Issue of September 9, 2018
Mt. Province

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Blood diseases

Laboratory tests are done to diagnose a blood disease. Blood tests measure the function and cellular components of the blood itself while other tests measure the function of body organs whose dysfunction can give rise to a blood disease. The results of blood tests are interpreted by a doctor in light of the person’s condition:

1. Complete blood count (CBC) is the most commonly performed blood test and provides the number of blood cells and platelets, percentage of each type of white blood cells, the size and shape of red blood cells, and hemoglobin and hematocrit (percentage of red blood cells). Reticulocyte count shows the number of newly formed red blood cells in the circulation. Reticulocytes normally comprise only one percent of the total red blood cell count and increase in their number means the bone marrow is producing more red blood cells to compensate for body needs, such as in anemia when there are low blood levels of oxygen. Reticulocyte count also measures bone marrow response/function.

White blood cell count shows the total and differential count of leukocytes in the blood. It guides doctors in assessing and managing cases of infection like blood cancer such as leukemia.

2. Bone marrow examination. A sample of the bone marrow may be necessary to further evaluate a patient suspected to have a blood disease. A bone marrow aspirate or core biopsy is usually taken from the iliac crest (hipbone) in adults and from the vertebra (backbone) or tibia (leg bone) in children.

Diseases involving cellular components of the blood can either be due to underproduction or overproduction of the cells. Anemia is the condition in which the number of red blood cells or the amount of hemoglobin is low. Because the amount of oxygen delivered by red cells to body cells and tissues is low, the anemic patient develops signs and symptoms arising from low oxygen supply. The patient easily gets tired, feels weak, has low exercise tolerance, or would complain of light-headedness. Chest pain may occur if the patient has underlying heart disease.

Anemia may be due to the excessive loss of blood, decreased red blood cell production, or increased red blood cell destruction.

Excessive bleeding is the most common cause of anemia. Sudden blood loss may occur during accidents, surgery, rupture of a blood vessel, or complications of childbirth. When blood is lost, water from cells and tissues move to the circulation as a basic response of the body to preserve effective circulating blood volume, blood pressure and thus continue to adequately supply oxygen and nutrients to different parts of the body especially the most important organs (vital organs). The blood thus becomes diluted and the percentage of red blood cells is decreased. If the blood loss is sudden and excessive, blood flow to vital organs becomes low and the patient may develop a heart attack, stroke, or may die. Otherwise, increased bone marrow production of red blood cells may gradually compensate for the blood loss.

The body gradually then compensates by increasing red blood cell production to correct the anemia.

Anemia may also occur from chronic bleeding due to ulcers in the stomach or small intestine, cancers and polyps in the large intestine, bleeding hemorrhoids, repeated nosebleeds, heavy menstrual flow, and urinary bladder or kidney tumors.

How fast the blood loss occurs determines a patient’s signs and symptoms. When blood loss is fast, loss of more than 20 percent of blood can lead to loss of life. When blood loss is slower, occurring over several days to weeks or months, the loss of the same amount of blood may cause only tiredness and weakness or the patient may not feel anything at all because the body slowly adjusts/compensates for the anemia. Serious health problems like heart disease may however slowly develop. Prolonged and uncorrected anemia may cause the heart (considered a muscle by itself) to work harder, pump more blood to maintain continuous oxygenation of body cells and tissues. In the process, the heart walls thicken (heart enlargement seen on chest x-ray or hypertrophy seen on electrocardiogram or Ecg) and heart attack or heart failure may occur.

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Medical questions and concerns may be emailed to or Answers will be emailed or will be provided in the column.

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