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