Laboratory Tests for
Blood Disorders
Doctors select tests to help diagnose blood disorders based
on the person's symptoms and the results of the physical examination. Sometimes
a blood disorder causes no symptoms but is discovered when a laboratory test is
done for another reason. For example, a complete blood count done as part of a
regular check-up may reveal a low red blood cell count (anemia). When a blood
disorder is suspected, a complete blood count and other tests may need to be
done to determine the specific diagnosis.
How Blood Is Obtained
How Blood Is Obtained
Blood is obtained from a vein with a needle to fill one or
more sample tubes or sometimes from the fingertip by a needle prick to get just
a drop of blood.
A health care practitioner determines which vein to use,
usually one on the inside surface of the person's elbow. A tourniquet is
applied around the upper arm, causing the veins below it to fill with blood so
that they may be more easily seen or felt.
After the skin immediately surrounding the vein is cleaned
thoroughly, a needle is inserted into the vein. A stinging sensation is usually
felt when the needle is first inserted, but otherwise the procedure is
painless.
Blood moves through the needle and into a syringe or
collecting tube. Once enough blood is collected, the tourniquet is removed, the
needle is then removed from the vein, and pressure is applied to the area to
prevent bleeding from the puncture site.
If only a small amount of blood is needed, the area, usually
a finger (the heel in infants), is cleaned and a needle is used to prick the
skin.
Complete blood count
The blood test most commonly done is the complete blood
count (CBC). The CBC is an evaluation of all the cellular components (red blood
cells, white blood cells, and platelets) in the blood. Automated machines do
this test in less than 1 minute on a small amount of blood. The CBC is
supplemented in some instances by examination of blood cells under a microscope
(blood smear).
LAB TEST
Complete Blood Count icon
Red blood cell parameters evaluated by CBC include
Number of red blood cells (red blood cell count, RBCs)
Proportion of blood made up of red blood cells (hematocrit,
Hct)
Amount of hemoglobin (the oxygen-carrying protein in red blood
cells) in the blood (hemoglobin, Hb)
Average size of red blood cells (mean cellular volume, MCV)
Variability of size of red blood cells (red cell
distribution width, RDW)
Amount of hemoglobin in an individual red blood cell (mean
cellular hemoglobin, MCH)
Concentration of hemoglobin in an individual red blood cell
(mean cellular hemoglobin concentration, MCHC)
Abnormalities in these parameters can alert laboratory
workers to the presence of abnormalities in the red blood cells (which may then
be further evaluated by examination under a microscope).
Abnormal red blood cells may be fragmented or shaped like
teardrops, crescents (sickle-shaped), or a variety of other forms. Knowing the
specific shape and size of red blood cells can help a doctor diagnose a
particular cause of anemia. For example, sickle-shaped cells are characteristic
of sickle cell disease, small cells containing insufficient amounts of
hemoglobin are likely due to iron deficiency anemia, and large cells suggest
anemia due to a deficiency of folate (the vitamin folic acid) or a deficiency
of vitamin B12.
White blood cell parameters evaluated by the CBC include the
Total number of white blood cells
Percentages and numbers of the different types of white
blood cells
The white blood cells are the major component of the body's
immune system. There are normally five major types of white blood cells
(neutrophils, lymphocytes, monocytes, eosinophils, and basophils), and
different types are recruited into service when the immune system responds to
different stresses or disorders. Counting the number of white blood cells of
each type (differential white blood cell count) can suggest to a doctor
possible causes of a change in the total white blood cell count. For example,
if a person with cold symptoms has an increased white blood cell count due to
increased neutrophils, the doctor would likely suspect a bacterial pneumonia
rather than a viral infection because neutrophils are more often recruited to
fight bacterial infections.
To provide more information about the white blood cells, the
doctor can examine these cells under a microscope. The microscopic examination
can identify features of the cells that are characteristic of certain diseases.
For example, large numbers of white blood cells that have a very immature
appearance (blasts) may indicate leukemia (cancer of the white blood cells).
Platelets are also counted as part of a CBC. Platelets are
cells that help in the clotting process by gathering at a bleeding site and clumping
together to form a plug. The number of platelets is an important measure of the
blood's ability to form blood clots (forming blood clots is the body's
protective mechanism for stopping bleeding). Too few platelets may impair blood
clotting. A high number of platelets (thrombocytosis) can lead to excessive
blood clotting in small blood vessels, especially those in the heart or brain.
However, in some disorders, a high number of platelets may paradoxically result
in excess bleeding.
Complete Blood Count (CBC)*
Blood smear
Although automated machines can rapidly determine the number
of different blood cells and provide information about the size and shape of
red blood cells and types of white blood cells, examining a blood sample under
a microscope may provide additional information. To do this, a drop of blood is
smeared across a glass slide to form a thin layer that makes it easy to see
individual blood cells. The slide is then stained with colored chemicals to
reveal specific characteristics of the blood cells and examined under the
microscope. An experienced examiner can often obtain better information about
cell counts, size and shape, and specific characteristics of the cells than a
machine can.
Reticulocyte count
The reticulocyte count measures the number of newly formed
(young) red blood cells (reticulocytes) in a specified volume of blood.
Reticulocytes normally make up about 0.5 to 2.5% of the total number of red
blood cells. When the body needs more red blood cells, as after blood loss, the
bone marrow normally responds by producing more reticulocytes. Thus, the
reticulocyte count is a measure of the capacity of the bone marrow to make new
red blood cells.
Special tests of blood cells
Once a doctor determines that something is wrong with one or
more of the cell types in the blood, many additional tests are available to
shed more light on the problem. Doctors can measure the proportion of the
different types of white blood cells and can determine subtypes of these cells
by assessing certain markers on the surface of the cells. Tests are available
to measure the ability of white blood cells to fight infection, to assess the
functioning of platelets and their ability to clot, and to measure the contents
of red blood cells to help determine the cause of anemia or why the cells are
not functioning properly. Most of these tests are done on samples of blood, but
some require a sample from the bone marrow.
Clotting tests
One measure of the body's ability to stop bleeding is the
count of the number of platelets. Sometimes doctors need to test how well the
platelets function. Other tests can measure the overall function of the many
proteins needed for normal blood clotting (clotting factors). The most common
of these tests are the prothrombin time (PT) and the partial thromboplastin
time (PTT). The levels of individual clotting factors can also be determined.
LAB TEST
Partial Thromboplastin Time (PTT, aPTT) icon
LAB TEST
Prothrombin Time and International Normalized Ratio (PT/INR) icon
Measures of proteins and other substances
Blood plasma (the liquid portion of blood) contains many
proteins. Urine contains very small amounts of protein. Doctors sometimes
measure some of these proteins to look for abnormalities in their quantity or
structure that occur in certain blood disorders. For example, in multiple
myeloma, certain bone marrow cells, called plasma cells, become cancerous and
produce unusual antibody (immunoglobulin) proteins (including Bence Jones
proteins) that can be measured in blood and urine.
Erythropoietin is a protein made in the kidneys that
stimulates the bone marrow to produce red blood cells. The level of this
protein can be measured in the blood. Levels of iron and certain vitamins (for
example, B12 and folate) that are necessary for the production of healthy blood
cells also can be measured.
Blood typing
Blood type, which is determined by the presence of certain
proteins on the surface of red blood cells, can be identified by measuring the
reaction of a small sample of a person's blood to certain antibodies. Blood
typing requires evaluation of both the plasma and red blood cells. Blood typing
must be done before blood can be transfused.
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