Rodak’s Hematology: clinical principles and applications

917 Pages·2016·29.2 MB·English

by  Smith, Keohane, Elaine M., Rodak, Bernadette F.

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Unless otherwise noted, data for reference interval tables were compiled from multiple sources and may vary slightly from
intervals listed within chapters. Each laboratory must establish its particular intervals based on its instrumentation, meth-
odology and demographics of the population it serves.

Hematology/Hemostasis Reference Intervals

COMPLETE BLOOD COUNT REFERENCE INTERVALS (ADULT)
Assay
Units
Reference Intervals

RBC, male
3 106/µL (3 1012/L)
4.20–6.00

RBC, female
3 106/µL (3 1012/L)
3.80–5.20

HGB, male
g/dL (g/L)
13.5–18.0
(135–180)

HGB, female
g/dL (g/L)
12.0–15.0
(120–150)

HCT, male
% (L/L)
40–54
(0.40–0.54)

HCT, female
% (L/L)
35–49
(0.35–0.49)

MCV
fL
80–100

MCH
pg
26–34

MCHC
g/dL
32–36

RDW
%
11.5–14.5

RETIC
3 103/µL (3 109/L)
20–115

RETIC
%
0.5–2.5

NRBC
/100 WBC
0

WBC
3 103/µL (3 109/L)
3.6–10.6

NEUT
%
50–70

NEUT (ANC)
3 103/µL (3 109/L)
1.7–7.5

LYMPH
%
18–42

LYMPH
3 103/µL (3 109/L)
1.0–3.2

MONO
%
2–11

MONO
3 103/µL (3 109/L)
0.1–1.3

EO
%
1–3

EO
3 103/µL (3 109/L)
0–0.3

BASO
%
0–2

BASO
3 103/µL (3 109/L)
0–0.2

PLT
3 103/µL (3 109/L)
150–450

MPV
fL
7.0–12.0

Assay
Units
Reference Intervals

ESR, male (Westergren)
mm 1 hour
0–15 (0250 y)
0–20 (.50 y)

Serum iron
µg/dL
50–160

Total iron-binding

capacity

µg/dL
250–400

Transferrin saturation
%
20–55

Serum ferritin, male
ng/mL
40–400

Serum ferritin, female
ng/mL
12–160

ESR, female

(Westergren)

mm 1 hour
0–20 (0250 y)
0–30 (.50 y)

Serum vitamin B12
pg/mL
200–900

Serum folate
ng/mL
. 4.0

RBC folate
ng/mL
. 120

Haptoglobin
mg/dL
30–200

Free serum hemoglobin
mg/dL
0–10

HEMOGLOBIN FRACTION REFERENCE INTERVALS
Fraction
Adult Reference Intervals (%)
Newborn Reference Intervals (%)

Hb A
. 95
10–40

Hb F
0–2.0
60–90

Hb A2
0–3.5

Assay
Units
Reference Intervals

REFERENCE INTERVALS FOR OTHER COMMONLY ORDERED TESTS (ADULTS)

Assay
Units
Reference Intervals

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COMPLETE BLOOD COUNT REFERENCE INTERVALS (PEDIATRIC)

BONE MARROW ASPIRATE REFERENCE INTERVALS (ADULT)
WBC Differential
Reference Intervals (%)
Erythrocyte Series
Reference Intervals (%)

Blasts
0–3

Promyelocytes
1–5
Pronormoblasts
0–1

N. myelocytes
6–17
Basophilic NB
1–4

N. metamyelocytes
3–20
Polychromatophilic NB
10–20

N. bands
9–32
Orthochromic NB
6–10

N. segmented (polymorphonuclear)
7–30

Eosinophils
0–3
Other

Basophils
0–1
M:E ratio
1.5–3.3:1

Lymphocytes
5–18
Megakaryocytes
2–10/lpf

Plasma cells
0–1

Monocytes
0–1

Histiocytes (macrophages)
0–1

Assay Units
0–1 d
2–4 d
5–7 d
8–14 d
15–30 d 1–2 mo
3–5 mo
6–11 mo
1–3 y
4–7 y
8–13 y

RBC
3 106/µL

(3 1012/L)

4.10–6.10
4.36–5.96
4.20–5.80
4.00–5.60
3.20–5.00
3.40–5.00
3.65–5.05
3.60–5.20
3.40–5.20
4.00–5.20
4.00–5.40

HGB
g/dL (g/L)
16.5–21.5
(165–215)

16.4–20.8
(164–208)

15.2–20.4
(152–204)

15.0–19.6
(150–196)

12.2–18.0
(122–180)

10.6–16.4
(106–164)

10.4–16.0
(104–160)

10.4–15.6
(104–156)

9.6–15.6
(96–156)

10.2–15.2
(102–152)

12.0–15.0
(120–150)

HCT
%
48–68
48–68
50–64
46–62
38–53
32–50
35–51
35–51
34–48
36–46
35–49

MCV
fL
95–125
98–118
100–120
95–115
93–113
83–107
83–107
78–102
76–92
78–94
80–94

MCH
pg
30–42
30–42
30–42
30–42
28–40
27–37
25–35
23–31
23–31
23–31
26–32

MCHC
g/dL
30–34
30–34
30–34
30–34
30–34
31–37
32–36
32–36
32–36
32–36
32–36

RDW
%
*
*
*
*
*
*
*
11.5–14.5
11.5–14.5
11.5–14.5
11.5–14.5

RETIC
%
1.8–5.8
1.3–4.7
0.2–1.4
0–1.0
0.2–1.0
0.8–2.8
0.5–1.5
0.5–1.5
0.5–1.5
0.5–1.5
0.5–1.5

RETIC
3 103/µL

(3 109/L)

73.8–353.8
56.7–280.1
8.4–81.2
0.0–56.0
6.4–50.0
27.2–140.0
18.3–75.8
18.0–78.0
17.0–78.8
20–78.0
20–124.2

NRBC
/100 WBC
2–24
5–9
0–1
0
0
0
0
0
0
0
0

WBC
3 103/µL

(3 109/ L)

9.0–37.0
8.0–24.0
5.0–21.0
5.0–21.0
5.0–21.0
6.0–18.0
6.0–18.0
6.0–18.0
5.5–17.5
5.0–17.0
4.5–13.5

NEUT

(ANC)

3 103/µL

(3 109/L)

3.7–30.0
2.6–17.0
1.5–12.6
1.2–11.6
1.0–9.5
1.2–8.1
1.1–7.7
1.2–8.1
1.2–8.9
1.5–11.0
1.6–9.5

LYMPH
3 103/µL

(3 109/L)

1.6–14.1
1.3–11.0
1.2–11.3
1.5–13.0
2.1–12.8
2.5–13.0
2.7–13.5
2.9–14.0
2.0–12.8
1.5–11.1
1.0–7.2

MONO
3 103/µL

(3 109/L)

0.1–4.4
0.2–3.4
0.2–3.6
0.2–3.6
0.1–3.2
0.2–2.5
0.1–2.0
0.1–2.0
0.1–1.9
0.1–1.9
0.1–1.5

EO
3 103/µL

(3 109/L)

0.0–1.5
0.0–1.2
0.0–1.3
0.0–1.1
0.0–1.1
0.0–0.7
0.0–0.7
0.0–0.7
0.0–0.7
0.0–0.7
0.0–0.5

BASO
3 103/µL

(3 109/L)

0.0–0.7
0.0–0.5
0.0–0.4
0.0–0.4
0.0–0.4
0.0–0.4
0.0–0.4
0.0–0.4
0.0–0.4
0.0–0.3
0.0–0.3

PLT
3 103/µL

(3 109/L)

150–450
150–450
150–450
150–450
150–450
150–450
150–450
150–450
150–450
150–450
150–450

*The RDW is markedly elevated in newborns, with a range of 14.2% to 19.9% in the first few days of life, gradually decreasing until it reaches adult levels by 6 months of age.
Pediatric reference intervals are from Riley Hospital for Children, Indiana University Health, Indianapolis, IN.

Some reference intervals are listed in common units and in international system of units (SI units) in parenthesis.
ANC, absolute neutrophil count (includes segmented neutrophils and bands); BAND, neutrophil bands; BASO, basophils; d, days; EO, eosinophils; ESR, erythrocyte sedimentation rate;
Hb, hemoglobin fraction; HCT, hematocrit; HGB, hemoglobin; lpf, low power field; LYMPH, lymphocytes; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV,
mean cell volume; M:E, myeloid:erythroid; mo, month; MONO, monocytes; MPV, mean platelet volume; N, neutrophilic; NB, normoblast; NEUT, neutrophils; NRBC, nucleated red blood
cells; PLT, platelets; RBC, red blood cells; RDW, red blood cell distribution width; RETIC, reticulocytes; WBC, white blood cells; y, year.

Please see inside back cover for additional reference interval tables.

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Hematology
CLINICAL PRINCIPLES AND APPLICATIONS

RODAK’S

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Hematology

RODAK’S

Elaine M. Keohane, PhD, MLS
Chair and Professor, Department

of Clinical Laboratory Sciences

School of Health Related Professions
Rutgers, The State University of New Jersey
Newark, New Jersey
Larry J. Smith, PhD, SH(ASCP),
HCLD/CC(ABB)
Assistant Attending Scientist and Director,

Coagulation Laboratory

Department of Laboratory Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Adjunct Professor, Department of Health Professions
York College, The City University of New York
Jamaica, New York
Adjunct Associate Professor, Department of Clinical

Laboratory Sciences

School of Health Related Professions
Rutgers, The State University of New Jersey
Newark, New Jersey

CLINICAL PRINCIPLES AND APPLICATIONS

Fifth Edition

Jeanine M. Walenga, PhD,
MT(ASCP)
Professor, Thoracic-Cardiovascular Surgery, Pathology,

and Physiology

Co-Director, Hemostasis and Thrombosis Research Unit
Stritch School of Medicine
Loyola University Chicago
Maywood, Illinois
Director, Clinical Coagulation Core Laboratory and

Special Coagulation Laboratory

Director, Urinalysis and Medical Microscopy
Associate Director, Point of Care Testing
Loyola University Hospital
Maywood, Illinois

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St. Louis, Missouri 63043

RODAK’S HEMATOLOGY: CLINICAL PRINCIPLES
AND APPLICATIONS, FIFTH EDITION
ISBN: 978-0-323-23906-6

Copyright © 2016, 2012, 2007, 2002, 1995 by Saunders, an imprint of Elsevier Inc.

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To my students for being great teachers, and to

Camryn, Riley, Harper, Stella, Jackie, Alana, Ken, and Jake

for reminding me about the important things in life.

EMK

To my wonderful mentors and students who have taught me

so much about laboratory medicine.

LJS

To my teachers, both formal and informal, for all this

fascinating knowledge in clinical laboratory sciences which

made possible my interesting career.

JMW

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Special Dedication

To Bernadette “Bunny” F. Rodak, with great admiration and

gratitude for your vision, perseverance, and courage to first

publish Hematology: Clinical Principles and Applications

in 1995; for your over 20-year commitment to publish the

highest quality text through five editions; for your mentorship
and guidance of five co-editors and over 50 authors; and for
sharing your great enthusiasm for hematology and hemostasis

and lifelong learning that has inspired a generation of

students and faculty in this country and around the world.

Special Acknowledgment

To George A. Fritsma, with our sincere gratitude for your

dedication and reasoned approach that has kept Hematology:
Clinical Principles and Applications at the leading edge as
a comprehensive, state-of-the-art, yet practical textbook, guided
by you as co-editor for two editions and through the multiple
number of chapters that you have authored. We are indebted

to you for sharing your vast knowledge in hematology

and hemostasis and for your unwavering commitment to

the profession of clinical laboratory science.

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vii

Reviewers

Keith Bellinger, PBT(ASCP)
Medical Technologist
The United States Department of Veterans Affairs New Jersey

Health Care System

East Orange, New Jersey;
Adjunct Assistant Professor, Clinical Laboratory Sciences
Rutgers, The State University of New Jersey
Newark, New Jersey

Susan Conforti, EdD, MLS(ASCP)SBB
Associate Professor, Medical Laboratory Technology
Farmingdale State College
Farmingdale, New York

Shamina Davis, MS, MT(ASCP)
Faculty, College of Biomedical Sciences and Health

Professions

University of Texas at Brownsville
Brownsville, Texas

Kathleen Doyle, PhD, M(ASCP), MLS(ASCP)CM

Medical Laboratory Scientist, Consultant
Professor Emeritus, Clinical Laboratory and Nutritional

Sciences

University of Massachusetts Lowell
Lowell, Massachusetts

Michele Harms, MS, MLS(ASCP)
Program Director, School of Medical Technology
WCA Hospital
Jamestown, New York

Jeanne Isabel, MS, MT(ASCP), CLSpH(NCA)
Associate Professor and Program Director,

Allied Health and Communicative Disorders

Northern Illinois University
DeKalb, Illinois

Steve Johnson, MS, MT(ASCP)
Program Director, School of Medical Technology
Saint Vincent Health Center
Erie, Pennsylvania

Haywood B. Joiner, Jr., EdD, MT(ASCP)
Chair, Department of Allied Health
Louisiana State University at Alexandria
Alexandria, Louisiana

Amy R. Kapanka, MS, MT(ASCP)SC
MLT Program Director
Hawkeye Community College
Waterloo, Iowa

Linda Kappel, MLT(FCP, CAET)
Instructor, Medical Diagnostics
Saskatchewan Polytechnic, Saskatoon Campus
Saskatoon, Saskatchewan, Canada

Linda J. McCown, PhD, MLS(ASCP)CM

Chair and Program Director, Clinical Laboratory Science
University of Illinois Springfield
Springfield, Illinois

Christine Nebocat, MS, MT(ASCP)CM

Assistant Professor
Farmingdale State College
Farmingdale, New York

Tania Puro, CLS, MS, MT(ASCP)
Instructor, Clinical Lab Science Program
San Francisco State University
San Francisco, California

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viii

Contributors

Sameer Al Diffalha, MD
Pathology Resident PGY3
Loyola University Medical Center
Maywood, Illinois

Larry D. Brace, PhD, MT(ASCP)SH
Clinical Pathology/Laboratory Consultant
Emeritus Professor of Pathology
University of Illinois at Chicago
Chicago, Illinois;
Scientific Director of Laboratories
Laboratory and Pathology Diagnostics at Edward Hospital
Naperville, Illinois

Karen S. Clark, BS, MT(ASCP)SH
Point of Care Manager
Baptist Memorial Hospital
Memphis, Tennessee

Magdalena Czader, MD, PhD
Director, Division of Hematopathology
Director, Clinical Flow Cytometry Laboratory
Department of Pathology and Laboratory Medicine
Indiana University School of Medicine
Indianapolis, Indiana

Kathryn Doig, PhD, MLS(ASCP)CMSH(ASCP)CM

Professor, Biomedical Laboratory Diagnostics
College of Natural Science
Michigan State University
East Lansing, Michigan

Sheila A. Finch, CHSP, CHMM, MS, BS, MT(ASCP)
Executive Director, Environment of Care/Emergency

Management

Detroit Medical Center
Detroit, Michigan

George A. Fritsma, MS, MLS
Manager
The Fritsma Factor, Your Interactive Hemostasis Resource
Birmingham, Alabama

Margaret G. Fritsma, MA, MT(ASCP)SBB
Associate Professor, Retired
School of Health Professions
Division of Laboratory Medicine,

Department of Pathology

University of Alabama at Birmingham
Birmingham, Alabama

Pranav Gandhi, MD, MS
Hematopathology Fellow
Scripps Clinic
La Jolla, California

Bertil Glader, MD, PhD
Professor, Pediatric Hematology/Oncology
Stanford University
Palo Alto, California

Linda H. Goossen, PhD, MT(ASCP)
Professor, Medical Laboratory Science
Associate Dean, College of Health Professions
Grand Valley State University
Grand Valley, Michigan

Teresa G. Hippel, BS, MT(ASCP)SH
Laboratory Manager
Baptist Memorial Hospital
Memphis, Tennessee

Debra A. Hoppensteadt, BS, MT(ASCP),

MS, PhD, DIC

Professor of Pathology and Pharmacology
Loyola University Chicago
Maywood, Illinois

Cynthia L. Jackson, PhD
Director of Clinical Molecular Biology
Lifespan Academic Medical Center
Associate Professor of Pathology
Warren Alpert Medical School at Brown University
Providence, Rhode Island

Ameet R. Kini, MD, PhD
Director, Division of Hematopathology
Medical Director, Hematology & Flow Cytometry
Associate Director, Molecular Diagnostics
Associate Professor of Pathology,

Stritch School of Medicine

Loyola University Medical Center
Maywood, Illinois

Clara Lo, MD
Instructor, Pediatric Hematology/Oncology
Stanford University
Palo Alto, California

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Contributors
ix

Sharral Longanbach, MT, SH(ASCP)
Senior Technical Application Specialist
Siemens Healthcare Diagnostics
Deerfield, Illinois

Lynn B. Maedel, MS, MLS(ASCP)CMSHCM

Executive Director
Colorado Association for Continuing Medical

Laboratory Education, Inc. (CACMLE)

Denver, Colorado

Naveen Manchanda, MBBS
Associate Professor of Clinical Medicine, Division of

Hematology-Oncology

Indiana University School of Medicine
Indianapolis, Indiana

Steven Marionneaux, MS, MT(ASCP)
Manager, Clinical Hematology Laboratories
Memorial Sloan Kettering Cancer Center
New York, New York
Adjunct Assistant Professor, Clinical Laboratory Sciences
Rutgers, The State University of New Jersey
Newark, New Jersey

Richard C. Meagher, PhD
Section Chief, Cell Therapy Laboratory
Department of Laboratory Medicine
Memorial Sloan Kettering Cancer Center
New York, New York

Shashi Mehta, PhD
Associate Professor, Clinical Laboratory Sciences
School of Health Related Professions
Rutgers University, The State University of New Jersey
Newark, New Jersey

Martha K. Miers, MS, MBA
Assistant Professor, Division of Medical Education

and Administration

Vice Chair, Finance and Administration
Department of Pathology, Microbiology, and Immunology
Vanderbilt University School of Medicine
Nashville, Tennessee

JoAnn Molnar, MT(ASCP)
Core Laboratory Technical Specialist
Loyola University Medical Center
Maywood, Illinois

Kim A. Przekop, MBA, MLS(ASCP)CM

Assistant Professor, Clinical Laboratory Sciences
School of Health Related Professions
Rutgers, The State University of New Jersey
Newark, New Jersey

Tim R. Randolph, PhD, MT(ASCP)
Chair and Associate Professor, Department of Biomedical

Laboratory Science

Doisy College of Health Sciences
Saint Louis University
St. Louis, Missouri

Bernadette F. Rodak, MS, CLSpH(NCA),

MT(ASCP)SH

Professor, Clinical Laboratory Science Program
Department of Pathology and Laboratory Medicine
Indiana University School of Medicine
Indianapolis, Indiana

Woodlyne Roquiz, DO
Hematopathology Fellow
Loyola University Medical Center
Maywood, Illinois

Kathleen M. Sakamoto, MD, PhD
Professor and Chief, Division of Hematology/Oncology
Department of Pediatrics
Stanford University School of Medicine
Lucile Packard Children’s Hospital at Stanford
Stanford, California

Gail H. Vance, MD
Sutphin Professor of Cancer Genetics
Department of Medical and Molecular Genetics
Indiana University School of Medicine
Indianapolis, Indiana
Staff Physician
Indiana University Health Hospitals
Carmel, Indiana

Instructor and Student Ancillaries

Case Studies, Instructor’s Guide, Test Bank
Susan Conforti, EdD, MLS(ASCP)SBB
Associate Professor, Medical Laboratory Technology
Farmingdale State College
Farmingdale, New York

PowerPoint Slides
Kathleen Doyle, PhD, M(ASCP), MLS(ASCP)CM

Medical Laboratory Scientist, Consultant
Professor Emeritus, Clinical Laboratory and

Nutritional Sciences

University of Massachusetts Lowell
Lowell, Massachusetts

PowerPoint Slides
Carolina Vilchez, MS, MLS(ASCP)H
Assistant Professor, Clinical Laboratory Sciences
School of Health Related Professions
Rutgers, The State University of New Jersey
Newark, New Jersey

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x
Preface

The science of clinical laboratory hematology provides for the analy-
sis of normal and pathologic peripheral blood cells, hematopoi-
etic (blood-producing) tissue, and the cells in non-vascular body
cavities such as cerebrospinal and serous fluids. Laboratory he-
matology also includes the analysis of the cells and coagulation
proteins essential to clinical hemostasis. Hematology laboratory
assay results are critical for the diagnosis, prognosis, and moni-
toring treatment for primary and secondary hematologic disor-
ders. Similarly, hematology results are used to establish safety in
the perioperative period, monitor treatments during surgical
procedures, and monitor transfusion needs in trauma patients.

Clinical laboratory hematology has been enhanced by pro-

found changes as reflected in the numerous updates in the fifth
edition of Rodak’s Hematology: Clinical Principles and Applications.
Automation and digital data management have revolutionized the
way blood specimens are transported and stored, how assays are
ordered, and how results are validated, reported, and interpreted.

Molecular diagnosis has augmented and in many instances

replaced long-indispensable laboratory assays. Hematologic
disorders have been reclassified on the basis of phenotypic,
cytogenetic, and molecular genetic analyses. Diagnoses that
once depended on the analysis of cell morphology and cyto-
chemical stains now rely on flow cytometry, cytogenetic test-
ing, fluorescence in situ hybridization (FISH), end-point and
real-time polymerase chain reaction assays, gene sequencing,
and microarrays. Traditional chemotherapeutic monitoring of
leukemias and lymphomas at the cellular level has shifted to
the management of biologic response modifiers and detection
of minimal residual disease at the molecular level. Hemostasis
has grown to encompass expanded thrombophilia testing,
methods that more reliably monitor newly available antiplate-
let and anticoagulant drugs, molecular analysis, and a shift
from clot-based to functional and chromogenic assays.

Rodak’s Hematology: Clinical Principles and Applications sys-

tematically presents basic to advanced concepts to provide a
solid foundation of normal and pathologic states upon which
readers can build their skills in interpreting and correlating
laboratory findings in anemias, leukocyte disorders, and hem-
orrhagic and thrombotic conditions. It provides key features
for accurate identification of normal and pathologic cells in
blood, bone marrow, and body fluids. The focus, level, and
detail of hematology and hemostasis testing, along with the
related clinical applications, interpretation, and testing algo-
rithms, make this text a valuable resource for all healthcare
professionals managing these disorders.

ORGANIZATION

Rodak’s Hematology: Clinical Principles and Applications fifth edition
is reorganized into 7 parts and 45 chapters for enhanced pedagogy.
Chapter highlights and new content are described as follows:

Preface

Part I: Introduction to Hematology
Chapters 1 to 5 preview the science of clinical laboratory hema-
tology and include laboratory safety, blood specimen collection,
microscopy, and quality assurance. The quality assurance chap-
ter was significantly updated to include enhanced sections on
statistical significance; assay validation with applications of the
Student’s t test, ANOVA, linear regression, and Bland-Altman
difference plots; and assessment of diagnostic efficacy.

Part II: Blood Cell Production, Structure,
and Function
Chapters 6 and 7 use photomicrographs and figures to describe
general cellular structure and function and the morphologic and
molecular details of hematopoiesis. Chapters 8, 12, and 13 dis-
cuss erythropoiesis, leukopoiesis, and megakaryopoiesis using
numerous photomicrographs demonstrating ultrastructure and
microscopic morphology. Chapters 9 and 10 examine mature red
blood cell metabolism, hemoglobin structure and function, and
red blood cell senescence and destruction. Iron kinetics and labo-
ratory assessment in Chapter 11 was substantially updated with
new figures and updated coverage of systemic and cellular regula-
tion of iron. Chapter 13 includes detailed descriptions of platelet
adhesion, aggregation, and activation with updated figures.

Part III: Laboratory Evaluation of Blood Cells
Chapter 14 describes manual procedures such as microscopy-
based cell counts, hemoglobin and hematocrit determinations,
and point-of-care technology. Chapter 15 has been substan-
tially updated to include descriptions and figures of the latest
automated hematology analyzers. Chapter 16 describes pe-
ripheral blood film examination and the differential count
correlation to the complete blood count. New figures correlate
red blood cell and platelet histograms to their morphology.
Chapter 17 follows up with bone marrow aspirate and biopsy
collection, preparation, examination, and reporting. Chapter
18 describes methods for analyzing normal and pathologic
cells of cerebrospinal fluid, joint fluid, transudates, and exu-
dates, illustrated with many excellent photomicrographs.

Part IV: Erythrocyte Disorders
Chapter 19 provides an overview of anemia and describes cost-
effective approaches that integrate patient history, physical ex-
amination, and symptoms with the hemoglobin, red blood cell
indices, reticulocyte count, and abnormal red blood cell mor-
phology. Chapters 20 to 22 describe disorders of iron and DNA
metabolism and bone marrow failure. New algorithms help the
reader to distinguish types of microcytic and macrocytic ane-
mias. Chapters 23 to 26 discuss hemolytic anemias due to in-
trinsic or extrinsic defects. Chapter 23 is fully updated with new
figures that detail extravascular and intravascular hemolysis and
hemoglobin catabolism. Chapters 27 and 28 provide updates in

x

vip.persianss.ir

Preface
xi

technicians, and the faculty of undergraduate and graduate edu-
cational programs in the clinical laboratory sciences. This text is
also a helpful study guide for pathology and hematology-
oncology residents and fellows and a valuable shelf reference
for hematologists, pathologists, and hematology and hemosta-
sis laboratory managers.

TEXTBOOK FEATURES

Elaine M. Keohane, PhD, MLS, Professor, Rutgers University,
School of Health Related Professions, Department of Clinical
Laboratory Sciences, co-editor in the fourth edition, and lead
editor in the fifth edition, is joined by Larry J. Smith, PhD,
Coagulation and Satellite Laboratory Director, Memorial Sloan
Kettering Cancer Center, Adjunct Professor at Rutgers Univer-
sity, School of Health Related Professions and York College,
CUNY, Department of Health Professions, and Jeanine M.
Walenga, PhD, MT(ASCP), Professor, Loyola University Chi-
cago, Stritch School of Medicine, Clinical Coagulation Labora-
tories Director, Loyola University Health System.

The outstanding value and quality of Rodak’s Hematology:

Clinical Principles and Applications reflect the educational and
clinical expertise of its current and previous authors and editors.
The text is enhanced by nearly 700 full-color digital photomicro-
graphs, figures, and line art. Detailed text boxes and tables clearly
summarize important information. Reference intervals are pro-
vided on the inside front and back covers for quick lookup.

Each chapter contains the following pedagogical features:
•
Learning objectives at all taxonomy levels in the cogni-
tive domain.

•
One or two case studies with open-ended discussion
questions at the beginning of the chapter that stimulate
interest and provide opportunities for application of
chapter content in real-life scenarios.

•
A bulleted summary at the end of each chapter that pro-
vides a comprehensive review of essential material.

•
Review questions at the end of each chapter that corre-
late to chapter objectives and are in the multiple-choice
format used by certification examinations.

•
Answers to case studies and review questions that are
provided in the Appendix.

The Evolve website has multiple features for the instructor:
•
An ExamView test bank contains multiple-choice ques-
tions with rationales and cognitive levels.

•
Instructor’s manuals for every chapter contain key
terms, objectives, outlines, and study questions.

•
Learning Objectives with taxonomy levels are provided
to supplement lesson plans.

•
Case studies have been updated and feature discussion
questions and photomicrographs when applicable.

•
PowerPoint presentations for every chapter can be used
“as is” or as a template to prepare lectures.

•
The Image Collection provides electronic files of all the
chapter figures that can be downloaded into PowerPoint
presentations.

For the student, a Glossary is available as a quick reference

to look up unfamiliar terms electronically.

pathophysiology, diagnosis, and treatment of hemoglobinopa-
thies (such as sickle cell disease) and the thalassemias.

Part V: Leukocyte Disorders
Chapter 29 is significantly updated with many excellent photo-
micrographs and summary boxes of nonmalignant systemic
disorders manifested by the abnormal distribution or morphol-
ogy of leukocytes. These include bacterial and viral infections,
various systemic disorders, and benign lymphoproliferative dis-
orders. Chapter 30 provides details on traditional cytogenetic
procedures for detection of quantitative and qualitative chromo-
some abnormalities and more sensitive methods such as FISH
and genomic hybridization arrays. Chapter 31 covers molecular
diagnostics and was fully updated with new and enhanced fig-
ures on basic molecular biology, end-point and real-time poly-
merase chain reaction, microarrays, and DNA sequencing, in-
cluding next generation sequencing. Chapter 32 describes flow
cytometry and its diagnostic applications. It includes numerous
scatterplots of normal and leukemic conditions. Chapters 33 to
36, with significant updating, provide the latest classifications
and pathophysiologic models for myeloproliferative neoplasms,
myelodysplastic syndromes, acute lymphoblastic and myeloid
leukemias, chronic lymphocytic leukemia, and solid tumor lym-
phoid neoplasms, such as lymphoma and myeloma, with nu-
merous full-color photomicrographs and illustrations.

Part VI: Hemostasis and Thrombosis
Chapter 37 provides the plasma-based and cell-based coagula-
tion models and the interactions between primary and second-
ary hemostasis and fibrinolysis with updated illustrations.
Chapter 38 details hemorrhagic disorders, including the man-
agement of the acute coagulopathy of trauma and shock.
Chapter 39 updates the currently recognized risk factors of
thrombosis and describes laboratory tests that identify venous
and arterial thrombotic diseases, particularly for lupus antico-
agulant and heparin-induced thrombocytopenia (HIT) testing.
Chapters 40 and 41 detail the quantitative and qualitative
platelet disorders using additional tables and figures, and
Chapter 42 details laboratory assays of platelets and the coagu-
lation mechanisms with helpful new figures and diagrams.
Chapter 43 covers the mechanisms and monitoring methods
of the traditional warfarin and heparin-derived antithrombotic
drugs, as well as all thrombin and factor Xa inhibitor drugs. It
also includes methods for monitoring the different classes of
antiplatelet drugs, including aspirin. Chapter 44 reviews the
latest coagulation analyzers and point of care instrumentation.

Part VII: Hematology and Hemostasis
in Selected Populations
Chapter 45 provides valuable information on the hematology
and hemostasis laboratory findings in the pediatric and geriatric
populations correlated with information from previous chapters.

READERS

Rodak’s Hematology: Clinical Principles and Applications is de-
signed for medical laboratory scientists, medical laboratory

vip.persianss.ir

xii
Preface

The editors express their immense gratitude to Bernadette F.
(Bunny) Rodak, who laid the foundation for this textbook with
her expert writing, editing, detailed figures, and especially her
contribution of over 200 outstanding digital photomicrographs
over the past 2 decades. Now in its fifth edition, she has
authored three chapters, provided invaluable contributions and
assistance with additional photomicrographs and figures, and
provided the opportunity for us to continue her work on this
outstanding textbook. We sincerely thank George A. Fritsma for
his significant contribution to this text as a previous coeditor
and author, for sharing his immense expertise in hemostasis,
for updating and authoring ten chapters in the fifth edition, and
for his constant support and encouragement. We thank Kathryn
Doig for her contributions as coeditor for the third edition;
author in previous editions; and for her tenaciousness, creativ-
ity, and care in updating the five chapters authored in the fifth
edition. The editors also thank the many authors who have
made and continue to make significant contributions to this
work. All of these outstanding professionals have generously

Acknowledgments

shared their time and expertise to make Rodak’s Hematology:
Clinical Principles and Applications into a worldwide educational
resource and premier reference textbook for medical laboratory
scientists and technicians, as well as pathology and hematology
practitioners, residents, and fellows.

We also express our appreciation to Elsevier, especially Ellen

Wurm-Cutter, Laurie Gower, Kellie White, Sara Alsup, Megan
Knight, and Rebecca Corradetti, whose professional support
and reminders kept the project on track, and to Debbie Prato
for her editorial assistance.

Finally, and with the utmost gratitude, we acknowledge our

families, friends, and professional colleagues who have sup-
ported and encouraged us through this project.

Elaine M. Keohane, PhD, MLS

Larry J. Smith, PhD, SH(ASCP), HCLD/CC(ABB)

Jeanine M. Walenga, PhD, MT(ASCP)

xii