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Managing CBC Services by 3 part differential cell counter
Dr A D Deshpande MD (Micro), MD (Patho)
Cell Counters are every where
3 Part Differential WBCs are counted as 3 Groups
NeutrophilsLymphocytes
E
M
B
5 Part Differential WBCs are counted as 5 Groups
N L E M B
Wallace Coulter
1960 Model
Principle of Cell Counter
Volume of cell is basis of differentiation.
Cells pass in one Line
Cells are bad conductors of electricity
Electrical impedance is proportional to cell volume
RBC chambers – RBCs and Platelets are counted
WBC chamber – WBCs and HB are estimated.
2 – 25 FlPlatelets
30 - 250 flRBCs
>35 fl – WBCs (Separate chamber)
Volume separate them Volume separate them
femtolitre = 10 −15 litres
Report in 2 formats
Numbers Graphs
We always look only
numbers
Don’t ignore me..
Normal Histogram
Platelet Graph
RBC Graph
30 200
Volume of cell
NUMBER
Of Cells
Platelet Graph
RBC Graph
30 200
Giant platelets / Microcytes / Fragmented RBCs
Platelet Graph RBC Graph
30 200
RBC Clumping / Cold Agglutinin / Clotted sample
Platelet Graph RBC Graph
30 200
Macrocytic (Megaloblastic Anemia)
WBC Graph
L PM
Blood indices
MCVMCHMCHC
80 – 100 flNormal range
MCV
MCV80 100
NORMAL
706050 110Iron deficiencyThalassemia Anemia. of chronic disorders
B12 & Folic acid deficiencyLiver disease
MCH27-32 pgmNormal range
MCHC
32-36 %
Red cell Distribution Width
(RDW)
Rule of 3
RBC count X 3 = Hemoglobin %
Hemoglobin % X 3 = Hematocrit
Hb 7.4 gm %
MCV 65 fl
MCH 18 pgm
RDW 19
Low HbLow MCVHigh RDW
Low HbLow MCVHigh RDW
This can be seen in Anemia due to chronic disorders
Serum Iron Serum Ferritin TIBC % Saturation
Low HbLow MCVNormal RDW
Hb 8.2 gm %
MCV 105 fl
RDW 18
Low HbHigh MCVHigh RDW
Hypersegmented Neutrophil
Hb 9.1 gm %
TLC # # # # Platelet count 24,000 / cmm
Acute Leukemia
What else we can see in PS
Malarial Parasite
Sickle Cells
WBC Counts
LeukopeniaAplastic anemiaChemotherapyMalariaTyphoidDengue
<4000 WBCs / cmm
Leukocytosis
>11,000 WBCs / cmm
NeutrophilsBacterial infection
Trauma, Burn, SurgeryMyocardial infarctionMetabolic acidosisPregnancy
LymphocyteAcute viral infections – Infectious mononucleosis, hepatitis, cytomegalovirus infectionTuberculosisCLL
Eosinophilia Allergy –
Asthma, Urticaria, Rhinitis
Parasites – Filaria,
Trichinosis, Tropical
eosinophiliaEczema,
Dermatitis
Platelets
Normal range
1.5 Lakhs – 4.5 Lakhs/cmm
Thrombocytopenia (common causes)
Falciparum malariaDengueHIVLeptospiraMegaloblastic anemiaDrug induced
Errors in Platelet count
Take home message
• Numerical data + Graphs Important
• PS exam is mandatory• MCV MCH & RDW are useful • Advise necessary further
investigations - Iron studies , Hb electrophoresis
Thank you