Complete blood count analysis Dr Rahul Jain & Dr Sharda Jain

HAEMOGRAM=CBC+ESR

ALWAYS GET A PERIPHERAL SMEAR!

1. Topic :- Complete blood count analysis Dr Rahul Jain Dr Sharda Jain for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on slideshare.net ***for use of public/Doctors www.slideshare.net / Lifecarecentre

3. HAEMOGRAM AND CBC ARE THEY DIFFT? HAEMOGRAM=CBC+ESR ALWAYS GET A PERIPHERAL SMEAR!

4. BLOOD ANALYSIS HAEMOGLOBIN RBC COUNT HAEMATOCRIT MEAN CORPUSCULAR VOLUME MEAN CORPUSCULAR HAEMOGLOBIN MEAN CORPUSCULAR HAEMOGLOBIN CONCENTERATION RED CELL DISTRIBUTION WIDTH RETICULOCYTE COUNT TOTAL LEUCOCYTE COUNT DLC(N/L/M/E/B) PLATELET COUNT ESR PERIPHERAL SMEAR

5. RED BLOOD CELL DISORDERS-

6. ANAEMIA- DUE TO BLOOD LOSS-POST HAEMORRHAGE,CHRONIC BLOOD LOSS DUE TO IMPAIRED PRODUCTION- B12,FOLIC ACID,IRON,NUTRITIONAL DEFICIENCY APLSTIC ANAEMIA ANAEMIA OF CHRONIC DISEASES-TB,INFECTIONS,RENAL DISEASES,LIVER DISEASE BONE MARROW INFILTRATION-LEUKEMIA,LYMPHOMAS,MULTIPLE MYELOMA CONGENITAL ANAEMIAS-SIDEOBLASTIC ANAEMIA

7. ANAEMIA- ANAEMIA DUE TO INCREASED RED CELL DESTRUCTION- (HAEMOLYTIC ANAEMIA’S)

8. haemoglobin OXYGEN CARRYING PIGMENT IN RBC NORMAL LEVELS-MALE=14-18 GM/DL FEMALES=12-15.5GM/DL DECREASED IN ANAEMIA INCREASED IN CHRONIC SMOKERS,POLYCYTHEMIA,DEHYDRAT. ANAEMIA SEVERITY(WHO)- MILD ANAEMIA-9-11 GM/DL MODERATE ANAEMIA-7-9 GM/DL SEVERE ANAEMIA-<7 GM/DL

9. RBC COUNT NO. OF RBC PER MICROLITRE OF BLOOD NORMAL-MALES=5-6 MILLION/MM3 FEMALES=4.5-5.5 MILLION/MM3 DECREASED IN ANAEMIA INCREASED IN CHRONIC SMOKERS,DEHYDRATION,CHRONIC HYPOXIA,POLYCYTHEMIA

10. HAEMATOCRIT VOLUME OF RBC PER LITRE OF WHOLE BLOOD EXPRESSED IN PERCENTAGE NORMAL LEVELS-MALES 40-54% FEMALES 37-47% DECREASED IN ANAEMIA INCREASED IN CHRONIC SMOKERS,DEHYDRATION,CHRONIC HYPOXIA,POLYCYTHEMIA,SHOCK HELPS TO CALCULATE MCH,MCHC,MCV

11. MEAN CORPUSCULAR VOLUME AVERAGE VOLUME OF ONE RBC (FEMTOLITRE) NORMAL VALUES-77-93 FEMTOLITRES NORMAL VOLUME-NORMOCYTES DECREASED VOLUME-MICROCYTES(IRON DEFICIENCY,THALASSEMIA,SIDEROBLASTIC ANAEMIA, ACD) INCREASED VOLUME-MACROCYTES(MEGALOBLASTIC ANAEMIA,APLASTIC ANEMIA,CHRONIC LIVER DISEASES)

12. MEAN CORPUSCULAR HAEMOGLOBIN AVERAGE AMT OF HAEMOGLOBIN IN SINGLE RBC IN PICOGRAM Normal values-27-32 PICOGRAMS NORMAL AMOUNT-NORMOCHROMASIA DECREASED AMOUNT-HYPOCHROMIA( IRON DEFICIENCY,THALASSEMIA,SIDEROBLASTIC ANAEMIA, ACD) INCREASED AMOUNT-HYPERCHROMIA(SIDEROBLASTIC ANAEMIA)

13. MEAN CORPUSCULAR HAEMOGLOBIN CONCENTERATION HAEMOGLOBIN CONCENTERATION IN SINGLE RBC(PERCENTAGE OF HAEMOGLOBIN OCCUPIED IN SINGLE RBC) NORMAL 32-37% BETTER PREDICTOR OF HYPERCHROMASIA AND HYPOCHROMASIA

14. RED CELL DISTRIBUTION WIDTH VARIATION BETWEEN SMALLEST RBC AND LARGEST RBC NORMAL LEVELS(11.6-14%) VARIATION IN SIZE(ANISOCYTOSIS)-2 TYPES-MICRO AND MACROCYTES VARIATION IN SHAPE(POIKILOCYTOSIS)-SEEN IN IDA,MEGALOBLASTIC ANAEMIA,THALASSEMIA

15. Reticulocyte count INDICATES MARROW ERYTHROPOEITIC ACTIVITY NORMAL 0.5-2.5% HIGH RETIC COUNT-HAEMOLYTIC ANAEMIA,ACUTE HG,THALASSEMIA,RESPONSE TO IRON THERAPY LOW RETIC COUNT-IDA,B12,FOLIC ACID DEFICIENCY,ACD

16. ERYTHROCYTE SEDIMENTATION RATE- USED AS AN INDEX FOR PRESENCE OF ACTIVE DISEASE. NORMAL VALUES AT END OF 1 ST HOUR MALES-0-7MM FEMALES 0-15MM

17. PERIPHERAL SMEAR-

18. PERIPHERAL SMEAR RBC MORPHOLOGY SIZE(MICRO,NORMO,MACROCYTE) PIGMENT(HYPO,NORMO,HYPERCHROMIA) POIKILOCYTOSIS(VARIATION IN SHAPE) SPECIAL APPEARANCES-SICKLE CELLS,TEAR DROP CELLS,SPHEROCYTES,SCHISTOCYTES,HOWELL JOLLY BODIES,HEINZ BODIES) WBC MORPHOLOGY PRESENCE OF PLATELETS

19. IDA PS- MICROCYTES HYPOCHROMIA INCREASED CENTRAL PALLOR POIKILOCYTOSIS NORMAL WBC NORMAL PLATELETS

20. MEGALOBLASTIC ANAEMIA PS- MACROCYTES NORMOCHROMIC TEAR DROP CELLS ANISOPOIKILOCYTOSIS LESS PLATELETS HYPERSEGMENTED NEUTROPHILS

21. (QUALITATIVE)Sickle cell anaemia - RED CELLS DEVELOP SICKLING WHEN EXPOSED TO LOW OXYGEN TENSION(HYPOXIA,ACIDOSIS) DEFECTIVE BETA CHAIN IN GLOBIN(ALPHA2,BETA2) HAEMOLYSIS HISTORY ANAEMIA IN CBC( Hb 6-9 GM/DL) PERIPHERAL SMEAR-SICKLE CELLS,TARGET CELLS,HOWELL JOLLY BODIES HAEMOGLOBIN ELECTROPHORESIS

22. (QUANTITATIVE D/S)THALASSEMIA- SYNTHESIS OF GLOBIN CHAIN AFFECTED,ALPHA OR BETA MORE COMMONLY BETA,REDUCED FORMATION OF NORMAL HAEMOGLOBIN H/O MULTIPLE BLOOD TRANSFUSION,JAUNDICE,IRON CHEL. RBC WITH LESS HB ARE PRODUCED(SMALL AND PALE RBC’S) PERIPHERAL SMEAR-MICROCYTIC,HYPOCHROMIC,BASOPHILIC STIPPLING,TARGET CELLS,TEAR DROP CELLS ,NORMOBLASTS ,SLIGHTLY ELEV RETICULOCYTE COUNT HAEMOGLOBIN ELECTROPHORESIS-ABSENCE OF NORMAL HB,PRESENCE OF FOETAL HB

23. FEATURES IRON DEFICIENCY ANAEMIA THALASSEMIA BLOOD PICTURE MICROCYTIC HYPOCHROMIC MICROCYTIC HYPOCHROMIC ANISOCYTOSIS(SIZE VARIATION) ++ --(UNIFORM SIZE) RDW WIDE NARROW RETIC COUNT LOW SLIGHTLY HIGH RBC COUNT LOW(LOW IRON) HIGH(COMPENSATORY) (INEFF ERYTHOPOIESIS) MENTZER’S INDEX(MCV/RBC) MORE THAN 14 (MCV ↓/RBC COUNT↓↓) LESS THAN 12 (MCV ↓/RBC COUNT ↑↑) )IRON PROFILE SERUM FERRITIN LOW,SERUM IRON LOW NORMAL

24. TOTAL LEUCOCYTE COUNT TOTAL NO. OF WBC/MICROLITRE OF BLOOD NORMAL LEVELS-4000-11000/MICROLITRE LEUCOCYTOSIS(INC)- NEWBORN EXERCISE STRESS ANY INFECTIONS OF BODY(CHRONIC INFECTIONS,PUS FORMING INFECTIONS,FEVER PRODUCING INFECTIONS) LEUKEMIA(>50000/MICROLITRE) LEUKAMOID REACTION(>20,000/MICROLITRE)

25. TLC LEUKOPENIA- STARVATION DENGUE FEVER(VIRAL FEVER) BONE MARROW DEPRESSION STARVATION PSEUDOLEUKOPENIA-ACUTE MIGRATION OF WBC AT INFECTION SITE WILL CAUSE FALSE LEUKOPENIA IN PERIPERAL BLOOD

26. DIFFERENTIAL LEUKOCYTE COUNT NEUTROPHILS>LYMPHOCYTES>MONOCYTES>EOSINOPHILS>BASOPHILS(NEVER LET MONKEYS EAT BANANAS) N:L:M:E:B—50-70%:20-30%:2-6%:2-4%:0-1% NEUTROPHILS-BACTERIAL INFECTIONS,BURNS LYMPHOCYTES-CHRONIC INFECTIONS(TB),VIRAL INFECTIONS,LYMPHATIC LEUKEMIA MONOCYTES-SYPHILIS,LEUKEMIAS,MALARIA,KALA AZAR EOSINPHILS-ALLERGIES,PARASITES,SKIN DISEASES BASOPHILIS-CML,MYXOEDEMA,ULCERATIVE COLITIS

27. PLATELET COUNT- NO. OF PLATELETS PER MICROLITRE OF BLOOD NORMAL-1.5 LAKH-4.0 LAKHS/MM3 THROBOCYTOPENIA- IMPAIRED PRODUCTION-BONE MARROW FAILURE,B12 DEFICIENCY ACC PLATELET DESTRUCTION- IMMUNOLOGIC-ITP,POST TRANSFUSION,VIRAL(DENGUE) INCREASED CONSUMPTION-DIC,TTP SPLENIC SEQUESTRATION-SPLENOMEGALY DILUTIONAL-MASSIVE TRANSFUSION OF OLD STORAGE BLOOD

28. THANK YOU ANY QUESTIONS?