Bahan Kuliah Pakar Blok 9 Dewasa & Masa Tua

16 Desember 2014
Blok 9: Dewasa & Masa Tua
LABORATORY TEST
&
INTERPRETATION
Dr. Vivi Keumala Mutiawati, SpPK., MKes
Department/Division of Clinical Pathology

Zainoel Abidin Hospital-Medical Faculty University of Syiah Kuala
Banda Aceh
2013
MEDICAL CHECK-UP/MCU
Persiapan Pemeriksaan Laboratorium untuk
MCU:
1. Puasa selama 12 jam:
dimulai dari malam hari sebelum
pengambilan darah/sampling darah
2. Istirahat yang cukup:
dimulai ketika melaksanakan puasa
3. Tidak merokok
dimulai ketika melaksanakan puasa
Patient Preparation for Laboratory MCU

1. Fasting for 12 hours:
Starting from one night before blood
sample taken
(stop eating after last night dinner at 8 pm)
2. Have enough rest and sleep:
Starting same time with fasting
3. No smoking
Starting same time with fasting
Laboratory MCU include:

1.
2.
3.
4.
Clinical Hematology
Clinical Chemistry
Urinalisis (Clinical Chemistry)
Clinical Immuno-serology
Laboratory MCU include:

1.
2.
3.
4.
Clinical Hematology
Clinical Chemistry
Urinalisis (Clinical Chemistry)
Clinical Immuno-serology
Clinical Hematology
Routine Blood Count

1.
2.
3.
4.
5.
Hemoglobin/Hb
Hematocrit/Hct
Erythrocyte
Leucocyte
Thrombocyte
Complete Blood Count

1. Hemoglobin/Hb
2. Hematokrit/Hct
3. Erythrocyte
4. Leucocyte
5. Thrombocyte
6. Mean Corpuscular Volume/MCV
7. Mean Corpuscular
Hemoglobine/MCH
8. Mean Cospuscular
Hemoglobin Consentration/MCHC
9. Red Cell Distribution Width/RDW
10. Differential Counting/DC
Pagana KD, Pagana TJ. Mosbys Diagnostic and Laboratory Test Reference. 9th ed. Mosby Elsevier. 2009.
1. Hemoglobin/Hb
2. Hematokrit/Hct
3. Erythrocyte
4. Leucocyte
5. Thrombocyte
7. Mean Corpuscular
Hemoglobine/MCH
8. Mean Cospuscular
Hemoglobin Consentration/MCHC
9. Red Cell Distribution Width/RDW
10. Differential Counting/DC
Which one are

RED BLOOD CELL
INDICES
???
RED BLOOD CELL

INDICES

Main Function:
Provide information about

Size (MCV & RDW)
Weight (MCH)
Concentration (MCHC)
Investigating ANEMIA
How to calculate:
Necessary need the results of

Erythrocyte
Hematocrit
Hemoglobin
RED BLOOD CELL

INDICES

Size (MCV & RDW) indicated the terms
NORMOCYTIC : normal erythrocyte
MICROCYTIC : smaller than normal
MACROCYTIC : larger than normal
Weight (MCH) indicated the terms
NORMOCRHOMIC : color normal
HYPOCHROMIC : less than normal
HYPERCHROMIC : larger than norma
Concentration (MCHC)
Additional
information
about:
size, shape, color &
intracellular
structure
describe in
BLOOD CELL SMEAR
RED BLOOD CELL

INDICES

1.
Mean Corpuscular Volume/MCV

Hematocrit (%) x 10
= ______________________
Erythrocyte (million/mm3)
2. Mean Corpuscular Hemoglobin/MCH

Hemoglobin (gr/dL) x 10
= ______________________
Erythrocyte (million/mm3)
3. Mean Cospuscular Hemoglobin Consentration/MCHC
Hemoglobin (gr/dL) x 100
= ______________________
Hematocrit (%)
RED BLOOD CELL

INDICES

Adult/Elderly/Child : 80-95 fL
Newborn
: 96-108 fL
2. Mean Corpuscular Hemoglobine/MCH
Adult/Elderly/Child : 27-31 pg
Newborn
: 32-34 pg
3. Mean Cospuscular Hemoglobin Consentration/MCHC

Adult/Elderly/Child : 32-36 gr/dL
Newborn
: 32-33 gr/dL
NORMOCYTIC NORMOCRHOMIC ANEMIA

Iron Deficiency (detected early)
Chronic Illnes (e.g: sepsis, tumor)
Acute Blood Loss
Aplastic Anemia (e.g: chloramphenicol toxicosis)
Acquaired Hemolytic Anemia (e.g: from a prosthetic cardiac valve)
MYCROCYTIC HYPOCROMIC ANEMIA
Iron Deficiency Anemia (late detection)
Thalassemia
Lead Poisoning
MYCROCYTIC NORMOCHROMIC ANEMIA
Renal Disease (because of the loss of erythropoeitin)
MACROCYTIC NORMOCHROMIC ANEMIA
Vitamin B12 or Folic Acid Deficiensy
Hydantoin Ingestion
Chemotherapy
Some Myelodysplastic Syndromes
Myeloid Leukemia
Ethanol Toxicity
Thyroid Dysfunction
RED BLOOD CELL/RBC

(ERYTHROCYTE)
Normal Erythrocytes
Colour
Shape
Size
Nucleus
:
:
:
:
Red
Biconcave, with central area of pallor
6.7-7.7 m ( 8 m)
Anucleated cells
IMPORTANT
CLINICALLY
Consist : Haemoglobins (Hbs)
RED BLOOD CELL/RBC

(ERYTHROCYTE)
http://www.nature.com/leu/journal/v23/n5/images/leu200954f3.jpg
RED BLOOD CELL/RBC

(ERYTHROCYTE)
REFFERENCE VALUE
OR
NORMAL RANGE
Different in Ages
1 day (Neonates)
2-6 day (Newborn)
1- 4 weeks
2-7 months
8 months-10 years
Adult (Female)
Adult (Male)
:
:
:
:
:
:
:
15.2-23.6 gr/dL
15.0-24.6 gr/dL
12.7-18.7 gr/dL
10.3-12.9 gr/dL
10.5-15.6 gr/dL
12.0-16.0 gr/dL
14.0-18.0 gr/dL
RED BLOOD CELL/RBC

(ERYTHROCYTE)
METHODS
Manual: Talquis
Sahli
Analyzer:
Hemocytometer
Autoanalyzer (Flow Cytometry)
RED BLOOD CELL/RBC

(ERYTHROCYTE)
INTERPRETATION
= Anemia
Hemoglobin lower than normal range

(different in any of ages).
Caused by: classified as,

Nutritional deficiency
Vitamin B12/Folate
Blood Loss
Hemorrhage
Accelerated Destruction of RBCs
Immune & Nonimmune hemolysis
Bone Marrow Replacement
by cancer
Infection
Toxicity
Hematopietic Stem Cell Arrest or
Damaged
Hereditary or Acquired Defect
Is a common disease
= Erythrocytosis
(e.g: policythemia)
Hemoglobin higher than

normal range.
Caused by:
Myeloproliferative Disorders
Splenomegaly
Myeloid metaplasia
Myelofibrosis
Is a rare disease
RED BLOOD CELL/RBC

(ERYTHROCYTE)
INTERPRETATION
Relative Erythrocytosis
Absolute Erythrocytosis
The red cell mass is absence,

but the Hematocrit is elevated
The red cell mass is elevated
Caused by:
Dehydration
Hypertensive
Obese
Heavy smoking
Extreme Alcohol Consumption
Diuretic Therapy
Caused by:
Compensatory Increase in
erythropoietin in response to
tissue hypoxia
Those resulting from an
inappropriate or pathologic
secretion of erythropoietin
Those resulting from defective
oxygen transport
MORPHOLOGY
OF
RBC
Hypochromic Microcytic
ABNORMAL
MORPHOLOGY OF
RBC
Iron Deficiency Anemia (late detection)
ANEMIA DEFISIENSI FE (berat)
Pencil cell
Tear drops
Mikrosit
RETICULOCYTE
(= polychromatic erythrocyte)
One type of NORMOBLASTIC SERIES, Just seen in bone marrow
(unusually seen in pheripheral)
Morphologic findings, known as:
NORMOBLAST
Contain
: Ribonucleic Acid/RNA
Size
: 8-10 m
Ratio of Cytoplasm:
No nucleus
Granules
: No granules
RETICULOCYTE
METHODS
1. Reticulocyte Count
2. Absolute Reticulocyte
Also call as: Reticulocyte

Index
Manual
Reagen
Bryliant Crecil Blue/BCB
Refference Value
Newborn:
2.5-6.0%
Adult
:
0.5-2.0%
Calculation:
% Retic x RBC
Refference Value
24.000-84.000/L
RETICULOCYTE
Interpretation
= Reticulositosis
1.
2.
3.
4.
5.
6.
Bleeding
Hemolytic Anemias
Hemoglobinopathy
Sickle Cell Anemias
Enzyme Deficiency (Erythrocyte)
Malaria
WHITE BLOOD CELL/WBC

(LEUCOCYTE)
1. Granulocyte:
young cell: Blast, Promyelocyte,
Myelocyte, Metamyelocyte,
Band
old cell:
Neutrophil, Eosinophil,
Basophil
2. Lymphocyte
3. Monocyte

(LEUCOCYTE)
METHODS
Manual: Counting Chamber
Analyzer:
Hemocytometer

(LEUCOCYTE)
1. Granulocyte
Eosinophil
Basophil
Blast
Promyelocyte
Myelocyte
REFFERENCE VALUE
OR
NORMAL RANGE
:
:
:
:
2-6 %
0-2 %
Not seen in pheripheral blood
Not seen in pheripheral blood
: Not seen in pheripheral blood
Metamyelocyte: Not seen in pheripheral blood

Band
2. Lymphocyte
3. Monocyte
: 2-4 %
: 40-70 %
: 20-40 %

(LEUCOCYTE)
INTERPRETATION
Shift to the left/Sttl
Shift to the right/Sttr
If the WBC in differential

counting/DC mostly are young
granulocytes series
Ex: Band, metamyelocyte,
myelocyte.
If the WBC in differential

counting/DC mostly are
neuthrophil segmented and
monocyte
Caused by:
Acute stress
Infection
Toxemia
Acute bleeding
Caused by:
Liver disease
Megaloblastic anemias
Hereditary
Morphology:
DOHLE BODIES
Morphology:
HYPERSEGMENTATION

(LEUCOCYTE)
INTERPRETATION
= Leucocytosis
Leucocyte higher than 4x109/L

in circulation
Caused by:
Physiology
Exercise
Late pregnancy
Labor
Neonates
Idiopathic (normal)
Infection
Bacteria
= Leucopenia
Leucocyte lower than 4x109/L in

circulation
Caused by:
Agranulocitosis
BM depression
Aplastic Anemias
Osteosclerosis
Myelofibrosis
Neoplasm infiltration
Iradiation
Toxic
Benzene
Urethane
Auramine & others
Cytostatic Drugs
Infection
Virus
Imune
Neutrofils: Shift to the Left
Definition: Increased
number of the neutrofil
batangs or presence of
less mature neutrofils in
darah.
Keberadaan : normally
tidak ada
Pewarnaan: MGG
Perbesaran: x1000
DITEMUKAN
SEMUA SERI
GRANULOSIT
DALAM DARAH
TEPI PADA
MORFOLOGI
DARAH TEPI/MDT
Keterangan: Marked shift to the left in granulopoiesis. Also anisocytosis of erithrosit. Platelets
granulesless . 1.neutrofil segmen 2.neutrofil batang 3.Mielosit neutrofil 4.promielosit 5.eosinofil 6.monosit
EOSINOPHIL
Normal Eosinophil
Size
: 12-17 m
Colour
: Pale Blue
Ratio of Cytoplasmic:
High
Granules
: Many, large & Rounded, ReddishOrange
Nucleus
: Usually two segments
Main Function
:
Effector cells for antibody-dependent damage to
metazoal parasites
Regulate immediate-type hypersensitivity
reactions (inactivate histamine and heparin and
proteases)
Rodak BF, Fritsma GA, Keohane EM. Hematology Clinical Principles and Applications. 4th ed.
Elsevier Saunders. Missouri. 2008
EOSINOPHIL
INTERPRETATION
= EOSINOPHILIA
= EOSINOPENIA
Eosinophilia is defined as an
absolute eosinophil count above
0.4x109/L
Eosinopenia is defined as an
absolute eosinophil count
below 0.4x109/L
Caused by:
Allergic Reaction
(Ex: Asthma, Hay Fever, Drug
Sensitivity)
Parasitic Infection
Hypersensitivity Reaction
(Ex: Looeffler Syndrome)
Skin Disease
(Ex: Dermatitis Herpetiformis)
Tropical Eosinophilia
Malignant Myeloproliferative
Disorders
Certain Infection
(Ex: Scarlet Fever)
Caused by:
Thymoma
Hypogammaglobulinemia
Rare Inherited Forms
Autoimmune Disorders with
Antieosinophilia Antibodies
Unknown Causes
NORMAL
MORPHOLOG OF
EOSINOPHILS
Mature Eosinofils in Periferal darah
Ukuran sel: 15 - 25 m
Bentuk sel: oval atau
bulat
Warna sitoplasma:
pale, covered by granules
Granularitas: abundant
eosinofilik (orange-red)
Bentuk inti: lobulated,
semicircular
Tipe kromatin:
condensed
Ratio inti/sitoplasma:
low or veri low
Nukleolus: not visible
Keberadaan:
darah: 2 - 4 %
sumsum tulang: < 2 %
Pewarnaan: MGG
Perbesaran: x 1000
Keterangan: Single eosinofil leucosit with bi-lobulated nucleus. Also anisocytosis of erithrosit
and ovalosit. Normal platelets.
BASOPHIL
Normal Basophil
Size
: 10-14 m
Colour
:Ratio of Cytoplasmic:
High
Granules
: Several, large & rounded, dark
purplis-black
Nucleus
: Usually two segments, granules
overlie nucleus
Main Function:
Mediate immediate-type hypersensitivity
(IgE-coated basophilia react with spesific antigen and release
histamine and leukotrines).
Modulate inflammatory response by releasing heparin and
protease.
BASOPHIL
INTERPRETATION
= BASOPHILIA
Basophilia is defined as an
absolute basophil count
greater than 0.15x109/L
Caused by:
Disorders
Non Malignant
(Ex: Hypothyroidsm,
Ulcerative Colitis,
Bee stings,
Some types of
Nephrosis)
= BASOPENIA
Basopenia is defined as
an absolute eosinophil
count less than
0.15x109/L
Difficult to establish
Has been reported by:
Chronic Urticaria
NORMAL
MORPHOLOGY OF BASOPHILS
Basofils in Periferal darah
Bentuk sel: round or oval
Warna sitoplasma: lightpink, mostly covered by
granules and nucleus
Granularitas: veri dark,
basofilik, granules of
various size. The amount
varies
Bentuk inti: oval shaped
in not mature forms; lobular
shaped in mature forms
Tipe kromatin:
condensed, pale
low or veri low
Keberadaan:
darah: < 1 %
Pewarnaan: MGG
Perbesaran: x 1000
Basofils in Periferal darah
Bentuk sel: round or oval
Warna sitoplasma: lightpink, mostly covered by
granules and nucleus
Granularitas: veri dark,
basofilik, granules of
various size. The amount
varies
Bentuk inti: oval shaped
in not mature forms; lobular
shaped in mature forms
Tipe kromatin:
condensed, pale
low or veri low
Keberadaan:
darah: < 1 %
Pewarnaan: MGG
Perbesaran: x 1000
Keterangan: Single basofil leucosit. Also 3 schisosit
NEUTROPHIL SEGMENTED
Normal Neutrophil
In the blood are distributed between a
marginated granulocyte pool.
When cell counts are determined on
samples of periphera venous blood, only
the circulating granulocytes are being
studied.
NEUTROPHIL SEGMENTED
Normal Neutrophil
Size
: 9-15 m
Colour
: Slightly pink
High
Granules
: Numerous, very fine, faint purple
Nucleus
: Usually two to five segments
Main Function :
Chemotaxis, Phagocytosis, Killing
of Phagocytososed Bacteria
NEUTROPHIL
SEGMENTED
INTERPRETATION
= NEUTROPHILIA
= NEUTROPENIA
Is defined as an absolute neutrophil

count above 8.7x109/L.
Is defined as an absolute
neutrophil count below 2.0x109/L.
Caused by:
Physiologyc
(Ex: Sternous exercise)
Acute Infections
Inflammation
(Ex: Burns, After Surgery,
Myocardial Infarction)
Intoxication
(Ex: Uremia, Diabetic Acidosis,
Poisoning, Insect
Envenomation)
Acute Hemorrhage or Hemolysis
Response to Fast-Growing Tumors
Disorders
Certain Medications
(Ex: Steroids)
Caused by:
Overwhelming Infection
Hemodialysis
Physical Agents/Drugs
(Ex: Chemotherapy, Radiation,
Chloramphenicol, any agent
causing Aplasia)
Decreased or Ineffective Production
(Ex: Megaloblastic Anemia)
Splenic Sequestratio
Autoimmune Disorders
Debilitated States
(ex: Alcoholism)
Hereditary Disorders
(Ex: Cyclic Neutropenia)

(LEUCOCYTE)
INTERPRETATION
= Neutrophilia
Netrophil segmented higher than

>70% counted in differential
counting/DC.
Caused by:
Infection, after fagocitation
process
Organ Injury
Crush Injury
Neoplasm
Burn
Intoxication (Ex: Co, Pb)
Metabolic Disorder
Eclampsia
Acute Gout
Diabetes (Ketosis)
Cushing Syndrome
Leukemias
Granulocytic
Policytemia Vera
Myelosis (erythremic)
= Neutropenia
Netrophil segmented lower than >70% counted

in differential counting/DC.
Caused by:
Famial
Idiophatic
Chediac Higashi Syndrome Hypersplenism
Anafilactic Syock
Chirosis Hepatis
PNH
Tirotoxicosis
Drugs
Analgetic antipiretic (Ex: Amydopirine,
Metampiron)
Antityroid (Ex: Thiouracyl, methylthiouracyl)
Antihistamine (Ex: Promethazine,
Chlorpheniramine)
Tranquilizer (Ex: Chlorpromazine,Meprobamate,
Imipramine)
Antibiotic (Ex: Ristocetin, Tethracycline, Salicylazo sulfa pyridien, Strepthomycine)
Anticoagulant (Ex: Dicoumarol)
Antituberculosis (Ex: INH, PAS)
Antimalaria (Ex: Primaquine)
Diuretic (Ex; Thiazide)
Others (Ex: Metronidazole)
NORMAL
MORPHOLOGY OF
NEUTROPHILS
ABNORMAL
LYMPHOCYTES
Normal Lymphocytes
Peripheral blood:
65-80% are T cells
10-30% are B cells
2-10% are non-T & non-B cells
Function:
Involved in immune responses and
production of haemopoietic growth factors
Normal Lymphocytes
SMALL
Size
Colour
:
Ratio of
Cytoplasmic:
Granules
:
Nucleus
LARGE
7-12 m
12-16 m
Pale Blue
Pale Blue
Low or Very Low
Higher
Few, Fine
Several, Coarser,
purplish-red
Rounded with large

clumps of
condensed
chromatin
Less Condensation
of chromatin
LYMPHOCYTES
INTERPRETATION
= LYMPHOCYTOSIS
= LYMPHOCYTOPENIA
Young Children:
lymphocyte count greater
than 10.0x109/L.
Young Children:
lymphocyte count less than
2.0x109/L.
Adults:
lymphocyte count greater
than 4.8x109/L.
Adults:
lymphocyte count less than
1.0x109/L.
Caused by:
Caused by:
LYMPHOCYTES
INTERPRETATION (Continue)
= LYMPHOCYTOSIS
Caused by:
Without Morphologic
Alteration
Bordetella pertusis
infection
Acute infectious lymphocytosis
With Morphologic
Alterations
Infectious mononucleosis
Infectious hepatitis
Cytomegalovirus infection
Viral influenza
Lymphoid malignancies
= LYMPHOCYTOPENIA
Caused by:
Steroid therapy
Sternous exercise
Morphine administration
Human Immunodeficiency
Virus Infection
Genetic Abnormalities
NORMAL
MORPHOLOGY
OF
LYMPHOCYTES
Limfosit dalam darah tepi

Catatan:
Limfosit reaktif
yang terlihat
selama infeksi,
khususnya
infeksi virus.
Namun bisa
juga dijumopai
dalam darah
normal. Terlihat
beberapa
stomatosit
MONOCYTES
Normal Monocytes
Size
Colour
: 15-30
: Pale, Greyish Blue, Cytoplasmic
vacuole may be seen
Moderately High to High
Granules
: Variabel number, fine, purplish-red
(unussual)
Nucleus: Various shapes (rounded, C or U shape,
lobulated), skin-like or lacy chromatin
Main Function :
The precursor of tissue macrophage.
Phagositosis of microorganisms and cells coated with antibody.
Chemotaxis, Phagocytosis, Killing of some microorganisms,
Antigen presentation (dendritic cells/antigen presenting cell),
Release of Interleukin (IL) -1 and Tumor Necrozing Factor/TNF which
stimulate bone marrow stromal to produce GM-CSF, G-CFS, M-CFS and
IL-6

(LEUCOCYTE)
INTERPRETATION
= Monocytosis
= Monocytopenia
monocyte count above
1.1x109/L.
monocyte count below
0.4x109/L.
Caused by:
Bacterial Infection (Ex: Tbc,
subacute bacterial endocarditis,
syphillis)
Recovery from Acute Infection
Protozoal & Rickettsial
Infection
(Ex: malaria, typhus)
Certain Carcinomas
Granulomatous Disease
Collagen Vascular Disease
(Ex: SLE)
Malignancies of Monocyte Cell
Line
Caused by:
Overwhelming Infections in
Immunocompromised
Patients
Hemodialysis
Epstein-Barr Virus Infection
Steroid Therapy
MONOCYTES
INTERPRETATION
= MONOCYTOSIS
monocyte count greater
than 1.1x109/L.
Caused by:
Bacterial Infections
(Ex: Tuberculosis, Subacute
Bacterial Endocarditis,
Syphillis)
Recovery from Acute Infection
Protozoal & Rickettsial Infection
(Ex: Malaria, Thypus)
Certain Carcinomas
Granulomatous Diseases
(Ex: SLE)
Malignancies of monocytes cell
line
= MONOCYTOPENIA
monocyte count less
than 0.4x109/L.
Caused by:
Overwhelming Infections in
Immunocompromised Patients
Hemodialysis
Epstein-Barr Virus Infection
Steroid Therapy
NORMAL
MORPHOLOGY
OF
MONOCYTE
PLATELETS / TROMBOCYTE
Size
: 2-4 m
Colour
: Pale blue
Granules
: Fine Azurophillic
Nucleus
: Anucleated
Main Function:
Adhere to subendothelial connective tissue,
Participate in Blood Clotting (Hemostasis &
Thrombosis)
PLATELETS
(TROMBOCYTE)
METHODS
Manual: Counting Chamber

Analyzer:
Hemocytometer
REFFERENCE VALUE
OR
NORMAL RANGE
150.000-450.000 U/L
PLATELETS
(TROMBOCYTE)
INTERPRETATION
= Thrombocitosis
= Thrombocitopenia
Thrombocyte in circulation higher than

refference value (>450.000).
Thrombocyte in circulation lower than refference value

(<150.000).
Caused by:
Iron Deficiency Anemia
Hyposplenism
Postsplenectomy
Malignancy
Inflamatory Bowel Disease
Infection
Hemolysis
Hemorrhage
Idiopatic Mielofibrosis
Essential Thrombocytosis
Chronic Myelocitic Leucemia
Idiopathic Sideroblastic Anemia
Myelodysplasia
Post operation
Rebound ( stop alcohol, post correction
from Vitamin B12 deficiency/Folate)
Policythemia vera
Caused by:
Lower Production ec:
BMP damage
Aplasia
Drugs/Toxin
Hepatitis
Carcinoma
Congenital Defect
Fanconis anemia
TAR Syndrome
Rubella
May-Hegglin Syndrome
Wiskott Aldrich
Dominant Autosomal
Ineffective Production
B12/Folate Deficiency
Distribution ec:
Splenomegaly
Liver disease
Myelofibrosis
Higher Destruction ec:
Non Imune
DIC
HUS
TTP
HELLP Syndrome
Imune
SLE
Limphoproliferative Disease
AIDS
ITP
NORMAL
MORPHOLOGY
OF
THROMBOCYTES
The clinical sign of spontaneous bleeding in small areas of the skin and
mucous membranes (petechial bleeding),
which on injury diffuses out to form medium-sized subcutaneous
ecchymoses, is grounds for suspicion of thrombocyte (or vascular)
anomalies.
ABNORMAL
MORPHOLOGY OF THROMBOCYTES
Giant platelet
Ukuran: > 6 m
Bentuk: bulat atau
oval, dengan pinggir
tidak rata
Warna sitoplasma:
biru
Granularitas: granul
ungu halus yang
mengisi bagian tengah
trombosit
Pinggir tipis tanpa
granul pada bagian tepi
dari sel
Distribusi: dalam film
darah tepi hanya satu
giant plateklet
Pewarnaan: MGG
Perbesaran: x1000
Catatan: Trombosit raksasa dengan granulasi sedikit berkurang. Juga terlihat dua
ovalosit.
INFLAMATION MARKERS
Erythrocyte Sedimentation Rate/ESR
C-Reactive Protein/CRP
Serum Amiloid A/SAA
Procalcitonin/PCT
Known as
Acute Phase Reactan

Laju Endapan Darah/LED
Principle of examination,
have 3 phase:
1. Rouleaux phase
2. Sedimentation phase
3. Consolidation phase
METHODS
Westergren
(Widely used in Indonesia)
Wintrobe
Refference Value
Men
< 50 years: <15 mm/1 hour
> 50 years: >20 mm/1 hour
Women
< 50 years: <20 mm/1 hour
> 50 years: <30 mm/1 hour
METHODS
Advantage
Cheap
Simply
Usually:
monitoring therapy
(ex: Tuberculosis)
Disadvantage
Time Consuming
As screening test
Interpretation
= ESR Higher
Injury
Inflamation
Pregnancy
Acute Inflamatory Disease:
Local
Systemic
Chronic Disease
Ex: Rheumatoid Arthritis
Dysproteinemia
Ex: Multiple Myeloma
Solid Tumor
Collagen Disease
Ex: SLE
Macroglobulinemia
Ex: Waldenstrom Syndrome
Nefritis, Nefrosis
Tuberculosis
Carcinoma
= ESR Lower
Polyglobulin
Ex: Polycythemia
Clinical Chemistry
SERUM GLUTAMIC OXALOACETIC TRANSAMINASE/SGOT

= ASPARTATE AMINOTRANSFERASE/AST
Production:
Cleared from the blood in a few days

Become elevated 8 hours after cell injury
Peak at 24-36 hours
Return to normal in 3-7 days
Main Function:
Is used in the evaluation of patients with suspected hepatocellular disease.
Very High Concentrations

Highly metabolic tissue:
Heart muscle
Liver cells
Skeletal muscle cells
Lesser degree
Kidneys
Pancreas
Red Blood Cells/RBCs
Release by:
When disease or injury affects the of the tissues, the lyse.
If the cellular injury is chronic, levels will be persistently elevated.
Pagana KD, Pagana TJ. Mosbys Manual of Diagnostic and Laboraotry Test. 4th ed. Mosby Elsevier. 2010.
SGOT/AST
The AST/ALT Ratio

Greater than 1:
Alcoholic cirrhosis
Liver Congestion
Metastatic Tumors of the liver
Less than 1:
Actue Hepatitis
Viral Hepatitis
Infectious Mononucleosis
SGOT/AST
INTERPRETATION
= SGOT/AST
= SGOT/AST
= SGOT/AST
Increased Levels
Increased Levels
(Cont...)
Decreased Levels
Liver Disease
Hepatits
Hepatic Chirrhosis
Drug-Induced Liver
Injury
Hepatic Metastasis
Hepatic Necrosis
(Initial State Only)
Hepatic Surgery
Infectious
Mononucleosis with
Hepatitis
Hepatic Infiltrative
(e.g: Tumor)
Skeletal Muscle
Disease
Skeletal Muscle
Trauma
Recent Non Cardiac

Surgery
Multiple Traumas
Severe, Deep Burns
Progressive Muscular
Dystrophy
Recent Convulsions
Heat Stroke
Primary Muscle
Disease
Other Disease
Acute Hemolytic
Anemia
Acute Pancreatitis
Acute Renal
Disease
Beriberi
Diabetec
Ketoacidosis
Pregnancy
Chronic Renal
Dialysis
SERUM GLUTAMIC PIRUVATE TRANSVERASE/SGPT

= ALANINE AMINOTRANSFERASE/ALT
Production:
made joundice
Main Function:
to identify hepatocellular disease of the liver.
Predominanatly Found in:
Liver
Lesser Quantity found in:
Kidneys
Heart
Skeletal Muscle
Release by
:
Injury or disease affecting the liver parenchyma will cause a release of
this hepatocellular enzyme into bloodstream, thus elevating serum ALT
level.
SGPT/ALT
The ALT/AST Ratio

(RATIO DeRITIS)
Greater than 1:
Viral Hepatitis
Less than 1:
Other than Viral Hepatitis
SGOT/ASTSGPT/ALT
METHODS
Manual : Spectrophotometer
Analyzer : Autoanalyzer (Flow Cytometry)
REFFERENCE VALUE
OR
NORMAL RANGE
Elderly
: may be slightly higher than adults values
Adult/Child : 4-36 international unit/L at 37C

Infant
: may be twice as high as adults values

SGPT/ALT
INTERPRETATION
= SGPT/ALT
= SGPT/ALT
= SGPT/ALT
Mildly
Increased Levels
Moderately
Increased Levels
Significantly
Increased Levels
Myositis
Pancreatis
Myocardial
Infarction
Shock
Cirrhosis
Cholestasis
Hepatic Tumor
Hepatotoxic
Drugs
Obstructive
Jaundice
Severe Burns
Trauma to
Striated Muscle
Hepatitis
Hepatic Necrosis
Hepatic Ischemia
RENAL FUNCTION STUDIES

UREA & BLOOD UREA NITROGEN/BUN
CREATININE
UREA
: direct from serum
Production:
BUN
: indirect from serum (calculation)
Protein (exogenous/dietary or endogenous/tissue)

(Liver)
(metabolism & digestion)
(breakdown)
Amino Acid
(catabolized)
Ammonia
(deposited)
Blood
(transport)
Kidneys
(excretion)
Burtis CA, Ashwood ER. Tietz Fundamentals of Clinical Chemistry. 5th ed. Saunders An Imprint of Elsevier. Pennsylvania. 2001
UREA-BUN
INTERPRETATION
= BUN
ELEVATED
Have Azotemia
or
Be Azotemia
PRERENAL AZOTEMIA:
Shock
Dehydration
Congestive Heart Failure
Excessive Proteins Catabolism
Gastrointestinal Bleeding
= BUN
DECREASED
Severe Primary Liver
Disease
Combine Liver &
Renal Disease
(BUN can be Normal)
POSTRENAL AZOTEMIA:
Ureteral Obstruction
Urethral Obstruction
UREA-BUN
METHODS
REFFERENCE VALUE OR NORMAL RANGE
(depend on the methods)
Adult
: 6-20 mg/dL
Newborn
: 3-25 mg/dL
Adult >60 years : 8-23 mg/dL
(Elderly)

CREATININE
CREATININE
: synthesized in kidneys, liver, and pancreas
The amount of creatinine produces each day is related to muscle mass
(body weight)
Production:
Creatine
(Liver)
(creatine kinase)
(muscle cells)
Phosphocreatine
(catabolized)
Creatinine
(deposited)
Blood
(transport)
Kidneys
(excretion)
CREATININE
METHODS
Manual
: Spectrophotometer
REFERENCE VALUE OR NORMAL RANGE
Adult
Female
Male
Elderly
Adolescent
:
:
:
:
Infant
Newborn
Child
: 0.2-0.4 mg/dL
: 0.3-1.2 mg/dL
: 0.3-0.7 mg/dL
0.5-1.1 mg/dL
0.6-1.2 mg/dL
decrease in muscle mass may cause decreased values
0.5-1.0 mg/dL
CREATININE
INTERPRETATION
= CREATININE
= CREATININE
ELEVATED
(suggest chronicity of the disease)
DECREASED
Dehydration
Glomerulonephritis
Pyelonephritis
Acute Tubular Necrosis
Urinary Obstruction
Diabetic Nephrophaty
Rhabdomyolysis
Acromegaly
Gigantism
Debilitation
Decreased Muscle Mass
(e.g: muscular dysthropy,
myasthenia gravis)
SLIGHTLY ELEVATED
After meals (specially large

quantities of meat)
Diurnals variations (at 7 am-peak
at 7 pm)

CREATININE
The Most Important Renal Clearance as an Indicator

GLOMERULAR FILTRATION RATE/GFR (Calculation)
The rate in millimeters per minute that substances, such as urea
and creatinine, are filtered through the kidneys glomeruli; a
measure of the number of functioning nephrons.
The formula as follow:

CREATININE
The Most Important Renal Clearance as an Indicator

CREATININE CLEARANCE (Calculation)
The volume (V) of
The urine measured (mL)
Urine flow rate is calculated (mL/min)
Creatinine is measured in mg/dL or mmol/L in
Both of th urine (urine/U and serum/S)
The formula as follow:
REFERENCE VALUE OR NORMAL RANGE
CREATININE CLEARANCE
Adult
Female
Male
: 72-110 mL/min/1.73 m2
: 94-140 mL/min/1.73 m2
URIC ACID/UA
URIC ACID: Nitrogenous Compound
Large Degree Excreted by:
Kidney
Small Degree Excreted by:
Intestinal Tract
Production: Dietary Nucleic Acid
(Purine Catabolism)
Uric Acid Directly
URIC ACID
METHODS
Adult
Female : 2.7-7.3 mg/dL
Male
: 4.0-8.5 mg/dL
Elderly
: values may be slightly increased
Newborn
Child
: 2.0-6.2 mg/dL
: 2.5-5.5 mg/dL
Possible Critical Values
: >12 mg/dL
URIC ACID
INTERPRETATION
= URIC ACID/UA
= URIC ACID/UA
HYPERURICEMIA
DECREASED
Wilsons Disease
Fanconis Syndrome
Lead Poisoning
Yellow Atropy of the Liver
Gout
Increase Ingestion of Purines
Genetic
Metastatic Cancer
Multiple Myeloma
Leukemia
Cancer Chemotherapy
Hemolysis
Rhabdomyolisis
(e.g: heavy exercise, burns,
crush injury, epileptic
seizure, or myocardial
infarction)
Chronic Renal Disease
Hypothyroidism
Toxemia of pregnancy
Hyperlipoproteinemia
Alcoholism
LIPID PROFILE
Lipids,
Lipoproteins, and
Apolipoproteins
Fatty Acid
Chylomicron
Glycerol (acylglycerols)
High Density Lipoproteins
Low Density Lipoproteins
Very Low Density Lipoproteins
Triglycerides
Cholesterol
(Steroid Alcohol)
Clinical Significant
Cholesterol Total
LIPID PROFILE
Main Function
Required the for production of:

steroids, sex hormones, bile acid, and
cellular membranes
REMEMBER !!!
The purpose of cholesterol testing is:

To identify patients at risk for
ATERIOSCLEROTIC
LIPID PROFILE
METHODS

Adult/Elderly
<200 mg/dL
Infant
Newborn
Child
: 70-175 mg/dL
: 53-135 mg/dL
: 120-200 mg/dL
LIPID PROFILE
INTERPRETATION
= Hyperlipidemia
= Hypolipidemia
INCREASED LEVELS
DECREASED LEVEL
Hypercholesterolemia
Hyperlipidemia
Hypothyroidism
Uncontroled Diabetes Mellitus
Nephrotic Syndrome
Pregnancy
High-cholesterol Diet
Xanthomatosis
Hypertension
Myocardial Infarction
Atherosclerosis
Biliary Cirrhosis
Stress
Nephrosis
Malabsorption
Malnutrition
Hyperthyroidism
Cholesterol-lowering
medication
Pernicious Anemia
Sepsis
Stress
Liver Disease
Acute Myocardial Infarction
LIPID PROFILE
INTERPRETATION
=
INCREASED LEVELS
DECREASED LEVEL
Hypercholesterolemia
Hyperlipidemia
Hypothyroidism
Uncontroled Diabetes Mellitus
Nephrotic Syndrome
Pregnancy
High-cholesterol Diet
Xanthomatosis
Hypertension
Myocardial Infarction
Atherosclerosis
Biliary Cirrhosis
Stress
Nephrosis
Malabsorption
Malnutrition
Hyperthyroidism
Cholesterol-lowering
medication
Pernicious Anemia
Sepsis
Stress
Liver Disease
Acute Myocardial Infarction
BLOOD GLUCOSE
Product:
Carbohydrates Metabolism
Diets (e.g: grains, legumes)
(breakdown)
Glycogen (Body stores)
(Adipose tissue,
Liver, Muscle)
Exceed Calorie Intake
Hormon: Insulin
Glucagon
BLOOD GLUCOSE
SEFL-MONITORING OF BLOOD GLUCOSE
1. Patients undergoing intensive insulin treatment programs

(Their glucose levels should be measured at least 4 time/day)
2. Hypoglycemia-prone patients
(Who may not experience the early warning signs)
3. Avoidance of severe hyperglycemia
(Particularly in situations of increased risk)
4. Patients with unstable diabetes

5. Pregnant women with diabetes
BLOOD GLUCOSE

Sample Fasting Glucose
(mg/dL)
Plasma/Serum
Adults
Children
Premature Neonates
Term Neonates
Whole Blood
CFS
:
:
:
:
:
:
74-106 mg/dL
60-100 mg/dL
20-60 mg/dL
30-60 mg/dL
65-95 mg/dL
40-70 mg/dL
BLOOD SUGAR CONCENTRATION

NORMAL
DM
1. FASTING
70-110mg/dl
> 126 mg./dl
2. POST PRANDIAL
< 150 mg/dl
> 200 mg/dl
3. NON FASTING 100-150 mg/dl
> 200 mg/dl
BLOOD GLUCOSE
Manual
Analyzer
METHODS
: Spectrophotometer
: Autoanalyzer (Flow Cytometry)
CRITERIA for DIAGNOSIS of DIABETES MELLITUS

Diabetes Mellitus
Any one of following is diagnostic:
1.
Classic symptoms of diabetes and casual plasma glucose concentration 200 mg/dL
2.
Fasting plasma glucose 126 mg/dL
3.
A 2-hours postload plasma glucose concentration 200 mg/dL during the OGTT
Impaired Fasting Glucose
Fasting plasma glucose between 110 and 125 mg/dL
Impaired Glucose Tolerance
The following 2 criteria must be met:
1.
Fasting plasma glucose <126 mg/dL
2.
A 2-hour OGTT plasma glucose concentration between 140 and 199 mg/dL
DIAGNOSIS
BS mg/dl
FASTING
BS
POSTPR
NORMAL
< 110
< 150
GLUCOSE
INTOLERANCE
< 126
< 200
DIABETES
MELLITUS
> 126
>200
BLOOD GLUCOSE
INTERPRETATION
= HYPERGLYCEMIA
= HYPOGLYCEMIA
INCREASED LEVELS
DECREASED LEVELS
Diabetes Mellitus
Acute Stress Response
Cushings Syndrome
Pheochromacytoma
Chronic Renal Failure
Glucagonoma
Acute Pancreatitis
Diuretic Therapy
Acromegaly
Insulinoma
Hypothyroidism
Hypopituitarism
Addisons Disease
Extensive Liver Disease
Insulin Overdose
Starvation
CARDIAC MARKER
CARDIAC MARKER
METHODS
Manual:
Analyzer:
Specrophotometer
Christenson RH, Azzazy HME. Biomarkers of Myocardial Necrosis, Past, Present and Future. In:
Cardivascular Markers Pathophysiology and Disease Management. Humana Press Inc. New Jersey. 2006.
Properties of Biomarkers of Myocardial Necrosis
FORM
PERMINTAAN
PEMERIKSAAN
LABORATORIUM
DI
RSUDZA
BANDA ACEH
MANUAL
THANK YOU

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16 Desember 2014

Blok 9: Dewasa & Masa Tua

Department/Division of Clinical Pathology

Patient Preparation for Laboratory MCU

Laboratory MCU include:

Laboratory MCU include:

Routine Blood Count

Complete Blood Count

Which one are

Complete Blood Count

RED BLOOD CELL

Complete Blood Count

Provide information about

Necessary need the results of

RED BLOOD CELL

Complete Blood Count

RED BLOOD CELL

Complete Blood Count

Mean Corpuscular Volume/MCV

2. Mean Corpuscular Hemoglobin/MCH

RED BLOOD CELL

Complete Blood Count

3. Mean Cospuscular Hemoglobin Consentration/MCHC

NORMOCYTIC NORMOCRHOMIC ANEMIA

RED BLOOD CELL/RBC

Consist : Haemoglobins (Hbs)

RED BLOOD CELL/RBC

RED BLOOD CELL/RBC

RED BLOOD CELL/RBC

RED BLOOD CELL/RBC

Hemoglobin lower than normal range

Caused by: classified as,

Hemoglobin higher than

RED BLOOD CELL/RBC

The red cell mass is absence,

The red cell mass is elevated

Iron Deficiency Anemia (late detection)

ANEMIA DEFISIENSI FE (berat)

Also call as: Reticulocyte

WHITE BLOOD CELL/WBC

WHITE BLOOD CELL/WBC

Manual: Counting Chamber

WHITE BLOOD CELL/WBC

: Not seen in pheripheral blood

Metamyelocyte: Not seen in pheripheral blood

WHITE BLOOD CELL/WBC

Shift to the left/Sttl

Shift to the right/Sttr

If the WBC in differential

If the WBC in differential

WHITE BLOOD CELL/WBC

Leucocyte higher than 4x109/L

Leucocyte lower than 4x109/L in

Neutrofils: Shift to the Left

Mature Eosinofils in Periferal darah

Basofils in Periferal darah

Basofils in Periferal darah

Keterangan: Single basofil leucosit. Also 3 schisosit

Is defined as an absolute neutrophil

WHITE BLOOD CELL/WBC

Netrophil segmented higher than

Netrophil segmented lower than >70% counted

Low or Very Low

Rounded with large

Bahan Kuliah Pakar Blok 9 Dewasa & Masa Tua

Bahan Kuliah Pakar Blok 9 Dewasa & Masa Tua