1. What you need to know about CBC and coagulation profile
Ghada El Gohary
MB Bch, MSC,MD
Prof Of Internal Medicine/BMT
Ain Shams University
Cairo ,Egypt
Consultant Adult hematology and stem cell transplantation KSUH

2. Slide credits to many contributors

3. Objectives Practical approach to CBC
How to approach coagulation defect

4. CBC is one of the commonest investigation we use and you need to understand it.
Many items listed , some of them tell the same information in different way.
Most of the CBC now done in automated way

5. Haematopoiesis (Cell development)

6. WBC and diff RBC HB Htc MCV MCH MCHC Plat and MPV ESR Blood film RDW
Blood consists of (Red Blood Cells, White blood cells, Platelets, Plasma)
WBC and diff
RBC HB
Htc
MCV
MCH
MCHC
Plat and MPV
ESR
Blood film
RDW
Retics

7. NormaL Ranges (Adults)
Hemoglobin:
g/L (male)
g/L (female)
Hematocrit (PCV): The volume of packed RBC in 100 ml blood
40-50 % (male)
36-48 % (female)
RDW (Red Cell Distribution Width): %
RDW is a measure of the degree of anisocytosis (variation in RBC size)
Increased :Many types of anemia(Iron Deficiency ,folate deficiency),liver disease
Reticulocytes: %
ESR: 2-12 mm/1st hour

8. RBC s indices MCV =77-95 fl =PCV×10/RBC count/cmm
MCH =27-32 Picogram = hemoglobin×10 /RBC count/cmm
MCHC = gm/dL=hemoglobin (g/dl)/PCV×100
RBC COUNT /CMM=5

9. Interpret results in clinical context
All haematology results need to be
interpreted in the context of a thorough
history and physical examination, as well as
previous results.

10. History and clinical examination
Important features of history and clinical examination:
pallor, jaundice
fever, lymphadenopathy
bleeding/bruising
hepatomegaly, splenomegaly
frequency and severity of infections, mouth ulcers, recent viral illness
exposure to drugs and toxins
fatigue/weight loss

11. Low haemoglobin Useful to use MCV to classify the anaemia:
Microcytic, MCV < 80 fl
Normocytic, MCV 80 – 100 fl
Macrocytic, MCV > 100 fl

12. Microcytic Anaemia
The three most common causes for microcytic anaemia are:
Iron deficiency
Thalassaemia
Anaemia of Chronic disease

13. Normocytic anaemia The causes of normocytic anaemia include: Bleeding
Early nutritional anaemia (iron, B12, folate deficiencies)
Anaemia of renal insufficiency
Anaemia of chronic disease/chronic inflammation
Haemolysis
Primary bone marrow disorder

14. Macrocytic anaemia Common causes: Alcohol Liver disease
B12 or folate deficiency
Thyroid disease
Some drugs (especially hydroxyurea)

16. High haemoglobin  Hb often accompanied by PCV
Can reflect decreased plasma volume (eg: dehydration, alcohol, cigarette smoking, diuretics)
Increased red cell mass (eg polycythaemia)
This can be primary or secondary

18. Neutrophils – Low Significant levels
< 0.5 x 109/L (high risk infection)
Most common causes
viral (overt or occult)
autoimmune/idiopathic
drugs
Red flags
person particularly unwell
severity
lymphadenopathy, hepatosplenomegaly

19. Neutrophils – High Most common causes Red flags infection/inflammation
Necrosis/malignancy
any stressor/heavy exercise
Drugs
CML
Red flags
person particularly unwell
Severity
presence of left shift or blast

20. Lymphocytes Lymphocyte – Low not usually clinically significant
Lymphocyte – High
isolated elevated count not usually significant
Causes
acute infection (viral, bacterial)
smoking
hyposplenism
acute stress response
autoimmune thyroiditis
CLL

21. Monocytes Monocytes – Low Monocytes – High not clinically significant
usually not significant
watch levels > 1.5 x109/L more closely

22. Eosinophils Eosinophils – Low Eosinophils – High
no real cause for concern
Eosinophils – High
Most common causes:
allergy/atopy: asthma/hayfever
parasites (less common in developed countries)
Rarer causes:
Hodgkins
myeloproliferative disorders
Churg-Strauss syndrome

23. Basophils Basophils – Low Basophils – High Associated with
difficult to demonstrate/no clinical significance.
Basophils – High Associated with
myeloproliferative disorders
other rare causes

24. Platelets – Low Red flags Significant levels < 100 x109/L
Most common causes
viral infection
idiopathic thrombocytopenic purpura
liver disease
drugs
hypersplenism
autoimmune disease
Pregnancy
Artificial  confirm on blood film
Red flags
bruising
petechiae
signs of bleeding

25. Platelets – High Significant levels > 500 x109/L Most likely causes
reactive conditions eg infection, inflammation
pregnancy
iron deficiency
post splenectomy
essential thrombocythaemia

29. NORMAL COAGULATION PARAMETERS
PT (prothrombin time): sec
PTT ( partial thromboplastin time): sec
INR(international normalized ratio) :

30. Coagulation Cascade

31. Prolonged PT(Extrinsic Pathway) is seen in Vitamin K deficiency (1972) Warfarin therapy Liver disease Prolonged PTT (Intrinsic Pathway VIII,IX,XI,XII) is seen in Von Willbrand disease Hemophilia Heparin therapy Antiphospholipid syndrome Prolonged PT and PTT is seen in deficiencies of the final common pathway factors such as factor V, prothrombin, fibrinogen, or factor X. Liver disease, DIC. No all bleeding problems can be explained by this but most of it.

32. Hemophilia A:deficiency of factor VIII (XR)
Hemophilia B :deficiency of factor IX (XR)
Hemophilia C : deficiency of factor XI (AR)

33. Vit K Warfarin is oral anticoagulant which is a
vitamin K antagonist that inhibits
Vit K
dependant coagulation factors :II,VII,IX,X

34. ANTICOAGULANTS: IIa (thrombin)
Heparin (great efficacy)
LMWH (dalteparin, enoxaparin)
Direct thrombin inhibitors inhibitors (argatroban, bivalirudin,dabigatran)

35. ANTICOAGULANTS: Factor Xa
LMW (greatest efficacy)
Heparin
Direct Xa inhibitors (apixaban,rivaroxaban)
Fondaparinux

37. Which of the following anemias is associated with splenomegaly
a.chronic renal failure
b.aplastic anemia
c.hereditary spherocytosis
d.sickle cell anemia

38. All of the following produce microcytic anemia EXCEPT:
a.sideroblastic anemia
b. Thalassemia
c. Prenicious anemia
d. Lead poisoning

39. Red cell osmotic fragility is increased in :
a. Thalassemia
b. Hereditary spherocytosis
c. Iron deficiency anemia
d. ITP

40. Coagulation factor deficient in stored blood is :
a. VII
B. V
C.IX
D.II

41. Feature of sickle cell anemia do not include :
a. Nocturia
b. Priapism
c. Hypersplenism
d.Leg ulcers

43. Thank you