Haematology Immunohaematology Practical Portfolio Biology Essay

Published:

This essay has been submitted by a student. This is not an example of the work written by our professional essay writers.

The process of undertaking a white cell differential very similar in process to the red cell differential, with knowledge of leucocytes it is possible to recognise the possible presence of disease. In the normal peripheral blood, it is normal for mature phagocytic cells and lymphocytes to be present. Their function is to protect the body against infection, this process is closely connected to the protein systems in the body; immunoglobulins and complement, which are also involved in the destruction of blood cells in some diseases.

The origins of the components of blood and the immune system. Taken from Immunobiology: The Immune System in Health and Disease. 5th edition. Janeway CA (2001)As with red cells there are several types of white cells with different morphologies, some of which, in health, are only found in the bone marrow, however in disease may be found in the peripheral blood. The thymus and the bone marrow are the primary lymphoid organs in postnatal life, these are the areas in which lymphocytes develop. The lymph nodes, spleen and lymphoid tissues of the alimentary and respiratory tract are the secondary lymphoid organs, these produce the specific immune response. A specific immune response will depend on either/or the T and B cells, these cells originate from the haemopoietic stem cell. Developing in the bone marrow, B cells are present and circulate in the peripheral blood until they are facilitated and maturate into memory B cells, characterised by their unusual round nucleus with its distinctive chromatin pattern. Alternatively T cells reach maturation in the thymus, this occurs when they pass from the cortex to the medulla, during this passage the T cells that possess the human leucocyte antigen (HLA) are selected, the mature cells will express CD4 and the cytotoxic cells will express CD8, these act as co-receptors to the T cell. Simply primary function of the B cell is to produce antibodies and the T cells is to assist the B cells in antibody production and to attack viruses and cancer cells.

In this practical the blood films of 3 case studies will be analysed along with the brief background information. From this it will be possible to roughly diagnose the case studies based on what is seen on the blood films and from the blood counts provided.

Results

Case Study 1 - 60C

Eosinophil

11%

Lymphocyte

50%

Monocyte

2%

Neutraphil

8%

Basophil

-

Multilobed

1%

Plasma cell (w/ halo)

5%

Plasma cell (anti-release)

7%

Large platelets

-

Large lymphocyte

14%

Case Study 2 - 49

Eosinophil

33%

Lymphocyte

18%

Monocyte

1%

Neutraphil

37%

Basophil

33%

Multilobed

6%

Plasma cell (w/ halo)

-

Plasma cell (anti-release)

-

Large platelets

-

Large lymphocyte

18%

Case Study 3 - 30c

The blood film showed no significant changes other than high levels of platelets.

Discussion

Case Study 1

15 year old boy went to GP with swollen glands around the neck. He was tired and listless. He also complained of tenderness in the abdomen.

Blood Count -

Hb 13.5g/dl (Normal Range is 13.5-17.5)

WBC 18.0 x 109 /L (Normal Range is 4.3-10.8)

Platelets 270x109/L (Normal Range is 150-450)

MCV 94 fl (Normal Range is 80-95)

RBC 6.0 x 1012/L (Normal Range is 4.5-6.5)

Hct 46% (Normal Range is 40-52%)

The brief list of physical symptoms given initially fit with the clinical symptoms that are used to diagnose infectious mononucleosis caused by the Epstein-Barr virus (EBV), where patients are typically between the ages of 15 and 40. They present with headaches, lethargy, stiff neck and malaise, when the disease progresses there is swelling of the lymph nodes, sore throat, fever (ranging from mild to moderate) and possible palpable splenomegaly.

In this case the patient's blood count shows the WBC to be above the normal range, this is characteristic of this disease. The percentages from the patient's blood film are 50% lymphocytes and 11% large lymphocytes, the latter being atypical in health. The large lymphocytes indicate a viral infection, which in this case would tie in with the diagnosis of infectious mononucleosis.

It should be taken into account that the patient has a compromised immune system, using the process of differential diagnosis it would be prudent to rule out acute leukaemia, especially considering the patient's age. Other possible causes for the symptoms and the resultant blood film and blood count are HIV, rubella, influenza, cytomegalovirus, toxoplasmosis, bacterial tonsillitis and infectious hepatitis.

There is no direct treatment for infectious mononucleosis, only treatment of the symptoms is usually required. Patients usually recover within 4-6 weeks, prolonged malaise and lethargy often persists.

Case Study 2

28 year old male admitted to A&E with fatigue, haematuria and slight Jaundice.

Blood Count -

Hb 6.1g/dl (Normal Range is 13.5-17.5)

WBC 11.0 x 109 /L (Normal Range is 4.3-10.8)

Platelets 169x109/L (Normal Range is 150-450)

MCV 74 fl (Normal Range is 80-95)

RBC 3.0 x 1012/L (Normal Range is 4.5-6.5)

Hct 29% (Normal Range is 40-52%)

The patient blood count shows decreased levels of Hb and RBCs, decreased MCV and Hct with a slightly increased WBC level.

The blood film results show increased levels of eosinophils and basophils and lowered levels of lymphocytes. The increase in eosinophils could be the result of a bacterial infection or an allergy. However the patient does present with jaundice, fatigue and haematuria and is possibly suffering from a form of anaemia or hepatitis. Further investigation into the patient history such as recent travel, sexual activity, previous illnesses or drug history would provide more details that could provide a stronger diagnosis.

Case Study 3

58 year old male who had post gastrectomy 3 weeks ago was re-admitted for a splenectomy operation.

Blood Count -

Hb 13.5g/dl (Normal Range is 13.5-17.5)

WBC 12.0 x 109 /L (Normal Range is 4.3-10.8)

Platelets 370x109/L (Normal Range is 150-450)

MCV 105 fl (Normal Range is 80-95)

RBC 6.3 x 1012/L (Normal Range is 4.5-6.5)

Hct 46% (Normal Range is 40-52%)

In this case the patient's blood film appeared to be relatively normal, the blood count results show increased WBCs and an increased MCV, the increase in MCV is probably tied in with the increase in the WBCs. The patient's brief history informs of a major operation with another scheduled.

The increase in WBC could be the result of a post operative infection or just a lowered immune system as a result of the operation, the RBC levels are within normal range which doesn't immediately indicate a disorder effecting the spleen resulting in its imminent removal however the high platelet levels are. Another possibility and cause of the increased WBC level could be cancer in the stomach that has spread to the spleen, or during surgery the spleen was damaged when the gastrectomy was taking place.

References

Hoffbrand, AV . (2006). The white cells 1; granulocytes, monocytes and their benign disorders. In: Moss, PAH Pettit JE Essential Haemotology. Oxford: Blackwells Publishing. 94-100.

Immunobiology: The Immune System in Health and Disease. 5th edition. Janeway CA, Travers P, Walport M, et al. New York: Garland Science; 2001.

Practical 2 - Immunohaematology

Introduction

The ABO grouping system is the system where by a person's blood can be grouped based on the specific antigens and antibodies present. This system is extremely important with regards to blood transfusions; if a person receives the wrong blood type then the consequences can be very serious.

There are 3 allelic genes A, B and O, the A and B genes synthesise enzymes that are responsible for carbohydrates

Results

ABO Controls

A cells

B cells

O cells

Anti A

3 +ve

-ve

-ve

Anti B

-ve

3 +ve

-ve

Anti A+B

1 +ve

3 +ve

-ve

NaCl

-ve

-ve

-ve

ABO grouping of patients 1-4

P1(serum)

P2 (serum)

P3 (serum)

P4 (Serum)

A cells

2 +ve

-ve

-ve

2 +ve

B cells

4 +ve

4 +ve

-ve

-ve

O cells

-ve

-ve

-ve

-ve

P1 (Cells)

P2 (Cells)

P3 (Cells)

P4 (Cells)

Anti A

-ve

5 +ve

2 +ve

-ve

Anti B

-ve

-ve

3 +ve

3 +ve

Anti A+B

-ve

-ve

2 +ve

3 +ve

NaCl

-ve

-ve

-ve

-ve

Rhesus Grouping

O Rh Pos

O Rh Neg

P1

P2

P3

P4

+ve

-ve

-ve

+ve

+ve

+ve

Discussion

References

Practical 3 - Coagulation

Introduction

Results

Prothrombin Time

Normal - 16s

Test - 43s

Reference Range - 10-14s

Activated Partial Thromboplastin Time

Normal - 34s

Test - 70s

Reference Range - 30-40s

Thrombin Time

Normal - 15s

Test - 70s

Reference Range - 14-16s

Discussion

Writing Services

Essay Writing
Service

Find out how the very best essay writing service can help you accomplish more and achieve higher marks today.

Assignment Writing Service

From complicated assignments to tricky tasks, our experts can tackle virtually any question thrown at them.

Dissertation Writing Service

A dissertation (also known as a thesis or research project) is probably the most important piece of work for any student! From full dissertations to individual chapters, we’re on hand to support you.

Coursework Writing Service

Our expert qualified writers can help you get your coursework right first time, every time.

Dissertation Proposal Service

The first step to completing a dissertation is to create a proposal that talks about what you wish to do. Our experts can design suitable methodologies - perfect to help you get started with a dissertation.

Report Writing
Service

Reports for any audience. Perfectly structured, professionally written, and tailored to suit your exact requirements.

Essay Skeleton Answer Service

If you’re just looking for some help to get started on an essay, our outline service provides you with a perfect essay plan.

Marking & Proofreading Service

Not sure if your work is hitting the mark? Struggling to get feedback from your lecturer? Our premium marking service was created just for you - get the feedback you deserve now.

Exam Revision
Service

Exams can be one of the most stressful experiences you’ll ever have! Revision is key, and we’re here to help. With custom created revision notes and exam answers, you’ll never feel underprepared again.