7 WBC - White Blood Count - actual number of white blood cells per volume of blood. WBC differential - types of WBC present.
8 RBC - Red Blood Cells – actual number of red blood cells per volume of blood HGB - Hemoglobin - amount of the oxygen carrying protein in the blood (gm/dL)PLT - Platelets - actual number of platelets per volume of blood
9 MCV - Mean Corpuscular Volume, a measurement of the average size of RBCs (fl) MCH - Mean Corpuscular Hemoglobin - the mean cell hemoglobin (pg/cell) picogram per cellMCHC - Mean Corpuscular Hemoglobin Concentration - the mean concentration of hemoglobin per volume of red cells (gm/dl)RDW - Red Cell Distribution Width - a variation in the size of RBCs
10 CBC Normal valuesRBC count (varies with altitude):Male: 4.7 to 6.1 million cells/micro LFemale: 4.2 to 5.4 million cells/micro LWBC count: 4000 to cells/micro LHematocrit (varies with altitude):Male: 40.7 to 50.3%Female: 37-47%Hemoglobin (varies with altitude):Male: 13 to 18 gm/dLFemale: 12 to 16 gm/dLMCV: 80 to 96 femtoliterMCH: 27 to 31 pg/cellMCHC: 32 to 36 gm/dL
11 It is common for normal to vary from lab to lab.
12 Hemoglobin (Hb or HGB)The iron-containing oxygen-transport metalloprotein in the red blood cells .The main component of RBCsMales g/dlFemales g/dlNewborns g/dl
13 Hemoglobin, the main component of the red blood cell, functions in the transportation of oxygen and CO2. Hemoglobin consists of 1 molecule of globin and 4 molecules of heme (each containing 1 molecule of iron in the ferrous state). Globin consists of 2 pairs of polypeptide chains. In the hemoglobin molecule, each polypeptide chain is associated with 1 heme group; each heme group can combine with 1 molecule of oxygen or CO2.Hemoglobin carries oxygen from places of high oxygen pressure (lungs) to places of low oxygen pressure (tissues), where it readily releases the oxygen. Hemoglobin also returns CO2 from the tissues to the lungs.
15 Normal blood contains about 15-16 grams hemoglobin per 100 ml (dL). Each gram of hemoglobin can carry about 1.35 ml of gaseous oxygen.Fully saturated arterial blood will therefore contain about 20 ml of oxygen per 100 cc.The relative amount of oxygen in the blood compared to the carrying capacity of the hemoglobin is called the oxygen saturation, and is expressed as a percentage.
17 RBC Indices RBC indices include: Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin (MCH)Mean Corpuscular Hemoglobin Concentration (MCHC)RBC Distribution Width (RDW)
18 The secondary indices are derived from the three possible combinations of the primary indices thus: HaemoglobinMCHC=(Hb/PVC)MCH =(Hb/RCC)Hematocrit (PCV)Red cell count (RCC)MCV=(PCV/RCC)
19 MCV Mean corpuscular volume MCV is average size of RBC MCV = Hct x 10 RBC (millions)If fL, normal range, RBCs considered normocyticIf < 80 fL are microcyticIf > 96 fL are macrocyticNot reliable when have marked anisocytosis
20 It should be pointed out that, because the red cell count is involved, this determination may be subject to wide variations due to technical error. In general, if an accurate MCV determination is to be done, a triplicate red cell count should be done and the average taken. If this is not done, the results may be misleading as compared to the visual inspection of the red cells on the stained smear and a false impression may be passed on to the clinician.
21 Size variation Red blood cells can vary in size . smaller than normal: microcyteslarger than normal: macrocytes.When red cells of normal size, microcytes and macrocytes are present in the same field, the term anisocytosis is used.
22 Normal RBCs Round, elastic, non-nucleated, bi-concave discs. Many RBCs have an area of central pallor which covers about one-third of the cell.The pallor occurs as a result of the disc-shaped cells being spread on the slide.Size of normal RBC is almost the size of the nucleus of the lymphocyte.
30 MegalocytesMegalocytes are the result of decreased DNA synthesis, frequently due to vitamin B12 and/or folic acid deficiencies.Decreased DNA synthesis causes the nucleus in the developing red cells to mature at a slower than normal rate.Since hemoglobin production is not affected, the mature red cell is larger than normal
33 MCH The mean cell hemoglobin (pg/cell) The average amount of hemoglobin per red blood cellMCH = Hgb x 10RBC (millions)Normal pg/cell
34 MCHCThe mean concentration of hemoglobin per volume of red cells (gm/dl)The average concentration of hemoglobin in the cells.MCHC = Hgb x 100Hct (%)If MCHC is normal: normochromicIf MCHC is less than normal :hypochromicNormal gm/dL
35 It should be pointed out that the determination of the MCH involves the red cell count which should be done in triplicate if accurate results are to be obtained.The red cell count is not involved in the determination of the MCHC, so the results tend to be more standard.
36 RBC ColorErythrocytes, when spread on a glass slide, show varying degrees of central pallor.This central pallor is related to the hemoglobin concentration present in the red cells.Megalocytes (macrocytes) are normochromic
37 RBC ColorThe central area (1/3 of the cell) is white, while buff-colored hemoglobin is visible in the outer 2/3 of the cell.The MCHC (32-36 gm/dl) is the index value which is used to verify the presence of adequate hemoglobin concentration in the cells visible on the peripheral smear.
47 RDWMost automated instruments now provide an RBC Distribution Width (RDW)An index of RBC size variationMay be used to quantitate the amount of anisocytosis on peripheral blood smearNormal range is 11.5% to 14.5% for both men and women
48 RDWRDW is an expression of the homogeneity of the RBC population size.A large RDW says there's a wide variation in the RBC diameters within the test pool.It doesn't say the cells are large or small, rather that the population is not homogenous.
49 AnisocytosisIncreased variation in size of the red cell population present on a blood smear.Normal, small and large cells can be seen in one field.As the severity of the anemia increases, the amount of significant anisocytosis present also increases.
67 Definition of AnemiaAnemia is a functional inability of the blood to supply the tissue with adequate O2 for proper metabolic function.Anemia is usually associated with decreased levels of hemoglobin or a decreased RBC count.When you conclude that a patient has anemia, this is not a diagnosis but rather the expression of an underlying disorder or disease.
68 Quantitative Classification of Anemias Quantitatively by:HematocritHemoglobinBlood cell indices
69 Morphological Classification of Anemias Morphological based on sizes and color of RBCsNormochromic NormocyticHypochromic MicrocyticNormochromic Macrocytic
70 Decreased MCV and Decreased MCHC Microcytic/Hypochromic AnemiaIron deficiencyThalassemiaAnemia of chronic diseaseSideroblastic anemiaLead poisoning
73 ThalassemiasHeritable,microcytic hypochromic anemia-with varying degrees of severityGenetic defects result in decreased or absent production of globin chainHigh incidence in Asia, Africa, Mideast, and Mediterranean countries
76 IRON DEFICIENCY ANEMIA IRON METABOLISMABSORPTION IN DUODENUMTRANSFERRIN TRANSPORTS IRON TO THE CELLSFERRITIN AND HEMOSYDERIN STORE IRON10% of daily iron is absorbed
77 Most body iron is present in hemoglobin in circulating red cells The macrophages of the reticuloendotelial system store iron released from hemoglobin as ferritin and hemosiderinSmall loss of iron each day in urine, faeces, skin and nails and in menstruating females (1-2 mg daily)
78 IRON DEFICIENCY ANEMIA ETIOLOGY:CHRONIC BLEEDINGMENORRHAGIAPEPTIC ULCERSTOMACH CANCERULCERATIVE COLITISINTESTINAL CANCERHAEMORRHOIDSDECREASED IRON INTAKEINCREASED IRON REQUIRMENT (JUVENILE AGE, PREGNANCY, LACTATION)
79 IRON DEFICIENCY ANEMIA GENERAL ANEMIA’S SYMPTOMS:EASY FATIGABILITYDIZZENESHEADACHEIRRITABILITYPALLORPALPITATION
80 CHARACTERISTICS SYMPTOMS GLOSSITIS, STOMATITISDRY, PALE SKINSPOON SHAPED NAILS, KOILONYCHIA,HAIR LOSSRAPID BIG VOLUME PULSEINCREASED PLATELET COUNTMURMER