Hematological laboratory tests

It is also called as complete blood picture/complete blood count(CBP/CBC)
The FBC assesses several different parameters and can provide a great deal of information.
The red cell variables will determine whether or not the patient is anaemic. If anaemia is present the MCV is likely to provide clues as to the cause of the anaemia.
The white cells are often raised in infection neutrophilia in bacterial infections and lymphocytosis in viral (but not always so).
Platelets (size or number) may be abnormal either as a direct effect of underlying blood disease.

1. CLINICAL LABORATORY TESTS USED IN THE EVALUATION OF DISEASE STATES AND INTERPRETATION OF TEST RESULTS Presented by: Dr. S P SRINIVAS NAYAK, Assistant Professor, SUCP 1 Dr S P Srinivas Nayak , Clinical Pharmacy LAB DATA INTERPRETATION

2. Why ask for a CBC ? It is also called as complete blood picture/complete blood count(CBP/CBC) The FBC assesses several different parameters and can provide a great deal of information. The red cell variables will determine whether or not the patient is anaemic . If anaemia is present the MCV is likely to provide clues as to the cause of the anaemia . The white cells are often raised in infection neutrophilia in bacterial infections and lymphocytosis in viral (but not always so). Platelets (size or number) may be abnormal either as a direct effect of underlying blood disease. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 2

3. A. Haematological TESTS Main parameters measured 1. Hb concentration. 2. Red cell count (RCC). 3. MCV ( Mean cell volume) 4. MCH. 5. MCHC. 6. Haematocrit ( Hct ) or PCV. 7. Red cell distribution width (RDW). 8. White cell count. 9. WBC differential. 10.Platelet count 3 Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION

4. 1. Haemoglobin concentration ( Hb ) Haemoglobin concentration ( Hb ) Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs. Hemoglobin is made up of four protein molecules (globulin chains) that are connected together. It mainly Defines Anaemia Normal values: Male: 14 – 18 g/dl or g % Female: 12 - 16 g/dl or g % Values differ between males and females since androgens drive RBC production and hence adult males has higher Hb , PCV and RCC than adult females. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 4

5. 2. Red cell count (RCC). Normal values: male: 4.5 – 5.5 × 10 12 /L. or 4.5 – 5.5 × 10 6 /ml Female: 4 – 5× 10 12 /L. or 4 – 5 × 10 6 /ml Most clinicians pay little attention to the red cell count but this parameter is useful in the diagnosis of polycythaemic disorders and thalassaemias (the latter results in the increased production of red cells that are smaller than usual and contain low quantities of haemoglobin , i.e. are microcytic and hypochromic ). Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 5

6. Abnormalities in RBC count Causes of a low red cell count include Hypoproliferative anaemias , e.g. iron, vitamin B12 and folate deficiencies. Aplasias e.g. idiopathic or drug-induced (don’t forget chemotherapy). Parvovirus B19 infection-induced red cell aplasia resulting in transient marked anaemia . Causes of high red cell count include PRV. ( Polycythaemia Rubra Vera) Thalassaemia . Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 6

7. 3. MCV. ( Mean cell volume) Mean cell volume or Mean corpuscular volume (MCV) is the average volume of red cells in a specimen. MCV is elevated or decreased in accordance with average red cell size low MCV indicates microcytic (small average RBC size), normal MCV indicates normocytic (normal average RBC size), and high MCV indicates macrocytic (large average RBC size). Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 7

8. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 8

9. Mean cell haemoglobin concentration (MCHC) MCHC is High in Severe prolonged dehydration. Hereditary spherocytosis . Cold agglutinin disease. MCHC is Low in Iron deficiency anaemia . Thalassaemia . Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 9

10. 6. Haematocrit ( Hct ) or PCV. A hematocrit test is part of a complete blood count (CBC) Measuring the proportion of red blood cells in whole sample of anticoagulated blood centrifuged. There are two methods for estimation of PCV: macro method ( Wintrobe method) and micro method ( microhematocrit method). Micro method is preferred because it is rapid, convenient, requires only a small amount of blood, capillary blood from skin puncture can be used, and a large number of samples can be tested at one time High PCV is seen in Polycythaemia (any cause). Low PCV is seen in Anaemia (any cause). Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 10 Hct = 3 X Hb

11. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 11

12. 7. Red cell distribution width (RDW). Measures the range of red cell size in a sample of blood, providing information about the degree of red cell anisocytosis , i.e. how much variation there is between the size of the red cells. Of value in some anaemias : Example: Low MCV with normal RDW suggests Thalassaemia trait. Low MCV with high RDW suggests iron deficiency. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 12

13. 8. White cell count. Quantitative estimation of total WBC in human by manual method using Hemocytometer . Total WBC count is increased ( Leukocytosis ) in transiently in bacterial, viral, protozoal infections parasitic infections such as Filaria , and also in severe hemorrahage . The degree of leukocytosis depends on the severity and type of infection. Leukopenia (decrease in leukocyte count) occurs in certain viral infections such as Hepatitis, Influenza and Measles, Protozoal infections such as Malaria and bacterial infections such as Typhoid fever Sometimes in Leukemias , bone marrow depression due to any cause and in iron deficiency and megaloblastic anemias . Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 13

14. White cell count. REFERENCE RANGE Adults : 4000 – 11,000 cells/cu.mm At birth : 10,000 – 25,000 cells/cu.mm Infants : (one year) 6000–18000 cells/cu.mm 4–7 years : 6000 – 15,000 cells/cu.mm 8–12 years : 4,500 – 13,500 cells/cu.mm The 5 main white cell subtypes in peripheral blood which include: 1. Neutrophils . 2. Lymphocytes. 3. Monocytes . 4. Eosinophils . 5. Basophils Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 14

15. 1. Neutrophils : 2–7.5 ≈ 10 9 /L (40–75% of white blood cells but values are more meaningful than percentages) Increased in ( ie . neutrophilia ) Bacterial infections. Inflammation, eg : myocardial infarction, polyarteritis nodosa . Myeloproliferative disorders. Drugs (steroids). Disseminated malignancy. Stress, eg trauma, surgery, burns, haemorrhage , seizure Decreased in ( ie neutropenia ) Viral infections. Drugs, eg post chemotherapy, cytotoxic agents, carbimazole , sulfonamides. Severe sepsis. Neutrophil antibodies (SLE, haemolytic anaemia ) INCREASED destruction. Hypersplenism eg Felty’s syndrome Bone marrow failure REDUCED production Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 15

16. 2. Lymphocytes. Normal range: 1.5 – 4.5 X 10 9 /L (20–45%) Increased ( lymphocytosis ) in: Acute viral infections.Chronic infections, eg TB, Brucella , hepatitis, syphilis. Leukaemias and lymphomas, especially chronic lymphocytic leukaemia . Decrease ( lymphopenia ) in: Steroid therapy, SLE; Uraemia , Legionnaire’s disease; HIV infection, marrow infiltration post chemotherapy or radiotherapy. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 16

17. MONOCYTES: Monocytosis  is the state of excess monocytes in the peripheral blood. It may be indicative of various disease states. Examples of processes that can increase a monocyte count include : chronic inflammation diabetes stress  response Cushing's syndrome ( hyperadrenocorticism ) immune-mediated disease granulomatous disease atherosclerosis necrosis red blood cell regeneration viral fever sarcoidosis chronic myelomonocytic leukemia  (CMML) Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 17

18. Monocytopenia Monocytopenia Monocytopenia is a form of leukopenia associated with a deficiency of monocytes. A very low count of these cells is found after therapy with immuno -suppressive glucocorticoids . Also, non-classical slan + monocytes are strongly reduced in patients with Hereditary diffuse leukoencephalopathy with spheroids (HDLS), a neurologic disease associated with mutations in the macrophage colony-stimulating factor receptor gene Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 18

19. EOSINOPHILS In normal individuals, eosinophils make up about 1–3% of white blood cells, and are about 12–17 micrometres in size with bilobed nuclei Along with mast cells and basophils, they also control mechanisms associated with allergy and asthma . In normal individuals, eosinophils make up about 1–3% of white blood cells Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 19

20. EOSINOPHILIC DISORDERS EOSINOPHILIA An increase in eosinophils , i.e., the presence of more than 500 eosinophils / microlitre of blood is called an eosinophilia, It is typically seen in people with A parasitic infestation of the intestines; A utoimmune and collagen vascular disease (such as rheumatoid arthritis) and Systemic lupus erythematosus ; malignant diseases such as eosinophilic leukemia , clonal hypereosinophilia , and Hodgkin's disease; lymphocyte-variant hypereosinophilia . EOSINOPENIA Eosinopenia is a form of agranulocytosis where the number of eosinophil granulocytes is lower than NORMAL RANGE Leukocytosis with eosinopenia can be a predictor of bacterial infection. It can be induced by stress reactions,Cushing's syndrome, or the use of steroids. Pathological causes include burns and acute infections . Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 20

21. BASOPHILS Basophils are responsible for inflammatory reactions during immune response, as well as in the formation of acute and chronic allergic diseases, including anaphylaxis, asthma, atopic dermatitis and hay fever. They also produce compounds that co-ordinate immune responses, including histamine and serotonin that induce inflammation, heparin that prevents blood clotting. Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 21

22. SUCP THANK YOU Dr S P srinivas Nayak, Clinical Pharmacy LAB DATA INTERPRETATION 22