Complete Blood Count Interpretation

Complete Blood Count Interpretation - peripheral smear, platelet, neutrophils, smear and slide and parasites and morphology and interpretation

1. Complete Blood Count C hair Person: Dr Chandrashekar K Student: Dr Kiran Revankar

2. Sample Collection EDTA Trisodium citrate Heparin

3. HEMATOCRIT HEMATOCRIT HCT=HB x 3 HB= RBC x 3

4. R aised Haematocrit

5. Reduced Haematocrit DECREASED RED BLOOD CELLS OR HAEMODILUTION

6. RED BLOOD CELLS

7. Raised RBC counts

8. Haemoglobin

9. Mean Corpuscular Volume MCV is average volume of the red blood cell 80-100 fl > 100 fl <80 fl

10. Small intestine absorption defect Crohn disease Sprue Lymphoma Diverticulosis blind loop with bacterial overgrowth Fish tapeworm Ileal resection Zollinger-EIIison syndrome HIV infection Causes of macrocytosis • Myelodysplastic syndromes • Myelophthisic anemia • Post splenectomy • Alcoholism • Liver disease • Anaemia of hypothyroidism • Drugs : – Anticonvulsants, (e.g. phenytoin, primidone, phenobarbital) – Antitumor agents, (e.g. methotrexate, hydroxyurea, cyclophosphamide) – Antimicrobials, (e.g. sulfamethoxazole, sulfasalazine, zidovudine, pyrimethamine ).

11. Causes of M icrocytosis Interference in MCV

12. Mean Corpuscular Haemoglobin (MCH)

13. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)

14. RETICULOCYTE COUNTS

15. Absolute reticulocyte count=reticulocyte% X number of RBCs Ex: ARC=1%x50 lac =50,000 Corrected reticulocyte count =reticulocyte % x patients HCT/45 Ex:6% x 22/45=3%

16. Red cell distribution width (RDW)

17. Thalassemia Iron deficiency anaemia Red cell fragmentation Agglutination Dimorphic cell populations

18. RBCs ON PERIPHERAL SMEAR

19. Microcytic Hypochromic A naemia Iron deficiency anaemia Thalassemia Anaemia of chronic disease Sideroblastic anaemia Lead toxicity Copper deficiency Pyridoxine deficiency

20. Megaloblastic anaemia Giant band forms Macrovovalocytes Hypersegmented neutrophil

21. Sideroblastic anaemia

22. Microcytic + hypochromic+ basophilic stippling Lead toxicity

23. Thalassemia MINOR Major Pinch bottle cells ( knizocyte ) Target cells Tear drop cells Poikilocytosis (major>>minor)

24. Tear drop cells and nucleated RBCs Myelofibrosis H yposplenism

25. Heinz bodies- refractile intracellular haemoglobin precipitates detected in patients with unstable hemoglobins , thalassemias and G6PD defficiency

26. Spherocytes (seen in HS/AIHA)

27. E liptocytosis

28. Stomatocyte

29. Acanthocyte (“Spur cell”)

30. Echinocyte(“Burr cell”)

31. Schistocytes Microangiopathic hemolytic anemia (TTP, DIC, vasculitis,glomerulonephritis , renal graft rejection) Carcinomatosis Heart-valve haemolysis ( prosthetic or pathologic valves ) Severe burns

32. RBC clumping in Cold agglutination/PNH

33. WHITE BLOOD CELLS

34. Neutrophils(50-70%) Monocytes(2-6%) Basophills (0-1%) Eosinophils (0-3%) Lymphocytes(20-40%)

35. Leucocytosis

36. Leukocytopenia

37. Increased Neutrophil (Neutrophilia)

38. Eosinophilia

39. E osinopenia

40. BASOPHILIA – CAUSES

41. Monocytosis – CAUSES

42. Lymphocytosis

43. Lymphocytopenias

44. Atypical lymphocytes in infectious mononucleosis

45. Lymphoblast Myeloblast

46. Acute P romyelocytic leukemia

47. Chronic myeloid leukaemia

48. Hand mirror blasts in ALL

49. Primary Myelofibrosis

50. PLATLETS

51. Normal platelets are about 1–3 μm in diameter 1 megakaryocyte produces about 4000 platelets Lifespan of platelets is about 9–12 days Production of platelet is regulated by hormone called thrombopoietin Normal count : 150000–450000/μ L

52. Thrombocytosis

53. Marrow failure • Aplastic anemia • Myelodysplastic syndrome (MDS) • Bone marrow hypoplasia due to – Chemotherapy – Radiation – Toxins – Immune. • Bone marrow infiltration by – Fibrosis – Malignancy – Granulomas .

54. Selective marrow suppression of platelet production due to— – Drugs – Infections – Ethanol . Ineffective thrombopoiesis due to — – Folate or B12 deficiency . Hereditary disorders – May- Hegglin anomaly – Wiskott -Aldrich syndrome Dhole bodies

55. Immune mediated • Systemic lupus erythematosus • Lymphoproliferative disorders • Drugs including- heparin induced • Infections including HIV related • Post-transfusion • Idiopathic/immune thrombocytopenia (ITP ) Nonimmune mechanisms • Severe bleeding • Disseminated intravascular coagulation (DIC) • Abnormalities in small vessels • Vasculitis • von Willebrand disease ( vWD ) • Thrombotic thrombocytopenic purpura • Hemolytic uremic syndrome .

56. Platelet Satellitism Platelet clumping EDTA induced

57. MEAN PLATELET VOLUME (MPV) Average size of platelet in the blood In general peripheral distruction with normal functioning marrow increases MPV And marrow failure decreases the MPV Normal value : 7.4–10.4 fL