1. Complete Blood Count (CBC)
Islamic University – Gaza (IUG)

2. Complete Blood Count (CBC)
Panel of tests that examine different components of the blood.

6. Complete Blood Count (CBC)
CBC values
RBC count
Hemoglobin
Hematocrit
RBC indices
WBC count and differential
Platelet count

7. WBC - White Blood Count - actual number of white blood cells per volume of blood.
WBC differential - types of WBC present.

8. RBC - Red Blood Cells – actual number of red blood cells per volume of blood
HGB - Hemoglobin - amount of the oxygen carrying protein in the blood (gm/dL)
PLT - Platelets - actual number of platelets per volume of blood

9. MCV - Mean Corpuscular Volume, a measurement of the average size of RBCs (fl)
MCH - Mean Corpuscular Hemoglobin - the mean cell hemoglobin (pg/cell) picogram per cell
MCHC - Mean Corpuscular Hemoglobin Concentration - the mean concentration of hemoglobin per volume of red cells (gm/dl)
RDW - Red Cell Distribution Width - a variation in the size of RBCs

10. CBC Normal values
RBC count (varies with altitude):
Male: 4.7 to 6.1 million cells/micro L
Female: 4.2 to 5.4 million cells/micro L
WBC count: 4000 to cells/micro L
Hematocrit (varies with altitude):
Male: 40.7 to 50.3%
Female: 37-47%
Hemoglobin (varies with altitude):
Male: 13 to 18 gm/dL
Female: 12 to 16 gm/dL
MCV: 80 to 96 femtoliter
MCH: 27 to 31 pg/cell
MCHC: 32 to 36 gm/dL

11. It is common for normal to vary from lab to lab.

12. Hemoglobin (Hb or HGB)
The iron-containing oxygen-transport metalloprotein in the red blood cells .
The main component of RBCs
Males g/dl
Females g/dl
Newborns g/dl

13. Hemoglobin, the main component of the red blood cell, functions in the transportation of oxygen and CO2. Hemoglobin consists of 1 molecule of globin and 4 molecules of heme (each containing 1 molecule of iron in the ferrous state). Globin consists of 2 pairs of polypeptide chains. In the hemoglobin molecule, each polypeptide chain is associated with 1 heme group; each heme group can combine with 1 molecule of oxygen or CO2.
Hemoglobin carries oxygen from places of high oxygen pressure (lungs) to places of low oxygen pressure (tissues), where it readily releases the oxygen. Hemoglobin also returns CO2 from the tissues to the lungs.

14. Structure of Hb

15. Normal blood contains about 15-16 grams hemoglobin per 100 ml (dL).
Each gram of hemoglobin can carry about 1.35 ml of gaseous oxygen.
Fully saturated arterial blood will therefore contain about 20 ml of oxygen per 100 cc.
The relative amount of oxygen in the blood compared to the carrying capacity of the hemoglobin is called the oxygen saturation, and is expressed as a percentage.

17. RBC Indices RBC indices include: Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
RBC Distribution Width (RDW)

18. The secondary indices are derived from the three possible combinations of the primary indices thus:
Haemoglobin
MCHC=(Hb/PVC)
MCH =(Hb/RCC)
Hematocrit (PCV)
Red cell count (RCC)
MCV=(PCV/RCC)

19. MCV Mean corpuscular volume MCV is average size of RBC MCV = Hct x 10
RBC (millions)
If fL, normal range, RBCs considered normocytic
If < 80 fL are microcytic
If > 96 fL are macrocytic
Not reliable when have marked anisocytosis

20. It should be pointed out that, because the red cell count is involved, this determination may be subject to wide variations due to technical error. In general, if an accurate MCV determination is to be done, a triplicate red cell count should be done and the average taken. If this is not done, the results may be misleading as compared to the visual inspection of the red cells on the stained smear and a false impression may be passed on to the clinician.

21. Size variation Red blood cells can vary in size .
smaller than normal: microcytes
larger than normal: macrocytes.
When red cells of normal size, microcytes and macrocytes are present in the same field, the term anisocytosis is used.

22. Normal RBCs Round, elastic, non-nucleated, bi-concave discs.
Many RBCs have an area of central pallor which covers about one-third of the cell.
The pallor occurs as a result of the disc-shaped cells being spread on the slide.
Size of normal RBC is almost the size of the nucleus of the lymphocyte.

25. Microcyte Smaller than a nucleus of the lymphocyte,
central pallor is greater than 1/3 of the cell

26. Microcytes

28. Macrocyte (megalocyte)
diameter of 9-14 microns ( times larger than normal red cells)
MCV is 100 fL or more.

30. Megalocytes
Megalocytes are the result of decreased DNA synthesis, frequently due to vitamin B12 and/or folic acid deficiencies.
Decreased DNA synthesis causes the nucleus in the developing red cells to mature at a slower than normal rate.
Since hemoglobin production is not affected, the mature red cell is larger than normal

31. Macrocytes

33. MCH The mean cell hemoglobin (pg/cell)
The average amount of hemoglobin per red blood cell
MCH = Hgb x 10
RBC (millions)
Normal pg/cell

34. MCHC
The mean concentration of hemoglobin per volume of red cells (gm/dl)
The average concentration of hemoglobin in the cells.
MCHC = Hgb x 100
Hct (%)
If MCHC is normal: normochromic
If MCHC is less than normal :hypochromic
Normal gm/dL

35. It should be pointed out that the determination of the MCH involves the red cell count which should be done in triplicate if accurate results are to be obtained.
The red cell count is not involved in the determination of the MCHC, so the results tend to be more standard.

36. RBC Color
Erythrocytes, when spread on a glass slide, show varying degrees of central pallor.
This central pallor is related to the hemoglobin concentration present in the red cells.
Megalocytes (macrocytes) are normochromic

37. RBC Color
The central area (1/3 of the cell) is white, while buff-colored hemoglobin is visible in the outer 2/3 of the cell.
The MCHC (32-36 gm/dl) is the index value which is used to verify the presence of adequate hemoglobin concentration in the cells visible on the peripheral smear.

38. Normochromic cells

40. Hypochromic cells

43. Hyperchromic cells

46. Polychromasia

47. RDW
Most automated instruments now provide an RBC Distribution Width (RDW)
An index of RBC size variation
May be used to quantitate the amount of anisocytosis on peripheral blood smear
Normal range is 11.5% to 14.5% for both men and women

48. RDW
RDW is an expression of the homogeneity of the RBC population size.
A large RDW says there's a wide variation in the RBC diameters within the test pool.
It doesn't say the cells are large or small, rather that the population is not homogenous. 

49. Anisocytosis
Increased variation in size of the red cell population present on a blood smear.
Normal, small and large cells can be seen in one field.
As the severity of the anemia increases, the amount of significant anisocytosis present also increases.

50. Anisocytosis

51. Anisocytosis

52. Poikilocytosis
Variations in shape.

54. Acanthocytes
3-12 thorn-like projections irregularly spaced around the cell.

56. Codocyte
Target cells are thin-walled cells showing a darkly-stained centre area of hemoglobin which has been separated from the peripheral ring of hemoglobin.

58. Dacrocyte
Dacryocytes are pear-shaped or teardrop shaped cells.

59. Drepanocytes
Drepanocytes or sickle cells are formed as a result of the presence of hemoglobin S in the red cell.

62. Echinocyte
The projections are rounded and evenly spaced around the cell.
Acanthocytes have irregularly spaced thorn-like projections.

64. Elliptocytes
Elliptocytes can vary in appearance from slightly oval to thin pencil-shaped forms.
Less than 1% of red cells in normal blood are oval.

66. Anemias

67. Definition of Anemia
Anemia is a functional inability of the blood to supply the tissue with adequate O2 for proper metabolic function.
Anemia is usually associated with decreased levels of hemoglobin or a decreased RBC count.
When you conclude that a patient has anemia, this is not a diagnosis but rather the expression of an underlying disorder or disease.

68. Quantitative Classification of Anemias
Quantitatively by:
Hematocrit
Hemoglobin
Blood cell indices

69. Morphological Classification of Anemias
Morphological based on sizes and color of RBCs
Normochromic Normocytic
Hypochromic Microcytic
Normochromic Macrocytic

70. Decreased MCV and Decreased MCHC
Microcytic/Hypochromic Anemia
Iron deficiency
Thalassemia
Anemia of chronic disease
Sideroblastic anemia
Lead poisoning

71. Increased MCV, Decreased MCHC
Macrocytic/Normochromic Anemia
Folate deficiency
B12 deficiency

72. Thalassemias

73. Thalassemias
Heritable,microcytic hypochromic anemia-with varying degrees of severity
Genetic defects result in decreased or absent production of globin chain
High incidence in Asia, Africa, Mideast, and Mediterranean countries

75. IRON DEFICIENCY ANEMIA

76. IRON DEFICIENCY ANEMIA
IRON METABOLISM
ABSORPTION IN DUODENUM
TRANSFERRIN TRANSPORTS IRON TO THE CELLS
FERRITIN AND HEMOSYDERIN STORE IRON
10% of daily iron is absorbed

77. Most body iron is present in hemoglobin in circulating red cells
The macrophages of the reticuloendotelial system store iron released from hemoglobin as ferritin and hemosiderin
Small loss of iron each day in urine, faeces, skin and nails and in menstruating females (1-2 mg daily)

78. IRON DEFICIENCY ANEMIA
ETIOLOGY:
CHRONIC BLEEDING
MENORRHAGIA
PEPTIC ULCER
STOMACH CANCER
ULCERATIVE COLITIS
INTESTINAL CANCER
HAEMORRHOIDS
DECREASED IRON INTAKE
INCREASED IRON REQUIRMENT (JUVENILE AGE, PREGNANCY, LACTATION)

79. IRON DEFICIENCY ANEMIA
GENERAL ANEMIA’S SYMPTOMS:
EASY FATIGABILITY
DIZZENES
HEADACHE
IRRITABILITY
PALLOR
PALPITATION

80. CHARACTERISTICS SYMPTOMS
GLOSSITIS, STOMATITIS
DRY, PALE SKIN
SPOON SHAPED NAILS, KOILONYCHIA,
HAIR LOSS
RAPID BIG VOLUME PULSE
INCREASED PLATELET COUNT
MURMER

81. IRON DEFICIENCY ANEMIA
MCV
MCH
MCHC

82. IRON Indices Iron concentration (Fe) Total Iron Binding Capacity
Transferrin saturation
Transferrin receptor concentration
Ferritin concentration

87. Iron deficiency anaemia Vs. Thalassemia
ASSIGNMENT
Iron deficiency anaemia Vs. Thalassemia
Compare USING MCV , MCH , MCHC