Interpretation of Hb ,CBC and RBC indices

Comprehensive CBC report interpretation

1. Interpretation of Hemoglobin, CBC , RBC Indices

2. Hemoglobin levels • Males: 13 to 17 g/dL • Females: 12 to 15 g/dL • Children: 11 to 16 g/dL •• Factors affecting levels: Age, sex, altitude, and overall health.

3. Low Hemoglobin (Anemia) Causes : Iron deficiency, chronic diseases, blood loss, malnutrition, Vitamin B 12 deficiency Symptoms : Fatigue, weakness, shortness of breath, dizziness. Clinical Significance : P otential anemia or underlying conditions.

4. High Hemoglobin (Polycythemia) • Causes : High altitudes, smoking, dehydration, bone marrow disorders. •• Symptoms : Headaches, dizziness, itching, blurred vision . •• Clinical Significance : May indicate polycythemia, lung or heart disease.

5. Low Haemoglobin detected Microcytic Anemia (MCV <80 fl ) Normocytic Anemia (MCV 80-100 fl ) Macrocy tic Anemia (MCV > 100 fl) Iron deficiency Chronic diseases Vitamin B 12/ Folate ( check ferritin, serum iron, (Check inflammatory markers, deficienc y TIBC ). Renal function) . (Check vitB12, folate level)

6. Hemoglobin Abnormalities - There are 3 main categories of inherited Hemoglobin abnormalities • Structural or qualitative : The amino acid sequence is altered because of incorrect DNA code (Hemoglobinopathy). • Quantitative : Production of one or more globin chains is reduced or absent (Thalassemia). • Hereditary persistence of Fetal Hemoglobin(HPFH) : Complete or partial failure of gamma globin to switch to B globin.

7. Laboratory Methods to evaluate Hemoglobin Solubility test ●Electrophoresis ●High-Performance Liquid Chromatography HPLC)

8. Most common Hemoglobin abnormalities Thalassemias - • Alpha • Beta Hemoglobinopathies - • HbS trait; disease • НЬС trait; disease - • НЬЕ • Hereditary Persistence of Hemoglobin F(HPHF)

9. Introduction to CBC and Hemoglobin CBC (Complete Blood Count) is a comprehensive test that measures various components of blood, including: • - White Blood Cells (WBCs) • - Red Blood Cells (RBCs) • - Hemoglobin (Hb) • - Hematocrit (HCT) • - Platelet Count • The test is used to diagnose a wide range of conditions, such as anemia, infections,and hematologic disorders.

10. Step 1: Obtain CBC and Hemoglobin Results 1. Start by obtaining the CBC and hemoglobin (Hb) results from the patient. 2. Check if the hemoglobin levels are within the normal range or if they are low, indicating anemia. 3. Depending on the results, follow the further diagnostic steps.

11. Step 2: Is Hemoglobin Low? (Anemia) • If hemoglobin levels are low, the patient likely has anemia • Evaluate the MCV (Mean Corpuscular Volume) to classify the type of anemia: - Microcytic Anemia (MCV < 80 fL) - Normocytic Anemia (MCV 80-100 fL) - Macrocytic Anemia (MCV > 100 fL) •Based on the MCV, proceed to the appropriate diagnostic category.

12. Step 3: Microcytic Anemia (MCV < 80 fL) • Evaluate Iron Studies: - Low Ferritin = Iron Deficiency Anemia - High TIBC = Iron Deficiency Anemia - Low Serum Iron = Iron Deficiency Anemia • If Iron Studies are normal, consider Thalassemia . • Hemoglobin Electrophoresis can help confirm Thalassemia diagnosis.

13. Step 4: Normocytic Anemia (MCV 80-100 fL) • Assess Reticulocyte Count: - High Reticulocyte Count suggests increased RBC production due to blood loss or hemolysis. - Low Reticulocyte Count suggests impaired bone marrow response or chronic disease. • Further classification based on specific causes: - Acute blood loss - Chronic disease (e.g., kidney disease)

14. Step 5: Macrocytic Anemia (MCV > 100 fL) • Evaluate Vitamin B12 and Folate levels: - Low B12 = Vitamin B12 Deficiency Anemia (common causes: pernicious anemia, malabsorption, diet) - Low Folate = Folate Deficiency Anemia (common causes: alcoholism, poor nutrition, malabsorption) • Check for other causes of macrocytosis: - Liver Disease (check liver enzymes) - Alcoholism (assess history)

15. Step 6: Evaluate WBC and Platelet Count • Evaluate White Blood Cell (WBC) Count: - Leukocytosis (high WBCs) could indicate infection, inflammation, or leukemia. - Leukopenia (low WBCs) could indicate viral infections, bone marrow suppression, or bone marrow diseases. • Evaluate Platelet Count: - Thrombocytosis (high platelets) may be caused by inflammation, iron deficiency, or myeloproliferative disorders.

16. Step 7: Normal Hemoglobin and CBC Values • If Hemoglobin and CBC values are normal, continue routine monitoring. • Investigate any other abnormal findings, such as abnormal WBC or platelet counts. • Further tests may be required based on clinical suspicion and patient symptoms. • Proper interpretation of CBC can provide insights into underlying conditions such as nutritional deficiencies, bone marrow disorders, and systemic diseases.

17. Patterns of Anemia* 1Microcytic Hypochromic Anemia: -Low MCV, Low MCHC. - Common causes: Iron deficiency anemia, Thalassemia. Normocytic Normochromic Anemia: - Normal MCV, Normal MCHC. - Common causes: Acute blood loss, Chronic disease. Macrocytic Anemia: - High MCV. - Common causes: Vitamin B12 deficiency, Folate deficiency, Liver disease.

18. Case Study Microcytic Hypochromic Anemia- Patient: 45-year-old female. Symptoms: Fatigue, pallor. Lab Results: - *MCV*: 72 fL (Low) MCH: 24 pg (Low) MCHC: 30 g/dL (Low) RDW: 16% (High) Diagnosis: Likely Iron Deficiency Anemia

19. Conclusion RBC indices are critical tools for diagnosing and differentiating various types of anemia. MCV helps categorize anemia as microcytic, normocytic, or macrocytic. MCH and MCHC provide insight into hemoglobin content and color of RBCs. RDW is useful in assessing variability and mixed etiologies

20. White Blood Cell Count The normal range : 4500 - 11000 cells/mcL

21. Differential Cell Count

22. Leukopenia ~ Low white cell count may be due to Acute viral infections (cold or influenza). It can be associated with chemotherapy, radiation therapy, Myelofibrosis and Aplastic anemia HIV and AIDS are also a threat to white cells. ~ Other causes of low white blood cell count include Systemic lupus erythematosus, Hodgkin's lymphoma, Infection (typhoid, malaria, tuberculosis, dengue, rickettsial infections, enlargement of the spleen, folate deficiencies, psittacosis, sepsis and Lyme disease.) Minerals, such as copperand zinc.

23. Leukocytosis ~ Known as leukocytosis Infection, most commonly bacterial orviral ~Inflammation ~Leukemia, myeloproliferative disorders ~Allergies, asthma ~Tissue death (trauma, burns, heart attack) ~Intense exercise or severe stress o Will mention in detail in respective cell line.

24. Neutrophilia Neutropenia Neutrophilia │ ├─ Causes │ ├─ Pregnancy │ ├─ Acute Infections │ ├─ Inflammation │ ├─ Alcohol Intoxication │ ├─ Corticosteroid Therapy │ └─ Acute Blood Loss or Red Cell Destruction │ ├─ Additional Findings │ ├─ Anaemia │ │ ├─ Chronic Infection or Inflammation │ │ └─ Malignant Conditions │ ├─ High Hct │ │ └─ Polycythaemia Vera │ ├─ Increased Platelet Count │ │ ├─ Infectious or Inflammatory Processes │ │ ├─ Malignant Conditions │ │ └─ Marrow Recovery │ └─ Thrombocytopenia │ ├─ Sepsis │ └─ Microangiopathic Haemolytic Anaemia Neutropenia │ ├─ Causes │ ├─ Nonhaematological │ │ ├─ Overwhelming Infection │ │ ├─ Autoimmune Disorders │ │ │ └─ Systemic Lupus Erythematosus │ │ ├─ Irradiation │ │ ├─ Drugs │ │ │ └─ Anticancer Agents │ │ └─ Large Granular Lymphocytic Leukaemia │ └─ Bone Marrow Examination │ ├─ Peripheral Destruction │ │ └─ Increased Marrow Myeloid Precursors │ └─ Stem Cell Failure │ └─ Lack of Marrow Myeloid Precursors │ └─ Specific Conditions ├─ Drug-Induced Neutropenia │ └─ Relative Paucity of Mature Neutrophils └─ Infant Genetic Agranulocytosis (Kostmann Syndrome) └─ Maturation Arrest at Promyelocytic Stage

25. Lymphocytosis Infections Predominantly viral (commonest is infectious mononucleosis) Occasionally bacterial (e.g. pertussis and chronic infections like tuberculosis) Unusually parasites (e.g. babesiosis) Stress and Postsplenectomy Smoking Hypersensitivity Reactions Autoimmune Disorders Thymoma Clonal Monoclonal B cell lymphocytosis Lymphoproliferative disorders especially chronic lymphocytic leukaemia and lymphomas

26. Monocytosis Monocytosis │ ├─ Causes │ ├─ Infections │ │ ├─ Protozoal │ │ ├─ Rickettsial │ │ └─ Bacterial │ │ ├─ Malaria │ │ ├─ Typhus │ │ └─ Tuberculosis │ └─ Myelodysplastic/Myeloproliferative Neoplasms │ ├─ Chronic Myelomonocytic Leukaemia (CMML) │ │ └─ Associated with Neutrophilia │ └─ Atypical Chronic Myeloid Leukaemia │ ├─ Additional Findings │ ├─ Elevated Monocyte Count (> 1 × 10^9/l) │ └─ Diagnostic Indicators │ ├─ Splenomegaly │ ├─ Quantitative and Qualitative Abnormalities in Other Cell Lines │ └─ Clonal Cytogenetic Abnormality

27. Eosinophilia Parasitic Infections - Especially with Helminths Neoplastic Diseases Primary (or neoplastic) hypereosinophilia, Other acute or chronic eosinophilic leukaemia Other myeloproliferative neoplasms such as chronic myeloid leukaemia and systemic mastocytosis Reactive to other neoplasms, e.g. to B- or T-cell lymphoma or leukaemia or solid tumour Allergic Disorders Gastrointestinal disorders - may be associated with tissue eosinophilia rather than peripheral blood eosinophilia Drug reactions including the DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) Allergic rhinitis, asthma and atopic dermatitis Immunodeficiency Disorders Hyper IgE (Job) syndrome Autoimmune lymphoproliferative syndrome Graft-versus-host disease Eosinophilia │ ├─ Causes │ ├─ Parasitic Infections │ ├─ Skin Diseases │ └─ Allergic Disorders │ ├─ Tissue Involvement │ ├─ Heart │ ├─ Lungs │ └─ Gut │ ├─ Diagnostic Approach │ ├─ Clinical History │ │ ├─ Medications │ │ └─ Foreign Travel │ ├─ Stool Examination │ │ ├─ Parasites │ │ ├─ Cysts │ │ └─ Ova │ └─ Urine Examination │ ├─ Parasites │ ├─ Cysts │ └─ Ova │ └─ Other Causes (Details in supplementary information)

28. Basophilia Basophilia │ ├─ Common Features │ ├─ Myeloproliferative Neoplasms │ │ ├─ Chronic Myeloid Leukaemia (CML) │ │ │ └─ Increasing Basophil Count as Indication of Accelerated Phase Disease │ ├─ Other Causes │ ├─ Endocrinopathies │ │ ├─ Myxoedema │ │ └─ Oestrogen Abnormalities │ ├─ Infections │ ├─ Allergic Diseases │ └─ Rare Haematological Malignancies

29. Reduced Numbers of Lymphocytes, Monocytes, Eosinophils, and Basophils │ ├─ Causes │ ├─ Physical Stress │ │ ├─ Surgery │ │ ├─ Trauma │ │ └─ Infection │ ├─ Specific Conditions │ ├─ Lymphopenia │ │ ├─ With Neutrophilia │ │ │ └─ Severe Acute Respiratory Syndrome (SARS) │ │ ├─ HIV Infection │ │ └─ Renal Failure │ ├─ Monocytopenia │ │ └─ Hairy Cell Leukaemia │ │ ├─ Pancytopenia │ │ ├─ Typical Bone Marrow Histology │ │ └─ Lymphocytes with Characteristic Cytology and Immunophenotype │ └─ Other Notes ├─ Eosinophils and Basophils │ └─ Reduced by Physical Stress └─ Lymphocytes └─ Affected by Physical Stress, HIV, and Renal Failure