Blood Science

Blood Science is a relatively new discipline which merges biochemistry, haematology, immunology, transfusion science and genetics. This bringing together of traditional disciplines requires a corresponding change in education and training for healthcare scientists and Blood Science: Principles and Pathology is written in response to this emerging need. An introduction to the subject and an overview of the techniques used in blood science are followed by a series of chapters based on groups of analytes investigated in blood - red blood cells, white blood cells and platelets, followed by the constituents of plasma, including waste products, electrolytes, glucose, lipids, enzymes, hormones, nutrients, drugs, poisons and others. Each chapter is supported by learning objectives, summaries and further information, and a focus is given to chapter specific case studies with interpretation to demonstrate how laboratory data in conjunction with clinical details is utilised when investigating patients with actual or suspected disease. Finally, a separate chapter offers more detailed case reports that integrate the different aspects of blood science. Undergraduate students taking blood science modules as part of their BSc programmes in Biomedical and Healthcare Sciences will appreciate the level of integration between clinical biochemistry and haematology. In addition, this book will provide suitable initial reading for those students embarking on blood science modules on MSc programmes and will be of value to new graduates entering the profession and starting their career in blood science departments by supplementing practice-based training with the required theoretical underpinning. This book is approved by the Institute of Biomedical Science and written by its expert writers, many of whom work on the Institute s advisory panels.

Blood Science is a relatively new discipline which merges biochemistry, haematology, immunology, transfusion science and genetics. This bringing together of traditional disciplines requires a corresponding change in education and training for healthcare scientists and Blood Science: Principles and Pathology is written in response to this emerging need.An introduction to the subject and an overview of the techniques used in blood science are followed by a series of chapters based on groups of analytes investigated in blood - red blood cells, white blood cells and platelets, followed by the constituents of plasma, including waste products, electrolytes, glucose, lipids, enzymes, hormones, nutrients, drugs, poisons and others.Each chapter is supported by learning objectives, summaries and further information, and a focus is given to chapter specific case studies with interpretation to demonstrate how laboratory data in conjunction with clinical details is utilised when investigating patients with actual or suspected disease. Finally, a separate chapter offers more detailed case reports that integrate the different aspects of blood science.Undergraduate students taking blood science modules as part of their BSc programmes in Biomedical and Healthcare Sciences will appreciate the level of integration between clinical biochemistry and haematology. In addition, this book will provide suitable initial reading for those students embarking on blood science modules on MSc programmes and will be of value to new graduates entering the profession and starting their career in blood science departments by supplementing practice-based training with the required theoretical underpinning.This book is approved by the Institute of Biomedical Science and written by its expert writers, many of whom work on the Institute's advisory panels.

Preface, xiiiAcknowledgements, xvList of Abbreviations, xviiAbout the Companion Website, xxi1 Introduction to Blood Science, 11.1 What is blood science?, 11.2 Biochemistry, 61.3 Blood transfusion, 81.4 Genetics, 101.5 Haematology, 141.6 Immunology, 171.7 The role of blood science in modern healthcare, 191.8 What this book will achieve, 22Summary, 23References, 23Further reading, 23Web sites, 232 Analytical Techniques in Blood Science, 252.1 Venepuncture, 252.2 Anticoagulants, 262.3 Sample identification and tracking, 272.4 Technical and analytical confidence, 272.5 Major techniques, 322.6 Molecular genetics, 432.7 Point of care testing, 472.8 Health and safety in the laboratory, 48Summary, 49Further reading, 50Web sites, 503 The Physiology of the Red Blood Cell, 513.1 Introduction, 513.2 The development of blood cells, 523.3 Erythropoiesis, 563.4 The red cell membrane, 583.5 The cytoplasm of the red cell, 603.6 Oxygen transport, 663.7 Recycling the red cell, 683.8 Red cell indices in the full blood count, 693.9 Morphology of the red cell, 72Summary, 74Further reading, 744 The Pathology of the Red Blood Cell, 754.1 Introduction: diseases of red cells, 754.2 Anaemia resulting from attack on, or stress to, the bone marrow, 784.3 Anaemia due to deficiency, 804.4 Intrinsic defects in the red cell, 854.5 External factors acting on healthy cells, 1004.6 Erythrocytosis and polycythaemia, 1034.7 Molecular genetics and red cell disease, 1054.8 Inclusion bodies, 1054.9 Case studies, 105Summary, 107References, 107Further reading, 1075 White Blood Cells in Health and Disease, 1095.1 Introduction, 1095.2 Leukopoiesis, 1115.3 Neutrophils, 1155.4 Lymphocytes, 1165.5 Monocytes, 1175.6 Eosinophils, 1185.7 Basophils, 1195.8 Leukocytes in action, 1205.9 White cells in clinical medicine, 1275.10 Case studies, 132Summary, 132Further reading, 1336 White Blood Cell Malignancy 1356.1 The genetic basis of leukocyte malignancy, 1356.2 Tissue techniques in haemato-oncology, 1396.3 Leukaemia, 1416.4 Lymphoma, 1496.5 Myeloma and related conditions, 1526.6 Myelofibrosis and myelodysplasia, 1576.7 Case studies, 157Summary, 158Further reading, 159Guidelines, 1597 The Physiology and Pathology of Haemostasis, 1617.1 The blood vessel wall, 1627.2 Platelets, 1637.3 The coagulation pathway, 1657.4 Haemostasis as the balance between thrombus formation and removal, 1687.5 The haemostasis laboratory, 1717.6 The pathology of thrombosis, 173Summary, 175Further reading, 1758 The Diagnosis and Management of Disorders of Haemostasis, 1778.1 Thrombosis 1: overactive platelets and thrombocytosis, 1778.2 Thrombosis 2: overactive coagulation, 1818.3 Haemorrhage 1: platelet underactivity and thrombocytopenia, 1938.4 Haemorrhage 2: coagulation underactivity, 1998.5 Disseminated intravascular coagulation, 2038.6 Molecular genetics in haemostasis, 2048.7 Case studies, 205Summary, 206References, 206Further reading, 207Guidelines, 207Web sites, 2079 Immunopathology, 2099.1 Introduction, 2099.2 Basics of the immune system, 2109.3 Humoral immunity, 2129.4 Immunopathology 1: immunodeficiency, 2159.5 Immunopathology 2: hypersensitivity, 2219.6 Immunopathology 3: autoimmune disease, 2269.7 Immunotherapy, 2329.8 The immunology laboratory, 2349.9 Case studies, 238Summary, 239References, 240Further reading, 240Guidelines, 240Web sites, 24010 Immunogenetics and Histocompatibility, 24110.1 The genetics of antigen recognition, 24110.2 Human leukocyte antigens, 24510.3 Transplantation, 25110.4 Autoimmunity and human leukocyte antigens, 257Summary, 260Further reading, 260Guidelines, 260Web sites, 26011 Blood Transfusion, 26111.1 Blood collection and processing, 26211.2 Blood groups, 26511.3 Laboratory practice of blood transfusion, 27311.4 Clinical practice of blood transfusion, 27911.5 Hazards of blood transfusion, 281Summary, 284References, 284Further reading, 284Guidelines, 284Web sites, 28512 Waste Products, Electrolytes and Renal Disease, 28712.1 Renal anatomy and physiology, 28712.2 Homeostasis, 28812.3 Excretion, 29512.4 Renal endocrinology, 29712.5 Renal disease, 29812.6 Case studies, 301Summary, 303Further reading, 303Guidelines, 303Web sites, 30313 Hydrogen Ions, pH, and Acid-Base Disorders, 30513.1 Ions and molecules, 30513.2 Blood gases, 30813.3 Acidosis (pH13.4 Alkalosis (pH >7.5), 31313.5 Mixed acid-base conditions, 31413.6 Clinical interpretation, 31413.7 Case studies, 315Summary, 316Further reading, 317Web site, 31714 Glucose, Lipids and Atherosclerosis, 31914.1 Glucose, 31914.2 Dyslipidaemia, 33314.3 Atherosclerosis, 34314.4 Case studies, 347Summary, 348Further reading, 348Guidelines, 349Web sites, 34915 Calcium, Phosphate, Magnesium and Bone Disease, 35115.1 Calcium, 35215.2 Phosphates, 35515.3 Magnesium, 35515.4 The laboratory, 35515.5 Disorders of calcium homeostasis, 35715.6 Disorders of phosphate homeostasis, 36015.7 Disorders of magnesium homeostasis, 36215.8 Bone physiology, 36315.9 Bone disease, 36415.10 Case studies, 368Summary, 369Further reading, 370Guidelines, 370Web sites, 37016 Nutrients and Gastrointestinal Disorders, 37116.1 Nutrients, 37116.2 The intestines, 37516.3 Case studies, 381Summary, 382Further reading, 382Guidelines, 38217 Liver Function Tests and Plasma Proteins, 38317.1 Anatomy and physiology of the liver, 38417.2 Liver function tests, 38917.3 Diseases of the liver, 39017.4 Plasma proteins, 39617.5 Case studies, 405Summary, 406Further reading, 406Web sites, 40618 Hormones and Endocrine Disorders, 40718.1 Endocrine physiology, 40718.2 The pathology of the endocrine system, 41718.3 Case studies, 434Summary, 435Further reading, 435Web sites, 43619 Cancer and Tumour Markers, 43719.1 General concepts in cancer biology, 43719.2 Blood science and cancer, 44019.3 Molecular genetics, 44419.4 Case studies, 445Summary, 446Further reading, 446Guidelines, 447Web sites, 44720 Inherited Metabolic Disorders, 44920.1 The genetics of inheritance, 44920.2 Molecular inherited metabolic disorders, 45120.3 Organelle inherited metabolic disorders, 45520.4 Antenatal diagnosis and neonatal screening, 45520.5 Case studies, 456Summary, 457Further reading, 45721 Drugs and Poisons, 45921.1 Toxicology, 45921.2 Toxicology of specific compounds, 46121.3 Therapeutic drug monitoring, 46521.4 Case studies, 468Summary, 469References, 469Further reading, 46922 Case Reports in Blood Science, 471Abbreviations, 471Case report 1, 472Anaemia, hypercalcaemia, proteinuria, myelomaCase report 2, 473Diabetes, glycated haemoglobin, chronic renal failureCase report 3, 474Acute kidney injury, leucocytosis, neutrophilia, virusesCase report 4, 475Part 1: Obesity, colorectal cancer, CEA, hypothyroidism. Part 2: Alcoholism, raised GGT and triacylglycerolsCase report 5, 477Part 1: No abnormalities. Part 2: Asthma, raised IgE. Part 3: Falling haemoglobin, rising ESR, lung cancerCase report 6, 479Hypothyroidism, marginally reduced haemoglobinCase report 7, 480Raised CRP, ESR, rheumatoid factor and anti-nuclear antibodies; borderline anti-dsDNA antibodies, low C3, low eGFR and so mild renal failure, systemic lupus erythematosusCase report 8, 481Normal blood results in renal transplantationCase report 9, 482Falling albumin, eGFR, haemoglobin, red cell count and platelets, rising ESR, white cell count and neutrophila, CRP, urea and creatinine, septicaemiaCase report 10, 484Microcytic anaemia, thrombocytopenia, lymphocytosis, abnormal LFTs, falling albumin, raised CRP, myositis with raised CK, virusesCase report 11, 486Acidosis, hyperglycaemia, diabetic ketoacidosis, acute renal injury, raised urea and creatinineCase report 12, 487Low haemoglobin, thrombocytopenia, raised CRP and d-dimers, abnormal LFTs, malaria, pregnancyCase report 13, 488Raised aldosterone, hypernatraemia, hypokalaemia, Conn's syndrome Case report 14, 489Paediatric diabetic ketoacidosis, hyperglycaemia, low bicarbonate, raised phosphates, ALP and proteinsReferences, 490Appendix: Reference Ranges, 491Further Reading, 493Glossary, 495Index, 519