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P e d i a t r i a P o l s k a t o m 8 7, n r 1 , s t y c z e l u t y 2 0 1 2

PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS72

Optimizing Use of the Complete Blood Count

Optymalne stosowanie badania morfologicznego krwi

Bruce M. Camitta, Rebecca Jean Slye

ABSTRACTThe CBC is more than a collection of numbers. Understanding its strengths and limitations provides more useful in-formation. When used in conjunction with careful review of the peripheral smear and a limited number of other tests, the CBC can be a more effective diagnostic tool.Key words: complete blood counts (CBC)

STRESZCZENIEBadanie morfologiczne krwi nie stanowi jedynie zbioru liczb. Poznanie jego zalet i ogranicze umoliwia zdobycie wielu przydatnych informacji. Badanie wykonane wraz z dokadnym rozmazem krwi obwodowej oraz kilku innymi testami moe by bardzo przydatnym narzdziem diagnostycznym.Sowa kluczowe: badanie morfologiczne krwi, morfologia krwi obwodowej

Pediatr Pol 2012; 87(1): 7277

2012 by Polskie Towarzystwo Pediatryczne

Otrzymano/Received: 20.11.2011

Zaakceptowano do druku/Accepted:

20.12.2011

Midwest Center for Cancer and Blood Disorders

Department of Pediatrics

Konflikt interesu/ Conflicts of interest:

Autorzy pracy nie zgaszaj konfliktu interesw

Adres do korespondencji/ Address for

correspondence: Bruce M. Camitta

Medical College of Wisconsin and Childrens

Hospital of Wisconsin 8701 Watertown Plank Road

Milwaukee, Wisconsin, USA 53226

Tel.: 414-456-4106 Fax: 414-456-6543

e-mail: bcamitta@mcw.edu

Presented at the 2nd Polish-American Meeting of Pediatricians; Rzeszw, Poland: May 2829, 2010

Table I. Relationship of age and normal MCV Tabela I. Prawidowe MCV w zalenoci od wieku dziecka

Term newborn 104118 fl

32 week premature 105125 fl

Age Lowest normal MCV

1218 mo 70 fl

1848 mo 74 fl

47 yr 76 fl

812 yr 78 fl

>12 yr 80 fl

Adult normal 8095 fl

To jest Open Access artykule pod CC BY-NC-ND licencji

http://creativecommons.org/licenses/by-nc-nd/4.0/

P e d i a t r i a P o l s k a t o m 8 7, n r 1 , s t y c z e l u t y 2 0 1 2

PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS 73

Table II. Differential diagnosis of macrocytic anemia Tabela II. Rnicowanie niedokrwistoci makrocytarnej

Spurious newborn, reticulosis

Nonmegaloblastic liver disease, marrow aplasis, hypothyroidism, copper deficiency, ethanol

Megaloglastic B12 deficiency, folate deficiency

orotic aciduria, B6 deficiency, thiamine deficiency, erythroleukemia

Table III. Differential diagnosis of microcytic anemia Tabela III. Rnicowanie niedokrwistoci mikrocytarnej

Common iron deficiency, thalassemias, lead poisoning (usually with iron deficiency), chronic disease

Rare B6 diseases, copper deficiency, atransferrinemia, sideroblastic anemias

Table IV. Differential diagnosis of iron deficiency versus thalas-semia trait Tabela IV. Rnicowanie niedoboru elaza i talasemi

Iron deficiency diet, pica, bleedingserum paleMCV 4580MCV/RBC .13Fe low: Fe/IBC 515%RDW highNL/low A2: NL F HGBmicrocitosis and poikilocytosis

B-Thalassemia Trait +family historyserum color normalMCV 5570MCV/RBC

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PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS74

Table V. Differential diagnosis of iron deficiency and the anemia of chronic disease Tabela V. Rnicowanie niedoboru elaza i niedokrwistoci w chorobach przewlekych

Iron deficiency diet, pica, bleedingserum paleMCV 4580Fe low: Fe/IBC 515%ferritin lowtransferrin receptor HITfR/log ferritin HImicrocitosis and poikilocytosis

Chronic disease poor growthserum color normalMCV 6080 (may be lower)Fe low: Fe/IBC 15ferritin hightransferrin receptor LOTfR/log ferritin lowmild microcytosis but normocytic

Table VI. Differential diagnosis of PMN leukocytosis Tabela VI. Przyczyny leukocytozy

Increased production infectionchronic inflammationtumorsmarrow recoverymyeloproliferative diseasedrugsfamilial cold urticarialleukemoid reactionschronic idiopathic

Increased bm release steroids, stress, hypoxiaendotoxin, acute infection

Decreased blood egress

steroid, splenectomyleukocyte, adhesion deficit

Reduced margination stress, infection, exerciseepinephrine

Table VII. Differential diagnosis of neutropenia Tabela VII. Przyczyny neutropenii

Intrinsic (heritable) severe congenitalcyclicbenign familialalbinism/neutropeniacartilage-hair hypoplasiamyelokathexisreticulodysgenesisSchwachman-Diamondbone marrow failure

Extrinsic alloimmuneautoimmunebone marrow infiltrationdrug-inducedimmune dysfunctioninfectionmetabolic diseasesnutritional

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PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS 75

Table VIII. Differential diagnosis of eosinophilia Tabela VIII. Przyczyny eozynofilii

allergic disorders, eosinophilic GE

pemphigus, eosinophilic fasciitis, polyarteritis nodosa, scleroderma, sarcoidosis

brucellosis, helminthes, malaria, scrabies, scarlet fever, tuberculosis

hemo/peritoneal dialysis, toxins

familial, hereditary angioedema, hyper-IgE syndrome, omen syndro-me, congenital neutropenia, Tar syndrome, Wiscott-Aldrich

ALL, lymphomas, metastatic cancers, myeloproliferative dis.

clonal/idiopatic HES

adrenal insulficiency, graft vs host disease

Fig. 2. Relationship of the platelet count and the bleeding time Ryc. 2. Zaleno liczby pytek krwi i czasu krwawienia

PLATELET COUNT and BLEEDING TIME

BLEEDINGTIME

(MINUTES)

PLATELETS/ul/103

0 50 100 150 200

50

40

30

20

10

0

AA

ITP

WAS vWD

U

ASA

WAS WISKOTT ALDRICHAA APLASTIC ANEMIAvWD vonWILLEBRAND DISEASEU UREMIAASA ASPIRIN

NORMOCYTIC ANEMIA

PERIPHERAL SMEAR (MCV)

RETICULOCYTES

LOW HIGH

COOMBS +

MARROW DISEASEPLASMA VOLUME

BLOODLOSS

IMMUNEHEMOLYSIS

RBC DEFECT

INTRINSICMEMBRANE

HGBENZYME

EXTRINSIC

HEMOLYSIS

Fig. 1. Suggested algorithm for workup of normocytic anemia Ryc. 1. Zalecany algorytm diagnostyki niedokrwistoci normocytarnej

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PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS76

Conclusions

R e f e r e n c e s

P e d i a t r i a P o l s k a t o m 8 7, n r 1 , s t y c z e l u t y 2 0 1 2

PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS 77

Test sprawdzajcy pytania Test sprawdzajcy odpowiedzi

Optimizing Use of the Complete Blood CountElectronic CountersAnemias: generalAnemias: macrocyticAnemias: normocyticAnemias: microcyticPMN: leukocytosisPMN: neutropeniaPMN: infectionEosinophiliaLymphocytes: lymphocytosisLymphocytes: lymphocytopeniaLymphocytes: vacuolizationPlateletsConclusionsKonflikt interesu/ Conflicts of interest:Test sprawdzajacy - pytaniaTest sprawdzajacy - odpowiedzi

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