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COMPLETE BLOOD COUNT
INTERPRETATIONS
Dr. Gauhar Mahmood Azeem
House Officer, Medical Unit 4
Services Hospital Lahore
‘COMPLETE’ BLOOD COUNT
COMPLETE BLOOD COUNT
A complete blood count (CBC) is an important and
readily available investigation that focuses on Red
Blood Cells, White Blood Cells and Platelets, and
their various parameters. It can help to serve as a
screening test for many disorders and as a
prognostic or follow up tool.
COMPONENTS
WBC
RBC
Hemoglobin
Hematocrit
MCV
MCH
MCHC
• RDW
• Platelets
• Neutrophils
• Lymphocytes
• Monocytes
• Basophils
• ImmatureGranulocytes
• Reticulocyte count
RBC
Normal Values
Males 4.7 to 6.1 million cells per microliter
Females 4.2 to 5.4 million cells per microliter
LOW RBC COUNT
Known as anemia
Acute or chronic bleeding
RBC destruction (e.g., hemolytic anemia, etc.)
Nutritional deficiency (e.g., iron deficiency, vitamin B12 or folate deficiency)
Bone marrow disorders or damage
Chronic inflammatory disease
Kidney failure
HIGH RBC COUNT
Known as polycythemia
Dehydration
Pulmonary disease
Kidney or other tumor that produces excess
erythropoietin
Smoking
Genetic causes (altered oxygen sensing,
abnormality in hemoglobin oxygen release)
Polycythemia vera
HEMOGLOBIN
Is the protein molecule that carries oxygen in the
Red Blood Cells.
13.0-18.0 g/dl in males
11.5-16.5 g/dl in females
We can have N HB in N RBC
We can have N HB in D RBC
We can have D HB in D RBC
Thus the other indices MCH and MCHC come into
play.
HEMATOCRIT OR PCV
Males normal 45%
Females normal 40%
• High Hct
• Increased risk of Dengue Shock Syndrome
• Polycythemia Vera
• COPD
• EPO or Erythropioten use
• Dehydration
• Capillary leak syndrome
• Sleep apnea
• Anabolic Steroid use
• Low Hct
• Due to anemia
• Anemia can be
characterised by using
the indices
MEAN CORPUSCULAR VOLUME
Normal 77-95fL
Low MCV indicates RBCs are smaller than normal
(microcytic); caused by iron deficiency anemia,
or thalassemias, Congenital sideroblastic Anemia,
Lead Poisoning, pyridoxine deficiency, anemia of
chronic disease
High MCV indicates RBCs are larger than normal
(macrocytic)
MEGALOBLASTIC MACROCYTIC ANEMIA
Macrocytes in bone marrow smear
Medications affecting folate metabolism
Vit B12 deficiency (Pernicious Anemia)
Folate deficiency (Alcohol related often)
Atrophic Gastitis
Gastrointestinal malabsorption
Nitrous oxide abuse
Primary Bone marrow disorders
NON MEGALOBLASTIC MACROCYTIC ANEMIAS
Alcohol Abuse
Emphysema
Hypothyroidism
Accelerated Erythropoiesis (High Reticulocyte Index)
Hemolytic Anemia
Post-hemorrhagic Anemia
Increased RBC membrane surface area
Obstructive Jaundice Hepatic disease Post-splenectomy
Bone Marrow disorders Myelophthisic Anemia Myelodysplastic Anemia (Myelodysplastic Syndrome) Aplastic Anemia
Acquired Sideroblastic Anemia
COULDN’T GET PAST THE SPLEEN!
MCH AND MCHC
Mean corpuscular hemoglobin (MCH) measures the
amount, or the mass, of hemoglobin present in one
RBC. The weight of hemoglobin in an average cell is
obtained by dividing the hemoglobin by the total RBC
count. The result is reported by a very small weight
called a picogram (pg).
Mean corpuscular hemoglobin concentration (MCHC)
measures the proportion of each cell taken up by
hemoglobin. The results are reported in percentages,
reflecting the proportion of hemoglobin in the RBC. The
hemoglobin is divided by the hematocrit and multiplied
by 100 to obtain the MCHC
MCH AND MCHC
Less in Microcytic Anemias
Normal in Macrocytic Anemias
Elevated in hereditary spherocytosis, sickle cell
disease and Honozygous Hemoglobin C disease
RED CELL DISTRIBUTION WIDTH
Low value indicates uniformity in size of RBCs
High value indicates mixed population of small and
large RBCs; immature RBCs tend to be larger. For
example, in iron deficiency anemia or pernicious
anemia, there is high variation (anisocytosis) in
RBC size (along with variation in shape –
poikilocytosis), causing an increase in the RDW
RETICULOCYTE COUNT
Absolute reticulocyte count = # or % retics X (pt’s Hct/ Normal
Hct)
Can be absolute or %
In the setting of anemia, a low reticulocyte count indicates a
condition is affecting the production of red blood cells, such as
bone marrow disorder or damage, or a nutritional deficiency
(iron, B12 or folate)
In the setting of anemia, a high reticulocyte count generally
indicates peripheral cause, such as bleeding or hemolysis, or
response to treatment (e.g., iron supplementation for iron
deficiency anemia)
RETICULOCYTE INDEX
Reticulocyte Index= Absolute Retic
Count/Maturition Factor
Maturation Factor
Hct > 35% : 1.o
Hct 25-35% : 1.5
Hct 20-25% : 2.0
Hct <20% : 2.5
WHITE BLOOD CELL COUNT
The normal number of WBCs in the blood is
4,500-11,000 white blood cells per microliter
(mcL). Normal value ranges may vary slightly
among different labs.
LEUKOPENIA
Low white cell count may be due to acute viral infections, such as with a cold or influenza. It can be associated with chemotherapy, radiation therapy, myelofibrosis and aplastic anemia (failure of white cell, red cell and platelet production). HIV and AIDS are also a threat to white cells.
Other causes of low white blood cell count include systemic lupus erythematosus, Hodgkin's lymphoma, some types of cancer, typhoid, malaria, tuberculosis, dengue, rickettsialinfections, enlargement of the spleen, folate deficiencies, psittacosis, sepsis and Lyme disease. Many other causes exist, such as deficiency in certain minerals, such as copperand zinc.
PSEUDOLEUKOPENIA
Pseudoleukopenia can develop upon the onset of
infection. The leukocytes (predominately neutrophils,
responding to injury first) start migrating towards the site
of infection and can be scanned at the site of infection.
Their migration causes bone marrow to produce more
WBCs to combat infection as well as to restore the
leukocytes in circulation, but as the blood sample is
taken upon the onset of infection, it contains low amount
of WBCs, which is why it is called "pseudoleukopenia".
DRUGS CAUSING LEUKOPENIA
LOADS!!!
Clozapine, buproprion, valproic acid, minocycline,
lamotrigine.
Immunosuppressive drugs, such
as sirolimus, mycophenolate
mofetil, tacrolimus, cyclosporine, Leflunomide
(Arava) and TNF inhibitors.[2] Interferonsused to
treat multiple sclerosis, such as Rebif, Avonex,
and Betaseron, can also cause leukopenia.
Chemotherapeutic drugs.
Lots of others.
GIVE AUGMENTIN!!!
LEUKOCYTOSIS
Known as leukocytosisInfection, most
commonly bacterial orviral
Inflammation
Leukemia, myeloproliferative disorders
Allergies, asthma
Tissue death (trauma, burns, heart attack)
Intense exercise or severe stress
Will mention in detail in respective cell line.
DIFFERENTIAL COUNTS
ABSOLUTE NEUTROPHIL COUNT
{(% of Neutrophils+ % of Bands) X WBC}/100
NEUTROPENIA
Decreased production in the bone marrow due to: aplastic anemia
arsenic poisoning
cancer, particularly blood cancers
certain medications
hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia)
radiation
Vitamin B12, folateor copper deficiency
Increased destruction: autoimmune neutropenia
chemotherapy treatments, such as for cancer and autoimmune diseases
Marginalisation and sequestration: Hemodialysis
Medications
Flecainide (a class 1C cardiac
antiarrhythmic drug)
Phenytoin
Indomethacin
Propylthiouracil
Carbimazole
Chlorpromazine
Trimethoprim/sulfamethoxazole (cotri
moxazole)
Clozapine
Ticlodipine
Often, a mild neutropenia is seen in viral
infections. Additionally, a condition
called morning pseudoneutropenia might
be a side effect of certain antipsychotic
medications.
NEUTROPHILIA
Post splenectomy
Cigarette smoking
Hypoxia
Epinephrine
Exercise
• Acute or Chronic Infection
• Myeloprofilerative disorders
• Acute stress
• Lukemoid reactions
• Drugs (steroids)
• Chronic Inflammation
• Tumors
• Myelophthisis
• Hyperactive marrow
LYMPHOCYTOPENIA
Autoimmune disorders (e.g., lupus, Rheumatic
Arthritis)
Infections (e.g., HIV, viral hepatitis, typhoid
fever, inluenza)
Bone marrow damage (e.g., chemotherapy,
radiation therapy)
Corticosteroids
LYMPHOCYTOSIS
Acute viral infections (e.g., chicken
pox, cytomegalovirus (CMV),Epstein-Barr virus
(EBV), herpes,rubella)
Certain bacterial infections (e.g. pertussis,
whooping cough, tuberculosis (TB))
Toxoplasmosis
Chronic inflammatory disorder (e.g., ulcerative
colitis)
Lymphocytic leukemia, lymphoma
Stress (acute)
LOW MONOCYTES
Usually, one low count is not medically
significant.Repeated low counts can indicate:
Bone marrow damage or failure
Hairy cell leukemia
MONOCYTOSIS
Chronic infections (e.g., TB, Fungal Infections)
Infection within the heart (bacterial endocarditis)
Collagen vascular diseases (e.g.,
lupus, scleroderma, rheumatoid arthritis, vasculitis)
Monocytic or myelomonocytic leukemia (acute or
chronic)
LOW EOSINOPHILS
Numbers are normally low in the blood. One or an
occasional low number is usually not medically
significant
EOSINOPHILIA
Asthma, allergies such as hay fever
Drug reactions
Parasitic infections
Inflammatory disorders (celiac
disease, inflammatory bowel disease)
Some cancers, leukemias or lymphomas
BASOPENIA :D
As with eosinophils, numbers are normally low in
the blood; usually not medically significant
BASOPHILIA
Rare allergic reactions (hives, food allergy)
Inflammation (rheumatoid arthritis, ulcerative colitis)
Some leukemias
PLATELET COUNT
Normal platelet counts are in the range of 150,000
to 400,000 per microliter (or 150 - 400 x 109 per
liter), but the normal rangefor the platelet count
varies slightly among different laboratories.
THROMBOCYTOPENIA
Immune Thrombocytopenias (ITP) – formerly known as immune thrombocytopenia purpura and idiopathic thrombocytopenic purpura
Cirrhosis
Splenomegaly Gaucher’s disease
Familial thrombocytopenia
Chemotherapy, radiotherapy
Babesiosis, Dengue, Onyalai, Rocky mountain spotted fever
Thrombotic Thrombocytopenic Purpura
HELLP Syndrome
Hemolytic Uremic Syndrome
Drug Induced Thrombocytopenia (Heparin Induced Thrombocytopenia, acetaminophen, quinidine, sulfa drugs)
Pregnancy associated
Neonatal alloimmune associated
Aplastic Anemia, leukemia, lymphoma
Transfusion associated
THROMBOCYTOSIS
Reactive Chronic infection
Chronic inflammation
Malignancy
Hyposplenism (post-splenectomy)
Iron deficiency
Acute blood loss
Myeloprofirative disorders – platelets are both elevated and activated Essential Thrombocytosis
Polycythemia Vera
Associated with other myeloid neoplasms
Congenital
Cancer (lung, gastrointestinal, breast,ovarian, lymphoma)
Kawasaki disease
Soft tissue sarcoma
Osteosarcoma
Dermatitis (rarely)
Inflammatory bowel
disease
Rheumatoid arthritis
Nephritis
Nephrotic syndrome
Bacterial diseases,
including pneumonia, sep
sis, meningitis, urinary
tract infections, and
septic arthritis
MEAN PLATELET VOLUME
Typical range of platelet volumes is 9.7–12.8 fL
Low value indicates average size of platelets is
small; older platelets are generally smaller than
younger ones and a low MPV may mean that a
condition is affecting the production of platelets by
the bone marrow.
High volume indicates a high number of larger,
younger platelets in the blood; this may be due to
the bone marrow producing and releasing platelets
rapidly into circulation.
PLATELET DISTRIBUTION WIDTH
A high PDW means increased variation in the size
of the platelets, which may mean that a condition is
present that is affecting platelets
LOW BLOOD COUNTS
All three lines depressed in
Aplastic Anemia, Myelodysplastic Syndrome,
Chemotherapy
HIGH BLOOD COUNTS
Polycythemia Vera (Secondary)
THANK YOU