Complete blood count (CBC)

Complete blood count, INTERPRETATION OF complete blood count, blood, blood cells, haemoglobin, haemocrit, WBC, RBC, PLATELETS, PLT

1. Complete Blood Count ( CBC) Dr.SAIMA SHAHID e Blood Count (CBC)

2. objective The CBC interpretation are useful in the diagnosis of various types of anemias . It can reflect acute or chronic infection, allergies, and problems with clotting.

3. Common Components of the CBC Red blood cell count Hemoglobin ( Hgb ) Hematocrit ( Hct ) { packed cell vol } Mean Corpuscular Volume ( MCV) Mean Corpuscular Hemoglobin Concentration (MCHC ) Platelets (PLT) White blood cell count White blood cell differential

4. Red Blood Cells (RBCs) RBC  count range: 3.6-5.4 RBCs transport oxygen to body tissues. Body tissues that are adequately oxygenated are said to be well-perfused High levels may indicate dehydration. This is because the blood becomes less diluted with dehydration, so the number of RBCs will be more concentrated Low levels indicate a lack of oxygen, malnutrition, or blood loss. Low RBCs levels from blood loss results in hypovolemia (low fluid volume in the vasculature) secondary to hemorrhage. Common causes of hemorrhage include trauma, post-operative complications, and adverse effects from certain medications that reduce the viscosity of the blood (such as heparin and warfarin )

5. Routine use of IV fluid replacement commonly leads to low levels that are unrelated to a pathology. This is because the blood becomes hypervolemic (high fluid volume in the vasculature). Small alterations are usually not concerning. However, risks exists when IV fluids are used excessively, causing fluid overload. This can be particularly dangerous to patients with heart disease as increased fluid volume may raise the blood pressure, leading to elevated systemic vascular resistance (SVR) and increasing the cardiac preload, making the heart work harder to pump blood. Furthermore, hypervolemia from overhydration can also cause crucial electrolyte values to become deficient in comparison (such as sodium and potassium)

6. Hemoglobin ( Hgb ) Index of O2 - carrying capacity of blood in anemia, hemorrhage Hemoglobin ( Hgb ) range: ♥ 12-16 gm / dL ; ♠ 13.8-17.2 gm / dL Criteria for anemia for both boys and girls that are 3-12 years of age: hemoglobin level less than 11.0 g/ dL

7. Hemoglobin ( Hgb ) Hemoglobin  is the oxygen-carrying pigment found in RBCs. Each hemoglobin contains a heme group that binds with iron molecules (up to 4 ). Although hemoglobin levels are evaluated to predict oxygen transport, they only reveal the number of molecules  available  to bind to red blood cells, rather than the  actual  number of red blood cells that are saturated in oxygen. Anemia is linked to low hemoglobin levels.   Anemia , which is a symptom of a condition rather than an actual disease in of its own right, is characterized by low red blood cell levels but is actually  measured  by the hemoglobin values.

8. Hemoglobin ( Hgb ) Broad causes of anemia include poor nutritional status (either from diet or secondary to an absorption issue), an acute disease state, or a chronic pathology that either renders the baseline hemoglobin levels low (as in the hemoglobin is always low in the patient) or can cause acute exacerbations that temporarily affect levels (such as cases of sickle cell anemia, when the individual experiences a “sickle cell crisis” or another exacerbation ). The underlying cause of anemia is determined by analyzing a combination of hematological findings. These include hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and the mean corpuscular hemoglobin concentrate (MCHC)

9. Classification of anemias Classify by: − RBC size = by MCV - microcytic, normocytic, macrocytic − RBC colour = by MCHC - hypochromic = low hemoglobin e.g., microcytic hypochromic anemia - may be due to iron deficiency macrocytic normochromic anemia - associated with folic acid deficiency

10. haemoglobin Hemoglobin levels are often used to determine if a patient needs a blood transfusion. The cut-off point varies between facility policies, but most mandate transfusion for values under  7-8 gm / dL Low hemoglobin values are seen in patients with  hemoglobinopathies , or inherited blood disorders that either affect hemoglobin structure or synthesis. The most common include thalassemia syndromes, including alpha-thalassemia and beta-thalassemia (β-thalassemia), and structural hemoglobin variants (abnormal hemoglobins ), including  HbS (sickle cell anemia), HbE , and HbC . As expected, a major symptom of hemoglobinopathies is anemia

11. Hematocrit Hematocrit ( Hct ): ♥ 37-47%; ♠ 41-50 % It is ratio of the volume of red cell to the volume of whole blood Hct is the percentage of red blood cells present in the blood (the ‘composition’). Testing is an important indicator in diagnosing anemia and narrowing down the type of etiology in which it originates A high hematocrit can suggest fluid deficit or dehydration A low hematocrit can suggest fluid overload. Patients on intravenous fluids often experience a slightly decreased hematocrit as their blood becomes ‘diluted.’ It may also be present in anemia related to poor nutrition, renal insufficiency, or bone marrow suppression

12. THE INDICES (MCV & MCHC) These give information regarding the type of anemia, if present. They indicate if the anemia is due to B12, folic acid, iron, B6, zinc or copper deficiency, blood loss or genetic origin. MEAN CORPUSCULAR VOLUME ( MCV ) MCV Optimal levels are 86 - 90 fl. This test describes the individual red blood cell size. Increased levels, as seen in macrocytic anemia, result from a nutritional deficiency of folic acid or vitamin B12 and may also be associated with digestive complaints, lack of Hydrochloric acid, celiac sprue , alcohol related diseases or after certain types of cancer chemotherapy. Decreased levels may indicate a deficiency of iron, B6, zinc, copper or molybdenum. small = microcytic normal = normocytic large = macrocytic

13. THE INDICES (MCV & MCHC) MEAN CORPUSCULAR HEMOGLOBIN (MCH) Normal levels are 27.5 – 33.0 pg. Increases levels indicate B12 or Folic Acid deficiency. Decreased levels are found with parasites, iron anemia, Vit C deficiency, lack of hydrochloric acid, B6 anemia, rheumatoid arthritis, or lead toxicity. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION ( MCHC ) MCHC Optimal level are 330 - 345 g/L. MCHC is a most valuable test in evaluating anemia therapy as it measures the concentration of hemoglobin in an average red blood cell. Increased levels indicate that the red blood cells are shaped like "spheres" instead of "donuts". Decreased levels indicate that the red blood cells contain less hemoglobin than normal and will require specific nutritional therapy.

14. Platelets Platelet count range: 130,000-400,000 per microliter Platelets are the most abundant yet smallest type of blood cell. They are actually cellular fragments that originate from megakaryocytes. They have a 8-10 day life span and play a vital role in coagulation Thrombocytopenia, or a low platelet count, may be related to failure of the bone marrow to produce enough platelets or can indicate an infection, vitamin deficiency, or a medication that affects coagulation, such as heparin (an anticoagulant that’s often administered following surgery as prophylaxis for deep vein thrombosis). Heparin induced thrombocytopenia (HIT) is seen in patients that develop an immune reaction to heparin use; therefore, patients that are given heparin should have their platelet counts monitored. Acquired thrombocytopenia may occur following chemotherapy due to bone marrow destruction

15. platelets High platelet counts can increase blood viscosity and place a patient at risk for stroke Inherited low platelet counts, such as those seen in genetics blood disorders, places the patient at risk for excessive bleeding

16. Petechial (localized skin ) hemorhage . Easy bruising. Mucosal bleeding e.g. _ epistaxes . _ gum bleeding Manifestaton of thrombocytopenia

17. Mean Platelet Volume (MPV) MPV range: 9.4-12.3 FL The MCV is a platelet marker High levels of MCV have been linked to an increased risk of risk of thrombosis. High-grade inflammatory diseases are often associated with low levels.

18. Differential leucocyte count (WBC’s) defence leukocytosis = increased # WBC - suggests invading organism, tissue destruction • WBC count changes with age, stress, exercise, diurnal rhythm WBC differential: − Calculate % of each of the 5 types of WBC. − lymphocytosis - commonly due to viral infection − eosinophilia - associated with allergic conditions, parasites − immature band neutrophils - appear if prolonged heavy demand for neutrophils results in release of immature cells = “shift to the left” - referring to usual left to right illustration of neutrophil development

19. White Blood Cells (WBCs) WBC count range: 5.0-10 mm3 Standard evaluation included in the CBC to assess for signs of infection or to determine a baseline The two components include the overall WBC count and the differential. The differential looks at the composition of each individual type of cell in the overall WBC population WBCs are more diagnostically valuable by considering the individual cell types that compose the WBC count White blood cells are also called leukocytes Leukopenia, a low WBC count, can result from chemotherapy, antibiotics, or bone marrow dysfunction

20. White Blood Cells (WBCs) Severe infections can result in leukemoid reaction in which the WBC count becomes incredibly high Absolute lymphopenia is defined as WBC count less than 1,500 mm3; it’s most common in immunocompromised viral infections such as AIDS A “shift to the left” is a term used to denote that an increase in leukocytes, especially neutrophils, meaning that the cellular population is characterized by immature precursors, rather than segmented or matured neutrophils

21. Neutrophils Neutrophil range: 48-73% Neutrophilia (+) is often present with certain acute infections that form pus It can also be related to mental stress Neutropenia (-) is seen in aplastic anemia, following chemotherapy for certain malignancies such as acute myeloid leukemias , extreme dietary deficiencies, or during severe infections, signaling a long and overwhelming battle with pathogen that may possibly have gone septic

22. Lymphocytes Lymphocytes range: 20-40% Lymphocytes include B cells and T cells Lymphocytosis (+) is present in acute infections, such as mononucleosis or hepatitis, and during radiation exposure Lymphocytopenia (-) often occurs with sepsis and in leukemia This test is ordered to evaluate T-Cells, B-Cells, and to monitor for signs of infection

23. Monocytes Monocyte range: 0-9% Monocytosis (+) is seen in cases of tuberculosis, viral infections, and chronic inflammatory disorders Monocytopenia (-) can occur as the result of prednisone use

24. Eosinophils Eosinophil range: 0-5% Eosinophilia (+) is common during parasitic infections, eczema, allergic reactions, and some immune diseases Eosinopenia (-) could be related to the increase of adrenosteroid production Ordered to evaluate for the presence of an infection, especially parasitic, or immune diseases and allergies

25. Basophils Basophils 0-2% Basophilia (+) is seen with myeloproliferative diseases and leukemia Basopenia (-) is common in cases of allergic responses, stress, and hyperthyroidism An increase is seen in the recovery phase of an infection

26. Abnormal result of WBC (Leukocytosis) may indicate: _ Infectious diseases _Inflammatory disease (such as rheumatoid arthritis or allergy) _Leukemia _Severe emotional or physical stress _Tissue damage (e.g. necrosis,or burns) (Leukopenia) may result from: _ Decreased WBC production from BM. _ Irradiation. _ Exposure to chemical or drugs.

27. Fever Malaise Weakness Others depend on each system which is involved e.g. » chest: cough , and chest pain » abdomen: diarrhea, vomiting, dehydration. »CNS: headache, visual disturbance, Neck stiffness and so 0n. Manifestation of leukocytosis

28. Infection of the mouth and throat. Painful skin ulceration. Recurrent infection. Septicemia. Manifestation of leukopenia