Complete Blood Count, Interpretations

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Complete Blood Count Interpretations

Complete Blood CountInterpretationsDr. Gauhar Mahmood AzeemHouse Officer, Medical Unit 4Services Hospital LahoreCOMPLETE BLOOD COUNT

Complete Blood CountA 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.ComponentsWBCRBCHemoglobinHematocritMCVMCHMCHCRDWPlatelets NeutrophilsLymphocytesMonocytesBasophilsImmature GranulocytesReticulocyte countRBCNormal ValuesMales 4.7 to 6.1 million cells per microliterFemales 4.2 to 5.4 million cells per microliter

Low RBC Count Known asanemia

Acute or chronic bleedingRBC 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 CountKnown aspolycythemia DehydrationPulmonary diseaseKidney or other tumor that produces excess erythropoietinSmokingGenetic causes (altered oxygen sensing, abnormality in hemoglobin oxygen release)Polycythemia veraHemoglobinIs the protein molecule that carries oxygen in the Red Blood Cells.13.0-18.0 g/dl in males11.5-16.5 g/dl in femalesWe can have N HB in N RBCWe can have N HB in D RBCWe can have D HB in D RBC Thus the other indices MCH and MCHC come into play. Hematocrit or PCVMales normal 45%Females normal 40%

High HctIncreased risk of Dengue Shock SyndromePolycythemia VeraCOPDEPO or Erythropioten useDehydrationCapillary leak syndromeSleep apneaAnabolic Steroid use

Low HctDue to anemiaAnemia can be characterised by using the indicesMean Corpuscular VolumeNormal 77-95fLLow MCV indicates RBCs are smaller than normal (microcytic); caused by iron deficiency anemia, orthalassemias, 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 smearMedications affecting folate metabolismVit B12 deficiency (Pernicious Anemia)Folate deficiency (Alcohol related often)AtrophicGastitisGastrointestinal malabsorptionNitrous oxide abusePrimaryBone marrowdisorders

Non Megaloblastic Macrocytic AnemiasAlcohol Abuse Emphysema Hypothyroidism Accelerated Erythropoiesis (High Reticulocyte Index) Hemolytic AnemiaPost-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 AnemiaCouldnt get past the spleen!

MCH and MCHCMean 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 MCHCMCH and MCHCLess in Microcytic AnemiasNormal in Macrocytic Anemias Elevated in hereditary spherocytosis,sickle cell diseaseandHonozygous Hemoglobin C diseaseRed Cell Distribution WidthLow 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 RDWReticulocyte CountAbsolute reticulocyte count = # or % retics X (pts 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 orhemolysis, or response to treatment (e.g., iron supplementation for iron deficiency anemia)Reticulocyte indexReticulocyte Index= Absolute Retic Count/Maturition FactorMaturation FactorHct > 35% : 1.oHct 25-35% : 1.5Hct 20-25% : 2.0Hct

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