Complete Blood Count

Normal Ranges WBC: WBC DIFFERENTIAL: 4,000 – 11,000/cubicmm Neutrophil 40-75% Lymphocytes 15-75% Monocytes 1-10% Eosinophils 1-6% Basophils 0-2%

examples of causes of a high count Test examples of causes of a low count examples of causes of a high count White Blood Cell Count Known as leukopenia or damage Autoimmune conditions Severe infections (sepsis) lymphoma or other cancer that spread to the bone marrow Diseases of immune system (e.g., HIV) Known as leukocytosis infections most commonly bacterial or viral Leukemia, myeloproliferative disorders inflammation Allergies , Asthma Tissue death (trauma, burns, heart attack) Intense exercise or severe stress

examples of causes of a low count examples of causes of a high count Test Full Name examples of causes of a low count examples of causes of a high count Neu, PMN, polys Absolute neutrophil count, % neutrophils Known as neutropenia Severe,over whelming infection (sepsis) Autoimmune disorders Reaction to drugs, chemotherapy Immunodeficiency Bone marrow damage (e.g., chemotherapy, radiation therapy) Known as neutrophilia Acute bacterial infections Inflammation Tissue death (necrosis) caused by trauma, heart attack, burns leukemia eos Absolute eosinophil count, % eosinophils  not medically significant. Parasitic infections, asthma,allergic reaction. baso Absolute basophil count, % basophils not medically significant bone marrow related conditions such as leukemia or lymphoma

examples of causes of a low count examples of causes of a high count TEST Full Name examples of causes of a low count examples of causes of a high count mono Absolute monocyte  count, % monocytes not medically significant. bacterial infection, tuberculosis, malaria, monocytic leukemia lympho Absolute  Lymphocyte count, % lymphocytes Known as lymphocytopenia Autoimmune disorders (e.g., lupus rheumatoid arthritis) Infections (e.g., HIV, viral hepatitis , typhoid fever, influenza) Bone marrow damage (e.g., chemotherapy, radiation therapy) Corticosteroids Known as lymphocytosis Acute viral infections (e.g., chicken pox,cytomegalovirus (CMV), Epstein-Barr virus (EBV),herpes) Certain bacterial infections (e.g. tuberculosis Lymphocytic leukemia, lymphoma Stress (acute)

Complete Blood Count : Hb, RBC, MCV, MCH, MCHC, WBC & Diff, Platelet, Reticulocyte

Anemia Anemia: RBC mass ed level of Hb more than 2SD of mean normal of Hb according to age Age Hb level New born <13 gr/dl 2-3 months < 9 FT < 7 premature 6m-2y <9.5 2y – 6 years old <10.5 6 – 12 y/o <11.5 >12 y/o Male < 14 Female < 12 Anemia

Mean corpuscular volume:  100 (fl) Age: 2-10 y/o MCV= Age (year) + 70 Age ≥ 10 y/o MCV < 80: Microcytosis MCH Mean corpuscular hemoglobin:  100 (Pg) More sensitive than MCV MCH 25- 27 hypochromia

Calculating the Hematocrit More commonly the Hct is calculated directly from the RBC and MCV Hematocrit % = RBC (cells/liter) x MCV (liter/cell) Because the Hct is a derived value, errors in the RBC or MCV determination will lead to false results Calculating the Hematocrit

Mean Corpuscular Volume The MCV is a measure of the average volume, or size, of an RBC It is determined by the distribution of the red blood cell histogram The mean of the red blood cell distribution histogram is the MCV Mean Corpuscular Volume

RBC Distribution Histogram Number Of cells MCV 60 120 Cell Size (fl)

Use of MCV Result The MCV is important in classifying anemias Normal MCV = normocytic anemia Decreased MCV = microcytic anemia Increased MCV = macrocytic anemia

RBC Distribution Histogram Number Of cells Microcytic Red blood cells Macrocytic Red blood cells MCV 60 120 Cell Size (fl)

MCHC Mean corpuscular hemoglobin concentration:  100   100 It is important in diagnosis of congenital Spherocytosis (MCHC > 35) :

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

Measurement Normal Range RBC count 5 million 4 to 6 Hemoglobin 15 g% 12 to 17 Hematocrit 45 38 to 50 A x 3 = B x 3 = C - This is the rule of thumb Check whether this holds good in given results If not -indicates micro or macrocytosis or hypochro.

‘RBC to be’ or Apprentice RBC Fragments of nuclear material RETICULOCYTE COUNT % ‘RBC to be’ or Apprentice RBC Fragments of nuclear material RNA strands which stain blue Normal Less than 2%

The reticulocyte count Increased reticulocytes (greater than 2-3% or 100,000/mm3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemias will present with a normal reticulocyte count due to immune destruction of red cell precursors. Retic counts are most helpful if extremely low (<0.1%) or greater than 3% (100,000/mm3 total).

To be useful the reticulocyte count must be adjusted for the patient's hematocrit. Thus: Corrected retic. = Patients retic. x (Patients Hct/45) Reticulocyte index (RPI) = corrected retic. count/Maturation time (Maturation time = 1 for Hct=45%, 1.5 for 35%, 2 for 25%, and 2.5 for 15%.) Absolute reticulocyte count = retic x RBC number.

Red Cell Size

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

Classification by Pathophysiology Blood Loss Decreased Production Increased Destruction Classification by Morphology Normocytic Microcytic Macrocytic

RDW Red cell distribution width = anisocytosis RDW = 11-14.5% IDA: RDW -thalassemia minor: RDW

Evaluation of platelets The platelet count is the number of platelets in a person's sample of blood. Mean platelet volume (MPV) may be reported with a CBC. It is a calculation of the average size of platelets. Platelet distribution width (PDW) may also be reported with a CBC. It is a measurement of the variation of platelet size.

Normal Range Platelet count : 140,000 to 450,000 /cubic mm Mean platelet volume: 7.5 – 11.5 fL Platelet distribution width: 10% - 17.9%

Test examples of causes of low result examples of causes of high result Platelet Count Known as thrombocytopenia: Viral infection (mononucleosis,hepatitis) Rocky mountain spotted fever Platelet autoantibody acetaminophen, quinidine, sulfa cirrhosis Autoimmune disorders Sepsis Leukemia, lymphoma Myelodysplasia Chemo or radiation therapy Know as thrombocytosis: Cancer (lung, GI,lymphoma) Rheumatoid arthritis, IBD, lupus IDA Hemolytic anemia Myeloproliferative disorder (essential thrombocythemia)

Examples of causes of low result Test Examples of causes of low result Examples of causes of high result Mean Platelet Volume Indicates average size of platelets is small; older platelets are generally smaller than younger ones and a low MPV may mean that a condition is affecting the production of platelets by the bone marrow. Indicates a high number of larger, younger platelets in the blood; this may be due to the bone marrow producing and releasing platelets rapidly into circulation. Platelet Distribution Width Indicates uniformity in Indicates increased variation in the size of the platelets, which may mean that a condition is present that is affecting platelets