Optimizing Use of the Complete Blood Count

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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 2PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS72Optimizing Use of the Complete Blood CountOptymalne stosowanie badania morfologicznego krwiBruce 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 obwodowejPediatr Pol 2012; 87(1): 7277 2012 by Polskie Towarzystwo PediatryczneOtrzymano/Received: 20.11.2011Zaakceptowano do druku/Accepted: 20.12.2011Midwest Center for Cancer and Blood Disorders Department of PediatricsKonflikt interesu/ Conflicts of interest: Autorzy pracy nie zgaszaj konfliktu intereswAdres 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.eduPresented at the 2nd Polish-American Meeting of Pediatricians; Rzeszw, Poland: May 2829, 20105IF DPNQMFUF CMPPE DPVOU $#$ JT POF PG UIFNPTUDPNNPOMZ PSEFSFE MBCPSBUPSZ UFTUT 1SFWJPVTMZQFSGPSNFEMBSHFMZCZIBOEJUJTOPXEPOFCZFMFDUSPOJDDPVOUFST JO NPTU TFUUJOHT "U UIF TBNF UJNF UIFBWBJMBCJMJUZPGBMPUPGlOVNCFSTmIBTCFFOBDDPNQBOJFECZBEFDSFBTFEBQQSFDJBUJPOPGXIBUUIF$#$EPFTPSEPFTOPUUFMMVT*OUIFGPMMPXJOHQBHFTUIFEJGGFSFOUFMFNFOUT PG UIF $#$ BSF SFWJFXFE 4VHHFTUJPOT BSFNBEFBTUPIPXDBSFGVMDPOTJEFSBUJPOPGUIFEBUBDBOJNQSPWFJUTEJBHOPTUJDVTFGVMOFTT&MFDUSPOJD$PVOUFST&MFDUSPOJD DPVOUFST IBWF TPNF MJNJUBUJPOT 5IFZEJSFDUMZ NFBTVSF )HC IFNPHMPCJO .$7 NFBODPSQVTDVMBS WPMVNF SFE DFMM DPVOU 3#$ XIJUFDFMM DPVOU 8#$ QMBUFMFUT BOE QMBUFMFU TJ[F 5IFIFNBUPDSJU )DU NFBO DPSQVTDVMBS IFNPHMPCJO.$) BOE NFBO DPSQVTDVMBS IFNPHMPCJODPODFOUSBUJPO .$)$ BSF DBMDVMBUFE XIJDI NBZMFBE UP FSSPST JO UIFTF WBMVFT"EEJUJPOBM FMFDUSPOJDDPVOUFSFSSPSTNBZBSJTFJOTQFDJGJDDJSDVNTUBODFTMJQFNJBWFSZIJHI8#$IZQFSJNNVOPHMPCVMJOFNJBBOE NBSLFE IFNPMZTJT NBZ HJWF B TQVSJPVTMZ IJHI)HCNJDSPDZUJDDFMMTEPOPUMZTFXFMMHJWJOHBGBMTFMZMPX)HCUIF.$7JTVOEFSFTUJNBUFEJOQBUJFOUTXJUINBSLFE QPJLJMPDZUPTJT UIF .$7 NBZ CF IJHI XJUIIZQFSHMZDFNJB PS IZQFSOBUSFNJB UIF 3#$ NBZ CFGBMTFMZIJHI JG UIF8#$ JT WFSZIJHI UIF3#$NBZCFGBMTFMZMPXXJUIDPMEBHHMVUJOJOTPSBDMPUJOUIFDPMMFDUJOHUVCFUIF8#$NBZCFJOBDDVSBUFJGMPS M BOE OVDMFBUFE 3#$ XJMM CF DPVOUFEBT8#$'JOBMMZFMFDUSPOJDDPVOUFSTEPOPUTFF UIFDPMPS PG UIF QMBTNB " QBMF PS DPMPSMFTT QMBTNB JTGSFRVFOUMZ QSFTFOU JO QBUJFOUT XJUI NPEFSBUF UPTFWFSF JSPO EFGJDJFODZ %BSLFS QMBTNB TVHHFTUTIZQFSCJMJSVCJOFNJBEVFUPIFNPMZTJTMJWFSEJTFBTFPSCJMJBSZPCTUSVDUJPO"OFNJBTHFOFSBM"OFNJBT NBZ CF DMBTTJGJFE CZ UIF SFE DFMM TJ[FNBDSPDZUJDOPSNPDZUJDPSNJDSPDZUJD0OBQFSJQIFSBMCMPPETNFBSOPSNBM3#$BSFUIFTJ[FPGUIFOVDMFVTPGBTNBMMMZNQIPDZUF*GUIF3#$BSFMBSHFSUIFZBSFNBDSPDZUPJDJGUIFZBSFTNBMMFSUIFZBSFNJDSPDZUJD&MFDUSPOJD DPVOUFST QSPWJEF BO .$7 *O BEVMUT UIFOPSNBM .$7 JT q GM *O QFEJBUSJDT UIF OPSNBM.$7 WBSJFT XJUI BHF 5BC * /FXCPSOT FTQFDJBMMZQSFNBUVSFJOGBOUTOPSNBMMZIBWFBNVDIIJHIFS.$7$POWFSTFMZ ZPVOH DIJMESFONBZ IBWF BO.$7 UIBUJTMPXFSUIBOBEVMUOPSNBM3FUJDVMPDZUFTBSFMBSHFSUIBONBUVSF3#$QBUJFOUTXJUIBIJHISFUJDVMPDZUFDPVOU NBZ IBWF B IJHI .$7 'JOBMMZ UIF SFE DFMMTable I. Relationship of age and normal MCV Tabela I. Prawidowe MCV w zalenoci od wieku dzieckaTerm newborn 104118 fl32 week premature 105125 flAge Lowest normal MCV1218 mo 70 fl1848 mo 74 fl47 yr 76 fl812 yr 78 fl>12 yr 80 flAdult normal 8095 flP 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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q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able II. Differential diagnosis of macrocytic anemia Tabela II. Rnicowanie niedokrwistoci makrocytarnejSpurious newborn, reticulosisNonmegaloblastic liver disease, marrow aplasis, hypothyroidism, copper deficiency, ethanolMegaloglastic B12 deficiency, folate deficiencyorotic aciduria, B6 deficiency, thiamine deficiency, erythroleukemiaTable III. Differential diagnosis of microcytic anemia Tabela III. Rnicowanie niedokrwistoci mikrocytarnejCommon iron deficiency, thalassemias, lead poisoning (usually with iron deficiency), chronic diseaseRare B6 diseases, copper deficiency, atransferrinemia, sideroblastic anemiasTable 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 poikilocytosisB-Thalassemia Trait +family historyserum color normalMCV 5570MCV/RBC 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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able V. Differential diagnosis of iron deficiency and the anemia of chronic disease Tabela V. Rnicowanie niedoboru elaza i niedokrwistoci w chorobach przewlekychIron deficiency diet, pica, bleedingserum paleMCV 4580Fe low: Fe/IBC 515%ferritin lowtransferrin receptor HITfR/log ferritin HImicrocitosis and poikilocytosisChronic disease poor growthserum color normalMCV 6080 (may be lower)Fe low: Fe/IBC 15ferritin hightransferrin receptor LOTfR/log ferritin lowmild microcytosis but normocyticTable VI. Differential diagnosis of PMN leukocytosis Tabela VI. Przyczyny leukocytozyIncreased production infectionchronic inflammationtumorsmarrow recoverymyeloproliferative diseasedrugsfamilial cold urticarialleukemoid reactionschronic idiopathicIncreased bm release steroids, stress, hypoxiaendotoxin, acute infectionDecreased blood egresssteroid, splenectomyleukocyte, adhesion deficitReduced margination stress, infection, exerciseepinephrineTable VII. Differential diagnosis of neutropenia Tabela VII. Przyczyny neutropeniiIntrinsic (heritable) severe congenitalcyclicbenign familialalbinism/neutropeniacartilage-hair hypoplasiamyelokathexisreticulodysgenesisSchwachman-Diamondbone marrow failureExtrinsic alloimmuneautoimmunebone marrow infiltrationdrug-inducedimmune dysfunctioninfectionmetabolic diseasesnutritionalP 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 2PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS 75PSHBOJTNTNBZCFTFFOPOUIFQFSJQIFSBMTNFBSUIFMJLFMJIPPE PG QPTJUJWF SFTVMUT JT JODSFBTFE XIFO UIFTNFBSJTNBEFGSPNBCVGGZDPBUQSFQBSBUJPO&PTJOPQIJMJB*UJTDPNNPOUPUIJOLPGFPTJOPQIJMJBBTCFJOHUIFSFTVMUPG BMMFSHJFT PS JOGFDUJPOT )PXFWFS UIF EJGGFSFOUJBMEJBHOPTJTJTNVDICSPBEFSBOEJODMVEFTBVUPJNNVOFEJTFBTFTUPYJOTNBMJHOBODJFTIFSFEJUBSZDPOEJUJPOTBOEPUIFSEJTFBTFT5BC7***-ZNQIPDZUFTMZNQIPDZUPTJT"OJODSFBTFEOVNCFSBOEQFSDFOUPGMZNQIPDZUFTBSFOPSNBM GJOEJOHT JO OFXCPSOT BGUFS UIF GJSTU TFWFSBMEBZT PG MJGF "O BCTPMVUF MZNQIPDZUPTJT NBZ BMTPSFGMFDUCBDUFSJBMQFSUVTTJTQBSBQFSUVTTJTWJSBMDZUPNFHBMPWJSVTBEFOPWJSVTPSPUIFSUPYPQMBTNPTJTTZQIJMJTJOGFDUJPOT"SFMBUJWFMZNQIPDZUPTJTJTTFFOJOQBUJFOUTXJUIOFVUSPQFOJBPSBESFOBMJOTVGGJDJFODZ"UZQJDBM MZNQIPDZUFTBSF5DFMMT UIBUIBWFCFFOBDUJWBUFE JO SFTQPOTF UP TQFDJGJD BOUJHFOT 5IFZWBSZJOTJ[FBOETIBQFXIFSFBTJOBDVUFMZNQIPDZUJDMFVLFNJB UIF BCOPSNBM DFMMT UFOE UP CF NPSFNPOPUPOPVT5IFNPTUDPNNPOBUZQJDBMMZNQIPDZUFUZQF JT DIBSBDUFSJ[FE CZ NFNCSBOF JOEFOUBUJPOGSPNTVSSPVOEJOH3#$BOEBUIJOSJNPGEBSLFSCMVFDZUPQMBTN 5ZQF BUZQJDBM MZNQIPDZUFT MPPL MJLFQMBTNB DFMMTXIJMF UZQF DFMMT MPPL MJLFNPOPDZUFTXJUICMVJTISBUIFS UIBOHSBZDZUPQMBTN *ODSFBTFEOVNCFSTBOEQFSDFOUBHFTPGBUZQJDBMMZNQIPDZUFTBSFTFFO JO JOGFDUJPVT NPOPOVDMFPTJT DZUPNFHBMPWJSVTJOGFDUJPO UPYPQMBTNPTJT BOE JOGFDUJPVT IFQBUJUJT-PXFS OVNCFST BOE QFSDFOUBHFT NBZ PDDVS BGUFSESVHT TFSVN TJDLOFTT USBOTGVTJPOT BOE PUIFSTFUUJOHT-ZNQIPDZUFTMZNQIPDZUPQFOJB%FDSFBTFEMZNQIPDZUFTNBZCFQSFTFOUJOBOVNCFSPG TFSJPVT EJTFBTFT 5IFTF JODMVEF DPOHFOJUBMPS BDRVJSFE JNNVOF EFGJDJFODJFT JOUFTUJOBMMZNQIBOHJFDUBTJB BDUJWF UVCFSDVMPTJT BVUPJNNVOFEJTFBTFT)PEHLJOEJTFBTFBOEDPSUJDPTUFSPJEFYDFTTBESFOBMIZQFSQMBTJBPSUVNPSTNFEJDBUJPO-ZNQIPDZUFTWBDVPMJ[BUJPO7BDVPMFT JO MZNQIPDZUFT PDDVS JO QBUJFOUT XJUITUPSBHF EJTFBTFT NVDPQPMZTBDDIBSJEPTFT /JFNBO1JDL EJTFBTF (. HBOHMJPTJEPTJT *DFMM EJTFBTFNBOOPTJEPTJT BOE BDVUF MFVLFNJBT )PXFWFS UIFZNBZBMTPPDDVSBTBOBSUJGBDUJGUIFQFSJQIFSBMTNFBSJTNBEFGSPNCMPPEBOUJDPBHVMBUFEXJUI&%5"1MBUFMFUT5IF QMBUFMFU DPVOU DBO CF FTUJNBUFE GSPN UIFQFSJQIFSBMTNFBSYUIFOVNCFSPGQMBUFMFUTJOBOBWFSBHFIJHIQPXFSGJFMETable VIII. Differential diagnosis of eosinophilia Tabela VIII. Przyczyny eozynofiliiallergic disorders, eosinophilic GEpemphigus, eosinophilic fasciitis, polyarteritis nodosa, scleroderma, sarcoidosisbrucellosis, helminthes, malaria, scrabies, scarlet fever, tuberculosishemo/peritoneal dialysis, toxinsfamilial, hereditary angioedema, hyper-IgE syndrome, omen syndro-me, congenital neutropenia, Tar syndrome, Wiscott-Aldrich ALL, lymphomas, metastatic cancers, myeloproliferative dis.clonal/idiopatic HESadrenal insulficiency, graft vs host diseaseFig. 2. Relationship of the platelet count and the bleeding time Ryc. 2. Zaleno liczby pytek krwi i czasu krwawieniaPLATELET COUNT and BLEEDING TIMEBLEEDINGTIME(MINUTES)PLATELETS/ul/10305010015020050403020100AAITPWAS vWDUASAWASWISKOTTALDRICHAAAPLASTICANEMIAvWD vonWILLEBRAND DISEASEUUREMIAASAASPIRINNORMOCYTIC ANEMIAPERIPHERALSMEAR(MCV)RETICULOCYTESLOW HIGH COOMBS +MARROWDISEASEPLASMAVOLUMEBLOODLOSSIMMUNEHEMOLYSISRBCDEFECTINTRINSICMEMBRANEHGBENZYMEEXTRINSICHEMOLYSISFig. 1. Suggested algorithm for workup of normocytic anemia Ryc. 1. Zalecany algorytm diagnostyki niedokrwistoci normocytarnejP 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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qMHBTUSPJOUFTUJOBMqMTLJONVDPVTNFNCSBOFTBOETPGUUJTTVFTBOEMDFOUSBMOFSWPVTTZTUFN#MFFEJOH JT BMTP SFMBUFE UP QMBUFMFU GVODUJPO'JH5IVTQBUJFOUTXJUI*51IBWFMFTTSJTLPGCMFFEJOHGPSBOZHJWFOQMBUFMFUDPVOUCFDBVTFUIFJS MBSHFQMBUFMFUTBSFVTVBMMZNPSFGVODUJPOBM$POWFSTFMZQBUJFOUTXJUIVSFNJBPSXIPIBWFUBLFOBTQJSJOIBWFMPOHFSCMFFEJOHUJNFTBOEBOJODSFBTFESJTLPGIFNPSSIBHFCFDBVTFPGMFTTGVODUJPOBMQMBUFMFUTConclusions5IF $#$ JT NPSF UIBO OVNCFST 6OEFSTUBOEJOHJUT TUSFOHUIT BOE MJNJUBUJPOT QSPWJEFT JNQPSUBOUBEEJUJPOBM JOGPSNBUJPO 8IFO VTFE JO DPOKVODUJPOXJUIDBSFGVMSFWJFXPGUIFQFSJQIFSBMTNFBSUIF$#$JTBNPSFJOGPSNBUJWFUFTUR e f e r e n c e s ;BOEFDLJ.(FOFWJFWF ' (FSBSE + (PEPO " 4QVSJPVTDPVOUT BOE TQVSJPVT SFTVMUT PO IBFNBUPMPHZ BOBMZ[FSTB SFWJFX 1BSU ** XIJUF CMPPE DFMMT SFE CMPPE DFMMTIBFNPHMPCJOSFEDFMMJOEJDJFTBOESFUJDVMPDZUFT*OU+-BC)FNBUPMq #FTTNBO +% (JMNFS 13 +S (BSEOFS ') *NQSPWFEDMBTTJGJDBUJPO PG BOFNJBT CZ.$7 BOE 3%8 "N +M $MJO1BUIPMq .FOU[FS 8$ %JGGFSFOUJBUJPO PG JSPO EFGJDJFODZ GSPNUIBMBTTFNJBUSBJUCZSPVUJOFCMPPEDPVOU-BODFU 5PEE +, $IJMEIPPE JOGFDUJPOT %JBHOPTUJD WBMVF PGQFSJQIFSBMXIJUFCMPPEDFMMBOEEJGGFSFOUJBMDPVOUT"N+%JT$IJMEq .D$BSUIZ 1- +FLFM +' %PMBO 5' 5FNQFSBUVSF HSFBUFSUIBOPSFRVBMUP$JODIJMESFOMFTTUIBONPOUITPGBHFBQSPTQFDUJWFTUVEZ1FEJBUSJDTq 8BHFMJF4UFGGFO " "DFWFT 44 &PTJOPQIJMJD EJTPSEFST JODIJMESFO$VSS"MMFSHZ"TUINB3FQqP 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 2PODYPLOMOWA SZKOA PTP / POSTGRADUATE SCHOOL OF PAEDIATRICS 77Test sprawdzajcy pytania1ZUBOJF*/JFEPLSXJTUPvNJLPDZUBSOBKFTUTUXJFSE[BOBQS[ZOJFEPCPS[FB XJUBNJOZ#C LXBTVGPMJPXFHPD FMB[BE [BUSVDJVPPXJFNF UBMBTFNJJPEQPXJFEy BC BCD DEF CE DE1ZUBOJF**8OJFEPLSXJTUPvDJXDIPSPCBDIQS[FXMFLZDITUXJFSE[BNZB OJTLJQP[JPNGFSSZUZOZC XZTPLJQP[JPNGFSSZUZOZD OJTLJQP[JPNFMB[BE XZTPLJQP[JPNFMB[BF XZTPL[EPMOPvXJ[BOJBFMB[BPEQPXJFEy BE DF BDF CD CEF1ZUBOJF***0COJFOJFMJNGPDZUXNPFCZTUXJFSE[BOF[XZKULJFNB XSPE[POZDIJOBCZUZDIOJFEPCPSXPEQPSOPvDJC BLUZXOFKHSVyMJDZD DIPSCBVUPJNNVOPMPHJD[OZDIE [JBSOJDZ[PvMJXFKF [BLBFOJBXJSVTPXFHP1ZUBOJF*7%VZSP[NJBSQZUFLLSXJ.17NPFCZTUXJFSE[BOZ[XZKULJFNB NBPQZULPXPvDJJNNVOPMPHJD[OFKC [FTQPV8JTLPUU"MESJDID [FTQPVIFNPMJUZD[OPNPD[OJDPXFHPE PEOPXZT[QJLVF BOFNJJBQMBTUZD[OFKPEQPXJFEy BC BF BDF CF CEFTest sprawdzajcy odpowiedzi 1ZUBOJF*DEF1ZUBOJF**CD1ZUBOJF***F1ZUBOJF*7CFOptimizing 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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