This document provides information on normal ranges and significance of components of a complete blood count (CBC) and their relevance to pulmonary conditions. It discusses red blood cell measurements, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and their associations with anemia, polycythemia, and other disorders. White blood cell types and counts are also covered, along with significance of leukocytosis, neutrophilia, lymphocytes, eosinophilia, and thrombocytopenia. Pulmonary manifestations of disseminated intravascular coagulation are summarized.
2. RBC measurments
– M: 4.7 to 6.1 x10^12 /L
– F: 4.2 to 5.4 x10^12 /L
Hemoglobin :
– M: 13.8 to 17.2 gm/dL
– F: 12.1 to 15.1 gm/dL
Hematocrit : (packed cell volume)
It is ratio of the volume of red cell to the volume of whole blood.
– M: 40.7 to 50.3 %
– F: 36.1 to 44.3 %
3. MCV&MCHC
– MCV = mean corpuscular volume
80-100 mm3
• decreased = microcytic
• normal = normocytic
• Increased = macrocytic
– MCHC= mean corpuscular hemoglobin
concentration 26-34 g /dl
• decreased = hypochromic
• normal = normochromic
4. WBC
• WBCs are involved in the immune response.
• The normal range: 4 – 11x10^9 /L
• Two types of WBC:
1) Granulocytes consist of:
– Neutrophils: 50 - 70% 3000 – 7000 cell / mm3
– Eosinophils: 1 - 5% up to 450 cell / mm3
– Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40% 1000 – 4000 cell / mm3
– Monocytes: 1 - 6%
5. ANEMIA
anemia has been defined as a reduction in one or more of the
major red blood cell (RBC) measurements: hemoglobin
concentration, hematocrit, or RBC count.
WHO criteria for anemia in men and women are <13 and <12
g/dL, respectively.
Falling HB level .
6. Polycythemia
Polycythemia in the adult patient is suspected when the HCT is
>48 or >52 percent in women and men, respectively.
Polycythemia in the adult is suspected when the HGB is >16.5
or >18.5 g/dL in women and men, respectively.
8. leukocytosis
leukocytosis to values in excess of 50,000 cells/microL, when
due to causes other than leukemia, is termed a leukemoid
reaction or hyperleukocytosis.
Neutrophilic leukocytosis is defined as a total WBC greater than
11,000/microL plus an absolute neutrophil count (ANC) more
than 7700/microL in adults.
9. Neutrophilia
Any active inflammatory condition or infection
Cigarette smoking
Pregnancy
Previously diagnosed hematologic disease (such as acute and
chronic leukemias, chronic myeloproliferative or myelodysplastic
disease)
Recent vigorous exercise
Recent thermal burn, electric shock, surgery, or trauma
Prior splenectomy or known asplenia
Recent vaccination or snake bite
10. Lymphocytes
lymphocytosis may indicate
_ Viral infection
e.g. Infectious mononucleosis, CMV .
_ Bacterial infection
e.g. TB
Lymphopenia – caused by
_Stress.
_Steroid therapy
11. Eosinophilia
The degree of eosinophilia can be categorized into mild (500 to
1500 cells/microL), moderate (1500 to 5000 cells/microL) or
severe (>5000 cells/microL).
Asthma .
Fungal infections — Aspergillosis.
14. Thrombocytosis
thrombocytosis is defined as a platelet count >500,000/microL.
Reactive thrombocytosis (RT) . Examples are recent surgery,
bacterial infection, and trauma.
15. Thrombocytopenia
Certain drugs, most notably heparin
Disseminated intravascular coagulation (DIC)
The antiphospholipid syndrome
The HELLP syndrome (hemolytic anemia, elevated liver function
tests, and low platelet count) in pregnant women
16. Thrombocytopenia in the ICU patient
Infection, sepsis, septic shock
Massive blood transfusion
Cardiopulmonary resuscitation
Adult respiratory distress syndrome
Pulmonary embolism
Use of intravascular catheters
17. Heparin-induced thrombocytopenia
overall incidence of 2.6 percent .
Although there are several mechanisms associated with drug-
induced thrombocytopenia, HIT is distinct among them in being
associated with platelet activation. This may explain why HIT is
uniquely associated with thrombosis rather than bleeding.
18. Among patients receiving heparin for thromboprophylaxis or
treatment, the initial sign of HIT usually is the development of
thrombocytopenia. If such a patient develops an initial or
recurrent thrombotic event, the presence of thrombocytopenia
suggests that it is due to HIT rather than failure of
anticoagulation .
19. Onset of otherwise unexplained thrombocytopenia.
Venous or arterial thrombosis associated with
thrombocytopenia.
A platelet count which has fallen 50 percent or more from a prior
value, even if absolute thrombocytopenia is not present .
Necrotic skin lesions at heparin injection sites .
Acute systemic (anaphylactoid) reactions occurring after IV
heparin bolus administration.
20. The first intervention in a patient with HIT should be immediate
cessation of all exposure to heparin, including heparin-bonded
catheters and heparin flushes .
Fondaparinux .
Platelet transfusions ("add fuel to the fire").
21. The most frequently reported drugs associated with
thrombocytopenia include :
Heparin
Quinine and quinidine
Trimethoprim-sulfamethoxazole
Vancomycin
Rifampin
Piperacillin
Beta-lactam antibiotics
Measles-mumps-rubella vaccine
Carbamazepine
Phenytoin
22.
23. Disseminated Intravascular Coagulation
consumption coagulopathy
defibrination syndrome
systemic process producing both thrombosis and
hemorrhage.
A secondary group of symptoms that is always triggered
by a primary condition that does not necessarily involve
coagulation.