values for Bone Marrow *
Formed Cell Elements Normal Mean (%)
Undifferentiated Cells 0.0 0.0–1.0
Reticulum Cells 0.4 0.0–1.3
Myeloblasts 2.0 0.3–5.0
Promyelocytes 5.0 1.0–8.0
Myelocytes
Neutrophilic 12.0 5.0–19.
Eosinophilic 1.5 0.5–3.0
Basophilic 0.3 0.0–0.5
Metamyelocytes 25.6 17.5–33
Neutrophilic 0.4 0.0–1.0
Eosinophilic 0.0 0.0–0.2
Segmented Granulocytes
Neutrophilic 20.0 11.6–30
Eosinophilic 2.0 0.5–4.0
Basophilic 0.2 0.0–3.0
Monocytes 2.0 0–3
Lymphocytes 10.0 8–20
Megakaryocytes 0.4 0.0–3.0
Plasma Cells 0.9 0.0–2.0
Erythroid Series
Pronormoblasts 0.5 0.2–4.2
Basophilic Normoblasts 1.6 0.24–4.
Polychromatic Normoblasts 10.4 3.5–20.
Orthochromatic Normoblasts 6.4 3.0–25
Promegaloblasts 0 0
Basophilic Megaloblasts 0 0
Polychromatic Megaloblasts 0 0
Orthochromatic Megaloblasts 0 0
Myeloid: Erythroid Ratio (Ratio Of WBC To Nucleated RBC) 2:1–4:1 (Slightly
*These Values Are Only For Adults, And Should Be Used As A Guideline. (Each Laboratory Should
Reference Range.)
Procedure
1. Follow Standard Precautions. Check For Latex Allergy; If Allergy Is Present, Do Not Use Late
Products. Position The Patient On The Back Or Side According To Site Selected. The Posteri
Preferred Site In All Patients Older Than 12 To 18 Months. Alternate Sites Include The Anterio
Sternum, Spinous Vertebral Processes T10 Through L4, The Ribs, And The Tibia In Children.
Generally Used In Children Because The Bone Cavity Is Too Shallow, The Risk For Mediastin
Perforation Is Too Great, And The Child May Be Uncooperative.
2. Shave, Cleanse, And Drape The Site As For Any Minor Surgical Procedure.
3. Inject A Local Anesthetic (Procaine Or Lidocaine). This May Cause A Burning Sensation. At T
Incision Of 3 Mm Is Often Made.
, c. Anemia, Including Megaloblastic, Macrocytic, And Normocytic Anemias
d. Toxic States That Produce Bone Marrow Depression Or Destruction
e. Neoplastic Diseases In Which The Marrow Is Invaded By Tumor Cells (Metastatic Carcino
And Lymphoproliferative Diseases); Assists In Diagnosis And Staging
f. Agranulocytosis (A Decrease In The Production Of White Cells). This Occurs When Bo
Severely Depressed, Usually As A Result Of Radiation Therapy Or Chemotherapeutic D
The Patient Focus On The Risk For Death From Overwhelming Infection.
g. Platelet Dysfunction
h. Some Types Of Infectious Diseases, Especially Histoplasmosis And Tuberculosis
i. Deficiency Of Body Iron Stores, Microcytic Anemia
j. Lipid Or Glycogen Storage Disease
Interventions
Pretest Patient Care
1. Instruct The Patient About The Test Procedure, Purpose, Benefits, And Risks.
2. Ensure That A Legal Consent Form Is Properly Signed And Witnessed. Bone Marrow Aspirati
Contraindicated In The Presence Of Hemophilia And Other Bleeding Dyscrasias. However, Ri
Benefit May Dictate The Choice Made.
3. Reassure The Patient That Analgesics Will Be Available If Needed.
4. Be Aware That Bone Marrow Biopsies Or Aspirations Can Be Uncomfortable. Squeezing A Pi
As A Distraction Technique.
5. Observe Standard Precautions.
Clinical Alert
1. Complications Can Include Bleeding And Sternal Fractures. Osteomyelitis Or Injury To Heart
Is Rare But Can Occur If The Sternal Site Is Used.
2. Manual And Pressure Dressings Over The Puncture Site Usually Control Excessive Bleeding
In 24 Hours. Redress Site If Necessary.
3. Fever, Headache, Unusual Pain, Or Redness Or Pus At Biopsy Site May Indicate Infection (L
Instruct Patient To Report Unusual Symptoms To Physician Immediately.
Posttest Patient Aftercare
1. Monitor Vital Signs Until Stable And Assess Site For Excess Drainage Or Bleeding.
2. Recommend Bed Rest For 30 Minutes; Then Normal Activities Can Be Resumed.
3. Administer Analgesics For Sedatives As Necessary. Soreness Over The Puncture Site For 3 T
After The Procedure Is Normal. Continued Pain May Indicate Fracture.
4. Interpret Test Outcomes And Monitor Appropriately.
5. Follow Chapter 1 Guidelines For safe, effective, informed posttest care.
BASIC BLOOD TESTS
Hemogram
A Hemogram Consists Of A White Blood Cell Count (WBC), Red Blood Cell Count (RBC), Hemoglo
(Hct), Red Blood Cell Indices, And A Platelet Count. A Complete Blood Count (CBC) Consists Of A
Differential WBC.
Complete Blood Count (CBC)
The CBC Is A Basic Screening Test And Is One Of The Most Frequently Ordered Laboratory Proce
,Normal Values For Hemogram
Age WBC (× 10 3/Mm 3) RBC (× 10 6/Mm 3) Hb (G/Dl) Hct (%) MCV (Fl)
Birth–2 Wk 9.0–30.0 4.1–6.1 14.5–24.5 44–64 98–112
2–8 Wk 5.0–21.0 4.0–6.0 12.5–20.5 39–59 98–112
2–6 Mo 5.0–19.0 3.8–5.6 10.7–17.3 35–49 83–97
6 Mo–1 Y 5.0–19.0 3.8–5.2 9.9–14.5 29–43 73–87
1–6 Y 5.0–19.0 3.9–5.3 9.5–14.1 30–40 70–84
6–16 Y 4.8–10.8 4.0–5.2 10.3–14.9 32–42 73–87
16–18 Y 4.8–10.8 4.2–5.4 11.1–15.7 34–44 75–89
>18 Y (Males) 5.0–10.0 4.5–5.5 14.0–17.4 42–52 84–96
>18 Y 5.0–10.0 4.0–5.0 12.0–16.0 36–48 84–96
(Females)
Age MCH (Pg/Cell) MCHC (G/Dl) Platelets (× 10 3/Mm 3) RDW (%) MPV (Fl)
Birth–2 Wk 34–40 33–37 150–450 — —
2–8 Wk 30–36 32–36 — — —
2–6 Mo 27–33 31–35 — — —
6 Mo–1 Y 24–30 32–36 — — —
1–6 Y 23–29 31–35 — — —
6–16 Y 24–30 32–36 — — —
16–18 Y 25–31 32–36 — — —
>18 Y 28–34 32–36 140–400 11.5–14.5 7.4–10.4
Interventions
Pretest Patient Care For Hemogram, CBC, And Differential (Diff) Count (All Components)
1. Explain Test Procedure. Explain That Slight Discomfort May Be Felt When Skin Is Punctured.
Venipuncture Procedure For Additional Information.
2. Avoid Stress If Possible Because Altered Physiologic Status Influences And Changes Normal
3. Select Hemogram Components Ordered At Regular Intervals (Eg, Daily, Every Other Day). Th
Drawn Consistently At The Same Time Of Day For Reasons Of Accurate Comparison; Natura
Cause Fluctuations In Laboratory Values At Certain Times Of The Day.
4. Dehydration Or Overhydration Can Dramatically Alter Values; For Example, Large Volume
―Dilute‖ The Blood, And Values Will Appear As Lower Counts. The Presence Of Either Of T
Be Communicated To The Laboratory.
5. Fasting Is Not Necessary. However, Fat-Laden Meals May Alter Some Test Results As A Res
Posttest Patient Aftercare For Hemogram, CBC, And Differential (Diff) Count (All Component
1. Apply Manual Pressure And Dressings To The Puncture Site On Removal Of The Needle.
2. Monitor The Puncture Site For Oozing Or Hematoma Formation. Maintain Pressure Dressings
Necessary. Notify Physician Of Unusual Problems With Bleeding.
3. Resume Normal Activities And Diet.
4. Bruising At The Puncture Site Is Not Uncommon. Signs Of Inflammation Are Unusual And Sho
If The Inflamed Area Appears Larger, If Red Streaks Develop, Or If Drainage Occurs.
Clinical Alert
NEVER Apply A Total Circumferential Dressing And Wrap Because This May Compromise Circul
,The Immune Response To A Foreign Substance (Antigen).
The WBC Serves As A Useful Guide To The Severity Of The Disease Process. Specific Patterns O
Response Can Be Expected In Various Types Of Diseases As Determined By The Differential Coun
The Different Types Of Leukocytes). Leukocyte And Differential Counts, By Themselves, Are Of Lit
Diagnosis Unless The Results Are Related To The Clinical Condition Of The Patient; Only Then Is A
Interpretation Possible.
Reference Values
Normal Black Adults: 3.2–10.0 × 10 3/Cells/Mm 3 Or × 10 9/L Or 3200–10,000 Cells/Mm 3 Adults: 4
3
Or × 10 9/L Or 4500–10,500 Cells/Mm 3 Children: 0–2 Weeks: 9.0–30.0 × 10 3/Cells/Mm 3 Or × 10
Cells/Mm 3 2–8 Weeks: 5.0–21.0 × 10 3/Cells/Mm 3 Or × 10 9/L Or 5000–21,000 Cells/Mm 3 2 Mont
10 3/Cells/Mm 3 Or × 10 9/L Or 5000–19,000 Cells/Mm 3 6–18 Years: 4.8–10.8 × 10 3/Cells/Mm 3 O
4800–10,800 Cells/Mm 3
NOTE
Different Labs Have Slightly Different Reference Values.
Procedure
1. Obtain A Venous Anticoagulated EDTA Blood Sample Of 5 Ml Or A Finger-Stick Sample. Plac
In A Biohazard Bag.
2. Record The Time When Specimen Was Obtained (Eg, 7:00 A.M.).
3. Blood Is Processed Either Manually Or Automatically, Using An Electronic Counting Instrumen
Coulter Counter Or Abbott Cell-Dyne.
Clinical Implications
1. Leukocytosis: WBC >11,000/Mm 3 Or >11.0 × 10 3/Mm 3 (Or >11 × 10 9/L)
a. It Is Usually Caused By An Increase Of Only One Type Of Leukocyte, And It Is Given The
Of Cell That Shows The Main Increase:
1. Neutrophilic Leukocytosis Or Neutrophilia
2. Lymphocytic Leukocytosis Or Lymphocytosis
3. Monocytic Leukocytosis Or Monocytosis
4. Basophilic Leukocytosis Or Basophilia
5. Eosinophilic Leukocytosis Or Eosinophilia
b. An Increase In Circulating Leukocytes Is Rarely Caused By A Proportional Increase In Leu
Types. When This Does Occur, It Is Usually A Result Of Hemoconcentration.
c. In Certain Diseases (Eg, Measles, Pertussis, Sepsis), The Increase Of Leukocytes Is So G
Picture Suggests Leukemia. Leukocytosis Of A Temporary Nature (Leukemoid Reaction) M
Distinguished From Leukemia. In Leukemia, The Leukocytosis Is Permanent And Progress
d. Leukocytosis Occurs In Acute Infections, In Which The Degree Of Increase Of Leukocytes
Severity Of The Infection, Patient's Resistance, Patient's Age, And Marrow Efficiency And
e. Other Causes Of Leukocytosis Include The Following:
1. Leukemia, Myeloproliferative Disorders
2. Trauma Or Tissue Injury (Eg, Surgery)
3. Malignant Neoplasms, Especially Bronchogenic Carcinoma
4. Toxins, Uremia, Coma, Eclampsia, Thyroid Storm
5. Drugs, Especially Ether, Chloroform, Quinine, Epinephrine (Adrenalin), Colony-Stimula
6. Acute Hemolysis
7. Hemorrhage (Acute)
8. After Splenectomy
9. Polycythemia Vera
, 8. Arsenicals
9. Cancer Chemotherapy (Causes A Decrease In Leukocytes; Leukocyte Count Is Used A
10. Cardiovascular Drugs
11. Diuretics
12. Analgesics And Antiinflammatory Drugs
d. Primary Bone Marrow Disorders:
1. Leukemia (Aleukemic)
2. Pernicious Anemia
3. Aplastic Anemia
4. Myelodysplastic Syndromes
5. Congenital Disorders
6. Kostmann's Syndrome
7. Reticular Agenesis
8. Cartilage-Hair Hypoplasia
9. Shwachman-Diamond Syndrome
10. Chédiak-Higashi Syndrome
e. Immune-Associated Neutropenia
f. Marrow-Occupying Diseases (Fungal Infection, Metastatic Tumor)
g. Pernicious Anemia
Clinical Alert
1. WBC <500/Mm 3 Or <0.5 × 10 3/Mm 3 (Or × 10 9/L) Represents A Panic Value.
2. WBC >30,000/Mm 3 Or >30.0 × 10 3 (Or × 10 9/L) Is A Panic Value.
Interfering Factors
1. Hourly Rhythm: There Is An Early-Morning Low Level And Late-Afternoon High Peak.
2. Age: In Newborns And Infants, The Count Is High (10,000/Mm 3 To 20,000/Mm 3 Or 10 × 10 9
9
/L); The Count Gradually Decreases In Children Until The Adult Values Are Reached Betwee
Years Of Age.
3. Any Stressful Situation That Leads To An Increase In Endogenous Epinephrine Production An
In The Leukocyte Count
Interventions
Pretest Patient Care
1. Explain Test Purpose And Procedure.
2. Refer To Standard Pretest Care For Hemogram, CBC, And Differential Count On Page 47. Al
Chapter 1 Guidelines For Safe, Effective, Informed Pretest Care.
Posttest Patient Aftercare
1. Interpret Test Outcome And Monitor Appropriately. Refer To Standard Posttest Care For Hem
And Differential Count On Page 47. Also, Follow Chapter 1 Guidelines For Safe, Effective, In
Posttest Care.
2. In Prolonged Severe Granulocytopenia Or Pancytopenia, Give No Fresh Fruits Or Vegetables
Kitchen, Especially In A Hospital, May Be A Source Of Food Contamination. When The WBC
Get A Bacterial, Pseudomonal, Or Fungal Infection From Fresh Fruits And Vegetables. Use A
Commercially Sterile Diet. All Food Must Be Served From A New Or Single-Serving Package.
Diet. See Dietary Department For Restrictions (Eg, Cooked Food Only) And Careful Food Pre
Intramuscular Injections. Do Not Take Rectal Temperature, Give Suppositories, Or Give Enem
Razor Blades. Do Not Give Aspirin Or Nonsteroidal Anti-Inflammatory Drugs (Nsaids), Which
A MANUAL OF LABORATORY AND DIAGNOST
, 2
Blood Studies; Hematology And Coagulation
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition of Blood
Blood Tests
BLOOD SPECIMEN COLLECTION PROCEDURES
Capillary Puncture (Skin Puncture)
Venipuncture
NOTE
NOTE
Bone Marrow Aspiration
BASIC BLOOD TESTS
Hemogram
Complete Blood Count (CBC)
TESTS OF WHITE BLOOD CELLS
White Blood Cell Count (WBC; Leukocyte Count)
Differential White Blood Cell Count (Diff; Differential Leukocyte Count)
NOTE
Segmented Neutrophils (Polymorphonuclear Neutrophils, Pmns, Segs, Polys)
Eosinophils
Basophils
Monocytes (Monomorphonuclear Monocytes)
Lymphocytes (Monomorphonuclear Lymphocytes); CD4, CD8 Count; Plasma Cells
Lymphocyte Immunophenotyping (T And B Cells)
STAINS FOR LEUKEMIAS
Sudan Black B (SBB) Stain
Periodic Acid–Schiff (PAS) Stain
Terminal Deoxynucleotidyl Transferase (TDT) Stain
Leukocyte Alkaline Phosphatase (LAP) Stain
Tartrate-Resistant Acid Phosphatase (TRAP) Stain
TESTS OF RED BLOOD CELLS
Red Blood Cell Count (RBC; Erythrocyte Count)
Hematocrit (Hct); Packed Cell Volume (PCV)
Hemoglobin (Hb)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Mean Corpuscular Hemoglobin (MCH)
Red Cell Size Distribution Width (RDW)
Stained Red Cell Examination (Film; Stained Erythrocyte Examination)
NOTE
Reticulocyte Count
Sedimentation Rate (Sed Rate); Erythrocyte Sedimentation Rate (ESR)
TESTS FOR PORPHYRIA
Erythropoietic Porphyrins; Free Erythrocyte Protoporphyrin (FEP)
Porphyrins; Fractionation Of Erythrocytes And Of Plasma
ADDITIONAL TESTS FOR HEMOLYTIC ANEMIA
Pyruvate Kinase (PK)
Erythrocyte Fragility (Osmotic Fragility and Autohemolysis)
Glucose-6-Phosphate Dehydrogenase (G6PD)
Heinz Bodies; Heinz Stain; Glutathione Instability
,Hypercoagulability States
Disorders Of Hemostasis
Clinical Alert
Clinical Alert
Tests For Disseminated Intravascular Coagulation (DIC)
Bleeding Time (Ivy Method; Template Bleeding Time)
Platelet Count; Mean Platelet Volume (MPV)
Platelet Aggregation
Thrombin Time (TT); Thrombin Clotting Time (TCT)
Partial Thromboplastin Time (PTT); Activated Partial Thromboplastin Time (APTT)
NOTE
Activated Coagulation Time (ACT)
Prothrombin Time (Pro Time; PT)
Coagulant Factors (Factor Assay)
Plasminogen (Plasmin; Fibrinolysin)
Fibrinolysis (Euglobulin Lysis Time; Diluted Whole Blood Clot Lysis)
Fibrin Split Products (Fsps); Fibrin Degradation Products (Fdps)
D-Dimer
Fibrinopeptide A (FPA)
Prothrombin Fragment (F1 + 2)
Fibrin Monomers (Protamine Sulfate Test; Fibrin Split Products)
Fibrinogen
Protein C (PC Antigen)
NOTE
NOTE
Protein S
Antithrombin III (AT-III; Heparin Cofactor Activity)
BIBLIOGRAPHY
OVERVIEW OF BASIC BLOOD HEMATOLOGY AND COAGULATION TESTS
Composition Of Blood
The Average Person Circulates About 5 L Of Blood (1/13 Of Body Weight), Of Which 3 L Is Plasma
Plasma Fluid Derives From The Intestines And Lymphatic Systems And Provides A Vehicle For Cel
Cells Are Produced Primarily By Bone Marrow And Account For Blood ―Solids.‖ Blood Cells Are Cla
Cells (Leukocytes), Red Cells (Erythrocytes), And Platelets (Thrombocytes). White Cells Are Furthe
Granulocytes, Lymphocytes, Monocytes, Eosinophils, And Basophils.
Before Birth, Hematopoiesis Occurs In The Liver. In Midfetal Life, The Spleen And Lymph Nodes Pl
Cell Production. Shortly After Birth, Hematopoiesis In The Liver Ceases, And The Bone Marrow Is T
Production Of Erythrocytes, Granulocytes, And Platelets. B Lymphocytes Are Produced In The Mar
Secondary Lymphoid Organs; T Lymphocytes Are Produced In The Thymus.
Blood Tests
Tests In This Chapter Are Basic Screening Tests That Address Disorders Of Hemoglobin (Hb) And
(Hematopoiesis), Synthesis, And Function. Blood And Bone Marrow Examinations Constitute The M
Determining Certain Blood Disorders (Anemias, Leukemia And Porphyrias Disorders, Abnormal Ble
Inflammation, Infection And Inherited Disorders Of Red Blood Cells, White Blood Cells, And Platele
Obtained Through Capillary Skin Punctures (Finger, Toe, Heel), Dried Blood Samples, Arterial Or V
Bone Marrow Aspiration. Specimens May Be Tested By Automated Or Manual Hematology Instrum
Evaluation.
BLOOD SPECIMEN COLLECTION PROCEDURES
, Drop Of Blood.
Clinical Alert
1. Do Not Squeeze The Site To Obtain Blood Because This Alters Blood Composition And Inva
2. Warming The Extremity Or Placing It In A Dependent Position May Facilitate Specimen Colle
Interventions
Pretest Patient Care
1. Instruct Patient About Purpose And Procedure Of Test.
2. Follow Chapter 1 Guidelines For Safe, Effective, Informed Pretest Care.
Posttest Patient Aftercare
1. Apply Small Dressing Or Adhesive Strip To Site.
2. Evaluate Puncture Site For Bleeding Or Oozing.
3. Apply Compression Or Pressure To The Site If It Continues To Bleed.
4. Evaluate Patient's Medication History For Anticoagulation Or Acetylsalicylic Acid (ASA)-Type
5. Follow Chapter 1 Guidelines For safe, effective, informed posttest care.
Clinical Alert
Dried Blood Spot
In This Method, A Lancet Is Used, And The Resulting Droplets Of Blood Are Collected By Blot
Filter Paper Directly. Check The Stability Of Equipment And Integrity Of Supplies When Doing A
Provided, Check The Humidity Indicator Patch On The Filter Paper Card. If The Humidity Circle
Use This Filter Paper Card. The Humidity Indicator Must Be Blue To Ensure Specimen Integrity.
After Wiping The First Drop Of Blood On The Gauze Pad, Fill And Saturate Each Of The Circles In
By Blotting The Blood Droplet With The Filter Paper. Do Not Touch The Patient's Skin To The Filte
Blood Droplet Should Come In Contact With The Filter Paper. If An Adult Has A Cold Hand, Run W
For Approximately 3 Minutes. The Best Flow Occurs When The Arm Is Held Downward, With The
Level, Making Effective Use Of Gravity. If There Is A Problem With Proper Blood Flow, Milk The F
Pressure To Stimulate Blood Flow Or Attempt A Second Finger Stick; Do Not Attempt More Than
Blood Circles Penetrate Through To The Other Side Of The Filter Paper, The Circles Are Fully Sa
Venipuncture
Venipuncture Allows Procurement Of Larger Quantities Of Blood For Testing. Usually, The Antecu
Veins Of Choice Because Of Ease Of Access. Blood Values Remain Constant No Matter Which
Selected, So Long As It Is Venous And Not Arterial Blood.
1. Observe Standard Precautions Appendix A). If latex allergy is suspected, use latex-free s
(See EquipmentAppendix
(See B).
2. Position And Tighten A Tourniquet On The Upper Arm To Produce Venous Congestion.
3. Ask The Patient To Close The Fist In The Designated Arm. Select An Accessible Vein.
4. Cleanse The Puncture Site And Dry It Properly With Sterile Gauze. Povidone-Iodine Must Dry
5. Puncture The Vein According To Accepted Technique. Usually, For An Adult, Anything Smalle
Needle Might Make Blood Withdrawal More Difficult. A Vacutainer System Syringe Or Butterfl
Used.
, 9. Failure To Release Tourniquet Before Needle Withdrawal
c. Posttest Errors
1. Failure To Apply Pressure Immediately To Venipuncture Site
2. Vigorous Shaking Of Anticoagulated Blood Specimens
3. Forcing Blood Through A Syringe Needle Into Tube
4. Mislabeling Of Tubes
5. Failure To Label Specimens With Infectious Disease Precautions As Required
6. Failure To Put Date, Time, And Initials On Requisition
7. Slow Transport Of Specimens To Laboratory
NOTE
A Blood Pressure Cuff Inflated To A Point Between Systolic And Diastolic Pressure Values Can Be
NOTE
The Vacutainer System Consists Of Vacuum Tubes (Vacutainer Tubes), A Tube Holder, And A Dis
Multisample Collecting Needle.
Interventions
Pretest Patient Care
1. Instruct Patient Regarding Sampling Procedure. Assess For Circulation Or Bleeding Problems
2. Reassure Patient That Mild Discomfort May Be Felt When The Needle Is Inserted.
3. Place The Arm In A Fully Extended Position With Palmar Surface Facing Upward (For Antecu
4. If Withdrawal Of The Sample Is Difficult, Warm The Extremity With Warm Towels Or Blankets.
Extremity To Remain In A Dependent Position For Several Minutes Before Venipuncture.
Clinical Alert
In Patients With Leukemia, Agranulocytosis, Or Lowered Resistance, Finger-Stick And Earlobe Pu
Likely To Cause Infection And Bleeding Than Venipunctures. Should A Capillary Sample Be Nece
Cleansing Agent Should Remain In Contact With The Skin For At Least 5 To 10 Minutes. Povidon
Cleansing Agent Of Choice. It Should Be Allowed To Dry. It May Then Be Wiped Off With Alcohol
With Sterile Gauze Before Puncture.
Posttest Patient Aftercare
1. If Oozing Or Bleeding From The Puncture Site Continues For An Unusually Long Time, Eleva
Apply A Pressure Dressing. Observe The Patient Closely. Check For Anticoagulant Or ASA-T
2. Be Aware That The Patient Occasionally Becomes Dizzy, Faint, Or Nauseated During The Ve
Phlebotomist Must Be Constantly Aware Of The Patient's Condition. If A Patient Feels Faint, I
The Tourniquet And Terminate The Procedure. If The Patient Is Sitting, Lower The Head Betw
Instruct The Patient To Breathe Deeply. A Cool, Wet Towel May Be Applied To The Forehead
Neck, And, If Necessary, Ammonia Inhalant May Be Applied Briefly. If The Patient Remains U
Physician Immediately.
3. Prevent Hematomas By Using Proper Technique (Not Sticking The Needle Through The Vein
Tourniquet Before The Needle Is Withdrawn, Applying Sufficient Pressure Over The Puncture
Maintaining An Extended Extremity Until Bleeding Stops.
Clinical Alert
1. Never Draw Blood From The Same Extremity Being Used For IV Medications, Fluids, Or Tra
,Reference Values
Normal See Table 2.1 for normal values
Table 2.1 Normal Values for Bone Marrow *
Formed Cell Elements Normal Mean (%)
Undifferentiated Cells 0.0 0.0–1.0
Reticulum Cells 0.4 0.0–1.3
Myeloblasts 2.0 0.3–5.0
Promyelocytes 5.0 1.0–8.0
Myelocytes
Neutrophilic 12.0 5.0–19.
Eosinophilic 1.5 0.5–3.0
Basophilic 0.3 0.0–0.5
Metamyelocytes 25.6 17.5–33
Neutrophilic 0.4 0.0–1.0
Eosinophilic 0.0 0.0–0.2
Segmented Granulocytes
Neutrophilic 20.0 11.6–30
Eosinophilic 2.0 0.5–4.0
Basophilic 0.2 0.0–3.0
Monocytes 2.0 0–3
Lymphocytes 10.0 8–20
Megakaryocytes 0.4 0.0–3.0
Plasma Cells 0.9 0.0–2.0
Erythroid Series
Pronormoblasts 0.5 0.2–4.2
Basophilic Normoblasts 1.6 0.24–4.
Polychromatic Normoblasts 10.4 3.5–20.
Orthochromatic Normoblasts 6.4 3.0–25
Promegaloblasts 0 0
Basophilic Megaloblasts 0 0
Polychromatic Megaloblasts 0 0
Orthochromatic Megaloblasts 0 0
Myeloid: Erythroid Ratio (Ratio Of WBC To Nucleated RBC) 2:1–4:1 (Slightly
*These Values Are Only For Adults, And Should Be Used As A Guideline. (Each Laboratory Should
Reference Range.)
Procedure
1. Follow Standard Precautions. Check For Latex Allergy; If Allergy Is Present, Do Not Use Late
Products. Position The Patient On The Back Or Side According To Site Selected. The Posteri
Preferred Site In All Patients Older Than 12 To 18 Months. Alternate Sites Include The Anterio
Sternum, Spinous Vertebral Processes T10 Through L4, The Ribs, And The Tibia In Children.
Generally Used In Children Because The Bone Cavity Is Too Shallow, The Risk For Mediastin
Perforation Is Too Great, And The Child May Be Uncooperative.
2. Shave, Cleanse, And Drape The Site As For Any Minor Surgical Procedure.
3. Inject A Local Anesthetic (Procaine Or Lidocaine). This May Cause A Burning Sensation. At T
Incision Of 3 Mm Is Often Made.
, c. Anemia, Including Megaloblastic, Macrocytic, And Normocytic Anemias
d. Toxic States That Produce Bone Marrow Depression Or Destruction
e. Neoplastic Diseases In Which The Marrow Is Invaded By Tumor Cells (Metastatic Carcino
And Lymphoproliferative Diseases); Assists In Diagnosis And Staging
f. Agranulocytosis (A Decrease In The Production Of White Cells). This Occurs When Bo
Severely Depressed, Usually As A Result Of Radiation Therapy Or Chemotherapeutic D
The Patient Focus On The Risk For Death From Overwhelming Infection.
g. Platelet Dysfunction
h. Some Types Of Infectious Diseases, Especially Histoplasmosis And Tuberculosis
i. Deficiency Of Body Iron Stores, Microcytic Anemia
j. Lipid Or Glycogen Storage Disease
Interventions
Pretest Patient Care
1. Instruct The Patient About The Test Procedure, Purpose, Benefits, And Risks.
2. Ensure That A Legal Consent Form Is Properly Signed And Witnessed. Bone Marrow Aspirati
Contraindicated In The Presence Of Hemophilia And Other Bleeding Dyscrasias. However, Ri
Benefit May Dictate The Choice Made.
3. Reassure The Patient That Analgesics Will Be Available If Needed.
4. Be Aware That Bone Marrow Biopsies Or Aspirations Can Be Uncomfortable. Squeezing A Pi
As A Distraction Technique.
5. Observe Standard Precautions.
Clinical Alert
1. Complications Can Include Bleeding And Sternal Fractures. Osteomyelitis Or Injury To Heart
Is Rare But Can Occur If The Sternal Site Is Used.
2. Manual And Pressure Dressings Over The Puncture Site Usually Control Excessive Bleeding
In 24 Hours. Redress Site If Necessary.
3. Fever, Headache, Unusual Pain, Or Redness Or Pus At Biopsy Site May Indicate Infection (L
Instruct Patient To Report Unusual Symptoms To Physician Immediately.
Posttest Patient Aftercare
1. Monitor Vital Signs Until Stable And Assess Site For Excess Drainage Or Bleeding.
2. Recommend Bed Rest For 30 Minutes; Then Normal Activities Can Be Resumed.
3. Administer Analgesics For Sedatives As Necessary. Soreness Over The Puncture Site For 3 T
After The Procedure Is Normal. Continued Pain May Indicate Fracture.
4. Interpret Test Outcomes And Monitor Appropriately.
5. Follow Chapter 1 Guidelines For safe, effective, informed posttest care.
BASIC BLOOD TESTS
Hemogram
A Hemogram Consists Of A White Blood Cell Count (WBC), Red Blood Cell Count (RBC), Hemoglo
(Hct), Red Blood Cell Indices, And A Platelet Count. A Complete Blood Count (CBC) Consists Of A
Differential WBC.
Complete Blood Count (CBC)
The CBC Is A Basic Screening Test And Is One Of The Most Frequently Ordered Laboratory Proce
,Normal Values For Hemogram
Age WBC (× 10 3/Mm 3) RBC (× 10 6/Mm 3) Hb (G/Dl) Hct (%) MCV (Fl)
Birth–2 Wk 9.0–30.0 4.1–6.1 14.5–24.5 44–64 98–112
2–8 Wk 5.0–21.0 4.0–6.0 12.5–20.5 39–59 98–112
2–6 Mo 5.0–19.0 3.8–5.6 10.7–17.3 35–49 83–97
6 Mo–1 Y 5.0–19.0 3.8–5.2 9.9–14.5 29–43 73–87
1–6 Y 5.0–19.0 3.9–5.3 9.5–14.1 30–40 70–84
6–16 Y 4.8–10.8 4.0–5.2 10.3–14.9 32–42 73–87
16–18 Y 4.8–10.8 4.2–5.4 11.1–15.7 34–44 75–89
>18 Y (Males) 5.0–10.0 4.5–5.5 14.0–17.4 42–52 84–96
>18 Y 5.0–10.0 4.0–5.0 12.0–16.0 36–48 84–96
(Females)
Age MCH (Pg/Cell) MCHC (G/Dl) Platelets (× 10 3/Mm 3) RDW (%) MPV (Fl)
Birth–2 Wk 34–40 33–37 150–450 — —
2–8 Wk 30–36 32–36 — — —
2–6 Mo 27–33 31–35 — — —
6 Mo–1 Y 24–30 32–36 — — —
1–6 Y 23–29 31–35 — — —
6–16 Y 24–30 32–36 — — —
16–18 Y 25–31 32–36 — — —
>18 Y 28–34 32–36 140–400 11.5–14.5 7.4–10.4
Interventions
Pretest Patient Care For Hemogram, CBC, And Differential (Diff) Count (All Components)
1. Explain Test Procedure. Explain That Slight Discomfort May Be Felt When Skin Is Punctured.
Venipuncture Procedure For Additional Information.
2. Avoid Stress If Possible Because Altered Physiologic Status Influences And Changes Normal
3. Select Hemogram Components Ordered At Regular Intervals (Eg, Daily, Every Other Day). Th
Drawn Consistently At The Same Time Of Day For Reasons Of Accurate Comparison; Natura
Cause Fluctuations In Laboratory Values At Certain Times Of The Day.
4. Dehydration Or Overhydration Can Dramatically Alter Values; For Example, Large Volume
―Dilute‖ The Blood, And Values Will Appear As Lower Counts. The Presence Of Either Of T
Be Communicated To The Laboratory.
5. Fasting Is Not Necessary. However, Fat-Laden Meals May Alter Some Test Results As A Res
Posttest Patient Aftercare For Hemogram, CBC, And Differential (Diff) Count (All Component
1. Apply Manual Pressure And Dressings To The Puncture Site On Removal Of The Needle.
2. Monitor The Puncture Site For Oozing Or Hematoma Formation. Maintain Pressure Dressings
Necessary. Notify Physician Of Unusual Problems With Bleeding.
3. Resume Normal Activities And Diet.
4. Bruising At The Puncture Site Is Not Uncommon. Signs Of Inflammation Are Unusual And Sho
If The Inflamed Area Appears Larger, If Red Streaks Develop, Or If Drainage Occurs.
Clinical Alert
NEVER Apply A Total Circumferential Dressing And Wrap Because This May Compromise Circul
,The Immune Response To A Foreign Substance (Antigen).
The WBC Serves As A Useful Guide To The Severity Of The Disease Process. Specific Patterns O
Response Can Be Expected In Various Types Of Diseases As Determined By The Differential Coun
The Different Types Of Leukocytes). Leukocyte And Differential Counts, By Themselves, Are Of Lit
Diagnosis Unless The Results Are Related To The Clinical Condition Of The Patient; Only Then Is A
Interpretation Possible.
Reference Values
Normal Black Adults: 3.2–10.0 × 10 3/Cells/Mm 3 Or × 10 9/L Or 3200–10,000 Cells/Mm 3 Adults: 4
3
Or × 10 9/L Or 4500–10,500 Cells/Mm 3 Children: 0–2 Weeks: 9.0–30.0 × 10 3/Cells/Mm 3 Or × 10
Cells/Mm 3 2–8 Weeks: 5.0–21.0 × 10 3/Cells/Mm 3 Or × 10 9/L Or 5000–21,000 Cells/Mm 3 2 Mont
10 3/Cells/Mm 3 Or × 10 9/L Or 5000–19,000 Cells/Mm 3 6–18 Years: 4.8–10.8 × 10 3/Cells/Mm 3 O
4800–10,800 Cells/Mm 3
NOTE
Different Labs Have Slightly Different Reference Values.
Procedure
1. Obtain A Venous Anticoagulated EDTA Blood Sample Of 5 Ml Or A Finger-Stick Sample. Plac
In A Biohazard Bag.
2. Record The Time When Specimen Was Obtained (Eg, 7:00 A.M.).
3. Blood Is Processed Either Manually Or Automatically, Using An Electronic Counting Instrumen
Coulter Counter Or Abbott Cell-Dyne.
Clinical Implications
1. Leukocytosis: WBC >11,000/Mm 3 Or >11.0 × 10 3/Mm 3 (Or >11 × 10 9/L)
a. It Is Usually Caused By An Increase Of Only One Type Of Leukocyte, And It Is Given The
Of Cell That Shows The Main Increase:
1. Neutrophilic Leukocytosis Or Neutrophilia
2. Lymphocytic Leukocytosis Or Lymphocytosis
3. Monocytic Leukocytosis Or Monocytosis
4. Basophilic Leukocytosis Or Basophilia
5. Eosinophilic Leukocytosis Or Eosinophilia
b. An Increase In Circulating Leukocytes Is Rarely Caused By A Proportional Increase In Leu
Types. When This Does Occur, It Is Usually A Result Of Hemoconcentration.
c. In Certain Diseases (Eg, Measles, Pertussis, Sepsis), The Increase Of Leukocytes Is So G
Picture Suggests Leukemia. Leukocytosis Of A Temporary Nature (Leukemoid Reaction) M
Distinguished From Leukemia. In Leukemia, The Leukocytosis Is Permanent And Progress
d. Leukocytosis Occurs In Acute Infections, In Which The Degree Of Increase Of Leukocytes
Severity Of The Infection, Patient's Resistance, Patient's Age, And Marrow Efficiency And
e. Other Causes Of Leukocytosis Include The Following:
1. Leukemia, Myeloproliferative Disorders
2. Trauma Or Tissue Injury (Eg, Surgery)
3. Malignant Neoplasms, Especially Bronchogenic Carcinoma
4. Toxins, Uremia, Coma, Eclampsia, Thyroid Storm
5. Drugs, Especially Ether, Chloroform, Quinine, Epinephrine (Adrenalin), Colony-Stimula
6. Acute Hemolysis
7. Hemorrhage (Acute)
8. After Splenectomy
9. Polycythemia Vera
, 8. Arsenicals
9. Cancer Chemotherapy (Causes A Decrease In Leukocytes; Leukocyte Count Is Used A
10. Cardiovascular Drugs
11. Diuretics
12. Analgesics And Antiinflammatory Drugs
d. Primary Bone Marrow Disorders:
1. Leukemia (Aleukemic)
2. Pernicious Anemia
3. Aplastic Anemia
4. Myelodysplastic Syndromes
5. Congenital Disorders
6. Kostmann's Syndrome
7. Reticular Agenesis
8. Cartilage-Hair Hypoplasia
9. Shwachman-Diamond Syndrome
10. Chédiak-Higashi Syndrome
e. Immune-Associated Neutropenia
f. Marrow-Occupying Diseases (Fungal Infection, Metastatic Tumor)
g. Pernicious Anemia
Clinical Alert
1. WBC <500/Mm 3 Or <0.5 × 10 3/Mm 3 (Or × 10 9/L) Represents A Panic Value.
2. WBC >30,000/Mm 3 Or >30.0 × 10 3 (Or × 10 9/L) Is A Panic Value.
Interfering Factors
1. Hourly Rhythm: There Is An Early-Morning Low Level And Late-Afternoon High Peak.
2. Age: In Newborns And Infants, The Count Is High (10,000/Mm 3 To 20,000/Mm 3 Or 10 × 10 9
9
/L); The Count Gradually Decreases In Children Until The Adult Values Are Reached Betwee
Years Of Age.
3. Any Stressful Situation That Leads To An Increase In Endogenous Epinephrine Production An
In The Leukocyte Count
Interventions
Pretest Patient Care
1. Explain Test Purpose And Procedure.
2. Refer To Standard Pretest Care For Hemogram, CBC, And Differential Count On Page 47. Al
Chapter 1 Guidelines For Safe, Effective, Informed Pretest Care.
Posttest Patient Aftercare
1. Interpret Test Outcome And Monitor Appropriately. Refer To Standard Posttest Care For Hem
And Differential Count On Page 47. Also, Follow Chapter 1 Guidelines For Safe, Effective, In
Posttest Care.
2. In Prolonged Severe Granulocytopenia Or Pancytopenia, Give No Fresh Fruits Or Vegetables
Kitchen, Especially In A Hospital, May Be A Source Of Food Contamination. When The WBC
Get A Bacterial, Pseudomonal, Or Fungal Infection From Fresh Fruits And Vegetables. Use A
Commercially Sterile Diet. All Food Must Be Served From A New Or Single-Serving Package.
Diet. See Dietary Department For Restrictions (Eg, Cooked Food Only) And Careful Food Pre
Intramuscular Injections. Do Not Take Rectal Temperature, Give Suppositories, Or Give Enem
Razor Blades. Do Not Give Aspirin Or Nonsteroidal Anti-Inflammatory Drugs (Nsaids), Which
