Upload
lily-booth
View
235
Download
2
Tags:
Embed Size (px)
Citation preview
Complete Blood Count
WBC: 4,000 – 11,000/cubicmm
WBC DIFFERENTIAL: Neutrophil 40-75% Lymphocytes 15-75% Monocytes 1-10% Eosinophils 1-6% Basophils 0-2%
Normal Ranges
Test examples of causes of
a low countexamples of causes of a high
count
White Blood
Cell Count
Known as leukopeniaor 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
TestFull Nameexamples 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
eosAbsolute eosinophil
count, % eosinophils
not medically significant. Parasitic infections, asthma,allergic reaction.
basoAbsolute basophil count, % basophils
not medically significant bone marrow related conditions such as leukemia
or lymphoma
TESTFull Nameexamples of causes of a low count
examples of causes of a high count
monoAbsolute monocyte
count, % monocytes
not medically significant. bacterial infection, tuberculosis, malaria, monocytic leukemia
lymphoAbsolute
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
MCV•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
Rbc
HCT
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
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
Cell Size (fl)
Number Of cells
60 120
MCV
RBC Distribution Histogram
Use of MCV Result
• The MCV is important in classifying anemias
• Normal MCV = normocytic anemia
• Decreased MCV = microcytic anemia
• Increased MCV = macrocytic anemia
Cell Size (fl)
Number Of cells
60 120
MCV
RBC Distribution Histogram
Microcytic Red blood cells
MacrocyticRed blood cells
MCHC
• Mean corpuscular hemoglobin concentration:
100 100
• It is important in diagnosis of congenital Spherocytosis (MCHC > 35)
:Rbc
Hb
Rbc
HCT
PCV or Hematocrit
• 57% Plasma
• 1% Buffy coat – WBC
• 42% Hct (PCV)
Measurement Normal Range
A. RBC count 5 million 4 to 6
B. Hemoglobin 15 g% 12 to 17
C. 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.
RETICULOCYTE COUNT%
NormalLess than
2%
• ‘RBC to be’ or Apprentice RBC
• Fragments of nuclear material
• RNA strands which stain blue
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
MCV
Normocytic Macrocytic
Iron Deficiency IDA
Chronic Infections
Thalassemias
Hemoglobinopathies
Sideroblastic Anemia
Chronic disease
Early IDA
Hemoglobinopathies
Primary marrow disorders
Combined deficiencies
Increased destruction
Megaloblastic anemias
Liver disease/alcohol
Hemoglobinopathies
Metabolic disorders
Marrow disorders
Increased destruction
• 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
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.
• Platelet count : 140,000 to 450,000 /cubic mm
• Mean platelet volume: 7.5 – 11.5 fL
• Platelet distribution width: 10% - 17.9%
Testexamples 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)
TestExamples of causes of
low resultExamples 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 Distributio
n Width
Indicates uniformity in size of platelets
Indicates increased variation in the size of the platelets, which may mean that a condition is present that is affecting platelets