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Clinical Pathology, Hematology and Blood Banking (For DMLT Students)
Nanda Maheshwari
SECTION 1: PATHOLOGY
CHAPTER 1:
Introduction to Clinical Pathology
TERMINOLOGY IN PATHOLOGY
Introduction to Pathology
BRANCHES OF PATHOLOGY
CHAPTER 2:
Cellular Pathology
CELL STRUCTURE
CELL ORGANELLES
Cell Membrane
Cytoplasm
Nucleus
Ribosomes
Endoplasmic Reticulum
Lysosomes
Centrosomes
Vacuoles
Golgi Bodies
Mitochondria
Peroxisomes
Cytoskeleton
FUNCTIONS OF CELL
CELL PATHOLOGY
OVERVIEW OF CELL INJURY
Cellular Adaptation to Injury
Atrophy
Hypertrophy
Hyperplasia
Metaplasia
Cellular Injury
Causes of Cell Injury
Morphology of Cell Injury
General Biochemical Mechanisms of Cell Injury
Types of Cell Injury
Cellular Swelling
Fatty Change (Steatosis)
Cholesterolosis
Lipofuscin
Melanin
Hemosiderin
Hemochromatosis
Bilirubin
Obstructive Jaundice
Hyalinosis
Amyloidosis
TYPES OF CELL DEATH
Apoptosis
Sequence of Events in Apoptosis
Morphologic Changes in Apoptosis
Necrosis
Cellular Changes
Cause of Necrosis
Morphological Types of Necrosis
CHAPTER 3:
Inflammation
INTRODUCTION
CAUSES OF INFLAMMATION
The Five Classical Signs of Inflammation
Effects of Inflammation
Systemic Effects of Inflammation
Leukocytosis
Fever
Endotoxemia
The Acute Inflammatory Response
Events Following Acute Inflammation
Healing and Repair
Suppuration
The Chronic Inflammatory Response
Causes of Chronic Inflammation
Morphologic Features and Clinical Signs
Chronic Inflammatory Cells
Morphologic Types
Granulomatous Chronic Inflammation
Nongranulomatous Chronic Inflammation
Function of Chronic Inflammation
Repair—Cell Growth and Regeneration—Wound Healing
Repair by Scar Formation
Healing of Skin Wounds
CHAPTER 4:
Pathology Laboratory
INTRODUCTION
LEVELS OF LABORATORIES
Primary Level
Secondary Level
Tertiary level
Reference Laboratories, Research Laboratories and Specific Disease Reference Laboratories
INFRASTRUCTURE
Equipment and Reagents
Specimen Collection
Data Management
SAFETY IN LABORATORIES
General Safety Measures
Levels of Biosafety Laboratories (BSL)
BIOMEDICAL WASTE
Segregation
Collection
Storage
Transportation
Standards for Treatment and Disposal of Biomedical Wastes
Standards for Waste Autoclaving
Routine Test
Standards for Liquid Waste
Standards of Microwaving
Standards for Deep Burial
CHAPTER 5:
Tumor Markers
INTRODUCTION
TYPES OF TUMOR MARKERS
USES OF TUMOR MARKERS
LIMITATIONS OF TUMOR MARKERS
LIST OF TUMOR MARKERS
TESTING OF TUMOR MARKERS
Chemiluminescent Magnetic Immunoassay (CMIA)
CHAPTER 6:
Electrolytes
DEFINITION
Description
Diagnostic Importance
SERUM SODIUM
Method
Specimen
Principle
Reagent
Procedure
Part I: Precipitation step
Part II: Color formation
Calculation
SERUM POTASSIUM
Method
Specimen
Principle
Reagent
Procedure
Reagent
Specimen
FLAME PHOTOMETER
Principle
Procedure
Normal Value
Clinical Significance
URINE SODIUM AND POTASSIUM
Urine Sodium
Calculation
Normal Value
Urine Potassium
Calculation
Normal Value
SERUM CHLORIDE
Method
Specimen
Principle
Reagent
Procedure
Calculations
Clinical Significance
URINE CHLORIDE
Calculation
Normal Values
Clinical Significance
SERUM PHOSPHORUS
Method
Principle
Reagents
Procedure
Calculation
Normal Value
Clinical Significance
URINE INORGANIC PHOSPHORUS
Method
Specimen
Procedure
Calculation
Clinical Significance
SERUM CALCIUM
Method
Specimen
Principle
Reagents
Procedure
Calculations
Normal Value
Clinical Significance
URINE CALCIUM
Specimen
Calculations
Clinical Significance
CHAPTER 7:
Body Fluid
SEMINAL FLUID
Sample Collection
Precautions While Collecting Sample
Analysis
Clinical Significance
Computer Assisted Semen Analysis
Additional Testing
AMNIOTIC FLUID
Physiology
Testing
Collection and Handling
Analysis
CEREBROSPINAL FLUID
Function
Morphologic Examination
Other Chemical Tests
SEROUS FLUID
Description of Serous Fluid
Pericardial Fluid
Causes
Symptoms
Complications of Pericarditis
Diagnosis of Pericardial Effusion
Pericardial Fluid Tests
Gross Appearance
Pericardiocentesis Biochemistry
PLEURAL FLUID
Symptoms
Pleural Effusion
Thoracentesis
Normal Findings
Pleural Fluid Analysis
SPECIFIC CONDITIONS AND TESTS
Tuberculous Pleurisy
Diagnostic Markers of Pleural TB
Connective Tissue Diseases
Rheumatoid Arthritis-Associated Pleural Effusions
Systemic Lupus Erythematosus
PERITONEAL FLUID
Symptoms
Diagnosis
Sample Collection
Peritoneal Fluid Tests
Gross Appearance
Paracentesis Biochemistry
Exudate Serum: Ascites Ratios
The Serum-Ascites Albumin Gradient
Microscopy and Analysis
SYNOVIAL FLUID
Collection and Analysis
CHAPTER 8:
Urine Analysis
COLLECTION AND PRESERVATION
PHYSICAL EXAMINATION
Quantity
Color
Odor
Pathologically
Appearance
Reaction or pH
Specific Gravity
CHEMICAL EXAMINATION
Albumin
Causes of Albuminuria
Glucose
Test for Glucose
Causes of Glycosuria
Ketone Bodies
Bile Salts (Hay's test)
Bile Pigments
Urobilinogen
Occult Blood
MICROSCOPIC EXAMINATION
Cells (Figs 8.2A and B)
Casts
Crystal
Parasites
Miscellaneous
CHAPTER 9:
Stool Analysis
INTRODUCTION
MACROSOPIC EXAMINATION
Color
Odor
Mucus
Pus
Calculus
Blood
Parasites
CHEMICAL EXAMINATION
MICROSCOPIC EXAMINATION
Other Abnormalities
Crystals
Concentration Methods for Ova and Cyst
Occult Blood Test
CHAPTER 10:
Automation in Pathology Laboratory
AUTOMATION OBJECTIVE
Care and Maintenance of Analyzers
Cleaning the Dispensing System
ANALYZERS IN HEMATOLOGY
Hematology Analyzer (Cell Counter) Technology
Electrical Impedance
Flow Cytometry
Fluorescent Flow Cytometry
Proprietary Technologies
What to Consider when Buying a Hematology Analyzer
Range of Tests
Manual Versus Automated Cell Counting
Blood Cell Counter (Fig. 10.1)
Advantages of the Automated Analyzers
Disadvantages of the Automated Analyzers
Software-generated WBC Suspect Flags
CONCLUSION
SECTION 2: HEMATOLOGY
CHAPTER 11:
The Blood
BLOOD
BLOOD CELLS
Erythrocyte (RBC)
Leukocyte (WBC)
Granulocyte
Agranulocyte
Platelets or Thrombocytes
PLASMA
FUNCTIONS OF BLOOD
CHAPTER 12:
Hemopoiesis
INTRODUCTION
ERYTHROPOIESIS
Requirements for Red Blood Cell Maturation
LEUKOPOIESIS
Neutrophil
Myeloblast
Promyelocyte
Neutrophilic Myelocyte
Neutrophilic Metamyelocyte
Band Cell
Neutrophil
Basophils
Myeloblast and Promyelocyte
Basophilic Myelocyte and Metamyelocyte
Basophil
Eosinophils
Myeloblast and Promyelocyte
Eosinophilic Myelocyte and Metamyelocyte
Eosinophil
Monocytes
Monoblast
Promonocyte
Monocyte
Macrophage
B-cell
T-cell
Role of Spleen in Hemopoiesis
THROMBOPOIESIS
Platelet Structure
CHAPTER 13:
Collection of Blood
INTRODUCTION
Capillary Blood Collection
Venous Puncture
The Collection Process (Fig. 13.1)
Needle
Syringe
Tourniquet
Disinfectant
Cotton Swab
Water Bath or Water Tray
Collection Bottle
Procedure
CHAPTER 14:
Anticoagulants
INTRODUCTION
Chemical Anticoagulant
Citrate
EDTA (Ethylene Diamine Tetracetic Acid)
CPD (Citrate Phosphate Dextrose)
Oxalate
Biological Anticoagulant—Heparine
CHAPTER 15:
Total RBC Count
INTRODUCTION
RED CELL COUNT
RBC Diluting Fluid
Formalin Citrate Diluting Fluid
Haym's Diluting Fluid
RBC Pipette
Hemocytometer
Blood Sample
Principle
Procedure
Calculations
CHAPTER 16:
Total White Cell Count
INTRODUCTION
Principle
EQUIPMENTS REQUIRED
WBC Diluting Fluid
Composition
WBC Pipette
Hemocytometer
Blood Sample
Procedure
Calculations
CHAPTER 17:
Differential Leukocyte Count
INTRODUCTION
PREPARATION OF BLOOD SMEAR
STAINING OF BLOOD
STAINING OF SMEAR
Leishman Stain
Composition
MICROSCOPIC EXAMINATION
Wright Stain
Composition
Procedure
Observation
Giemsa's Stain
Composition
Procedure
Observation
Clinical Significance
Normal Values
CHAPTER 18:
Absolute Eosinophil Count
INTRODUCTION
DIRECT METHOD
EQUIPMENTS REQUIRED
Blood Sample
Eosinophil Diluting Fluid
Composition
Hemocytometer
Procedure
Fuchs-Rosenthal Chamber
CHAPTER 19:
Erythrocyte Sedimentation Rate
INTRODUCTION
PRINCIPLE
METHODS
Westergren Method
Requirements
Procedure (Fig. 19.1)
Normal Values
Wintrobe Method
Requirements
Procedure (Fig. 19.2)
Normal Values
POSSIBLE ERRORS IN ESR
Factors Affecting ESR
Plasma
Red Cell
Anticoagulant
IMPORTANCE AND LIMITATIONS
CHAPTER 20:
Packed Cell Volume
INTRODUCTION
METHODS
Macrohematocrit
Principle
Requirement
Procedure
Normal Value
Microhematocrit
Principle
Requirement
Procedure
Card Reader (Fig. 20.1)
Importance
CHAPTER 21:
Hemoglobin Estimation
INTRODUCTION
BLOOD SPECIMEN
Sahlis Acid Hematin Method
Principle
Procedure
Colorimetric Method of Hemoglobin
Principle
Equipment
Reagent
Composition
Procedure
Specific Gravity Method
Principle
Procedure
Gasometric Method
CHEMICAL METHOD
CLINICAL IMPORTANCE
CHAPTER 22:
Red Cell Indices
INTRODUCTION
Mean Cell Volume
Mean Cell Hemoglobin
Mean Cell Hemoglobin Concentration
CHAPTER 23:
Special Red Cell Tests
LUPUS ERYTHEMATOSUS
Types of Lupus
Cause
Symptoms
Diagnosis
ROTARY BEAD METHOD
Principle
Procedure
Examination of Blood Film
OSMOTIC FRAGILITY
Osmosis
Osmosis across the Red Blood Cell Plasma Membrane
Osmotic Fragility Test
Principle
Specimen
Procedure
Observation
Normal Results (at 20°C and pH 7.4)
FETAL HEMOGLOBIN
Clinical Significance
Test Sample
Principle
Procedure
Total Hb
CHAPTER 24:
Reticulocyte Count
INTRODUCTION
PRINCIPLE
REQUIREMENT
Composition
PROCEDURE
Calculation
IMPORTANCE
CHAPTER 25:
Sickle Cells Preparation
INTRODUCTION
IMPORTANCE
LABORATORY FINDINGS
SICKLE CELL TRAIT
Blood Specimen
Principle
Requirement
Procedure
CHAPTER 26:
Morphology of Normal and Abnormal RBCs
NORMAL MORPHOLOGY
Clinical Significance
Color Reaction
Hypochromic RBC
Hyperchromic RBC
Anisochromic RBC
Polychromic RBC
Size Variations
Microcytic RBC
Macrocytic RBC
Anisocytic RBC
Shape Variation
Poikilocytosis
Stomatocytosis
Elliptocyte
Spherocyte
Sickle Cells
Target Cells
Ovalocytes
Acanthocytes
Abnormalities in Normal Content of RBC
Nucleated RBC
Heinz Bodies
Howell-Jolly Body
CHAPTER 27:
Preparation of Bone Marrow Smears
INTRODUCTION
Needle Aspiration
Microtrephine Biopsy
Surgical Biopsy
SITE OF BIOPSY
PREPARATION OF BONE MARROW FILM
Clinical Significance
CHAPTER 28:
Blood Coagulation
INTRODUCTION
COAGULATION FACTORS
MECHANISM OF COAGULATION
Stage 1
Stage 2
Stage 3
SIGNIFICANCE OF BLOOD CLOTTING
CHAPTER 29:
Hemorrhagic Disorders
INTRODUCTION
Inherited Hemorrhagic Disorders
Acquired Hemorrhagic Disorders
SCREENING TESTS OF HEMORRHAGIC DISORDERS
Bleeding Time
Principle
Dukes Method
Ivy's Method
Clinical Importance
Whole Blood Coagulation Time
Principle
Clinical Importance
Clot Retraction
Requirement
Procedure
Clinical Importance
Prothrombin Time
Principle
Procedure
Clinical Significance
Platelet Count
Direct Method
Requirement
Composition
Blood Specimen
Calculations
Indirect Method
Calculation
Clinical Significance
Tourniquet Test
Purpura
CHAPTER 30:
Hemophilia and Polycythemia
HEMOPHILIA
Hemophilia A
Hemophilia B
POLYCYTHEMIA
Relative Polycythemia
Absolute Polycythemia
Primary Polycythemia
Secondary Polycythemia
CHAPTER 31:
Anemia
CLASSIFICATION
Based upon Morphological Classification
Normochromic Normocytic Anemia
Hypochromic Microcytic Anemia
Normochromic Macrocytic Anemia
Normochromic Microcytic Anemia
Etiological Classification
Aplastic Anemia
Iron Deficiency Anemia
Pernicious Anemia
Hemolytic Anemia
Sickle Cell Anemia
Sideroblastic Anemias
THALASSEMIA (COOLEY'S ANEMIA)
SCHILLING TEST
CHAPTER 32:
Leukemia
CLASSIFICATION
Acute Leukemia
Chronic Leukemia
CLASSIFICATION
Clinical Classification
Acute
Chronic
SECTION 3: BLOOD BANKING
CHAPTER 33:
Historical Aspect
DEFINITION
HISTORY
Discovery of Blood Group
Use of Anticoagulant and Refrigerated Storage
Discovery of Rh Blood Group System and Isolation of Blood Components
Use of Plastic Bags and Spreading of Blood Bank
Development of Donor Screening Tests and Apheresis
CHAPTER 34:
Organization and Operation of Blood Bank
INTRODUCTION
OBJECTIVES OF THE BLOOD BANK
MAIN FUNCTIONS OF THE DEPARTMENT
ORGANIZATION OF A BLOOD BANK
Norms to Set-up a Blood Bank
Requirement of Staff
Requirement of Equipments
Reagent Requirements
Operation of Blood Bank
Documentation and Record Maintenance
Record Keeping
CHAPTER 35:
Immunohematology and Serum Immunoglobulin
INTRODUCTION
ANTIGENS
Red Cell Antigens
High Frequency Antigens (Public antigens)
Low Frequency Antigens (private antigens)
ANTIBODIES
Reactions in Immunohematology
Basic Structure of Immunoglobulins
Classes of Antibodies
Characteristics of IgG and IgM Antibodies
GENERAL FUNCTIONS OF IMMUNOGLOBULINS
Clinical Significance of Immunoglobulins
Immunoglobulin G
Immunoglobulin M
Immunoglobulin A
Immunoglobulin D
Immunoglobulin E
CHAPTER 36:
ABO Blood Group System
INTRODUCTION
ABO Blood Group
Characteristics of ABO Antigens
Characteristics of ABO Antibodies
Inheritance of Red Cell Antigens
BIOCHEMISTRY OF THE ABO SYSTEM
PRODUCTION OF A, B, AND H ANTIGENS
Importance of Blood Grouping
SUBGROUPS
Determination of Subgroups
Other A Subgroups
Importance of Subgroups
CHAPTER 37:
Rhesus Blood Group System
INTRODUCTION
RHESUS FACTOR
Rh Antigens
Alleles
Characteristics of Rh Antigens
Rh Antibodies
Characteristics
Importance of Rh Blood Group
Universal Donor and Universal Acceptor
Rh Nomenclature
RHESUS SYSTEM INHERITANCE
Rh Variant Du
CHAPTER 38:
Other Blood Group System
INTRODUCTION
OTHER TYPES OF GROUPING
High Frequency Antigens (Public Antigens)
Low Frequency Antigens (Private Antigens)
BOMBAY BLOOD GROUP
CHAPTER 39:
Preparation and Preservation of Antisera
ANTISERA
Monoclonal and Polyclonal Antibody
HYBRIDOMAS
CHAPTER 40:
Technique of Blood Grouping and Crossmatching
ABO BLOOD GROUPING
Introduction
Principle
Procedure
Slide Method
Tube Method
Forward and Reverse Grouping
RH BLOOD TYPING
Principle
Procedure
Slide Method
Tube Method
CROSSMATCHING
Requirements
Specimen
Procedure
Interpretation
Reasons for Blood Typing and Crossmatching
Limitations of Crossmatching
Coombs’ Crossmatch
CHAPTER 41:
Coombs’ Test
INTRODUCTION
DIRECT COOMBS’ TEST
Principle
Requirements
Reagents
Procedure
Interpretation
INDIRECT COOMBS’ TEST
Principle
Requirements and Reagents
Procedure
DETERMINATION OF DU
Principle
Additional Requirement
Procedure
ANTIBODY TITRATION
Specimen
Reagents
Procedure (Double Dilution)
NOTE
Avidity
Grading of Agglutination Reaction
CHAPTER 42:
Blood Transfusion Technique
INTRODUCTION
PREPARATION AND PROPERTIES OF ANTICOAGULANT
DONOR SELECTION
General Condition
Health Conditions
Donors for Babies
Autologous Blood Transfusion
Apheresis
BLOOD COLLECTION (PHLEBOTOMY)
Donor Room
Equipment and Chemicals Needed in Donor Room
Identification of Donor
Inspection of the Bag
Volume of Blood
Procedure of Venepuncture
Care of the Collected Blood Unit
Care of the Donor
INSTRUCTIONS TO THE BLOOD DONORS
Storage of Blood
Changes in Blood after Storage
CHAPTER 43:
Transfusion Reactions
INTRODUCTION
TYPES OF TRANSFUSION REACTIONS
Those which Result Immediately
Febrile Nonhemolytic Transfusion Reaction
Allergic Transfusion Reactions
Anaphylactic Reactions
Hemolytic Transfusion Reactions
Bacterial Contamination
Circulatory Overload
Microembolization
Delayed Transfusion Reactions
Delayed Hemolytic Reaction
RBC Alloimmunization
Platelets Alloimmunization
Grafts vs Host Reaction
Post-transfusion Purpura
Transfusion Transmitted Diseases
CHAPTER 44:
Hemolytic Disease of Newborn
DEFINITION
CAUSES
CLINICAL FEATURES
During Pregnancy
After Birth
SYMPTOMS
DIAGNOSIS
TREATMENT
PREVENTION
ABO INCOMPATIBILITY HDN
CHAPTER 45:
Exchange Transfusion
DEFINITION
SELECTION OF BLOOD FOR EXCHANGE TRANSFUSION
TYPES OF EXCHANGE TRANSFUSION
EXCHANGE TRANSFUSION TECHNIQUES
RISKS ASSOCIATED WITH EXCHANGE TRANSFUSION
CONVALESCENCE
CHAPTER 46:
Transfusion-Transmitted Diseases
INTRODUCTION
VIRUSES
BACTERIAL CONTAMINATION
Syphilis
PARASITIC INFECTION
Babesiosis
Chagas’ Disease
Malaria
Toxoplasmosis
Leishmaniasis
CHAPTER 47:
Blood Component Transfusion
INTRODUCTION
Preparation of blood components is possible due to
Centrifugation for Blood Component Preparation
Relative centrifugal force in g (rcf × g) for preparing components:
WHOLE BLOOD
Sedimentation
Centrifugation
Platelet Transfusion
Indications for platelet transfusion when
Platelet pheresis
Calculation of Platelet Yield
Calculation
Indications
Indications
Procedure
Reconstituting Cryoprecipitate
CHAPTER 48:
Recent Advances in Blood Banking
STEM CELLS
Embryonic Stem Cell
Adult Stem Cells
Adult Stem Cell Transplant: Bone Marrow Stem Cells
Adult Stem Cell Transplant: Peripheral Blood Stem Cell Transplant
Umbilical Cord Blood Stem Cell Transplant
ARTIFICIAL BLOOD
Volume Expanders
Oxygen Therapeutics
NEED FOR MOLECULAR TYPING
Disadvantages of Serology
Molecular Typing
COMMON TERMS USED IN MOLECULAR BIOLOGY
Basic Molecular Biology
Genes Detected By Molecular Typing
Molecular Typing
Polymerase Chain Reaction
Molecular Biology Techniques for Blood Grouping
Applications in Transfusion Medicine
Detect Blood Group Antigens in Donors
INDEX
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