HEMATOLOGIA

Hemograma

Hemácias:
Homem : 4,2 a 5,4 milhões/mm³
Mulher: 4,1 a 5,1 milhões/mm³
Baixo : Oligocitemia
Alta : policitemia ou eritremia
VCM - 82 a 92 (ver tabela relacionado com a idade)
HCM - de 29 a 31
CHCM - de 31 a 33
Hemoblogina
Homem: 15g% +/- 1,5
Mulher: 14g% +/- 1,5
Baixo: Anemia

Hematócrito
Homem: 48% +/- 6
Mulher : 42% +/- 4

Oligocitemia - Ht diminuído.
Pseudoanemias - Ht diminuído.
Hemorragia aguda - Hematócrito normal
Hemorragia aguda tardia - Ht. diminuído
Desidratação (de qualquer etiologia) - Ht elevado

VHS ( velocidade de Hemossedimentação)
Homem - 0-15 mm/h
Mulher - 0-20 mm/h
Elevado : doenças vasculares do colágeno, infecções, IAM, neoplasias, estados inflamatórios na fase aguda.

TESTE DE COOMBS DIRETO : Detecta anticorpos específicos ligados ao seu antígeno. O teste é positivo para:
Anemia auto-imune, eritroblastose fetal ( doença hemolítica do recém-nato), reações à transfusão ( confirma hemólise aguda por incompatibilidade , reações contra drogas ( penicilina, metildopa, sulfonamidas, cefalosporinas etc.)
TESTE DE COOMBS INDIRETO : Detecta anticorpos específicos livres : Anticorpos Anti-Rh, pesquisa de "D" fraco, pesquisa de aloanticorpos, prova cruzada, anemia hemolítica adquirida

Leucócitos

Leucócitos - 3200-10000/mm3.
Diferencial:
Neutrófilos bastonados ( neutrófilos jovens) - 2-6%
Neutrófilos segmentados ( maduros) - 60-70%
Eosinófilos : 1-4%
Basófilo : 0-1%
Monócito: 2-8%
Linfócitos : 25-40%
Neutropenia verdadeira : Neutrófilos periféricos <1800/mm3
Linfócitos <900/mm3 - Desnutrição Grave, AIDS, supressão da M.O., anemia aplástica, neoplasia, hiperfunção da adrenal, uso esteróides
Linfócitos elevados - acima de 2600/mm3 - infecções crônicas , mononucleose infecciosa e outras infeções virais, LLC, doença de Hodgkin, Retocolite ulcerativa, hipoaldosteronismo, púrpura trombocitopênica
Contagem de eosinófilos -1 a 4%( em torno até 440). Eosinofilia:
Alergia, infecções parasitáiras ( esquistossomose, estrongiloidíase e toxocaríase (extramemento alta) dão as mais altas eosinofilias), reações a drogas, rinites, linfomas, distúrbios melioproliferativos, doenças vasculares do colágeno, etc.
Plaquetas - 130 a 400 mil /mm3.

. Valores hemtológicos normais para crianças e adultos

Age Hemoglobin
(g/dL) Hematocrit
(%) Reticulocytes
(%) MCV
(fL) Leukocytes
(WBC/mm³) Neutrophils
(%) Lymphocytes
(%) Eosinophils
(%) Monocytes
(%)

Mean Range Mean Range Mean Lowest Mean Range Mean Range Mean Mean Mean

Cord blood 16.8 13.7–20.1 55 45–65 5.0 110 18,000 (9,000–30,000) 61 (40–80) 31 2 6

2 wk 16.5 13.0–20.0 50 42–66 1.0 12,000 (5,000–21,000) 40 63 3 9

3mo 16.5 9.5–14.5 36 31–41 1.0 12,000 (6,000–18,000) 30 48 2 5

6 mo–6 yr 12.0 10.5–14.0 37 33–42 1.0 70–74 10,000 (6,000–15,000) 45 48 2 5

7–12 yr 13.0 11.0–16.0 38 34–40 1.0 76–80 8,000 (4,500–13,500) 55 38 2 5

Adult

Female 14 12.0–16.0 42 37–47 1.6 80 7,500 (5,000–10,000) 55 (35–70) 35 3 7

Male 16 14.0–18.0 47 42–52 80

*Relatively wide range.
fL = femtoliters; MCV = Volume corposcular médio; WBC = white blood cells (leucócitos)

. *Valores hemtológicos normais para crianças e adultos*
Age	Hemoglobin (g/dL)	Hematocrit (%)	Reticulocytes (%)	MCV (fL)	Leukocytes (WBC/mm³)	Neutrophils (%)	Lymphocytes (%)	Eosinophils (%)	Monocytes (%)
*Mean*	*Range*	*Mean*	*Range*	*Mean*	*Lowest*	*Mean*	*Range*	*Mean*	*Range*	*Mean*	*Mean*	*Mean*
Cord blood	16.8	13.7–20.1	55	45–65	5.0	110	18,000	(9,000–30,000)	61	(40–80)	31	2	6
2 wk	16.5	13.0–20.0	50	42–66	1.0		12,000	(5,000–21,000)	40		63	3	9
3mo	16.5	9.5–14.5	36	31–41	1.0		12,000	(6,000–18,000)	30		48	2	5
6 mo–6 yr	12.0	10.5–14.0	37	33–42	1.0	70–74	10,000	(6,000–15,000)	45		48	2	5
7–12 yr	13.0	11.0–16.0	38	34–40	1.0	76–80	8,000	(4,500–13,500)	55		38	2	5
Adult
Female	14	12.0–16.0	42	37–47	1.6	80	7,500	(5,000–10,000)	55	(35–70)	35	3	7
Male	16	14.0–18.0	47	42–52		80
Relatively wide range. fL = femtoliters; MCV = Volume corposcular médio; WBC = white blood cells (leucócitos)*

Classification of Anemia

Microcytic

Iron deficiency

Thalassemias

Lead poisoning

Chronic disease

Infection

Cancer

Inflammation

Renal disease

Vitamin B₆ responsive

Copper deficiency

Sideroblastic (some)

Normocytic

Decreased production

Aplastic anemia

Congenital

Acquired

Pure RBC aplasia

Congenital (Diamond-Blackfan)

Acquired (transient erythroblastopenia)

Bone marrow replacement

Leukemia

Tumors

Storage diseases

Osteopetrosis

Myelofibrosis

Blood loss

Internal or external

Sequestration

Hemolysis: Intrinsic RBC abnormalities

Hemoglobinopathies

Enzymopathies

Membrane disorders

Hereditary spherocytosis

Acquired: paroxysmal nocturnal hemoglobinuria

Hemolysis: Extrinsic RBC abnormalities

Immunologic

Passive (hemolytic disease of the newborn)

Active: Autoimmune

Toxins

Infections

Microangiopathic

Disseminated intravascular coagulation (DIC)

Hemolytic uremic syndrome

Hypertension

Cardiac disease

Macrocytic

Normal newborn (spurious)

Reticulocytosis (spurious)

Vitamin B₁₂ deficiency

Folate deficiency

Oroticaciduria

Myelodysplasia

Liver disease

Hypothyroidism (some)

Vitamin B₆ deficiency (some)

Thiamine deficiency

RBC = red blood cell.

Classification of Anemia
Microcytic Iron deficiency Thalassemias Lead poisoning Chronic disease Infection Cancer Inflammation Renal disease Vitamin B₆ responsive Copper deficiency Sideroblastic (some) Normocytic Decreased production Aplastic anemia Congenital Acquired Pure RBC aplasia Congenital (Diamond-Blackfan) Acquired (transient erythroblastopenia) Bone marrow replacement Leukemia Tumors Storage diseases Osteopetrosis Myelofibrosis Blood loss Internal or external	Sequestration Hemolysis: Intrinsic RBC abnormalities Hemoglobinopathies Enzymopathies Membrane disorders Hereditary spherocytosis Acquired: paroxysmal nocturnal hemoglobinuria Hemolysis: Extrinsic RBC abnormalities Immunologic Passive (hemolytic disease of the newborn) Active: Autoimmune Toxins Infections Microangiopathic Disseminated intravascular coagulation (DIC) Hemolytic uremic syndrome Hypertension Cardiac disease Macrocytic Normal newborn (spurious) Reticulocytosis (spurious) Vitamin B₁₂ deficiency Folate deficiency Oroticaciduria Myelodysplasia Liver disease Hypothyroidism (some) Vitamin B₆ deficiency (some) Thiamine deficiency
RBC = red blood cell.