Interpretation of CBC

Copyright © 1982 - 2009 Dr. Erfan & Bagedo Hospital

INTERPRETATION OF COMPLETE

BLOOD COUNT

DR AHEL BADAWY

CONSULTANT PAEDIATRICAIN

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.


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**


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


Anemia in Children

Definition.

Causes.

History and physical

examination.

Interpretation of

complete blood count

and the peripheral

blood smear.

Additional tests.


Definition

Reduction in the hemoglobin concentration,

hematocrit, or number of red blood cells

(RBC).

Functional consideration is important.




Causes

Ineffective red cell production.

Accelerated destruction or loss of red blood

cells.



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.


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


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% )






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


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



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.


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



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


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


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


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


Disorders associated with Basophilia

and Basophilopenia Basophilia

Hypersensitivity reactions

Drug and food hypersensitivity

Urticaria

Inflammation and infection

Ulcerative colitis


Infleunza

Chickenpox

Smallpox

Tuberculosis

Myeloproliferative diseases

Chronic myelogenous leukemia

Myeloid metaplasia

BasophilopeniaGlucocorticoid adminstration

Thyrotoxicosis Nathan and Oski


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


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



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


PLATELETS CONT.

THROMBOCYTOPENIA

Bone marrow failure

Bone marrow infiltration

Increased peripheral

destruction


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.


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!


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Interpretation of CBC

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