Disorders of the blood cells and coagulation system are called hematologic disorders. A visit to the hematology department should be made when the following symptoms occur. Depending on the patient’s symptoms, the physician may recommend different tests to help determine the patient’s disease.
Manifestations of blood disorders
Symptoms of blood disorders are generally inconspicuous and nonspecific, meaning that they may be similar to symptoms of a lesion anywhere else in the body, including weakness, weakness, difficulty breathing, fever, weight loss, pain, dizziness, fainting, excessive bleeding, and skin that bruises easily or appears as very small red-purple dots.
Although no one symptom can accurately indicate a blood disorder, certain symptoms may suggest a diagnosis. These symptoms are often associated with a decrease in blood cells, such as erythrocytopenia (anemia), leukopenia (leukopenia), and thrombocytopenia (thrombocytopenia). Patients presenting with weakness or dyspnea may have anemia, patients presenting with fever as well as infection may have leukopenia, and patients presenting with cyanosis or bleeding may have thrombocytopenia.
Sometimes, the patient’s symptoms may be related to increased blood cells, such as when red or white blood cells are increased the patient’s blood is sticky and may present with dyspnea, headache, dizziness, and confusion.
Lesions of factors involved in normal blood clotting can lead to impaired blood clotting (manifested by easy bruising or bleeding) or the formation of abnormal clots (causing leg fever, pain, or sudden tightness of breath or chest pain).
Diagnosis of blood disorders
Laboratory blood tests
Physicians rely on the results of many laboratory tests to diagnose and monitor conditions. Because the fluid portion of the blood (plasma) contains many substances that are important to body function, blood tests may reveal what is wrong with various parts of the body.
It is easier to test blood than to obtain tissue from a specific organ. For example, if you want to find out about thyroid function, it is much easier to test the level of thyroid hormones in the blood than to just punch the thyroid gland and take a test. Similarly, it is easier to test the blood for liver enzymes and proteins than to take liver tissue. Some blood tests are responsive to the composition and function of the blood itself, and these tests are mostly used to diagnose blood disorders.
Complete blood count
The most commonly performed test is the complete blood count (CBC), who is the most basic test of blood cell composition (red blood cells, white blood cells, platelets). A fully automated instrument can perform a complete blood count in less than a minute and requires only a small drop of blood specimen. In most cases, a microscopic examination is also performed.
The CBC can detect blood cell and hemoglobin (oxygen-carrying protein) content, in addition to assessing red blood cell size and suggesting to the lab technician the possible presence of morphologically abnormal red blood cells (microscopic observation can be performed to clarify). Abnormal red blood cells can appear in various shapes such as fragments, teardrops, target shapes, sickle shapes, etc. Knowing the specific morphology of red blood cells in terms of and size can help the physician determine the cause of anemia. For example, sickle cell anemia has sickle-shaped red blood cells, small red blood cells with insufficient hemoglobin content suggest possible iron deficiency anemia, and large red blood cells suggest folic acid or vitamin B12 deficiency.
Depending on the number, size, and morphology of the red blood cells, the physician may order other tests to clarify the cause of the anemia, including a red blood cell fragility test, the presence or absence of abnormal hemoglobin, and the amount of certain substances within the red blood cells.
CBC can also accurately determine the number of white blood cells. If the physician needs more information, a special white blood cell count (sorted count) may be done, and if the total number of white blood cells or a certain white blood cell count is higher or lower than normal, the physician will look at it with a microscope. Microscopic examination may reveal typical signs of certain diseases, such as a large number of immature cells (primitive and/or cellular) suggestive of leukemia (white blood cell malignancy).
Platelets are also part of the CBC and their number reflects the body’s ability to stop bleeding. An elevated platelet count (thrombocytosis) can lead to clot formation in blood vessels, especially small vessels in the heart and brain.
Reticulocyte count
Reticulocyte count measures the number of new red blood cells per unit volume of blood. Normally, reticulocytes account for 1% of all red blood cells, and when the body needs more red blood cells such as in anemia, the bone marrow produces more reticulocytes, therefore, reticulocyte count reflects the function of the bone marrow.
Blood type
Blood type is determined by the proteins on the surface of red blood cells. Blood type can be checked by reacting specific antibodies with red blood cells and must be checked before blood transfusion.
Bleeding time and other coagulation tests
Bleeding time reflects the ability of the patient to stop bleeding (platelet count is also checked). To perform this test, a small incision is made on the patient’s forearm and the time from making the incision to stopping the bleeding is measured. The bleeding time mainly responds to platelet function, and other experiments that respond to blood cell function are done mainly by fully automated instruments. There are also some experiments to detect the proteins involved in coagulation (coagulation factors), commonly used are prothrombin time, partial thromboplastin time, and also can detect various coagulation factors.
Other blood tests
Some blood tests are used to detect other blood disorders, such as a physician may need to check a patient’s whole blood volume or the total number of certain blood cells, and these tests are generally performed with radionuclides.
Bone Marrow Tests
Sometimes it is necessary to go to a bone marrow specimen to find out why the blood cells are abnormal. There are two types of bone marrow specimens: bone marrow aspiration and bone marrow biopsy. Both types of specimens can be obtained from the iliac bone, from the sternum, or from the leg bone (tibia) of a child.