[醫如往常] Senior Clerkship Day 93: Lab Medicine: 藍紅黃綠紫灰黑

20161123

李醫師

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Good Marker

• Sensitivity
• Specific
• Low molecular weight
• Long half life

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Syncope

VT

• >120 /min
• 1/3
• AV dissociation
• Capture beat
• Fusion beat

V1 rbbb

Lbbb

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Pacemaker

• Subclavian vein
• LBBB

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ANB monocyte

CAE eosinophil

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Cytospin

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AML

Cd34 immature

Cd11b, 15 mature

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A Coulter counter [1] [2] is an apparatus for counting and sizing particles suspended in electrolytes. It is used for cells, bacteria, prokaryotic cells and virus particles.[3]

A typical Coulter counter has one or more microchannels that separate two chambers containing electrolyte solutions. As fluid containing particles or cells is drawn through each microchannel, each particle causes a brief change to the electrical resistance of the liquid. The counter detects these changes in electrical resistance.

來自 <https://en.wikipedia.org/wiki/Coulter_counter>

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CML

Basophil

Eosinophil

Megakaryocytes small

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藍紅黃綠紫灰黑

• Blue 3.2% citrate (以前用3.6%): PT, aPTT 
• 採血量較少時，依1:9比例使用。
• 紅: 生化
• 黃
• 綠色 heparin: NH3, LDH
• Purple EDTA: CBC, Hb 電泳, HbA1C
• Gray NaF EDTA: glucose

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ACD 淺黃 lymphocytes

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胡助教授

血小板生命 兩周

全血 四個月

Fy-ab (-) 有anti-malaria效果，非洲人很多

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MCHC 正常值33+-3 代表RBC central pale zone的比例
RDWCV 正常值13+-1.5

Ret 正常<2%

IRF(Immature Retic Fraction)=(HFR+MFR)/Reticulocyte 正常<20%

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遇到Platelet EDTA agglutination

改用citrate

MDS plt沒有granule會不準確

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NTUH每天6000個CBC 常規35項

1200要做WBC differential

300機器會自動染色觀看

60個需要人工染色

NTUH是大宗的

所以NHI打七折給付

Positive: 異常

• count
• differential
• morphology

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Chédiak–Higashi syndrome[1] is a rare autosomal recessive disorder that arises from a mutation of a lysosomal trafficking regulator protein,[2] which leads to a decrease in phagocytosis. The decrease in phagocytosis results in recurrent pyogenic infections, partial albinism and peripheral neuropathy. It occurs in humans, cattle, blue Persian cats, Australian blue rats,[3] mice,[4] mink,[4] foxes,[4] and the only known captive albino orca.[5]

https://www.wikiwand.com/en/Ch%C3%A9diak%E2%80%93Higashi_syndrome

<http://memim.com/chediak-higashi-syndrome.html>

<http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/chediak-higashi_syndrome.aspx>

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