DISCOVER CBC DISCOVER CBC PROF / ABDUL HAMID ABDUL MONEM, MD

1 B A S I C S

1 CBC Report Contents RBCS count HB (gm/dl) HCT Blood indices ⁻ MCV ⁻ MCH ⁻ MCHC RBCS count HB (gm/dl) HCT Blood indices ⁻ MCV ⁻ MCH ⁻ MCHC WBCS count ₋ Netrophils ₋ Segmented ₋ Staff ₋ Lymphocytes ₋ Esinophils ₋ Monocytes ₋ Abnormal cells Platelets WBCS count ₋ Netrophils ₋ Segmented ₋ Staff ₋ Lymphocytes ₋ Esinophils ₋ Monocytes ₋ Abnormal cells Platelets BASIC

BASICS 1 RBCS It is a circular non nucleated biconcave disc with dense rim & clear contents RBCS count : 4-5 million /mm3 RBCS formation take place in bone marrow It is a circular non nucleated biconcave disc with dense rim & clear contents RBCS count : 4-5 million /mm3 RBCS formation take place in bone marrow BASIC

BASICS 1 It Is An O2 Carrier It Is Intracorpscular Components It Is Main Parameter Used To Diagnose Anemia Anemia Is Diagnosed According To Age Group ― New born : ↓13 gm/dl ― 3months: ↓9.5 gm/dl ― 3-12months : ↓10 gm/dl ― 1-12years:↓11gm/dl ― >12years: ↓12gm/dl It Is An O2 Carrier It Is Intracorpscular Components It Is Main Parameter Used To Diagnose Anemia Anemia Is Diagnosed According To Age Group ― New born : ↓13 gm/dl ― 3months: ↓9.5 gm/dl ― 3-12months : ↓10 gm/dl ― 1-12years:↓11gm/dl ― >12years: ↓12gm/dl HEMOGLOBIN BASIC NADIR

BASICS 1 It is volume of RBCS as regard to the whole blood Average in newborn : 50%. Infant & child : 35% - 40%. Decrease HB & HCT : Anemia Increase HB & HCT : Polycythemia It is volume of RBCS as regard to the whole blood Average in newborn : 50%. Infant & child : 35% - 40%. Decrease HB & HCT : Anemia Increase HB & HCT : Polycythemia HEMATOCRIT (HCT) HCT

BASICS 1 MCV = HCT % × 10 / RBCS ↓MCV : Microcytosis ↑MCV: Macrocytosis Normal MCV : Normocytosis Average : FL Lower Limit = 70 Age/Year Upper Limit (↓10 Years →90 Fl, ↑10 Years →95 Fl) MCV = HCT % × 10 / RBCS ↓MCV : Microcytosis ↑MCV: Macrocytosis Normal MCV : Normocytosis Average : FL Lower Limit = 70 Age/Year Upper Limit (↓10 Years →90 Fl, ↑10 Years →95 Fl) MEAN CURPSCULAR VOLUME (MCV) MCV

BASICS 1 MCH = Average quantity of hemoglobin in RBCS MCH = HB (gm%)×10 / RBCS = pgm It ↓ in iron deficiency & thalassemia MCH = Average quantity of hemoglobin in RBCS MCH = HB (gm%)×10 / RBCS = pgm It ↓ in iron deficiency & thalassemia BASIC MCH MEAN CORPUSCULAR HAEMOGLOBIN

BASICS 1 RDW RDW : red cell distribution width It denotes size variability of RBCS It is quantification of ansiocytosis Normal : 10 – 15% Used in DD between IDA & Thalassemia It is markedly increased in IDA up to 30 – 40% RDW : red cell distribution width It denotes size variability of RBCS It is quantification of ansiocytosis Normal : 10 – 15% Used in DD between IDA & Thalassemia It is markedly increased in IDA up to 30 – 40%

BASICS 1 Reticulocytes Reticulocytosis Hemolytic anemia Hemorrhagic anemia IDA Reticulocytosis Hemolytic anemia Hemorrhagic anemia IDA Reticulocytopenia Aplasia Leukemia Infiltration Reticulocytopenia Aplasia Leukemia Infiltration Bone Marrow Mirror Image Normal : (0.5 – 2%) Bone Marrow Mirror Image Normal : (0.5 – 2%)

BASICS 1 Reticulocytes BASIC Example : anemic pt with HB of 9 gm%, retics was 5 %, & HCT was 7% Corr, retics = 5× 7/35= 1% Example : anemic pt with HB of 9 gm%, retics was 5 %, & HCT was 7% Corr, retics = 5× 7/35= 1% Corrected retics Retics. Count × HCT/Normal HCT Corrected retics Retics. Count × HCT/Normal HCT

BASICS 1 WBCS BASIC TLC below 10 years : 6000 – TLC above 10 years : TLC below 10 years : 6000 – TLC above 10 years : Normal Infection Inflammation Malignancy Infection Inflammation Malignancy Leukocytosis Aplastic anemia Malignancy Infiltration Aplastic anemia Malignancy Infiltration Leukopenia ↑14000 ↓4000

BASICS 1 Differential TLC BASIC Neutrophils: 60% Lymphocytes : 35% Esinophils: 2% Monocytes : 3-7% Basophils : 0 – 1% Neutrophils: 60% Lymphocytes : 35% Esinophils: 2% Monocytes : 3-7% Basophils : 0 – 1% Differential

BASICS 1 Neutropenia BASIC Sever infection Autoimmune Hypersplensim BM failure Cyclic neutropenia Congenital Sever infection Autoimmune Hypersplensim BM failure Cyclic neutropenia Congenital Neutropenia

BASICS 1 Eosinophilia BASIC Eosinophilia Asthma Eczema Parasitic IBD(UC) Malignancy Asthma Eczema Parasitic IBD(UC) Malignancy ↑50%

BASICS 1 Lymphocytosis BASIC Lymphocytosis Viral infection TB ALL Whooping cough Viral infection TB ALL Whooping cough ↑60%

BASICS 1 Abnormal cells BASIC Band cells N: less than 20% of total neutrophils Bandemia :↑ band cells (bacterial infection ). Metamylocytes & myleocytes in prepheripheral blood is abnormal & denotes bacterial infection. Band cells N: less than 20% of total neutrophils Bandemia :↑ band cells (bacterial infection ). Metamylocytes & myleocytes in prepheripheral blood is abnormal & denotes bacterial infection.

BASICS 1 Platelets BASIC Platelets are produced by bone marrow Normal count : (150,000 – 450,000) Platelets are produced by bone marrow Normal count : (150,000 – 450,000) Function Hemostasis Platelets aggregation Platelets adhesion Clot formation Hemostasis Platelets aggregation Platelets adhesion Clot formation Disorders Thrombocytopenia Thromboasthenia Thrombocytosis Thrombocytopenia Thromboasthenia Thrombocytosis

2 ANEMIA APPROACH

2 Lab. Approach To Anemia ↓ RBCS, HB & HCT ↓MCV MICROCYTIC ANEMIA ↓MCV MICROCYTIC ANEMIA NORMAL MCV NORMOCYTIC ANEMIA NORMAL MCV NORMOCYTIC ANEMIA ↑MCV MACROCYTIC ANEMIA ↑MCV MACROCYTIC ANEMIA DIFFERENCATE EACH TYPE

ANEMIA APPROACH 2 DD Of Microcytic Anemia Iron deficiency anemia Thalassemia Chronic illness o Chronic infection o Chronic inflammation o Chronic renal failure Lead poisoning Sideroblastic anemia Iron deficiency anemia Thalassemia Chronic illness o Chronic infection o Chronic inflammation o Chronic renal failure Lead poisoning Sideroblastic anemia By far the commonest is IDA & Thalassemia

ANEMIA APPROACH 2 Microcytic anemia (DO SERUM IRON) ↓serum iron Consider IDA OR Chronic illness Do serum ferritin IDA ↓ferritin ↓TS% ↑IBC ↑FEP IDA ↓ferritin ↓TS% ↑IBC ↑FEP Chronic illness Normal ferritin Infection Inflammation CRF Chronic illness Normal ferritin Infection Inflammation CRF Normal serum iron Blood film (basophilic stippling ) Blood film (basophilic stippling ) Positive Consider Lead poisionig Positive Consider Lead poisionig Do serum lead Negative Do HB electrophoresis Abnormal Thalassemia Abnormal Thalassemia Normal Do BM SIDEROBLASTIC ANEMIA

ANEMIA APPROACH 2 IRON DEFFECIENCY ANEMIA Therapeutic Trail Of 4-6 Mg/KG /d Of Elemental Iron Can Be Initial Step In Diagnosing Of Microcytic Anemia, Response To Test By Reticulocytosis By The 5 th – 7 th Day And Increase HB I Gm With In 1- 2 Weeks Is Diagnostic, If No Response You Can Evaluate The Other Causes Of Microcytic Anemia. Iron depletionIron deficiencyAnemia ↓ ferritin ↓ transferrin saturation ↑ EEP ↓ ferritin ↓ transferrin saturation ↑ EEP ↓ HB ↓ MCV Therapeuti c test Stage of IDA

ANEMIA APPROACH 2 IRON DEFFECIENCY ANEMIA Decrease ferritin is early lab. Sign for IDA as it a mirror for iron stores however it is an acute phase reactant and it can increased by inflammation even with URTI. NB1 RDW and corrected retics can hepps in DD between IDA & thalassemia NB2

ANEMIA APPROACH 2 DD Of Normocytic Anemia Hemolytic anemia except for thalassemia Aplastic anemia Hemorrhagic anemia Hemolytic anemia except for thalassemia Aplastic anemia Hemorrhagic anemia

ANEMIA APPROACH 2 Normocytic anemia (DO reticulocyte count) Low retics PLT & WBCS Normal Consider Pure red cell anemia BLAST CELLS High retics Serum bilirubin Normal History of acute hemorrhage & investigate for bleeding High comb's test Positive AHA Positive AHA Negative Pancytopenia YESNO LEUKEMIA Aplastic anemia A leukemic leukemia BM infiltration Bone Marrow Aspiration Do blood film Heinz bodies Sickle Sphrocyte SCA HB electro Spherocytosis OFT G6PD ENZYME ESSAY

ANEMIA APPROACH 2 Normocytic anemia At what time the retics count is normal or decreased in hemolytic anemia ? Aplastic crisis : parvo virus infection Decrsed erythropoietin : CKD Decreased micronutrient for erythropoiesis : decrees iron & folate Autoimmune hemolytic anemia when the autoantibodies reacts with antigens that are presently on reticulocytes which increase clearance of the cells

ANEMIA APPROACH 2 Normocytic anemia Direct : coombs reagent + patient RBCS if agglutination (positive) Indirect : coombs reagent + patient serum + known RBCS if agglutination (positive) Coombs test is negative in about 10% of patients with AHA the patient should be treated for AIHA if the disease is strongly suspected even direct coombs is negative Coombs test

ANEMIA APPROACH 2 Normocytic anemia Amount Of Enzyme Activity Depend On The Age Of RBCS G6PD It is difficult to be diagnosed by HB electrophoresis It should requested for HbH & hb Bart, Hb HPLC,high performance liquid chromatography It is difficult to be diagnosed by HB electrophoresis It should requested for HbH & hb Bart, Hb HPLC,high performance liquid chromatography May needed in diagnosis of anemia with bone marrow failure in cases of osteoporosis Alpha thalassemia Skeletal survey

ANEMIA APPROACH 2 DD Of Macrocytic Anemia Pernicious anemia (do serum B12) Folic acid deficiency ( Do serum folic acid) Aplastic anemia (bone marrow ) Pernicious anemia (do serum B12) Folic acid deficiency ( Do serum folic acid) Aplastic anemia (bone marrow ) WBCS,platelets may also decreased in megaloblastic anemia (pancytopenia) Hypersegmented neutrophils are characterstic >3 lobes Schilling test : help to diagnose the the cause of B12 deffeciency WBCS,platelets may also decreased in megaloblastic anemia (pancytopenia) Hypersegmented neutrophils are characterstic >3 lobes Schilling test : help to diagnose the the cause of B12 deffeciency

3 BLOOD FILM

BLOOD FILM BLOOD FILM 3 Heinz Bodies

BLOOD FILM BLOOD FILM 3 Spherocytosis

BLOOD FILM BLOOD FILM 3 SICKLE CELLS

BLOOD FILM BLOOD FILM 3 SCHISTOCYTES

BLOOD FILM BLOOD FILM 3 Basophilic Stippling

BLOOD FILM BLOOD FILM 3 TARGET CELL

BLOOD FILM BLOOD FILM 3 ACANTHOCYTOSIS

CREDIT A HMAD SOLIMMAN ADUL HALIM AHMAD MOHMOD ATTIA CREDIT A HMAD SOLIMMAN ADUL HALIM AHMAD MOHMOD ATTIA