How to interpret Hematology CBC reports

Discussing important points from usual CBC report.

1. Managing CBC Services by 3 part
differential cell counter
Dr A D Deshpande
MD (Micro), MD (Patho)

2. Cell Counters are every
where

4. 3 Part Differential
WBCs are counted as 3 Groups
Neutrophils
Lymphocytes
E
M
B

5. 5 Part Differential
WBCs are counted as 5 Groups
N L E M B

6. Wallace Coulter
1960 Model

7. Principle of Cell Counter
Volume of cell is basis of differentiation.

8. Cells pass in one Line

9. Cells are bad conductors of electricity
Electrical impedance is proportional to
cell volume

10. RBC chambers – RBCs and Platelets are
counted
WBC chamber – WBCs and HB are estimated.

11. 2 – 25 Fl
Platelets
30 - 250 fl
RBCs
>35 fl – WBCs
(Separate chamber)
Volume separate them Volume separate them
femtolitre = 10
−15
litres

12. Report in 2 formats
Numbers Graphs
We always look only
numbers

13. Don’t ignore me..

15. Normal Histogram
Platelet Graph
RBC Graph
30
200
Volume of cell
N
U
M
B
E
R
Of
Cells

16. Platelet Graph
RBC Graph
30
200
Giant platelets / Microcytes / Fragmented RBCs

17. Platelet Graph RBC Graph
30
200
RBC Clumping / Cold Agglutinin / Clotted sample

18. Platelet Graph RBC Graph
30
200
Macrocytic (Megaloblastic Anemia)

19. WBC Graph
L P
M

20. Blood indices
MCV
MCH
MCHC

21. 80 – 100 fl
Normal range
MCV

22. MCV
80100
N
O
R
M
A
L
706050 110
Iron deficiency
Thalassemia
Anemia. of chronic
disorders
B12 & Folic acid
deficiency
Liver disease

23. MCH
27-32 pgm
Normal range

24. MCHC
32-36 %

25. Red cell Distribution Width
(RDW)

26. Rule of 3
RBC count X 3 = Hemoglobin %
Hemoglobin % X 3 = Hematocrit

28. Hb 7.4 gm %
MCV 65 fl
MCH 18 pgm
RDW 19

29. Low Hb
Low MCV
High RDW

30. Low Hb
Low MCV
High RDW
This can be seen in
Anemia due to
chronic disorders

31. Serum Iron
Serum Ferritin
TIBC
% Saturation

32. Low Hb
Low MCV
Normal RDW

33. Hb 8.2 gm %
MCV 105 fl
RDW 18

34. Low Hb
High MCV
High RDW

35. Hypersegmented Neutrophil

36. Hb 9.1 gm %
TLC # # # #
Platelet count 24,000 / cmm

37. Acute Leukemia

38. What else we can see in PS
Malarial Parasite

39. Sickle Cells

40. WBC
Counts

41. Leukopenia
Aplastic anemia
Chemotherapy
Malaria
Typhoid
Dengue
<4000 WBCs / cmm

42. Leukocytosis
>11,000 WBCs / cmm

43. Neutrophils
Bacterial infection
Trauma, Burn, Surgery
Myocardial infarction
Metabolic acidosis
Pregnancy

44. Lymphocyte
Acute viral infections –
Infectious mononucleosis, hepatitis,
cytomegalovirus infection
Tuberculosis
CLL

45. Eosinophilia
Allergy – Asthma,
Urticaria, Rhinitis
Parasites – Filaria,
Trichinosis, Tropical
eosinophilia
Eczema, Dermatitis

46. Platelets

47. Normal range
1.5 Lakhs – 4.5 Lakhs/cmm

48. Thrombocytopenia
(common causes)
Falciparum malaria
Dengue
HIV
Leptospira
Megaloblastic anemia
Drug induced

49. Errors in Platelet count

50. Take home message
•Numerical data + Graphs
Important
•PS exam is mandatory
•MCV MCH & RDW are useful
•Advise necessary further
investigations
- Iron studies , Hb electrophoresis

51. Thank
you