HAEMOGRAM=CBC+ESR ALWAYS GET A PERIPHERAL SMEAR!

1. Topic :- Complete blood count analysis
Dr Rahul JainDr Sharda Jain
for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. HAEMOGRAM AND CBC ARE THEY
DIFFT?
• HAEMOGRAM=CBC+ESR
• ALWAYS GET A PERIPHERAL SMEAR!

4. BLOOD ANALYSIS
• HAEMOGLOBIN
• RBC COUNT
• HAEMATOCRIT
• MEAN CORPUSCULAR VOLUME
• MEAN CORPUSCULAR HAEMOGLOBIN
• MEAN CORPUSCULAR HAEMOGLOBIN CONCENTERATION
• RED CELL DISTRIBUTION WIDTH
• RETICULOCYTE COUNT
• TOTAL LEUCOCYTE COUNT
• DLC(N/L/M/E/B)
• PLATELET COUNT
• ESR
• PERIPHERAL SMEAR

5. RED BLOOD CELL DISORDERS-

6. ANAEMIA-
• DUE TO BLOOD LOSS-POST HAEMORRHAGE,CHRONIC
BLOOD LOSS
• DUE TO IMPAIRED PRODUCTION-
1. B12,FOLIC ACID,IRON,NUTRITIONAL DEFICIENCY
2. APLSTIC ANAEMIA
3. ANAEMIA OF CHRONIC DISEASES-
TB,INFECTIONS,RENAL DISEASES,LIVER DISEASE
4. BONE MARROW INFILTRATION-
LEUKEMIA,LYMPHOMAS,MULTIPLE MYELOMA
5. CONGENITAL ANAEMIAS-SIDEOBLASTIC ANAEMIA

7. ANAEMIA-
• ANAEMIA DUE TO INCREASED RED CELL
DESTRUCTION-
(HAEMOLYTIC ANAEMIA’S)

8. haemoglobin
• OXYGEN CARRYING PIGMENT IN RBC
• NORMAL LEVELS-MALE=14-18 GM/DL
FEMALES=12-15.5GM/DL
• DECREASED IN ANAEMIA
• INCREASED IN CHRONIC
SMOKERS,POLYCYTHEMIA,DEHYDRAT.
• ANAEMIA SEVERITY(WHO)-
1. MILD ANAEMIA-9-11 GM/DL
2. MODERATE ANAEMIA-7-9 GM/DL
3. SEVERE ANAEMIA-<7 GM/DL

9. RBC COUNT
• NO. OF RBC PER MICROLITRE OF BLOOD
• NORMAL-MALES=5-6 MILLION/MM3
FEMALES=4.5-5.5 MILLION/MM3
• DECREASED IN ANAEMIA
• INCREASED IN CHRONIC
SMOKERS,DEHYDRATION,CHRONIC
HYPOXIA,POLYCYTHEMIA

10. HAEMATOCRIT
• VOLUME OF RBC PER LITRE OF WHOLE BLOOD
• EXPRESSED IN PERCENTAGE
• NORMAL LEVELS-MALES 40-54%
FEMALES 37-47%
• DECREASED IN ANAEMIA
• INCREASED IN CHRONIC
SMOKERS,DEHYDRATION,CHRONIC
HYPOXIA,POLYCYTHEMIA,SHOCK
• HELPS TO CALCULATE MCH,MCHC,MCV

11. MEAN CORPUSCULAR VOLUME
• AVERAGE VOLUME OF ONE RBC (FEMTOLITRE)
• NORMAL VALUES-77-93 FEMTOLITRES
• NORMAL VOLUME-NORMOCYTES
• DECREASED VOLUME-MICROCYTES(IRON
DEFICIENCY,THALASSEMIA,SIDEROBLASTIC

12. MEAN CORPUSCULAR
HAEMOGLOBIN
• AVERAGE AMT OF HAEMOGLOBIN IN SINGLE
RBC IN PICOGRAM
• Normal values-27-32 PICOGRAMS
• NORMAL AMOUNT-NORMOCHROMASIA

13. MEAN CORPUSCULAR
HAEMOGLOBIN CONCENTERATION
• HAEMOGLOBIN CONCENTERATION IN SINGLE
RBC(PERCENTAGE OF HAEMOGLOBIN
OCCUPIED IN SINGLE RBC)
• NORMAL 32-37%

14. RED CELL DISTRIBUTION WIDTH
• VARIATION BETWEEN SMALLEST RBC AND
LARGEST RBC
• NORMAL LEVELS(11.6-14%)
• VARIATION IN SIZE(ANISOCYTOSIS)-2 TYPES-
MICRO AND MACROCYTES
• VARIATION IN SHAPE(POIKILOCYTOSIS)-SEEN
IN IDA,MEGALOBLASTIC

16. Reticulocyte count
• INDICATES MARROW ERYTHROPOEITIC
ACTIVITY
• NORMAL 0.5-2.5%
• HIGH RETIC COUNT-HAEMOLYTIC
ANAEMIA,ACUTE HG,THALASSEMIA,RESPONSE
TO IRON THERAPY
• LOW RETIC COUNT-IDA,B12,FOLIC ACID
DEFICIENCY,ACD

17. ERYTHROCYTE SEDIMENTATION
RATE-
• USED AS AN INDEX FOR PRESENCE OF ACTIVE
DISEASE.
• NORMAL VALUES AT END OF 1ST HOUR MALES-
0-7MM
FEMALES 0-
15MM

18. PERIPHERAL SMEAR-

19. PERIPHERAL SMEAR
• RBC MORPHOLOGY
1. SIZE(MICRO,NORMO,MACROCYTE)
2. PIGMENT(HYPO,NORMO,HYPERCHROMIA)
3. POIKILOCYTOSIS(VARIATION IN SHAPE)
4. SPECIAL APPEARANCES-SICKLE CELLS,TEAR
DROP
CELLS,SPHEROCYTES,SCHISTOCYTES,HOWELL
JOLLY BODIES,HEINZ BODIES)

20. IDA PS-
• MICROCYTES
• HYPOCHROMIA
• INCREASED CENTRAL
PALLOR
• POIKILOCYTOSIS
• NORMAL WBC

21. MEGALOBLASTIC ANAEMIA PS-
• MACROCYTES
• NORMOCHROMIC
• TEAR DROP CELLS
• ANISOPOIKILOCYTOSIS
• LESS PLATELETS
• HYPERSEGMENTED
NEUTROPHILS

22. (QUALITATIVE)Sickle cell anaemia-
• RED CELLS DEVELOP SICKLING WHEN
EXPOSED TO LOW OXYGEN
TENSION(HYPOXIA,ACIDOSIS)
• DEFECTIVE BETA CHAIN IN
GLOBIN(ALPHA2,BETA2)
• HAEMOLYSIS HISTORY
• ANAEMIA IN CBC(Hb 6-9 GM/DL)
• PERIPHERAL SMEAR-SICKLE CELLS,TARGET
CELLS,HOWELL JOLLY BODIES

23. (QUANTITATIVE D/S)THALASSEMIA-
• SYNTHESIS OF GLOBIN CHAIN AFFECTED,ALPHA
OR BETA
• MORE COMMONLY BETA,REDUCED
FORMATION OF NORMAL HAEMOGLOBIN
• H/O MULTIPLE BLOOD
TRANSFUSION,JAUNDICE,IRON CHEL.
• RBC WITH LESS HB ARE PRODUCED(SMALL AND
PALE RBC’S)

25. FEATURES IRON DEFICIENCY ANAEMIA THALASSEMIA
BLOOD PICTURE MICROCYTIC HYPOCHROMIC MICROCYTIC HYPOCHROMIC
ANISOCYTOSIS(SIZE
VARIATION)
++ --(UNIFORM SIZE)
RDW WIDE NARROW
RETIC COUNT LOW SLIGHTLY HIGH
RBC COUNT LOW(LOW IRON) HIGH(COMPENSATORY)
(INEFF ERYTHOPOIESIS)
MENTZER’S INDEX(MCV/RBC) MORE THAN 14
(MCV↓/RBC COUNT↓↓)
LESS THAN 12
(MCV↓/RBC COUNT ↑↑)
)IRON PROFILE SERUM FERRITIN LOW,SERUM
IRON LOW
NORMAL

26. TOTAL LEUCOCYTE COUNT
• TOTAL NO. OF WBC/MICROLITRE OF BLOOD
• NORMAL LEVELS-4000-11000/MICROLITRE
• LEUCOCYTOSIS(INC)-
1. NEWBORN
2. EXERCISE
3. STRESS
4. ANY INFECTIONS OF BODY(CHRONIC
INFECTIONS,PUS FORMING
INFECTIONS,FEVER PRODUCING INFECTIONS)

27. TLC
• LEUKOPENIA-
1. STARVATION
2. DENGUE FEVER(VIRAL FEVER)
3. BONE MARROW DEPRESSION
4. STARVATION
• PSEUDOLEUKOPENIA-ACUTE MIGRATION OF
WBC AT INFECTION SITE WILL CAUSE FALSE
LEUKOPENIA IN PERIPERAL BLOOD

28. DIFFERENTIAL LEUKOCYTE COUNT
• NEUTROPHILS>LYMPHOCYTES>MONOCYTES>E
OSINOPHILS>BASOPHILS(NEVER LET
MONKEYS EAT BANANAS)
• N:L:M:E:B—50-70%:20-30%:2-6%:2-4%:0-1%
• NEUTROPHILS-BACTERIAL INFECTIONS,BURNS
• LYMPHOCYTES-CHRONIC
INFECTIONS(TB),VIRAL
INFECTIONS,LYMPHATIC LEUKEMIA
• MONOCYTES-
SYPHILIS,LEUKEMIAS,MALARIA,KALA AZAR

29. PLATELET COUNT-
• NO. OF PLATELETS PER MICROLITRE OF BLOOD
• NORMAL-1.5 LAKH-4.0 LAKHS/MM3
• THROBOCYTOPENIA-
1. IMPAIRED PRODUCTION-BONE MARROW
FAILURE,B12 DEFICIENCY
2. ACC PLATELET DESTRUCTION-
• IMMUNOLOGIC-ITP,POST
TRANSFUSION,VIRAL(DENGUE)
• INCREASED CONSUMPTION-DIC,TTP

30. • THANK YOU
• ANY QUESTIONS?