Complete blood count & Coagulation Screening Lab Tests DR. HAILIN WU DR. YOSEPH FELEKE

Blood plasma Blood plasma is prepared by spinning a tube of fresh blood containing an anticoagulant in a centrifuge until the blood cells fall to the bottom of the tube. The blood plasma is then poured or drawn off.

Blood Plasma Approximately 90% water Contains: Ions – Na+ and Cl- Nutrients – sugars, amino acids, lipids, cholesterol, vitamins and trace elements Three main proteins - Albumin (60%), globulin (35%), fibrinogen (4%) Dissolved Gasses – including O2 and CO2 Waste Products – other protein wastes such as urea and bilirubin

Complete Blood Count (CBC) A series of tests of the peripheral blood that provides valuable information about the hematologic system. Is very inexpensive and can be performed rapidly

Complete Blood Count (CBC) Provides information on cellular components of blood Includes RBC count, Hemoglobin (Hgb), Hematocrit (Hct), RBC indices, White blood cell (WBC) count and differential, Platelet count

RBC Count Test Range and Collection (RBC, or erythrocyte count), whole blood 4.3–6.0 x 106/mcL (male) 3.5–5.5 x 106/mcL (female)

Erythrocyte count (RBC) Increased in: erythrocytosis, congenital heart disease, severe COPD, polycythemia vera, severe dehydration, hemoglobinopathies Decreased in: anemia, hemoglobinopathy, hemorrhage, bone marrow failure, renal disease, leukemia, prosthetic valves, normal pregnancy, multiple myeloma, Hodgkin disease, lymphoma, dietary deficiency

Erythrocyte Sedimentation Rate(ESR) Female: 1-25 mm/hr Male: 0-17 mm/hr Increased: inflammatory diseases, e.g. rheumatic conditions Alternative calculation of normal value: Female: (age + 10) / 2 Male: age / 2

Hemoglobin whole blood (Hb) Male: 13.6–17.5 Test Range and Collection whole blood (Hb) Male: 13.6–17.5 Female: 12.0–15.5 g/dL (age-dependent) Increased in: Hemoconcentration (as in dehydration, burns, vomiting), polycythemia, extreme physical exercise. Decreased in: Macrocytic anemia (liver disease, hypothyroidism, vitamin B12 deficiency, folate deficiency), normocytic anemia (early iron deficiency, anemia of chronic disease, hemolytic anemia, acute hemorrhage), and microcytic anemia (iron deficiency, thalassemia). Hypertriglyceridemia and very high white blood cell counts can cause false elevations of Hb

Hematocrit Hematocrit Men 40–54%; women 37–47% Calculated from MCV and red cell number; the percentage volume of red cells in a given volume of blood Increased: Primary polycythemia (polycythemia vera), secondary polycythemia (reduced fluid intake or excess fluid loss), congenital or acquired heart and lung disease, high altitude, heavy smoking, tumors (renal cell carcinoma, hepatoma) Decreased: Megaloblastic anemia (folate or B12 deficiency); iron deficiency anemia; sickle cell anemia or other hemoglobinopathy; acute or chronic blood loss; sideroblastic anemia, hemolysis; anemia due to chronic disease, dilution, alcohol, or drugs

RBC indices Measures size and hgb content of RBCs Used to classify anemias Includes Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW)

MCV Measure of average volume/size of single RBC Normal: 80 – 100 mm3 MCV = Hct (%) x 10/RBC (million/mm3) Useful in anemia classification Normal: 80 – 100 mm3 Increased in (macrocytic): pernicious anemia (vit B12 deficiency), folic acid deficiency, antimetabolic therapy, alcoholism, chronic liver disease, hypothyroidism Normocytic: bone marrow failure/replacement, acute blood loss, chronic diseases, hemolytic anemias Decreased in(microcytic): Fe deficiency anemia, thalassemia, anemia of chronic illness

Mean Corpuscular Hemoglobin (MCH) Test Range and Collection blood (MCH) 26–34 pg MCH = (Hb/RBC) x 10 Increased in: Macrocytosis, hemochromatosis. Decreased in: Microcytosis (iron deficiency, thalassemia), hypochromia (lead poisoning, sideroblastic anemia, anemia of chronic disease). Low MCH can mean hypochromia or microcytosis or both. High MCH is evidence of macrocytosis.

MCHC Measure of average [hgb] within a single RBC MCHC = Hgb (g/dL) x 100/Hct (%) 37 g/dL = maximum Hgb able to fit into an RBC (cannot be hyperchromic) Normal (normochromic): 32 – 36 g/dL Increased in : spherocytosis, intravascular hemolysis, cold agglutinins Decreased in (hypochromic): Fe deficiency anemia, thalassemia

RDW Measure of variation of RBC size (indicator of degree of anisocytosis) Useful in anemia classification Normal: variation of 11.5 – 16.9% Increased in : Fe deficiency anemia, vit B12 or folate deficiency anemia, hemoglobinopathies, hemolytic anemias, posthemorrhagic anemias

Platelet Count Test Range and Collection whole blood (Plt) 150–450 x 103/mcL [x 109/L] Panic: <25 x 103/mcL Increased in: Myeloproliferative disorders (chronic myeloid leukemia, essential thrombo-cythemia, myelofibrosis), acute blood loss, post-splenectomy, pre-eclampsia, reactive thrombocytosis secondary to inflammatory disorders, infection, tissue injury, iron deficiency, malignancies. Decreased in: Decreased production: bone marrow suppression or replacement/infiltration, chemotherapy, drugs, alcohol, infection (eg, HIV), congenital marrow failure; increased destruction or excessive pooling: hypersplenism, DIC, platelet antibodies

Thrombocyte count The terms thrombocytopenia and thrombopenia  refer to a disorder in which there is a relative decrease of thrombocytes, commonly known as platelets, present in the blood. A normal human platelet count ranges from 150,000 to 450,000 platelets per microlitre of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease. One common definition of thrombocytopenia is a platelet count below 50,000 per microlitre.

Total WBCs (leukocytes) Measurement of total WBC count Consists of total # of WBCs/mm3 of peripheral venous blood Part of “routine” testing Useful for evaluation of infection, neoplasm, allergy & immunosuppression Normal: 4,000 – 10,000/mm3 Critical: < 2,500 or > 30,000/mm3 Increased in:(leukocytosis): infection, malignancy, trauma, stress, hemorrhage, tissue necrosis, inflammation, dehydration, thyroid storm Decreased in: (leukopenia): drug toxicity, bone marrow failure, overwhelming infections, dietary deficiency, congenital marrow aplasia, bone marrow infiltration, autoimmune disease, hypersplenism

White Blood Cell Count w/ Differential Test Range and Collection blood Reference ranges are age- and laboratory-specific Adult ranges: WBC 4.5–11.0 x 103/mcL; differential: segmented neutrophils 50–70%; band neutrophils 0–5%; lymphocytes 20–40%; monocytes 2–6%; eosinophils 1–4%; basophils 0–1%. Panic: <1.5 x 103/mcL

White Blood Cell Count w/ Differential Increased in: Acute infections, inflammatory disorders, acute and chronic leukemias, myeloproliferative disorders, circulating lymphoma, tissue injury/necrosis, various drugs, corticosteroids, allergies, hypersensitivity reactions, stress, smoking. Decreased in: Infections, constitutional and acquired myeloid hypoplasia, myelosuppression (eg, chemotherapy, radiation, various drugs), myelodysplasia, collagen vascular diseases, hypersplenism, cyclic neutropenia, autoimmune neutropenia, alcoholism It is important to perform a manual differential in certain conditions such as presence of blasts, immature granulocytes, nucleated red blood cells, leukemia or lymphoma cells, plasma cells, or dysplasia.

Coagulation Screening Used to evaluate a patient’s blood coagulation system status Has multiple factors that are measured: Prothrombin Time (PT) Partial Thromboplastin Time (PTT) INR Bleeding time (BT)

Prothrombin Time (PT) Test Range and Collection whole blood (PT) 11–15 seconds (laboratory specific) Increased in: Warfarin, liver disease, DIC, vitamin K deficiency, hereditary deficiency in factors VII, X, V and II, fibrinogen abnormality (eg, hypofibrinogenemia, afibrinogenemia, dysfibrinogenemia), circulating anticoagulant affecting the PT system (rarely lupus anticoagulant), massive transfusion. Routine preoperative measurement of PT is unnecessary unless there is clinical history of a bleeding disorder

Partial Thromboplastin Time (PTT) Test Range and Collection activated, plasma (aPTT) 25–35 seconds (range varies) Panic: 60 seconds (off heparin) Increased in: Deficiency of any individual coagulation factor except Factors XIII and VII, presence of nonspecific inhibitor (eg, lupus anticoagulant), specific factor inhibitor, von Willebrand disease (PTT may also be normal), hemophilia A and B, DIC. Drugs: heparin, direct thrombin inhibitor (eg, hirudin, argatroban), warfarin. Decreased in: Hypercoagulable states (eg, increased factor VIII levels). PTT cannot be used to monitor very high doses of heparin (eg, cardiac bypass surgery) because the clotting time is beyond the analytical measurement range of PTT.

INR Test Range and Collection International Normalized Ratio (INR) is calculated. INR = [Patient PT/Normal mean PT] Warfarin therapeutic range is INR 2.0–3.0. Bleeding has been reported to be three times more common in patients with INRs of 3.0–4.5 than in patients with INRs of 2.0–3.0.

BT Normal 1-6 min Measures quality of platelets Prolonged in thrombocytopenia Bleeding time is a medical test done on someone to assess their platelets function. It involves making a patient bleed then timing how long it takes for them to stop bleeding.