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Hematology for Students and Practitioners Ramnik Sood

1:History and Scope
2:Blood Formation
- SITES OF BLOOD FORMATION
- DEVELOPMENT OF BLOOD CELLS
- LEUKOPOIESIS (FIG. 2.8)
3:Red Blood Cells
- HISTORICAL ASPECTS
- STRUCTURE
  - SHAPE
    - Dimensions
- PHYSIOLOGY OF THE RED BLOOD CELLS
- NORMAL RED CELL VALUES
  - RBC COUNT
- ANEMIA
4:Basic Principles in Diagnosing and Treating Anemias
- INVESTIGATIONS
5:Iron Deficiency Hypochromic Anemia
- RELEVANT NORMAL VALUES
- IRON DEFICIENCY ANEMIA
- PLUMMER-VINSON SYNDROME (PATERSON KELLY SYNDROME)
- INVESTIGATIONS OF A PATIENT WITH IRON DEFICIENCY ANEMIA
- IRON OVERLOAD
  - HEMOSIDEROSIS
  - HEMOCHROMATOSIS
- SIDEROBLASTIC ANEMIAS
  - RADIOACTIVE 59Fe STUDIES
  - BONE MARROW IRON
    - Criteria for Grading Iron Stains in Bone Marrow Aspirated
6:Megaloblastic, Macrocytic Anemias
- RELEVANT NORMAL VALUES
- VITAMIN B12 KINETICS
- FOLATE KINETICS
- VITAMIN B12 DEFICIENCY
- FOLATE DEFICIENCY
- PERIPHERAL BLOOD FINDINGS IN VITAMIN B12 OR FOLIC ACID DEFICIENCY (FIGS 6.3 TO 6.5)
  - BONE MARROW (FIGS 6.4A TO E)
  - MECHANISM OF ANEMIA IN MEGALOBLASTIC ANEMIA
    - Biochemical Basis of Megaloblastic Anemia
    - dU Suppression Test
- DIAGNOSIS OF PERNICIOUS ANEMIA
- INHERITED DISORDERS ALTERING DNA SYNTHESIS
- DRUG INDUCED DISORDERS OF DNA SYNTHESIS
- CAUSES OF MACROCYTOSIS OTHER THAN MEGALOBLASTIC ANEMIA
7:Symptomatic Anemias
- ACUTE HEMORRHAGIC ANEMIA
- ANEMIA OF INFECTION
- TUBERCULOSIS
- CHRONIC RENAL FAILURE
- MALIGNANCY
  - MECHANISMS OF ANEMIA IN MALIGNANCY
  - TYPE OF ANEMIA
- ANEMIA ASSOCIATED WITH SECONDARY CARCINOMA OF THE BONE MARROW
- LIVER DISEASE
- COLLAGEN DISEASE
  - RHEUMATOID ARTHRITIS
    - Pathogenesis
  - SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
- ENDOCRINE DISORDERS
- PROTEIN MALNUTRITION
- SCURVY
- PHYSIOLOGICAL ANEMIA OF PREGNANCY
  - PATHOGENESIS
  - NUTRITIONAL ANEMIA OF PREGNANCY
- ANEMIA OF CHRONIC DISORDERS
- NORMOCYTIC AND NORMOCHROMIC ANEMIAS (CHART 7.1)
  - ETIOLOGICAL CLASSIFICATION OF NORMOCYTIC ANEMIA
- SUMMARY OF THE INVESTIGATIONS OF A PATIENT WITH NORMOCYTIC ANEMIA
8:Hemolytic Anemias
- DEFINITION
- CLASSIFICATION
- APPROACH TO DIAGNOSIS
  - CONDITIONS THAT CAN SOMETIMES BE MISTAKEN FOR HEMOLYTIC ANEMIA
    - Specific Cause Determination
- TREATMENT
- HEREDITARY SPHEROCYTOSIS AND OTHER ANEMIAS DUE TO ABNORMALITIES OF THE ERYTHROCYTE MEMBRANE
- GLUCOSE-6 PHOSPHATE DEHYDROGENASE DEFICIENCY AND RELATED DISORDERS OF HEXOSE MONOPHOSPHATE SHUNT AND GLUTATHIONE METABOLISM
- AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
- HEMOLYTIC ANEMIA DUE TO DRUGS AND CHEMICALS
- DRUG-INDUCED IMMUNE HEMOLYTIC ANEMIA
  - DRUG ADSORPTION MECHANISM (see next page for Pictorial presentation)
  - IMMUNE COMPLEX MECHANISM (see next page for Pictorial presentation)
- DRUG-INDUCED AUTO-IMMUNE HEMOLYTIC ANEMIA (TABLE 8.8)
- MECHANICAL HEMOLYTIC ANEMIA
- SUMMARY OF CLINICAL INVESTIGATIONS
9:Disorders of Hemoglobin Structure and Synthesis
- NORMAL HEMOGLOBIN
- HEMOGLOBIN TYPES
  - HEMOGLOBIN STRUCTURE
  - GENETIC REGULATION
- ABNORMAL HEMOGLOBINS AND THE HEMOGLOBINOPATHIES
- SICKLE HEMOGLOBINOPATHIES
  - SICKLE CELL TRAIT (AS)
  - SICKLE CELL ANEMIA
- COMBINATION OF HbS WITH OTHER HEMOGLOBINOPATHIES
- OTHER HEMOGLOBINOPATHIES
- UNSTABLE HEMOGLOBIN HEMOGLOBINOPATHIES
  - LABORATORY DIAGNOSIS
- HEMOGLOBINOPATHIES ASSOCIATED WITH POLYCYTHEMIA
  - LABORATORY DIAGNOSIS
- THALASSEMIAS (Reduced Synthesis Rate)
- DELTA BETA THALASSEMIA
- THE HEMOGLOBIN-LEPORE SYNDROMES
  - HEREDITARY PERSISTENCE OF FETAL HEMOGLOBIN (HPFH)
- α THALASSEMIA
- METHEMOGLOBINEMIA
10:Aplastic Anemia, Pancytopenia
- PANCYTOPENIA
- APLASTIC ANEMIA
- PURE RED CELL APLASIA
  - CONGENITAL OR DIAMOND-BLACKFAN ANEMIA
  - ACQUIRED PURE RED CELL APLASIA
- DIFFERENTIAL DIAGNOSIS OF PANCYTOPENIA
11:White Blood Cells
- PHYSIOLOGY OF WHITE BLOOD CELLS
- NEUTROPENIA AND AGRANULOCYTOSIS
12:Leukemias
- ETIOLOGY
- CLASSIFICATION
  - REVISED FAB CLASSIFICATION (WITH CRITERIA) OF AML
  - FAB CLASSIFICATION OF MYELODYSPLASTIC SYNDROMES
- THE ACUTE LEUKEMIAS
- THE CHRONIC LEUKEMIAS
- LEUKEMOID REACTIONS
13:Paraproteinemias
- MULTIPLE MYELOMA
- PRINCIPLES OF THE DIFFERENTIAL DIAGNOSIS OF MONOCLONAL GAMMOPATHIES
  - CAUSES OF HYPERVISCOSITY SYNDROME
14:Lymphoid Tissue Tumors (Malignant Lymphomas)
- CLASSIFICATION OF LYMPHOMAS HODGKIN'S DISEASE
- CLASSIFICATION OF NON-HODGKIN'S LYMPHOMAS
- NON-HODGKIN'S LYMPHOMA (NHL)
- TREATMENT
15:Myeloproliferative Disorders
- POLYCYTHEMIA
  - VARIOUS CAUSES OF POLYCYTHEMIA
    - Primary
    - Secondary
- POLYCYTHEMIA VERA
- FAMILIAL POLYCYTHEMIA (FAMILIAL ERYTHROCYTOSIS)
- RELATIVE POLYCYTHEMIA
- PSEUDOPOLYCYTHEMIA
- THROMBOCYTHEMIA
  - CAUSES OF RAISED PLATELET COUNT
    - Reactive
    - Endogenous
  - ESSENTIAL THROMBOCYTHEMIA (FIG. 15.3)
    - Laboratory Findings, Treatment and Course
- MYELOFIBROSIS (MYELOSCLEROSIS)
16:Platelets, Blood Coagulation and Hemostasis
- NORMAL HEMOSTATIC MECHANISM (FIG. 16.1)
  - HEMOSTATIC PLUG–EVENTUAL FATE
  - EXTRAVASCULAR FACTORS
- HEMORRHAGIC DISORDERS DUE TO CAPILLARY DEFECTS: NON THROMBOCYTOPENIC PURPURA (see Table 16.1)
- HEMORRHAGIC DISORDERS DUE TO PLATELET ABNORMALITIES
  - PLATELET PRODUCTION
    - Platelet Antigens and Antibodies
- THROMBOCYTOPENIA
- PLATELET TRANSFUSION
- FUNCTIONAL PLATELET DISORDERS
- CLASSIFICATION OF PLATELET DYSFUNCTION
17:Coagulation Disorders
- BLOOD COAGULATION PHYSIOLOGY
- THE COAGULATION SYSTEM
- THEORY OF BLOOD COAGULATION
- PLASMINOGEN-PLASMIN SYSTEM
  - ACTIVATORS
  - FIBRINOLYSIS
- PATHOGENESIS OF COAGULATION ABNORMALITIES
- DIAGNOSIS OF COAGULATION DISORDERS
- CLINICAL DISORDERS DUE TO COAGULATION ABNORMALITIES
- CONGENITAL COAGULATION DISORDERS
- ACQUIRED COAGULATION DISORDERS
- ANTICOAGULANT DRUGS
- DISSEMINATED INTRAVASCULAR COAGULATION
- HEMORRHAGE AND BLOOD TRANSFUSION
- OUTLINE OF INVESTIGATIONS OF A PATIENT WITH A BLEEDING TENDENCY
18:Thrombosis: Clinical Features and Management
- DEFINITION OF THROMBOSIS
- TYPES OF THROMBUS
- EFFECTS OF THROMBOSIS
- ETIOLOGY OF THROMBOSIS
  - VASCULAR DISEASE AND ARTERIAL THROMBOSIS
  - CONDITIONS ASSOCIATED WITH VENOUS THROMBOSIS (see Table 18.1)
    - Congenital
    - Acquired
- FACTORS PREDISPOSING TO BOTH ARTERIAL AND VENOUS THROMBOSIS
- CLINICAL SYNDROMES OF THROMBOSIS
- INVESTIGATIONS OF THROMBOTIC DISORDERS (see Table 18.3)
- MANAGEMENT OF THROMBOTIC DISORDERS
19:Hypersplenism, Splenomegaly
- NORMAL SPLENIC FUNCTIONS
- HYPERSPLENISM
- SPLENOMEGALY
  - CAUSES OF SPLENOMEGALY
- INDICATIONS FOR SPLENECTOMY
  - EFFECTS OF SPLENECTOMY
    - Hematological Effects
- SPLENIC ATROPHY
  - CLINICAL EFFECTS
    - Susceptibility to Infection after Splenectomy
20:Bone Marrow Transplantation
- INDICATIONS
  - BONE MARROW (OR PERIPHERAL BLOOD STEM CELL) TRANSPLANTATION
    - Allogeneic (or Syngeneic)
    - Autologous
- COMPLICATION OF BONE MARROW TRANSPLANTATION
  - EARLY (<100 DAYS)
    - Acute GVHD
  - LATE (>100 DAYS)
    - Chronic GVHD
- GRAFT VERSUS HOST DISEASE (GVHD)
21:Immunodeficiency Disorders
- ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
  - CLINICAL STAGES OF INFECTIONS WITH THE HIV VIRUS
  - HEMATOLOGICAL MANIFESTATIONS OF HIV DISEASE
- OVERVIEW OF HIV/AIDS
  - HUMAN IMMUNODEFICIENCY VIRUS
- RAPID IMMUNOCONCENTRATION TEST FOR HIV 1 AND HIV 2 ANTIBODIES FLOW THROUGH METHOD Retroquick-HIV® Courtesy: Tulip Group of Companies
- THIRD GENERATION DOUBLE ANTIGEN SANDWICH ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) FOR THE DETECTION OF TOTAL ANTIBODIES TO HIV-1 AND HIV-2 INCLUDING HIV-1 GROUP “O” IN HUMAN SERUM OR PLASMA RETROLISA 3.0® Courtesy: Tulip Group of Companies
22:Bone Marrow in Non-Hemopoietic Disease
- GRANULOMATOUS DISEASE
- KALA-AZAR (VISCERAL LEISHMANIASIS) (FIG. 22.4)
- OTHER INFECTIONS
- GAUCHER'S DISEASE (FIG. 22.5)
- NIEMANN-PICK DISEASE (FIG. 22.6)
- SEA-BLUE HISTIOCYTE SYNDROME (FIG. 22.7)
  - CAUSES OF SEA-BLUE HISTIOCYTES
    - Large Numbers
    - Occasional or Moderate Numbers
- CYSTINOSIS
- OSTEOPETROSIS (ALBERS-SCHOENBERG OR MARBLE BONE DISEASE)
- AMYLOIDOSIS
  - CLASSIFICATION OF AMYLOIDOSIS
- RENAL OSTEODYSTROPHY AND OSTEOMALACIA
- PAGET'S DISEASE OF BONE (OSTEITIS DEFORMANS)
- ANOREXIA NERVOSA
- PRIMARY OXALURIA
23:Hemoparasites
- MALARIAL PARASITES OF MAN
- BLOOD FLAGELLATES OF MAN
- TISSUE ROUNDWORMS OF MAN, CHIEFLY FILARIAE
  - PLASMID NEMATODES (CONTD…)
- TOXOPLASMOSIS (FIG. 23.1)
- BABESIOSIS (FIG. 23.2)
- BARTONELLOSIS (FIG. 23.3)
- RELAPSING FEVER (FIG. 23.30)
24:Practical Hematology
- WAYS OF OBTAINING BLOOD
  - CAPILLARY OR PERIPHERAL BLOOD
  - VENOUS BLOOD (VENIPUNCTURE)
    - Complications
    - Clinical Alert
- ANTICOAGULANTS
  - EDTA
  - OXALATES
    - Making Double Oxalate Bulbs
  - TRISODIUM CITRATE
  - HEPARIN
  - SPECIAL ANTICOAGULANTS
  - WHEREVER POSSIBLE, THE NECESSARY TESTS, INVESTIGATIONS AND PREPARATION OF BLOOD FILMS SHOULD BE DONE IMMEDIATELY
  - ANTICOAGULATED BLOOD STORAGE AND BLOOD CELL MORPHOLOGY
    - Peripheral Smears
    - EDTA Blood
  - DIAGNOSTIC ALERTS
  - BLOOD COLLECTION SYSTEM
- HEMOGLOBIN (Hb)
  - HEMOGLOBIN ESTIMATION: SAHLI'S METHOD: (SAHLI'S HEMOGLOBINOMETER) (FIG. 24.3)
  - CYANMETHEMOGLOBIN METHOD
    - Drabkin's Reagent
  - SHEARD-SANFORD OXYHEMOGLOBIN METHOD
  - OTHER METHODS
  - SODIUM LAURYL SULPHATE METHOD (AVAILABLE FROM CORAL CLINICAL SYSTEMS, GOA)
    - Normal Hemoglobin Values
- HEMATOCRIT/PACKED CELL VOLUME (PCV)
  - DEFINITION
  - METHODS
    - Wintrobe's Tube
    - Microhematocrit
  - INTERPRETATION
- BLOOD CELL COUNTS
  - WBC
  - RBCs
  - PLATELETS
- ERYTHROCYTE INDICES
  - 1. THE MEAN CELL VOLUME (MCV)
  - 2. THE MEAN CELL HEMOGLOBIN (MCH)
  - 3. THE MEAN CELL HEMOGLOBIN CONCENTRATION (MCHC)
- COMPLETE BLOOD COUNT (CBC), BLOOD
  - NORMAL VALUES
  - COMPLETE BLOOD COUNT (CBC)
- ERYTHROCYTE SEDIMENTATION RATE (ESR)
  - METHODS
  - WESTERGREN'S METHOD
    - Normal Values
  - WINTROBE'S METHOD
    - Normal Values
  - MICROSEDIMENTATION (LANDAU) METHOD
    - Procedure
    - Normal Values
  - ZETA SEDIMENTATION RATE (ZSR)
  - SOURCES OF ERROR FOR ANY ESR METHOD
  - INTERPRETATION OF ESR
    - Rapid ESR is Found in
    - Slow ESR is usually seen in
  - FACTORS THAT PLAY A ROLE IN ESR
  - INTERFERING FACTORS
- BLOOD FILM EXAMINATION
  - PREPARATION OF A THIN BLOOD FILM
  - MAKING OF SPREADERS (FIG. 24.9)
  - MAKING THICK SMEARS
  - FIXING OF BLOOD FILMS
  - STAINING OF BLOOD FILMS
- RAPID DIAGNOSTICS
  - AUTOMATION IN HEMATOLOGY COULTER PRINCIPLE
  - THE BASICS OF HEMATOLOGY ANALYZERS IN A NUTSHELL
  - COULTER¨ MAXM AND MAXM AL HEMATOLOGY FLOW CYTOMETRY SYSTEMS (FIG. 24.11)
  - EXAMINATION OF A BLOOD FILM
    - Method
    - Always Note
  - BONE MARROW EXAMINATION
    - Bone Marrow Examination and Reporting
  - RETICULOCYTE COUNT
  - RED CELL FRAGILITY TEST
    - Quantitative Test
    - Clinical Implications
  - QUALITATIVE ASSESSMENT OF G6PD DEFICIENCY
    - Methemoglobin Reduction Test
- QUANTITATIVE ESTIMATION OF G6PD Courtesy: Tulip Group of Companies
  - EXAMINATION OF FETAL HEMOGLOBIN
    - Qualitative Method
    - Quantitative Method
  - TESTS FOR SICKLING
    - Methods
  - LABORATORY DIAGNOSIS OF LEUKEMIAS
- QUALITY CONTROL IN HEMATOLOGY
  - INTERNAL QUALITY CONTROL
  - EXTERNAL QUALITY ASSESSMENT
  - STANDARDIZATION
  - PROFICIENCY SURVEILLANCE
- PLATELETS, COAGULATION AND BLEEDING DISORDERS: LABORATORY INVESTIGATIONS
  - CAPILLARY FRAGILITY TEST OF HESS
    - (Rumpel-Leede Sign, Tourniquet Test)
    - Clinical Implications
  - LABORATORY DIAGNOSIS OF VASCULAR BLEEDING DISORDERS
    - Interfering Factors
  - BLEEDING TIME
  - COAGULATION TIME
    - Capillary Tube Method of Wright
    - Lee and White's Method
  - CLOT RETRACTION
- SENSITIVE THROMBOPLASTIN REAGENT FOR PROTHROMBIN TIME (PT) DETERMINATION (ISI=1.0) Uniplastin® (Courtesy: Tulip Group of Companies)
- APTT/PTTK CEPHALOPLASTIN REAGENT FOR PARTIAL THROMBOPLASTIN TIME (APTT) DETERMINATION USING ELLAGIC ACID AS ACTIVATOR Liquicecin-E® (Courtesy: Tulip Group of Companies)
  - REQUIREMENTS
    - Method
    - Result
- DILUTE BLOOD CLOT LYSIS TIME
- FDPS A Qualitative and Semiquantitative Latex Slide Test for Detecting Cross-linked Fibrin Degradation Products in Human Plasma X-L FDP Courtesy: Tulip Group of Companies
- AUTOMATION IN COAGULATION ANALYSIS
  - HEMOSTAR
    - Technical Features
  - HEMOSTAR XF
    - Technical Features
  - CoaLAB 6000
- TROUBLESHOOTING
  - GENERAL INSTRUCTIONS FOR COAGULATION TEST
  - INR SYSTEM
  - PROTHROMBIN TIME
    - Uniplastin®/Liquiplastin®/Lyoplastin®
- DPTT/PTTK
  - FIBRINOGEN DEGRADATION PRODUCTS (D-DIMER) ESTIMATION
25:Immunohematology Blood Banking
- BLOOD GROUP ANTIBODIES
- ABO GROUPING
  - SLIDE ABO GROUPING TEST
  - SIX-TUBE METHOD (FIG. 25.3)
    - Interpretation
- Rh BLOOD GROUP SYSTEM
  - Rh(D) GROUPING PROCEDURES
- ANTIHUMAN GLOBULIN TEST
- BLOOD TRANSFUSION
- TROUBLESHOOTING

INDEX

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Index

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Chapter Notes