1. CBC
Complete Blood Count

2. What is CBC? Commonly ordered blood test
Calculation of the formed elements of blood
RBC Count
RBC Indices
Hemoglobin
Hematocrit
WBC Count
WBC Differential
Platelet Count

3. CBC Collection Tube Purple top tube Anti-coagulant additive
Mix 5-10 times

4. Why are CBCs needed? Screening during a general physical examination
Especially on admission to a health care facility or before surgery

5. Red Blood Cells (RBC) Normal Values Males: 4.7-6.1 million/mm3
Females: million/mm3

6. RBC
Determines RBC/mm3
Contains hemoglobin which is responsible for the transport of oxygen and carbon dioxide
Increased RBC occurs in polychythmia vera
Decreased RBC occurs in anemia
Congenital heart disease and events that induce chronic hypoxia
Moving to a high altitude or lung disease

7. Red Blood Cell Indices
Red blood cell indices provide information about the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and Red blood cell distribution width (RDW)
Normal Values:
MCV: 85-95fL
MCH:28-32pg/cell
MCHC:33-35g/dL
RDW:

8. Results
Increased in…
MCV: Alcoholism, Antimetabolite therapy, liver disease, pernicious anemia, Vit. B12 anemia
MCH: Macrocytic anemias
MCHC: Thalassemia, Spherocytosis
RDW: Anemias with heterogeneous cell size

9. Results Decreased in… MCV: Iron-deficiency anemia, Thalassemias
MCH: Hypochromic anemias, Microcytic anemias
MCHC: Iron deficiency anemia
RDW: N/A

10. Nursing Interventions
Assist in the diagnosis of anemia
Detect a hematologic disorder, neoplasm, or immunologic abnormality
Determine the presence of a hereditary hematologic abnormality
Monitor the progression of nonhematologic disorders such as COPD, cancer, and renal disease
Monitor the response to drugs or chemotherapy, and evaluate undesired reactions to drugs that may cause blood dyscrasias

11. Hemoglobin Carries O2 and removes CO2
Buffer for acid-base balance in extracellular fluid
Levels used with Hematocrit to evaluate anemia
Normal ranges
Males: g/dL
Females: g/dL

12. Critical Values Less than 6.0 g/dL More than 18.0 g/dL High Hgb
Polychythmia
Low Hgb
Anemia

13. Results Burns CHF COPD Dehydration Erythrocytosis Anemia Carcinoma
Increased in…
Decreased in…
Burns
CHF
COPD
Dehydration
Erythrocytosis
Anemia
Carcinoma
Fluid retention
Incompatible blood transfusion
Hodgkin’s disease
Pregnancy

14. Nursing Interventions
Monitor fluid imbalances
Monitor response to drugs or chemotherapy and evaluate undesired reactions to drugs
Screening as part of CBC

15. Hematocrit Measures the amount of red blood cells (RBC) in the blood
Expressed as a fraction or percentage
Increases when RBC number increases or plasma level drops
Decreases due to RBC production decrease, blood loss or RBC destruction

16. Normal Values Age Hematocrit (%) Cord Blood 47-57 1 Day Old 51-65
2 Weeks Old
1 Month Old
38-52
6 Months Old
35-41
1 Year Old
37-41
10 Years Old
36-42
Adult Male
43-49
Adult Female
38-44

17. Abnormal Values Burns CHF COPD Dehydration Erythrocytosis
Increase
Decrease
Burns
CHF
COPD
Dehydration
Erythrocytosis
Hemoconcentration
High Altitudes
Polycythemia
Shock
Anemia
Blood Loss
Bone Marrow
Hyperplasia
Chronic Disease
Hemolytic Disorders
Hemorrhage
Fluid Retention
Nutritional Deficit
Pregnancy

18. White Blood Cells (WBC)
Normal Ranges: (adults) ,000/mm3
Critical Values
>30,000/mm 3
<2500mm3
WBCs constitute the body’s primary defense system against foreign organisms, and tissues
Life span = 13 to 20 days
Old WBCs are destroyed by the lymphatic system and excreted in feces
White “knobby” things = WBC

19. Nursing Interventions
Assist in determining the cause of an elevated WBC (e.g. infection, inflammatory process)
Monitor the progression of nonhematologic disorders (e.g. chronic obstructive pulmonary disease, malaborption syndrome, cancer, renal disease)
Monitor the response to medication (e.g. chemotherapy)

20. An increase in WBCs = Leukocytosis
Pathologic Conditions:
Transfusion reactions
All types of infections
Anemia
Appendicitis
Cushing’s disease
Inflammatory disorders
Leukemia
Physiological and environmental conditions:
Emotional stress
Exposure to cold
Menstruation
Pregnancy and labor
Strenuous exercise

21. A decrease in WBCs = Leukopenia
Physiological conditions:
Diurnal rhythms
Pathologic Conditions:
Alcoholism
Anemia
Bone marrow depression
Malnutrition
Radiation
Viral infections

22. White Blood Cell Count and Cell Differential
WBC’s constitute the bodies primary defence system
Normal life span is 13 to 20 days; old cells are destroyed by lymphatic system and excreted
Produced in the bone marrow

23. Differential WBC Count
The WBC’s in the count and differential are reported as an absolute value, as a percent or as SI Units
using a base cell count of 100 cells, the relative percentages are counted
Absolute value is obtained by multiplying the percentage by the total count
Contains K3 or K2 EDTA (Ethylenediaminetetracetic Acid), the chemical of choice to prevent sample clotting; binds to Ca and prevents the activation of clotting

24. Neutrophils
Defend against bacteria and fungal infection; first response
Activity and large numbers formulate pus
Normal Values: 50-70% or
↑Neutrophilia—acute hemolysis, hemorrhage, extremes in temperature, infection, inflammatory conditions
↓ Neutropenia—acromegaly, Addison’s disease, anaphylaxis, starvation, bone marrow depression,

25. Lymphocytes
A cell of the lymphatic system that participates in the immune response
3 Types
B Cells: make antibodies that bind to pathogens; retain memory
T Cells: immune response coordination
Natural Killer Cells: kill the cells of the body which display signal
Normal Values: 20-30% or
↑ Lymphocytosis—Addison’s disease, Infections, Lymphocytotic Leukemia, Lymphomas, Myeloma, Rickets, Ulcerative Colitis
↓ Lymphopenia—AIDS, Burns, Newborn Hemolytic Disease, Immunodeficiency, Malnutrition, Pneumonia, Radiation, Septicemia, Transfusion Reaction

26. Monocytes
Present pieces of pathogens to T-Cells so that pathogens can be recognized to mount antibody response; long living
Leave the blood stream to become tissue macrophages to remove dead cell debris and attack microorganisms
Normal Values: 2-8% or 0-0.8
↑ Monocytosis—Carcinomas, Hemolytic Anemia, Hodgkin’s Disease, Infections, Lymphomas, Monocytotic Leukemia
↓ Monocytopneia—Aplastic Anemia, Corticosteroid Therapy (Prednisone)

27. Eosiniphils Primary deal with parasitic infections
Inflammatory cells in allergic reactions
Normal Values: 2-4% or
↑ Eosinophilia—Allergies, Parasitic Infection, Autoimmune Disorders, Asthma
↓ Eosinopenia—Steroid Therapy

28. Basophils
Responsible for allergic and antigen response by releasing histamine causing inflammation
Inflammatory cells in allergic reactions
Normal Values: 0.5%-1% or 0-0.2
↑ Basophilia—Inflammatory processes during healing
↓ Basopenia—Hypersensitivity reactions and corticosteroid therapy

29. Platelets Small disk-like shaped fragments of cells
Formed in the red bone marrow and circulate freely in blood in an inactive state
When injury occurs, platelets collect at a site and are activated
Substances released from the platelet granules activate coagulation factors in the blood plasma and initiate the formation of a stable clot composed of fibrin

30. Platelets
Platelet counts are done to establish the patients coagulation abilities
Normal Values
Adults: / mm3 of blood
Abnormal Values
Increased Values
Decreased Values
Results in increased coagulation of blood
Results in decreased coagulation of blood

31. Nursing Interventions
Coagulation System Tests
Evaluate Bleeding Time
Amount of time for bleeding to stop after a small incision is made in the skin
Normal bleeding time: 3-7 minutes
Prolongation occurs in patients with decreased platelet count, anti-coagulation therapy, ASA ingestion, leukemia, or clotting factor deficiencies

32. Nursing Interventions
Coagulation System Tests
Evaluate Factors Assay
Measures the hemostatic activity
Decreased activity of the coagulation factors will result in defective clot formation

33. Nursing Interventions
Patients With Increased Platelet Count
Monitor patients for risk of vascular thrombosis or pulmonary emboli
Administer anti-coagulation therapy
Encourage healthy diet and exercise

34. Nursing Interventions
Patients With Decreased Platelet Count
Monitor patients for risk of spontaneous bleeding
Patient teaching

35. Interfering Factors Failure to fill tube
Hemolyzed or clotted specimens
Recent transfusion history

36. Nursing Implications for CBC
If lab is performing, make sure they
are aware of any latex allergies
Keep patient calm
Ensure they breathe normally
Avoid any movement
Ensure prompt transportation of
specimen to the lab

37. Case Study 1
Your patient is post-op day 1. She had a total knee replacement. You notice that the site is bleeding, inflamed and reddened upon your morning assessment. You call the doctor and he says to obtain a complete blood count and that he will be in tomorrow. You get it back later that day. What would you expect the results to be and why?

38. Answers RBC will  due to loss of blood
3.8 x 106 cells/mm3
Hematocrit and hemoglobin levels  due to loss of blood
Hemoglobin: 7g/dL
Hematocrit: 20%
WBC will be  due to risk for infection
mm3
Platelets will  due to inc bleeding and inability to clot
/mm3