Bonewit-West: Clinical Procedures for Medical Assistants ...



Bonewit: Clinical Procedures for Medical Assistants, 8th EditionChapter 18: HematologyContent OutlineIntroduction to Hematology1. Hematology: a. Includes2. Laboratory analysis in hematologya. Purpose: examining blood to detect pathologic conditionsb. Includesc. Determines if each blood component falls within its reference range3. Specific hematology testsa. b. c. d. e. f. g. 4. Complete blood count (CBC)a. Performed on- New patients - Patients with a pathologic conditionb. Tests included in a CBCComponents and Function of Blood1. a. Plasma: b. Cells: 2. Average adult body: 1. In an adult: a. b. c. d. e. 2. Immature form: a. 3. Hemoglobina. b. c. d. Reference rangeWomen: Men: e. Hemoglobin molecule consists off. Oxygen- Hemoglobin: (1) (2) (a) (b) Carbon dioxideg. Arterial bloodh. Venous blood5. Average life span of RBC: a. Hemolysis: - Hemoglobin breaks down into(1) Iron: (2) Globin (protein): (3) Bilirubin(a) (b) (c) (4) Leukocytes1. 2. Leukocytosis: 3. Leukopenia: 4. Function of leukocytes: a. b. 5. a. 6. a. 7. a. b. c. Thrombocytes 1. 2. 3. 4. 5. Function: Hemoglobin Determination1. Hemoglobin (Hgb): 2. 3. 4. Normal rangea. Female: b. Male: 5. 6. Decreased hemoglobin level: a. b. c. d. e. f. LeukemiaHodgkin’s disease7. Increased hemoglobin level: a. b. c. Hematocrit- 1. 2. Hematocrit means a. By centrifuging an anticoagulated blood specimenb. c. Top layer: d. Between layers Buffy coat: 3. Purpose of hematocrit: 4. Normal rangea. Women: b. Men: 5. Low reading: 6. High reading: 7. Used with other tests to diagnose the patient’s conditionWhite Blood Cell Count1. 2. Adult reference range: 3. Leukocytosis: a. Most commonly seen in acute infectionsb. Normal elevation can occur in4. Leukopenia: a. b. c. Red Blood Cell Count1. 2. Performed using blood cell counter3. Decrease in red blood cell counta.b. c. 4. Increase in red blood cell counta. b. c. Red Blood Cell Indices2. 3.4. 5. White Blood Cell Differential Count1. a. b. c. d. 2. Purpose of diffa. Increase or decrease in one or more types- Assists physician in making a diagnosis3. Types of White Blood Cells1. a. Granular: b. Nongranular: 2. Description of WBCsa. Neutrophils: 50% to 70%b. Eosinophils: 1% to 4%c. Basophils: 0% to 1%d. Lymphocytes: 20% to 35%e. Monocytes: 3% to 8%3. Reference range for diff counta. Neutrophils: 50% to 70%b. Eosinophils: 1% to 4%c. Basophils: 0% to 1%d. Lymphocytes: 20% to 35%e. Monocytes: 3% to 8%PT/INRCombination of: a. b. 2. Calculation performed on PT test ? To arrive at a standardized value - Known as an INR (International Normalized Ratio)3. PT/INR result a. b. Does not have a unit of measurement attached to itc. Healthy individual with a normal clotting ability Should have a PT/INR result that d. Example: PT/INR of 3.0 - e. 4. PurposeBrand names - - c. PT/INR test: d. Warfarin prescribed for:e. PT/INR - Unexplained nosebleeds- Excessive bleeding from gums- Easy bruising- Heavy menstrual periods - Unexplained blood in the stool or urine f. Goal of warfarin therapyIncrease clotting time to a level that prevents formation of blood clots - Without causing excessive bleeding or bruising g. Patient must undergo periodic PT/INR testingTo ensure the patient remains in his or her ideal PT/INR range - Minimizes complications of warfarin therapyh. Frequency of testing depends on:Stability of patient’s previous test results Occurrence of conditions that may cause test results to fall outside of the patient’s desired range i. When patient first placed on warfarin therapy:PT/INR test performed once or twice a week - To assess patient’s response to warfarinBased on PT/INR results - Dosage adjusted so that: (1) Results become stable (2) Consistently fall within patient’s ideal PT/INR rangej. Once test results become stabilized:Patient should have a PT/INR test performed every 2 to 4 weeksk. If the PT/INR result is outside of the patient’s predetermined ideal rangePhysician adjusts warfarin dosage - To bring patient back into optimal range l. Other factors that can affect the PT/INR resultsChange in dietPrescription and OTC medications that interact with warfarinVitaminsHerbal preparationsChange in level of exerciseIllnessSmokingAlcohol consumptionm. Important for the patient to keep the physician informed - Of factors that may alter their body’s response to warfarin ................
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