Full Blood Count (FBC) Interpretation.pptx

This presentation on full blood count(FBC) takes a deep dive into help you interpret any given FBC results. The presentation provides you with requisite explanations on the various FBC parameters. It also gives you possible conditions in which various parameters are affected. By going through this slides you will be able to diagnose various conditions such as Anemias.

1. I NTERPRETATION OF FULL BLOOD COUNT P resented By G amor Kwame Dickson

2. OUTLINE OF PRESENTATION Introduction to full blood count Types of full blood count components . Importance of full blood count (FBC) results interpretation . Methods of obtaining FBC. Interpretation of results . Conclusion 2

3. FULL BLOOD COUNT One of the most commonly ordered laboratory tests and the most ordered test in the hematology lab. Measure of the cellular components in the blood: white blood cells , red blood cells , platelets and features of blood. It gives useful information about the production of all blood cells. It also provides information about the immune system through the evaluation of the white blood cell (WBC) count. 3

4. Cont ’ When interpreted carefully and correctly in relation to clinical history, it provides information that assists; Diagnosis (anaemia, cancer, clotting issues, infections & immune system disorder) Drug monitoring Management of diseases 4

5. The Constituents of the Full Blood Count Red blood cells (RBC) count and its indices. White blood cells (WBC) count with differential count of the various leukocytes. The Platelet count. 5

6. Method obtaining FULL blood count Manuel Method of testing individual parameters. Automated Haematology analyzer. 3-part differential analyzer 5-part differential analyzer 6

7. Picture of Beckman-Coulter AcT 3-part differential haematology analyzer. Source : https://portal.issn.org/resource/ISSN/2578-501X Sysmex XN Series 5-Part differential Haematology Autoanalyzer Source : https://portal.issn.org/resource/ISSN/2578-501X 7

8. Full blood count and ranges PARAMETERS UNIT NORMAL RANGES White Blood Cells (WBCs) 10 3 / uL Adult M&F (3 .50 – 10.50) 6 – 12yrs (4.5 -14.5) 2 – 6mths (5.0 -15.0) Birth(8.0 – 24.0) Red Blood Cells (RBC) 10 6 / uL 2.50 – 5.50 Haemoglobin ( Hgb ) g/ dL Adult M (13.0 – 18.0) Adult F (12.0 – 16.0) 1 – 6yrs (11.5 – 15.5) Birth (14.0 – 24.0) Hematocrit ( Hct ) % 36.0 – 54.0 Mean Corpuscular Volume (MCV) fL Adult M& F (80.0 – 100.0) 1 – 6yrs (70.0 -85.0) Birth (100 – 125) Mean corpuscular hemoglobin (MCH) Pg 27.0 – 32.0 Mean Corpuscular Hemoglobin Con (MCHC) g/ dL 32.0 – 36.0 Platelets (PLT) 10 3 / uL 150.0 – 400.0 8

9. Fbc and normal ranges Red Cell Distribution Width (RDW) - SD fL 37.0 – 54.0 Red Cell Distribution Width (RDW) - CV % 11.0 – 16.0 Platelet Distribution Width (PDW) fL 11.0 – 16.0 Mean Platelet Volume (MPV) fL 6.0 – 11.0 Platelet Large Cell Ratio (PLCR) % 13.0 – 43.0 PCT % 0.17 – 0.35 NRBC% % NRBC# 10 9 /L NEUT% % 40.0 – 75.0 LYMPH% % 21.0 – 40.0 MONO% % 2.0 – 10.0 EO% % 1.0 – 6.0 BASO% % 0.0 – 1.0 Absolute Neutrophil Count (NEUT#) 10 9 /L 1.50 – 7.0 9

10. Full blood count and ranges Absolute Lymphocyte Count ( LYMPH#) 10 9 /L 1.0 – 3.7 Absolute Monocyte Count ( MONO#) 10 9 /L 0.0 – 0.7 Absolute Eosinophil Count ( EO#) 10 9 /L 0.0 – 0.4 Absolute Basophil Count ( BASO#) 10 9 /L 0.0 – 0.1 Immature Granulocytes percent ( IG%) % 0.0 – 72.0 Absolute Immature Granulocytes ( IG#) % 0.0 – 7.0 RET% % 0.0 – 99.9 Absolute Reticulocytes count( RET#) 10 6 / uL 0.0 – 0.99 Immature Reticulocyte Fraction( IRF) % 1.6 – 10.6 Low Fluorescence Reticulocytes (LFR) % 86.5 – 98.5 Medium Fluorescence Reticulocytes (MFR) % 1.5 – 11.5 High Fluorescence Reticulocytes ( HFR) % 0.0 – 1.7 Reticulocyte Hemoglobin Equivalent (RET-He) Pg 32.1 – 38.8 10

11. White Blood Cell (WBC) Count White blood cells are cellular elements which play a role in humoral and cell mediate immunity. Normal range for adult male & female– ( 3 .50 – 10.50) 10 3 / uL WBC count is most often used to help diagnose disorders related to having; high white blood cell count ( leukocytosis) low white blood cell count (leucopenia) 11

12. Conditions associated with leukocytosis & leucopenia LEUKOCYTOSIS Autoimmune diseases (Lupus ) Inflammatory diseases Bacterial , parasitic or viral infections Cancers such as leukemia Allergic reactions Tissue damage Kidney failure LEUCOPENIA Immune suppression -related diseases (HIV/AIDS ) Lymphoma Diseases of the liver or spleen Effect of chemotherapy and radiotherapy Splenomegaly Effect of drugs (antibiotics ) 12

13. HEMOGLOBIN (HGB ) & R ED BLOOD CELLS Haemoglobin (Hb) is a protein within the cytoplasm of the red blood cells which is composed of the protoporphyrin ring heme and globin. Haemoglobin plays a role in tissue perfusion . It is the most commonly used marker of anaemia . Red blood cells on a peripheral smear Source: Google 13

14. Cont ’ Reference ranges of Haemoglobin: Adult Male (13.0 – 18.0)g/ dL Adult Female (12.0 – 16.0)g/ dL Infants1 – 6yrs (11.5 – 15.5)g/ dL Birth (14.0 – 24.0)g/ dL 14

15. Cont ’ The red cell count reflects the number of circulating red blood cells. The red cell count is particularly useful in identifying erythrocytosis. RBC Reference range – ( 2.50 – 5.50 ) 10 6 / uL A decrease in the red cell count and/or haemoglobin is an indication of anaemia, and depending on the following indices; MCV MCH MCHC 15

16. Haematocrit (HCT) or Packed Cell Volume It is the percentage (%) of the concentration of red blood cells in blood . Normal Range – (36.0 -54.0)% Diagram of packed cell column in a microhematocrit tube. Source: Basic Clinical Laboratory Techniques 6 th Edition 16

17. Conditions associated with high & low HCT LOW HCT Anaemia Associated with long-term illness, infection or white blood cell disorders such as leukemia or lymphoma. Recent or long-term hemorrhage. HIGH HCT Dehydration Polycythemia vera Lung or heart disease Chronic obstructive pulmonary disease (COPD) Doping or erythropoietin (EPO) Recent blood transfusion. 17

18. Mean Cell Volume (MCV) The mean cell volume (MCV) is the volume of an average RBC in a blood sample . MCV ( fL ) = Haematocrit ( percent) x 10 RBC It is a measure of the average size of the red cells . Normal range – ( 80.0 – 100.0) fL Classification of different types of anaemia . NORMAL MCV LOW MCV HIGH MCV Normocytic anaemia Microcytic anaemia Macrocytic anaemia 18

19. Conditions associated with high & low mcv LOW MCV Iron deficiency anaemia Anaemia of chronic disease Sideroblastic anaemia Lead poisoning Spherocytosis HIGH MCV Vitamin B12 deficiency Folate deficiency Liver disease Alcoholism Hypothyroidism Myelodysplastic syndromes Aplastic anaemia 19

20. Mean Cell Hemoglobin Concentration ( MCHC ) MCHC is the average concentration of haemoglobin in a given volume of red blood cells . For diagnosing anaemia particularly when used in conjunction with MCV and RDW. MCHC = Haemoglobin / Haematocrit x 100 (g/ dL ) MCHC = MCH/MCV Normal Range: (32.0 – 36.0 ) g/ dL 20

21. Conditions associated with, NORMAL, LOW & HIGH mcHC NORMAL MCHC Blood loss anaemia Anaemia due to kidney disease Mixed anaemia Bone marrow failure LOW MCHC Iron deficiency Lead poisoning Thalassemia Sideroblastic anaemia Anaemia of chronic disease HIGH MCHC Autoimmune hemolytic anaemia Hereditary spherocytosis Cold agglutinin Liver disease Sickle cell disease 21

22. Relationship between MCV and MCHC and Anaemia MCV MCHC EXAMPLE OF CONDITON Low (Microcytic) Low (Hypochromic) Iron deficiency anaemia Low (Microcytic) Normal (Normochromic) Thalassemia Normal (Normocytic) Normal (Normochromic) Anaemia of chronic disease High (Macrocytic) Normal (Normochromic) Vitamin B12 deficiency 22

23. Mean Cell Hemoglobin(MCH) It is the average amount of hemoglobin in a person’s red cells . MCH = Haemoglobin/RBC x 10 Normal Range - (27.0 – 32.0) pg MCH value is low in the following conditions; Hypochromic anaemia Iron Deficiency Anaemia. 23

24. Red Cell Distribution Width (RDW) The RDW is a measurement of the degree of anisocytosis. Normal RDW is about 11.0%–16.0% in normal population and tend to be increased under some physiological and pathological conditions. RDW (%) = Standard deviation (SD) of MCV x 100 Mean MCV 24

25. ANAEMIA TYPE NORMAL RDW HIGH RDW Microcytic Thalassemia Iron deficiency anemia Some hemolytic anemias Normocytic Acute blood loss anaemia Anaemia of chronic disease Sickle cell anaemia Spherocytosis Sideroblastic anaemia Chronic blood loss Macrocytic Aplastic anaemia B12/folate deficiency Preleukaemia Cold agglutinin disease Anaemia based on mcv and rdw 25

26. Platelet count( plt ) Measures the average number of platelets in the blood . Normal Range – ( 150.0 – 400.0)10 3 / uL Initiate blood clotting following injuries to blood vessels. Low platelet count – thrombocytopenia. High platelet count - thrombocytosis . Megakaryocyte and platelets Source: Basic Clinical Laboratory Techniques 6 th Edition 26

27. Common causes of thrombocytosis and thrombocytopenia COMMON CAUSES OF THROMBOCYTOSIS. COMMON CAUSES OF THROMBOCYTOPENIA. Chronic infection Aplastic anaemia Acute blood loss Drug-induced thrombocytopenic purpura ( heparininduced thrombocytopenia (HIT) Hyposplenism (post- splenectomy ) Hemolytic–uremic syndrome Malignancy Immune thrombocytopenia (ITP) Chronic inflammation Idiopathic thrombocytopenic purpura Polycythemia vera Pregnancy 27

28. Conditions associated with thrombocytosis and thrombocytopenia THROMBOCYTOSIS. THROMBOCYTOPENIA. Splenectomy Thrombotic Thrombocytopenic Purpura (TTP) Inflammation Disseminated Intravascular Coagulation (DIC) Myeloproliferative disease Immune Thrombocytopenia (ITP) Iron deficiency anemia Splenomegaly Blood loss 28

29. Platelet distribution width(PDW) Platelet distribution width (PDW) is a component of a normal FBC. It reflects a variation in the size distribution (platelet anisocytosis). Normal range of PDW – (11.0 – 16.0) fL PDW tend to be increased in inflammatory reaction and clinical diseases Diabetes, Cancer etc 29

30. RETICULOCYTE count Reticulocytes are immature and anucleated red blood cell produced in the bone marrow and released into the peripheral blood They contain remnants of RNA and micro-organelles. RET% - (0.0 – 99.9) % Absolute Reticulocyte Count – ( 0.0 – 0.99) 10 6 / uL Reticulocyte count measures the compensatory ability of the bone marrow to replenish red cells in circulation. 30

31. Conditions Associated with RETICULOCYTE count LOW RETICULOCYTE COUNT HIGH RETICULOCYTE COUNT Iron deficiency anaemia Increased premature destruction ( haemolytic anaemia) Aplastic anaemia At high altitudes due to hypoxia Bone marrow failure due to effect of drug toxicity, infection or cancer Haemolytic Disease of the Foetus and Newborn (HDFN) Kidney disease Chronic Blood Loss Side effects from chemotherapy and radiotherapy 31

32. Differential Leucocytes Count The white cells or leukocytes in the peripheral blood comprise of five types of cell: The Neutrophils The Eosinophils The Basophils The Monocytes The lymphocytes 32

33. Neutrophilia Neutrophilia is defined as absolute neutrophil count above 7.0 x 10 9 /L. Normal absolute neutrophil count is 1.5 - 7.0 x 10 9 /L Neutrophilia is commonly seen in patients with bacterial infection . Physiological Neutrophilia can occur as a normal physiological process. 33

34. cont ’ CONDITIONS ASSOCIATED WITH NEUTROPHILIA CONDITIONS ASSOCIATED PHYSIOLOGICAL NEUTROPHILIA Acute and chronic bacterial infection (pyogenic bacteria including miliary TB). Neonates have a higher neutrophil count Chronic Myeloid leukaemia Women of childbearing age have higher neutrophil counts than men Inflammation Pregnancy causes a marked rise in the neutrophil Count Malignancy: carcinoma, lymphoma, melanoma, sarcoma Vigorous exercise can double the neutrophil count 34

35. Neutropenia Neutropenia is defined as absolute neutrophil count less than 1.5 x 10 9 /L. Neutropenic patients are more susceptible to bacterial infections. Neutropenia is commonly associated with; deficiencies of vit B12, folate , aplastic anaemia, tumors, effect of certain drug etc 35

36. Eosinophil Normal absolute eosinophil count is (0.0 - 0.4) 10 9 /L Common cause of eosinophilia: Asthma hay fever parasitic infection, allergic condition Hypersensitivity reaction , vasculitis and eczema. 36

37. Monocyte Normal absolute monocyte count is ( 0.0 – 0.7) 10 9 /L Monocytosis is an increase in the number of monocytes circulating in the blood . Monocytosis can be a feature in chronic infection. A persistent m onocytosis that is unexplained, particularly if associated with anaemia or thrombocytopenia , may be a feature of myelodysplastic and myeloproliferative disorders 37

38. Cont ’ Conditions associated with monocytosis Infections: TB, bacterial, viral etc Blood & Immune causes: chronic neutropenia and myeloproliferative disorders. Autoimmune diseases and vasculitis Malignancies: Hodgkin’s disease, chronic myelomococytic leukemia etc 38

39. lymphocytes Normal absolute lymphocyte count is ( 1.0 – 3.7) 10 9 /L Lymphocytosis is ( absolute lymphocyte>3.7 x 10 9 /L ). Some infections associated with lymphocytosis; Viral infections (Hepatitis A, Hepatitis B, etc ) Mononucleosis Acute & chronic lymphocytic leukaemia Tuberculosis Whooping cough 39

40. Basophils Normal absolute basophil count is ( 0.0 – 0.1) 10 9 /L Basophilia is ( absolute basophil count>0.1 x 10 9 /L ). Some infections associated with Basophilia ; Allergic reactions Inflammatory bowel disorder etc 40

41. Conclusion National service personnel should be able to interpret all full blood count (FBC) for both normal and abnormal results. 41

42. references Erhabor , O., Ha, M., Muhammad, K., Onwuchekwa , C., & Nb , E. (2021). Interpretation of Full Blood Count Parameters in Health and Disease . https://doi.org/10.23880/hij-16000180 Hematologist, C. (2020). The Basic Principles & Interpretation of Automated Full Blood Coun t . Learning, C., Reserved, A. R., & Learning, C. ( n.d. ). B asic C linical L aboratory T echniques . 42

43. Thank you 43