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Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
INTERPRETATION OF COMPLETE
BLOOD COUNT
DR AHEL BADAWY
CONSULTANT PAEDIATRICAIN
DR.ERFAN & BAGEDO HOSPITAL
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Complete Blood Count interpretation
The CBC is a bargain; its cost can be much less
than modern imaging studies, but like modern
imaging studies, its value is lost without
appropriate analysis.
The CBC is a deceptively simple test to order
and interpret. In most cases, the primary
assessment of interest are whether the patient is
anemic, whether the total and differential white
counts supports the diagnosis of infection, and
whether the platelet count is in a range that has
impact on hemostasis.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
CBC
WBC 8/cmm
RBC 5.5/cmm
HGB 15 g/dl
HTC 45 %
MCV 80
MCH 29
MCHC 34
RDW 12.8
PLATELET COUNT 300
DIFFERENTIAL COUNT
CELL MORPHOLOGY
RETICULOCYTE COUNT**
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Measurements The CBC consists of hemoglobin concentration, mean
corpuscular hemoglobin( MCH), MCH concentration ( MCHC), mean corpuscular volume( MCV), erythrocyte count, leukocyte count, and platelet count.
MCH = Hb (g/L)/RBC
MCHC = Hb ( g/dl)/HCT(%)
HCT = MCV X RBC
RDW ( red cell distribution width ): measure of dispersion of the erythrocyte size distribution, the coefficient of variation of the erythrocyte volume distribution expressed as percentage.
Mentzer formula: MCV / RBC = more than 13.5 or less than 11.5
RDW Index=MCV/RBCXRDW: 220 or more
less than 220
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Anemia in Children
Definition.
Causes.
History and physical
examination.
Interpretation of
complete blood count
and the peripheral
blood smear.
Additional tests.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Definition
Reduction in the hemoglobin concentration,
hematocrit, or number of red blood cells
(RBC).
Functional consideration is important.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Causes
Ineffective red cell production.
Accelerated destruction or loss of red blood
cells.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
History and physical examination
A detailed history and physical examination
are helpful in further defining the cause of
anemia.
A maternal history should be included in
evaluation of anemic infants from birth to
six months of age.
The relative frequency of the various causes
of anemia with age should be considered.
Physical examination can give clue to the
possible cause or duration of the anemia.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Important features in the history of the anemic child
1-Maternal History
a- Pregnancy/delivery complications
b- Drug ingestion
c- Pica, non-food product ingestion
d- Anemic during pregnancy
2-Family Historya- Ethnicity
b- Anemia
c- Jaundice
d- Splenomegaly
e- Gallstones
f- Bleeding disorders
g- Cancer
h- Transfusion
3-Patient Historya- Hyperbilirubinemia
b- Prematurity
c- Diet history
d- Medication
e- Activity level
f- Acute or recent infection
g- Evidence of chronic infection/disease
h- Evidence of endocrinopathy
i- Evidence of liver disease
j- Easy bruising/blood loss
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Evaluating Anemia: MCV, RDW, Reticulocytic count
MCV in children is lower than adults:
Between 2-10 years, the lower limit for MCV is approximately 70 + age ( in years )
The upper limit is 84+ 0.6 per year (beyond first year of life)
till the upper limit of 96 in adults.
Reticulocyte count is a measure of erythrocyte production, normal value 0.5 to 1.5 %.
Rticulocyte Production Index =
Observed Retic % X Patient Hematocrit
0.45
_____________________________________
Maturation time in peripheral blood in days
( 1 day when hct. Is 45 % to 2.5 days when hct. Is 15% )
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
RBC 4.53
HB 11.6
HTC 30.1
MCV 66.5
MCH 25.5
MCHC 38.4
RDW 21.1
ANISOCYTOSIS 2++
POLYCHROMASIA 1+
MICROCYTES 3+++
SPHEROCYTES 1+
SCHISOCYTES 1+
IRON 43, TIBC 250 , % IRON SAT 17.2
Abdominal US : large spleen for the age
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OSMOTIC FRAGILITY TEST
PATIENT: start of hemolysis
0.55% NACL
complete hemolysis
0.40%NACL
CONTROL: start of hemolysis
0.45% NACL
complete hemolysis
0.30% NACL
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
WHITE BLOOD CELLS
Low sensitivity and specificity.
Highly variable response to infection.
Astute clinical judgment is needed for proper interpretation.
Leukopenia is associated with a wide variety of viral and bacterial infections.
Leukocytosis is part of the body’s acute phase response to many conditions including infections.
Band cell count.
Peripheral blood smear is very important to characterize white cell abnormalities.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Classification of Neutropenia
Neutropenia Caused by Intrinsic Defect in Myeloid cells or Their Progenitors
Reticular dysgenesis
Severe congenital neutropenia ( Kostman’s syndrome )
Cyclic neutropenia
Myelokathexis
Schwachman’s syndrome
Dyskeratosis congenita
Chediak-Higashi syndrome
Familial benign neutropenia
Fanconi’s anemia
Bone marrow failure syndromes
Neutropenia Caused by Extrinsic FactorsInfection
Drug- induced neutropenia
Autoimmune neutropenia
Chronic benign neutropenia of childhood
Immune neonatal neutropenia
Neutropenia associated with immune dysfunction
Neutropenia associated with metabolic disease
Nutritional deficiencies
Reticuloendothelial sequestration
Bone marrow infiltration
Chronic idiopathic neutropenia Nathan and Oski
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
CBCs 11/9/05 13/9 14/9 15/9 16/9 17/9
WBC 3 8.7 7.8 6.3 8.6 10
RBC 4.48 6.74 5.32 4.88 4.76 4.31
HGB 12.3 18.5 14.5 13.2 13 11.9
HTC 35 52.5 40.8 37.3 36.9 33.5
PLATELETS 123 26 29 48 106 184
NEUT% 59.3 42 38 44 25 35
LYMPH 29.5 30 50 39 58 49
MONO 10.6 11 02 12 10 04
EOS 0.1 02 02 05
BASO 0.5 01
ATYPICAL LYMPH 17 08 05 04 06
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Classification of Neutrophilia Increased Production
Chronic infection
Chronic inflammation
Ulcerative colitis
Rheumatoid arthritis
Tumors (perhaps with necrosis)
Postneutropenia rebound
Myeloproliferative disease
Drugs (lithium, occasionally ranitidine )
Chronic idiopathic neutrophilia
Familial cold uricaria
Leukomoid reaction
Enhanced Release from Marrow Storage PoolCorticosteroids
Stress
Hypoxia
Acute infection
Endotoxin
Decreased Egress from CirculationCorticosteroids
Splenectomy
Leukocyte Adhesion Deficiency
Reduced MarginationStress
Infections
Exercise
Epinephrine
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Causes of Lymphocytopenia Aquired Causes
Infectious diseases
AIDS
Viral hepatitis
Infleunza
Tuberculosis
Typhoid fever
Sepsis
Iatrogenic
Immunosuppressive therapy
Coricosteroids
High dose PUVA therapy
Cytotoxic chemotherapy
Radiation
Thoracic duct drainage
Systemic and other diseases
Systemic lupus erythematosus
Myasthenia gravis
Hodgkin disease
Protein- losing enteropathy
Renal failure
Sarcoidosis
Thermal injury
Aplastic anemia
Dietary deficiency associated with ethanol abuse
Inherited Causes
Aplasia of lymphopoietic stem
cell
Severe combined
immunodeficiency
Ataxia-telangiectasia
Wiskott-Aldrich syndrome
Immunodeficiency with
thymoma
Cartilage-hair hypoplasia
Idiopathic CD4T
lymphocytopenia
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Causes of Eosinophilia Allergic Disorders
Asthma
Hay fever
Acute urticaria
Drug reaction
Allergic bronchopulmonary aspergillosis
Dermatitis
Pemphigus
Pemphegoid
Atopic dermatitis
Parasites and Other InfectionsMetozoon infection
Pneumocystis carnii infection
Toxoplasmosis
Amebiasis
Malaria
Scabies
Coccidiodomycosis
Tumors
Brain tumors
Hodgkins and non-Hodgkins lymphoma
Myeloproliferative disorders
Nathan and Oski
Hereditary Disorders
Hereditary eosinophilia
Gastrointestinal Disorders
Radiation therapy for intra-abdominal
neoplasms
Regional enteritis
Milk precipitin disease
Chronic active hepatitis
Hypereosinophilic Syndromes
Löffler’s syndrome
Eosinophilc leukemia
Polyarteritis nodosa
Miscellaneous
Immunodeficiency disorders
Peritoneal dialysis
Thrombocytopenia with absent radii
Familial reticuloendotheliosis
Episodic angioedema associated with
eosinophilia
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Disorders associated with Basophilia
and Basophilopenia Basophilia
Hypersensitivity reactions
Drug and food hypersensitivity
Urticaria
Inflammation and infection
Ulcerative colitis
Rheumatoid arthritis
Infleunza
Chickenpox
Smallpox
Tuberculosis
Myeloproliferative diseases
Chronic myelogenous leukemia
Myeloid metaplasia
BasophilopeniaGlucocorticoid adminstration
Thyrotoxicosis Nathan and Oski
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Disorders associated with Monocytosis
and Monocytopenia Monocytosis
Hematologic disorders and lymphomasPreleukemia
Acute myelogenous leukemia
Lymphoma
Chronic neutropenia
Histiocytic medullary reticulosis
Collagen vascular disease
Systemic lupus erythematosus
Rheumatoid arthritis
Myositis
Granulomatous diseasesUlcerative colitis
Regional enteritis
Sarcoidosis
Infection
Subacute bacterial endocarditis
Tuberculosis
Syphilis
Protozoal and rickettisial infections
Fever of unknown origin
Malignant disease
Miscellaneous disorders
Postsplenectomy state
Tetrachlorethane poisoning
MonocytopeniaGlucocorticoid administration
Infections associated with endotoxemia Nathan and Oski
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
PLATELETS
THROMBOCYTOSIS
Rarely causes complications in children
Primary causes as polycythemia vera or essential thrombocytosis are unusual in children
Thrombocytosis in children is almost always reactive or secondary
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
PLATELETS CONT.
THROMBOCYTOPENIA
Bone marrow failure
Bone marrow infiltration
Increased peripheral
destruction
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
CONCLUSION
CBC provides much more information
than is routinely used.
When anemia is present, the CBC
contains considerable information
regarding its cause and assist in
formulating a differential diagnosis and
directing further evaluation.
WBCs and platelet counts may similarly
direct practitioners to consider or dismiss
underlying conditions.
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital
CONCLUSION
Backup with a good laboratory services and
full-time hematologist capable of pursuing
the final diagnosis from data gathered by
CBC and history and clinical examination is
of utmost importance; if you do not have it,
look for it!
Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital