Lecture 5.cbc

CBC

2. CBC --- Interpretations

3. Abstract
Interpretation of different parameters reported on
modern day analyzers is bit tricky and demand
continuous monitoring and on-going learning. In
present paper interpretation of different reported
parameters has been discussed with approach to
diagnosis of various abnormalities.

4. The CBC interpretation are useful in
the diagnosis of various types of
anemias.
It can reflect acute or chronic
infection, allergies, and problems
with clotting.

5. •Component of the CBC:
• Red Blood Cells (RBCs)
• Hematocrit (Hct)
• Hemoglobin (Hgb)
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin
Concentration (MCHC)
- Red cell distribution width (RDW)
• White Blood Cells (WBCs)
• Platelet

6. •RBC (varies with altitude):
–M: 4.7 to 6.1 x10^12 /L
–F: 4.2 to 5.4 x10^12 /L
• Biconcave disc shape with diameter
of about 8 µm
•Function: - transport hemoglobin
which carries oxygen from the lung to
the tissues
-acid –base buffer.
•Life span 100-120 days.

7. Hemoglobin :
M: 13.8 to 17.2 gm/dL
F: 12.1 to 15.1 gm/dL
Hematocrit : (packed cell volume)
It is ratio of the volume of red cell to
the volume of whole blood.
M: 40.7 to 50.3 %
F: 36.1 to 44.3 %

8. –MCV = mean corpuscular volume
HCT/RBC count= 80-100fL
•small = microcytic
•normal = normocytic
•large = macrocytic
–MCHC= mean corpuscular hemoglobin
concentration HB/RBC count= 26-34%
•decreased = hypochromic
•normal = normochromic

9. •MCH (mean corpuscular hemoglobin)
HB/HCT = 27-32 pg
•RDW (red cell distribution width)
•It is correlates with the degree of
anisocytosis
_ Normal range from 10-15%

10. •This important value is needed in the evaluation
of any anemia.
•Normal range 1-2%
•Retic count goes up with
–Hemolytic anemia
•Retic goes down with
–Nutritional deficiencies
_ Diseases of the bone marrow itself

11. Screening Tests – Anaemia
•Clinical Signs and symptoms
• Routine Hemoglobin examination
Cut off marks for Hb
all possible sites
•Look for the causes for anemia

12. PCV or Hematocrit
•57% Plasma
•1% Buffy coat – WBC
•42% Hct (PCV)

13. The Three Basic Measures
Measurement Normal
Range
A.RBC count 5 million 4 to 6
B.Hemoglobin 15 g/dl 12 to 17
C.Hematocrit 45 % 38 to 50
Check whether this holds good in given results
If not -indicates micro or macrocytosis or
hypochromia.

14. The Three Basic Measures
MeasurTHE RULE OF THUMBNormal
R g% 12 to 17
A.Hematocrit 45 38 to
50 A x 3 = B x 3 = C - This is
Check whether this holds good in given results
If not -indicates micro or macrocytosis or
hypochromia.

15. Anaemia
RETICULOCYTE COUNT %
Normal
Less than 2%

16. Reticulocytes
Leishman’sSupravital

17. Normal CBC

18. Workup – Second Test
•The next step is ‘What is the size of RBC’ ?
•MCV indicates the Red cell volume (size)
•Both the MCH & MCHC tell Hb content of RBC
•If the Retic count is 2 or less
•We are dealing with either
–Hypoproliferative anaemia (lack of raw material)
–Maturation defect with less production
–Bone marrow suppression (primary/ secondary)

19. Anaemia Workup - MCV
Microcytic
MCV
Normocytic Macrocytic
Iron Deficiency IDA
Chronic Infections
Thalassemias
Hemoglobinopathies
Sideroblastic Anemia
Chronic disease
Early IDA
Hemoglobinopathies
Primary marrow disorders
Combined deficiencies
Increased destruction
Megaloblastic anemias
Liver disease/alcohol
Hemoglobinopathies
Metabolic disorders
Marrow disorders
Increased destruction

20. Mean Cell Volume (MCV)
•RBC volume (rather) is measured by
•The Mean Cell Volume or MCV and RDW
Microcytic
< 80 fl
MCV
Normocytic Macrocytic
80 -100 fl > 100 fl

21. Red cell Distribution Width - RDW
Normal
Population
Uniform
RDW
High
Population
Double

22. IDA -CBC

23. Microcytic Hypochromic - IDA

24. Anemia - Macrocytic (MCV > 100)
Premature gray hair – consider MBA
Mow as 6 grams
MCV 100-110 fl
must look for other causes of macrocytosis
MCV > 110 fl
almost always folate or B
12
deficiency

25. MBA

26. Macrocytosis -MBA

27. MBA

28. Basophilic Stippling - MBA
BS occurs in Lead poisoning also

29. RBC Size – Anisocytosis
Different sizes of RBC

30. Poikilocytosis
Different Shapes of RBC

31. Polychromasia - Spherocytosis

32. Target Cells

33. •WBCs are involved in the immune response.
•The normal range: 4 – 11x10^9 /L
•Two types of WBC:
1) Granulocytes consist of:
–Neutrophils: 50 - 70%
–Eosinophils: 1 - 5%
–Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40%
–Monocytes: 1 - 6%

34. The type of cell affected depends upon its primary
function:
In bacterial infections, neutrophils are most
commonly affected
In viral infections, lymphocytes are most
commonly affected
In parasitic infections, eosinophils are most
commonly affected.

35. • polymorphneuclear leukocytes (PMN,s)
•Nucleus 3-5 lobes.
•Diameter 10-14 µm
•50-70% WBC
=2.5-7.5x10^9/ L
•Function: Phagocytosis of bacteria and
cell debris
•Numbers rise with all manner of stress,
especially bacterial infections

36. •Neutrophil disorders
–Neutrophilia – an increase in neutrophils
–Conditions associated with neutrophilia are:
1-Bacterial infections (most common cause)
2-Tissue destruction
e.g. tissue infarctions, burns.
3- leukemoid reaction
4-Leukemia

37. –Neutropenia – this may result from
1-Decreased bone marrow production
e.g. BM hypoplasia.
2-Ineffective bone marrow production
–E.g. megaloblastic anemias and
myelodysplastic syndromes.
3- post acute infection
_ e.g. fever, brucellosis.

38. •Bilobed nucleus
•1-5% of WBC
=0.04-0.4x10^9/L
•Diameter about 10-14 µm
•Function: Involved in allergy,
parasitic infections
•Contains: eosinophilic granules

39. Eosinophilia may be found in
•Parasitic infections
•Allergic conditions and
hypersensitivity reaction

40. •No specific granules
• 20-40% of WBC
=1.55-3.5x10^9/ L
•Diameter 8-10 µm
•T cells: cellular
•(for viral infections)
• B cells: humoral
(antibody)

41. •Lymphocytosis – may indicate
_ Viral infection
e.g. Infectious mononucleosis, CMV or pertussis.

_ Bacterial infection
e.g. TB
•Lymphopenia – caused by
_Stress.
_Steroid therapy
_ Irradiation

42. • (Leukocytosis) may indicate:
_ Infectious diseases
_Inflammatory disease (such as rheumatoid
arthritis or allergy)
_Leukemia
_Severe emotional or physical stress
_Tissue damage (e.g. necrosis,or burns)

•(Leukopenia) may result from:
_ Decreased WBC production from BM.
_ Irradiation.
_ Exposure to chemical or drugs.

43. •Fever
•Malaise
•Weakness
•Others depend on each system which is involved
e.g. » chest: cough, and chest pain
» abdomen: diarrhea, vomiting, dehydration.
»CNS: headache, visual disturbance,
Neck stiffness

and so 0n.

44. •Infection of the mouth and throat.
•Painful skin ulceration.
•Recurrent infection.
•Septicemia.

45. •Small granular non-nucleated
discs.
•Diameter about 2-4 µm
•Normal range; 150-300x10^9 /L
•Destroyed by macrophage cells in
the spleen.
•Function; involved in coagulation
and blood haemostasis.
•Life span 7-10 days

46. •Numbers of platelets
–Increased (Thrombocythemia)
•Pregnancy.
•Exercise.
•High attitudes.
•splenectomy

–Decreased (Thrombocytopenia)
•Menstruation.
•Haemorrhage.
•Bone marrow destruction or suppression e.g. leukemia
•The values have to fit the clinical situation.

47. •Petechial hemorhage.
•Easy bruising.
•Mucosal bleeding
_gum bleeding