Hematology special function test

Hematology special function tests are some special examination methods for anemia, hemolytic and hemorrhagic diseases. Can be divided into: reticulocyte count and reticulocyte absolute value, red blood cell ratio measurement, calculation of red blood cell mean constant, red blood cell diameter curve determination four categories. Clinical significance: Can understand the hematopoietic function of the bone marrow. In general anemia, reticulocytes can be increased, hemolytic anemia is significantly increased, and only aplastic anemia is significantly reduced. The therapeutic effect can also be observed to guide the medication. All patients with anemia should do this check. Basic Information Specialist classification: growth and development examination classification: blood examination Applicable gender: whether men and women apply fasting: fasting Tips: Do not eat too greasy, high-protein foods the day before, and avoid heavy drinking. The alcohol content in the blood directly affects the test results. After 8 pm on the day before the medical examination, you should fast. Normal value Reticulocyte count and reticulocyte absolute value: 0.5 to 1.5% for adults, mean 1%; neonates 2 to 6%. The absolute value of reticulocytes is 24000 to 84000/mm3. The erythrocyte ratio measurement (PCV) is 40-50% for adult males and 37-48% for females. The average red blood cell constant MCV is 80 to 94 μm 3 , the MCH is 26 to 32 pg, and the MCHC is 0.31 to 0.35. The serum jaundice index is 4-6 units. Serum bilirubin quantifies total bilirubin 0.1-1.0 mg/dl serum, direct bilirubin 0.03-0.2 mg/dl serum, and indirect bilirubin 0.1-0.8 mg/dl serum. Urinary bilirubin examination of urinary bilirubin (-), urinary biliary original 1:40 (-), 1:20 (+), urinary bilirubin (-). Plasma-bound globin measures 70-150 mg/dl plasma. Plasma free hemoglobin was measured in 0-5 mg/dl plasma. The urine hemosiderin test was negative. The erythrocyte saline osmotic fragility test begins with hemolysis of 0.42 to 0.46% sodium chloride solution; complete hemolysis of 0.32 to 0.34% sodium chloride solution. The erythrocyte mechanical fragility test was 7.5 to 23.9%. Acidified glycerol dissolution test (AGLT) AGLT50 > 30 minutes. Self-hemolytic test and corrective test: 0.9% sodium chloride 10% glucose; 24 hours <0.5% <0.4%; 48 hours <3.5% <0.6%; Normal human red blood cells are not hemolyzed or slightly hemolyzed after 24 hours of incubation. Only a small amount of hemolysis after 48 hours. After adding glucose, the hemolysis was significantly slowed down. Self-hemolysis occurs rapidly and significantly in patients with hereditary spherocytosis caused by defects in cell membranes. In patients with congenital non-spherical erythrocyte hemolytic anemia caused by defects in enzymes, autologous hemolysis is also often enhanced, and in type I patients, if glucose or ATP is added to the experiment, hemolysis is significantly reduced, as seen in glucose-6-phosphate. Hydrogenase (G-6-PD) is deficient; in type II patients, the addition of ATP in the test can significantly reduce hemolysis. If glucose is added, it is ineffective, and it is found in pyruvate kinase deficiency. It can identify congenital non-spherical erythrocyte hemolytic anemia caused by different causes. The acid hemolysis test was negative. Sucrose (sugar water) hemolysis test does not cause hemolysis in normal people. Erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) activity assay. It is used to confirm the deficiency of G-6-PD, and the lack of G-6-PD can cause a decrease in NADPH production per unit time. Methemoglobin reduction test 4.97 ± 1.43 μm NADPH / min / gram hemoglobin. The denatured globin granules examined 0 to 28% of red blood cells containing more than 5 denatured globin bodies. The average G-6-PD deficiency was 67.8% (45-92%). Hemoglobin electrophoresis does not exceed 2% of hemoglobin F in adult blood. Determination of anti-alkali hemoglobin (HbF): When β-globin produced an anemia, HbF increased significantly, reaching more than 10%. Patients with acute leukemia and aplastic anemia can also be slightly increased. Hemoglobin H inclusion body formation test was negative. The anti-human globulin test was negative. The titer of the cold agglutination test is 1:8-16. The cold-hot hemolysis test was negative. Capillary fragility test Forearm flexion side diameter 5 cm Bleeding point in round skin <5, female <10. The bleeding time was measured for 1 to 4 minutes. The platelet count is 100 to 300 × 109 / L (100,000 to 300,000 / mm3). Platelet adhesion assay glass ball method, male 34.9 ± 5.95%, female 39.4 ± 5.19%. The platelet aggregation function was measured to show coarse aggregated particles in the naked eye within 10 to 15 s. The clotting time is 4 to 12 minutes. The recalcification time is within 3 minutes. The euglobulin lysis time is greater than 90 minutes. Serum FDP quantification-emulsion agglutination test 4.69 ± 1.75 μg/ml serum. Clinical significance Abnormal result The classification of anemia diseases can be divided into four categories: reticulocyte count and reticulocyte absolute value, red blood cell ratio measurement, calculation of red blood cell mean constant, and red blood cell diameter curve. Reticulocyte count and reticulocyte absolute value: understand the hematopoietic function of the bone marrow. In general anemia, reticulocytes can be increased, hemolytic anemia is significantly increased, and only aplastic anemia is significantly reduced. The therapeutic effect can also be observed to guide the medication. All patients with anemia should do this check. Red blood cell ratio measurement (PCV): The ratio of red blood cell product is related to the number and size of red blood cells and the amount of red blood cells. Therefore, anemia, polycythemia, blood concentration or blood dilution caused by various causes can cause red blood cell product. The change. The three mean constants of red blood cells can be calculated by erythrocyte ratio, red blood cell count and hemoglobin measurement for morphological classification of anemia. Erythrocyte mean constant: Observe the position and morphological changes of this curve to distinguish between small cell, large cell and normal cell anemia. Examination method for hemolytic disease The average life span of normal mature red blood cells is about 120 days. Hemolytic disease is a group of diseases caused by accelerated red blood cell destruction leading to a shortened life expectancy of red blood cells. The reason is divided into two types: the inherent defects of red blood cells themselves or the abnormal factors of red blood cells. Premature destruction of red blood cells can occur extravascularly or intravascularly. The former is called extravascular hemolysis, that is, red blood cells are destroyed in the mononuclear phagocytic system, the latter is called intravascular hemolysis, that is, red blood cells are destroyed in the blood circulation, and hemoglobin in red blood cells is directly released into the plasma. If the hematopoietic function of the bone marrow is compensated when hemolysis is increased, anemia may not occur, which is called compensatory hemolytic disease. However, if the destruction of red blood cells is accelerated and the bone marrow hematopoietic function is insufficient to compensate, hemolytic anemia occurs. ordinary inspection 1 serum jaundice index: When hemolysis occurs, the jaundice index increases, the higher the jaundice index, the greater the degree of erythrocyte destruction. However, it is not possible to distinguish whether blood bilirubin is direct or indirect, and quantitative determination of bilirubin is also required. 2 serum bilirubin quantification: to distinguish between hemolytic jaundice, obstructive jaundice and hepatic jaundice. In hemolytic jaundice, indirect bilirubin is increased and direct bilirubin is normal. In obstructive jaundice, direct bilirubin is increased and indirect bilirubin is normal. Indirect and direct bilirubin were increased in hepatic jaundice. 3 urine tri-biliary examination: in hemolytic disease, due to excessive destruction of red blood cells, indirect and direct bilirubin production increased, so the urine urinary biliary tract increased. Urinary bilirubin is negative because of the increase in indirect bilirubin content. 4 plasma-bound globin assay: plasma-bound globin content decreased, or even disappeared, seen in various intravascular hemolysis. The degree of reduction is often parallel to the severity of the condition. 5 plasma free hemoglobin determination. : Increase in plasma free hemoglobin is one of the indications for intravascular hemolysis. 6 urinary hemosiderin test: positive results indicate the presence of chronic intravascular hemolysis. However, this method has limited sensitivity, so negative can not completely exclude intravascular hemolysis. There are a variety of tests for the examination of red blood cell abnormalities. 1 erythrocyte saline osmotic fragility test: This test is used to determine whether the erythrocyte membrane is abnormal. Increased osmotic fragility is seen in hereditary spherocytosis. 2 erythrocyte mechanical fragility test: patients with hereditary spherocytosis, the percentage of hemolysis in this test can be increased to varying degrees. Especially in patients with mild hereditary spherocytosis, this test is more sensitive than the erythrocyte saline osmotic fragility test and is helpful for diagnosis. 3 Acidified Glycerol Dissolution Test (AGLT): This test is highly sensitive to the diagnosis of hereditary spherocytosis. Other hemolytic diseases have no false positive results, which is helpful for differential diagnosis. 4 self-hemolytic test and corrective test: normal human red blood cells after 24 hours of incubation, no hemolysis or very slight hemolysis. Only a small amount of hemolysis after 48 hours. After adding glucose, the hemolysis was significantly slowed down. Self-hemolysis occurs rapidly and significantly in patients with hereditary spherocytosis caused by defects in cell membranes. In patients with congenital non-spherical erythrocyte hemolytic anemia caused by defects in enzymes, autologous hemolysis is also often enhanced, and in type I patients, if glucose or ATP is added to the experiment, hemolysis is significantly reduced, as seen in glucose-6-phosphate. Hydrogenase (G-6-PD) is deficient; in type II patients, the addition of ATP in the test can significantly reduce hemolysis. If glucose is added, it is ineffective, and it is found in pyruvate kinase deficiency. It can identify congenital non-spherical erythrocyte hemolytic anemia caused by different causes. 5 acid hemolysis test: this test is positive in patients with paroxysmal nocturnal hemoglobinuria. 6 sucrose (sugar water) hemolysis test: almost all patients with paroxysmal nocturnal hemoglobinuria can be positive, so the test is more sensitive than the acid hemolysis test. However, it can also be weakly positive in some other types of anemia patients. 7 erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) activity assay: used to confirm the lack of G-6-PD, due to the lack of G-6-PD can cause a decrease in NADPH production per unit time. 8 methemoglobin reduction test: When G-6-PD is deficient, the methemoglobin reduction rate is generally less than 30%. This method is simple and easy to apply, and is suitable for screening tests, but it can have a false positive reaction. 9 Denatured globin corpuscle examination: as a screening test to check for G-6-PD deficiency. However, lack of specificity can also be seen in red blood cells of unstable hemoglobinopathy. 10 Hemoglobin Electrophoresis: This test is a reliable method for diagnosing thalassemia and most abnormal hemoglobin (Hbs, Hbc, HbD, HbH). Determination of anti-alkaline hemoglobin (HbF): When β-globin is an anemia, HbF is significantly increased, reaching more than 10%. Patients with acute leukemia and aplastic anemia can also be slightly increased. Hemoglobin H inclusion body formation test: This test is positive for the diagnosis of hemoglobin H disease. Unstable hemoglobin can also be positive, but must be kept for 24 hours. Hemoglobin c test: This test can help diagnose hemoglobin c disease. Red blood cell transmutation test. Red blood cells containing hemoglobin s are prone to sacral changes in the absence of oxygen. For the diagnosis of hemoglobin s disease. Isopropanol test. Normal hemoglobin was added to isopropanol and incubated at 37 ° C for 40 minutes before precipitation occurred, while precipitation with unstable hemoglobin for 5 minutes occurred. It is used to diagnose unstable hemoglobin, and its diagnostic value is higher than that of denatured globin corpuscle. Antibody testing for immunological hemolytic diseases includes the following tests 1 anti-human globulin test: anti-human globulin test positive reaction, found in neonatal hemolytic disease, autoimmune hemolytic anemia, hemolytic transfusion reaction. 2 cold agglutinin test: positive results for the diagnosis of cold agglutinin disease. However, some cold antibody-type autoimmune hemolytic diseases can also be positive. 3 cold-hot hemolysis test: for the diagnosis of paroxysmal cold hemoglobinuria. The following methods are used to check the abnormal function of the blood vessel wall. 1 capillary fragility test: vitamin C deficiency, allergic purpura, idiopathic thrombocytopenic purpura, thrombocytopenia, von Willebrand disease patients were positive. However, the positive reaction can also be seen in normal people, especially women, so its significance is limited. 2 bleeding time measurement: prolonged bleeding time seen in primary and secondary thrombocytopenic purpura, thrombocytopenia, vitamin C deficiency, telangiectasia or von Willebrand disease. Examination of abnormal platelet quantity and quality 1 platelet count: its pathological reduction is seen in hematopoietic dysfunction, such as aplastic anemia, leukemia, etc.; or increased platelet destruction, such as hypersplenism, idiopathic thrombocytopenic purpura; and platelet hyperreactivity, such as diffuse blood vessels During internal coagulation. Its pathological increase is seen in thrombocytosis, polycythemia vera, and the like. 2 platelet adhesion measurement: platelet adhesion rate is low, found in platelet weakness, von Willebrand disease, essential thrombocytosis. Platelet adhesion rate is high, found after surgery and after myocardial infarction. 3 platelet aggregation function measurement: platelet aggregation function is reduced in platelet weakness, von Willebrand disease, uremia, severe liver disease. 4 Clot retraction test: Clot retraction is seen when thrombocytopenia, thrombocytopenia, and fibrinogen or prothrombin are significantly reduced. Examination of abnormal coagulation function 1 clotting time: prolonged clotting time is seen in the more significant reduction of factors VIII, IX, XI, high prothrombin reduction, fibrinogen reduction and anticoagulant drugs or large amounts of FDP in the blood. When the reduction of factors VIII, IX, XI, etc. is not significant, the clotting time is still normal. Therefore, the test is not suitable for screening tests for the determination of factors VIII, IX, and XI. 2 recalcification time: clinical significance and clotting time are the same, but more sensitive. 3 Plasma prothrombin time: A test to determine the accessibility of the exogenous coagulation system. Prothrombin and factors V, VII, X deficiency, significant reduction of fibrinogen or increased antithrombin substances can prolong the test results. In order to further clarify the cause of the abnormality of this test, other tests are needed. 4 prothrombin consumption test: any factors that cause poor production of thromboplastin or decreased activity can reduce the consumption of prothrombin, so that the test results are shortened. Found in hemophilia and reduced platelet count or abnormal quality. It is one of the screening tests for endogenous coagulopathy. 5 Partial thromboplastin time in kaolin: A screening test to check for the absence of all factors in the endogenous coagulation system, which is more sensitive than the prothrombin consumption test. The results of this test may also be prolonged when factors II, V, X and fibrinogen are reduced, or when anticoagulant substances are present. 6 thromboplastin test: used to determine mild hemophilia and to type. 7 partial thromboplastin time correction test: The patient's serum, adsorbed plasma and normal serum and adsorbed plasma were combined in different combinations to determine the partial thromboplastin time, and observed whether it was corrected or not. For the diagnosis and stereotyping of hemophilia A and B. 8 prothrombin time correction test: the patient's plasma was compared with normal plasma, adsorbed plasma and adsorbed serum, and the prothrombin time was determined to observe whether it was corrected or not. For the differential diagnosis of prothrombin, factor V, VII, X deficiency. Fibrinolytic function and examination of fibrin degradation products 1 Fibrinogen quantification is found in liver disease or disseminated intravascular coagulation (DIC). 2 Thrombin time The clotting time after plasma was added to the normalized thrombin solution. It is normal to extend within 3 seconds of the normal control. If the time is prolonged, it is seen in the presence of fibrinolysis and the presence of FDP; there is heparin present; fibrinogen is significantly reduced or structurally abnormal. 3 plasma protamine protamine test (referred to as the three P test) FDP can form a soluble complex with fibrin monomer in the blood, this substance can not be coagulated by thrombin, but the fibrin monomer contained therein It can be separated by an appropriate concentration of protamine sulfate and polymerized to form a gelled state, which is called a secondary solidification phenomenon. The normal value is negative. This test helps to diagnose DIC. However, this test can be negative when DIC enters advanced stage. 4 euglobulin dissolution time in the plasma due to anti-plasmin, can interfere with the determination of plasmin. This method separates euglobulin by isoelectric precipitation method, which does not contain anti-plasmin, but still contains plasminogen activator and plasminogen, and then fibrinogen as matrix, and dissolved. time. One of the tests for DIC confirmation. 5 serum FDP quantification - emulsion agglutination test. It is suggested that there is fibrinolysis, which can be used as one of the DIC confirmation tests. The people who need to be examined have weak, weak, sleepy, pale skin, mucous membranes, palpitations, dizziness, headache, tinnitus, vertigo, inattention, and lethargy. Low results may be diseases: high anemia results may be diseases: leukemia considerations Inappropriate people: People with a significant tendency to bleed. Taboo before the test: Do not eat too greasy, high-protein foods the day before the test, to avoid heavy drinking. The alcohol content in the blood directly affects the test results. After 8 pm on the day before the medical examination, you should fast. Requirements for examination: When taking blood, you should relax your mind to avoid the contraction of blood vessels caused by fear and increase the difficulty of blood collection. Inspection process The classification of anemia diseases can be divided into four categories: reticulocyte count and reticulocyte absolute value, red blood cell ratio measurement, calculation of red blood cell mean constant, and red blood cell diameter curve. The methods for examination of hemolytic diseases are divided into: general examination to determine whether there is hemolytic disease; special examination of abnormalities inside and outside erythrocytes (including defects in erythrocyte membrane, defects in enzymes or abnormal globulin synthesis), and presence or absence of plasma in patients An autoantibody or the like which is destroyed by an antigen-antibody reaction to its own red blood cells to clarify the cause of hemolysis. Hemorrhagic disease examination method: Hemorrhagic disease is a group of diseases in which normal hemostasis and coagulation mechanisms are impeded, leading to bleeding. Its pathogenesis has three aspects: abnormalities of the microvascular wall; abnormalities of platelet mass or quantity; and obstacles of blood coagulation and anticoagulant function. If an abnormality occurs in one of the above steps, it can cause bleeding disorders. Not suitable for the crowd 1. Patients who have taken contraceptives, thyroid hormones, steroid hormones, etc., may affect the results of the examination and prohibit patients who have recently taken the drug history. 2, special diseases: patients with hematopoietic function to reduce disease, such as leukemia, various anemia, myelodysplastic syndrome, etc., unless the examination is essential, try to draw less blood. Adverse reactions and risks 1, subcutaneous hemorrhage: due to pressing time less than 5 minutes or blood draw technology is not enough, etc. can cause subcutaneous bleeding. 2, discomfort: the puncture site may appear pain, swelling, tenderness, subcutaneous ecchymosis visible to the naked eye. 3, dizzy or fainting: in the blood draw, due to emotional overstress, fear, reflex caused by vagus nerve excitement, blood pressure decreased, etc. caused by insufficient blood supply to the brain caused by fainting or dizziness. 4. Risk of infection: If you use an unclean needle, you may be at risk of infection.

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