What Are Blood Diagnostics?

Hematopoietic diseases are commonly known as hematological diseases, which are diseases that originate in the hematopoietic system and mainly involve the hematopoietic system. Many other systems have hematological changes and can only be referred to as hematological manifestations of systemic disease. There are many causes of blood diseases, including: chemical factors, physical factors, biological factors, genetic factors, and immune factors. The symptoms and signs of hematological diseases are various, and the common ones are: anemia, bleeding, fever, lymph nodes, liver, and splenomegaly.

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Hematopoietic diseases are commonly known as hematological diseases, which are diseases that originate in the hematopoietic system and mainly involve the hematopoietic system. Many other systems have hematological changes and can only be referred to as hematological manifestations of systemic disease. There are many causes of blood diseases, including: chemical factors, physical factors, biological factors, genetic factors, and immune factors. The symptoms and signs of hematological diseases are various, and the common ones are: anemia, bleeding, fever, lymph nodes, liver, and splenomegaly.

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Hematology

Chemical factors, physical factors, biological factors, genetic factors, and immune factors can all cause blood diseases.

Chemical factor

Some drugs, such as: sulfa drugs, penicillins, quinidine, methyldopa, cephalosporins, etc. may cause hemolysis; chloramphenicol, chemotherapeutic drugs, aminopyrine, methimazole, etc. can cause bone marrow failure. Exposure to certain harmful chemicals (such as pesticides, benzene, etc.) may inhibit bone marrow hematopoiesis.

2. Physical factors

Long-term exposure to X-rays and radionuclides can directly damage hematopoietic stem cells and the bone marrow microenvironment and affect bone marrow hematopoiesis.

3. Biological factors

Many years of research have shown that human T-cell leukemia virus (an RNA retrovirus) can cause human T lymphocytic leukemia; EB virus infection is associated with many lymphatic tumors; the occurrence of some aplastic anemia may be related to hepatitis virus, Parvovirus B19 and other viral infections.

4. Genetic factors

Some blood diseases are related to heredity: thalassemia, hereditary cytosis, G-6-PD deficiency, Fanconi anemia, hemophilia A, hemophilia B and other diseases are hereditary diseases. Some genetic diseases (Down syndrome, etc.) or genetic abnormalities in the family are often accompanied by higher incidence of hematological tumors.

5. Immune factors

The occurrence of a variety of hematological diseases is related to immunity, such as: aplastic anemia, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura and other blood system diseases; the occurrence of some blood system tumors is also related to the deficiency of the immune surveillance system .

Hematological diseases can be generally divided into: red blood cell diseases, such as various types of anemia; white blood cell diseases (including: granulocytes, monocytes-macrophages, and lymphatic and plasma cell diseases, etc.), such as agranulocytosis, various types of lymphoma, Acute and chronic lymphocytic leukemia; hemostatic and thrombotic diseases, such as vascular purpura, hemophilia, idiopathic thrombocytopenia, hemophilia, etc.

The symptoms and signs of hematological diseases are various, and the common ones are: anemia, bleeding, fever, lymph nodes, liver, and splenomegaly.

Anemia

The clinical manifestations of anemia can be divided into the manifestations of the primary cause of anemia and the symptoms and signs related to anemia. Anemia-related symptoms are: weakness, fatigue, fatigue, and decreased endurance of activity are the most common and earliest symptoms; pale skin and mucous membranes are the most common objective signs; respiratory and circulatory system performance: palpitations, shortness of breath, etc .; nervous system performance : Dizziness, headache, drowsiness, drowsiness, drowsiness, tinnitus, memory loss, slow response, etc .; digestive symptoms: loss of appetite, indigestion, nausea, vomiting, etc .; urogenital symptoms: increased nocturia, low specific gravity, women Increased menstruation or secondary amenorrhea, decreased libido, etc.

2. bleeding

Bleeding is also one of the important clinical manifestations of hematological diseases. It mainly manifests as skin and mucous membrane bleeding, such as skin petechiae, purpura, ecchymosis, and hematoma. It can also be manifested as nosebleeds, bleeding gums, and menstruation. Severe patients may have visceral bleeding, such as hematuria, gastrointestinal bleeding, intracranial bleeding, and so on. A few patients can die from severe bleeding. The main causes of bleeding are vascularity, abnormalities in the quantity and quality of platelets, and disorders of the coagulation mechanism. The first two manifestations are bleeding of the skin and mucous membranes, and the coagulation mechanism disorders are mostly deep muscle hematomas and joint cavity bleeding. Severe bleeding during surgery, local compression hemostasis effect lasting more often due to abnormal blood vessels or platelets; bleeding during surgery is not serious but severe bleeding after surgery, local compression hemostasis effect is mostly due to abnormal coagulation mechanism.

3. Fever

Fever is one of the clinical manifestations of hematological diseases, but it is the first manifestation of some patients. The mechanism of fever in hematological diseases mainly includes two aspects: one is that patients' immune system is low due to decreased granulocytes or immune function, and they are susceptible to infection by various pathogens, causing infectious fever; the other is fever caused by hematological diseases themselves Most are tumor fevers, such as lymphoma, malignant histiocytosis, leukemia, and bone marrow fibrosis. Hodgkin's lymphoma often causes characteristic periodic fever.

4. Lymph nodes, liver, and spleen

Mainly seen in hematopoietic tumor infiltration or extramedullary hematopoietic due to bone marrow lesions. Found in lymphoma, lymphocytic leukemia (acute and chronic), myeloid leukemia (acute and chronic), plasma cell disease, Langerhans cell histiocytosis and malignant histiocytosis, primary myelofibrosis, Lipid deposition and so on. Severe hemolytic anemia (especially extravascular hemolysis) and hypersplenism can cause splenomegaly, but usually do not appear giant spleen.

1. Blood routine and peripheral blood smear

It can obtain multiple parameters such as the amount of hemoglobin, the number of red blood cells, the average volume of red blood cells, the number of white blood cells, the number of white blood cells, the platelet count, and other parameters. It is the most basic test method. Different hematological diseases can have different hints on the blood routine.

2. Bone marrow examination

Including bone marrow perforating fluid smears and bone marrow biopsy, it has diagnostic value for certain blood diseases (such as leukemia, myeloma, bone marrow fibrosis, etc.) and reference value (such as proliferative anemia). Further detection of histochemistry, immunohistochemistry, chromosome, molecular biology, and immunotyping of the patient's bone marrow will help in the diagnosis of hematological diseases, stratification of prognosis, and provide an important reference index for the choice of clinical treatment.

3. Examination for bleeding disorders

Including: bleeding time, coagulation time, prothrombin time, partial clay thrombin time, fibrinogen quantitative and so on. Can also be used for blood clot retraction test, platelet aggregation and adhesion test, coagulation factor quantification, coagulation factor inhibitor screening, etc., which is helpful for the diagnosis and treatment of hemostasis and thrombotic diseases, and can be used for coagulation function of patients with other hematological diseases Evaluation can help symptomatic support treatment and prevent complications in some patients during treatment.

4. Examination of hemolytic disease

Commonly used tests are free hemoglobin determination, plasma binding globin determination, Rous test, occult urinary blood (intravascular hemolysis), acid hemolysis test, sucrose hemolysis test (paroxysmal nocturnal hemoglobinuria), osmotic fragility test (hereditary spherical Polycythemia), methemoglobin reduction test (red blood cell glucose-6-phosphate dehydrogenase deficiency), anti-human globulin test (autoimmune hemolytic anemia), etc., play an important role in the diagnosis and treatment of hemolytic diseases .

5. Biochemical and immunological examination

Biochemical and immunological examinations play an important role in the diagnosis and differential diagnosis of patients, and the assessment of their physical condition. For example, the iron metabolism test of iron deficiency anemia, the detection of nutritional anemia with folic acid + vitamin B12, and the detection of autoantibodies play important roles in the differential diagnosis of idiopathic thrombocytopenic purpura. Myeloma is one of the important criteria for diagnosis. It also has certain significance in some lymphatic malignant diseases. For example, the detection of anti-platelet antibodies, red blood cell antibodies, and coagulation factor antibodies is an important indicator for the diagnosis and efficacy judgment of some diseases. Immunohistochemistry is a necessary test for the diagnosis of lymphoma.

6. Cytogenetics and molecular biology technology

Cytogenetic testing (chromosome karyotype analysis and FISH analysis) plays an increasingly important role in the diagnosis, prognosis evaluation, and efficacy analysis of hematological tumors. With the development of molecular biology technology, it plays an increasingly important role in the diagnosis, typing, prognostic stratification, and efficacy analysis of hematological malignancies.

7. Imaging diagnosis

Imaging tests include: X-ray, CT, magnetic resonance, PET-CT, etc. For some hematological diseases (especially hematological malignancies: lymphoma, multiple myeloma, etc.), it plays an important role in the diagnosis, staging, grading, and evaluation of therapeutic effects.

8. Histopathological examination

Including: bone marrow biopsy, lymph node or infiltration mass biopsy, spleen biopsy, and humoral cytopathological examination, it plays an important role in the diagnosis and prognosis of the disease. The development of immunohistochemistry in recent years has further improved the Value.

Mainly rely on detailed medical history, comprehensive physical examination, combined with targeted auxiliary examination, comprehensive analysis and diagnosis. There are many tests for blood diseases, and doctors will comprehensively analyze and comprehensively consider to select the appropriate test for diagnosis.

Certain clinical manifestations of hematological diseases, such as fever, lymph nodes, liver, and splenomegaly, are common in other systemic diseases; abnormalities in blood routine can also occur in many diseases. Therefore, differential diagnosis is particularly important for the diagnosis of blood diseases.

1. Endocrine and metabolic diseases

Many endocrine and metabolic diseases can cause abnormal blood signs, and can have the same clinical manifestations as blood diseases, such as thyroid diseases (including hyperthyroidism, Hashimoto's thyroiditis, subacute thyroiditis, and thyroid cancer) and adrenal diseases (including Pheochromocytoma, Cushing syndrome, chronic adrenal insufficiency, etc.), as well as gouty arthritis, menopausal syndrome, etc. Differential diagnosis should be made during diagnosis.

2. Infectious diseases

Infectious diseases, such as viral infections: cytomegalovirus, EB virus infection, HIV virus infection, etc .; Bacterial infections such as miliary tuberculosis, spleen abscess, etc., can cause the same clinical manifestations and abnormal blood routines as blood diseases; Some patients with hematological diseases can coexist with infectious diseases and should be identified.

3. Connective tissue disease

Connective tissue disease: systemic lupus erythematosus, dermatomyositis, sarcoidosis, rheumatism, ankylosing spondylitis, etc., can also have the same clinical manifestations and blood routine abnormalities as blood diseases.

4. Tumorous diseases

Most tumors are diagnosed without obvious hematological abnormalities. Patients with advanced metastatic tumors (especially bone marrow metastases) may have different degrees of haematological abnormalities and clinical manifestations of hematological diseases. Patients with radiotherapy and chemotherapy may have different bone marrow damage due to chemotherapy drugs and radiation The degree of blood routine abnormalities; patients with long-term survival after receiving chemoradiation may develop a second hematological tumor.

1. Treatment for blood diseases

As soon as possible, the diagnosis of the patient's blood disease is clarified, and the primary disease treatment is performed according to the specific situation.

2. General treatment

Including diet and nutrition and mental and psychotherapy.

3. Remove the cause

Remove patients from the role of pathogenic factors.

4. Maintain normal blood composition and function

1) Supplements needed for hematopoiesis

In megaloblastic anemia, supplement folic acid and / or vitamin B12; supplement iron in iron deficiency anemia.

2) Component transfusion

Red blood cells are transfused during severe anemia or blood loss, platelets are reduced, and platelets are added when there is a risk of bleeding.

3) Anti-infective treatment

For patients with infection and fever, targeted treatment can be performed according to the infection site and pathogenic bacteria of the patient.

Hematological diseases may also affect the function of other important organs, aggravate the condition, and failure to treat in time can lead to death of patients. Most patients with hematological diseases have a weakened immune system and are affected by factors such as radiotherapy and chemotherapy, which are prone to infection. Infection is a common complication of hematological diseases and one of the leading causes of death in patients.

With the continuous development of medical career, the curative effect of hematological diseases has been greatly improved. For example, acute lymphoblastic leukemia in children and acute promyelocytic leukemia in adults can obtain more than 80% of the clinical curative effect.

Avoid contact with toxic chemicals and radioactive materials. Strengthen physical exercise and physical fitness. Quit smoking and limit alcohol. Regular medical examination.