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COMPLETE BLOOD COUNT
INTERPRETATIONS
Dr. Gauhar Mahmood Azeem
House Officer, Medical Unit 4
Services Hospital Lahore
‘COMPLETE’ BLOOD COUNT
COMPLETE BLOOD COUNT
 A complete blood count (CBC) is an important and
readily available investigation that focuses on Re...
COMPONENTS
 WBC
 RBC
 Hemoglobin
 Hematocrit
 MCV
 MCH
 MCHC
• RDW
• Platelets
• Neutrophils
• Lymphocytes
• Monocy...
RBC
 Normal Values
 Males 4.7 to 6.1 million cells per microliter
 Females 4.2 to 5.4 million cells per microliter
LOW RBC COUNT
 Known as anemia
 Acute or chronic bleeding
 RBC destruction (e.g., hemolytic anemia, etc.)
 Nutritional...
HIGH RBC COUNT
 Known as polycythemia
 Dehydration
 Pulmonary disease
 Kidney or other tumor that produces excess
eryt...
HEMOGLOBIN
 Is the protein molecule that carries oxygen in the
Red Blood Cells.
 13.0-18.0 g/dl in males
 11.5-16.5 g/d...
HEMATOCRIT OR PCV
 Males normal 45%
 Females normal 40%
• High Hct
• Increased risk of Dengue
Shock Syndrome
• Polycythe...
MEAN CORPUSCULAR VOLUME
 Normal 77-95fL
 Low MCV indicates RBCs are smaller than normal
(microcytic); caused by iron def...
MEGALOBLASTIC MACROCYTIC ANEMIA
 Macrocytes in bone marrow smear
 Medications affecting folate metabolism
 Vit B12 defi...
NON MEGALOBLASTIC MACROCYTIC ANEMIAS
 Alcohol Abuse
 Emphysema
 Hypothyroidism
 Accelerated Erythropoiesis (High Retic...
COULDN’T GET PAST THE SPLEEN!
MCH AND MCHC
 Mean corpuscular hemoglobin (MCH) measures the
amount, or the mass, of hemoglobin present in one
RBC. The w...
MCH AND MCHC
 Less in Microcytic Anemias
 Normal in Macrocytic Anemias
 Elevated in hereditary spherocytosis, sickle ce...
RED CELL DISTRIBUTION WIDTH
 Low value indicates uniformity in size of RBCs
 High value indicates mixed population of sm...
RETICULOCYTE COUNT
 Absolute reticulocyte count = # or % retics X (pt’s Hct/ Normal
Hct)
 Can be absolute or %
 In the ...
RETICULOCYTE INDEX
 Reticulocyte Index= Absolute Retic
Count/Maturition Factor
 Maturation Factor
 Hct > 35% : 1.o
 Hc...
WHITE BLOOD CELL COUNT
 The normal number of WBCs in the blood is
4,500-11,000 white blood cells per microliter
(mcL). No...
LEUKOPENIA
 Low white cell count may be due to acute viral infections, such
as with a cold or influenza. It can be associ...
PSEUDOLEUKOPENIA
 Pseudoleukopenia can develop upon the onset of
infection. The leukocytes (predominately neutrophils,
re...
DRUGS CAUSING LEUKOPENIA
 LOADS!!!
 Clozapine, buproprion, valproic acid, minocycline,
lamotrigine.
 Immunosuppressive ...
GIVE AUGMENTIN!!!
LEUKOCYTOSIS
 Known as leukocytosisInfection, most
commonly bacterial orviral
 Inflammation
 Leukemia, myeloproliferati...
DIFFERENTIAL COUNTS
ABSOLUTE NEUTROPHIL COUNT
 {(% of Neutrophils+ % of Bands) X WBC}/100
NEUTROPENIA
 Decreased production in
the bone marrow due to:
 aplastic anemia
 arsenic poisoning
 cancer, particularly...
NEUTROPHILIA
 Post splenectomy
 Cigarette smoking
 Hypoxia
 Epinephrine
 Exercise
• Acute or Chronic
Infection
• Myel...
LYMPHOCYTOPENIA
 Autoimmune disorders (e.g., lupus, Rheumatic
Arthritis)
 Infections (e.g., HIV, viral hepatitis, typhoi...
LYMPHOCYTOSIS
 Acute viral infections (e.g., chicken
pox, cytomegalovirus (CMV),Epstein-Barr virus
(EBV), herpes,rubella)...
LOW MONOCYTES
 Usually, one low count is not medically
significant.Repeated low counts can indicate:
 Bone marrow damage...
MONOCYTOSIS
 Chronic infections (e.g., TB, Fungal Infections)
 Infection within the heart (bacterial endocarditis)
 Col...
LOW EOSINOPHILS
 Numbers are normally low in the blood. One or an
occasional low number is usually not medically
signific...
EOSINOPHILIA
 Asthma, allergies such as hay fever
 Drug reactions
 Parasitic infections
 Inflammatory disorders (celia...
BASOPENIA :D
 As with eosinophils, numbers are normally low in
the blood; usually not medically significant
BASOPHILIA
 Rare allergic reactions (hives, food allergy)
 Inflammation (rheumatoid arthritis, ulcerative colitis)
 Som...
PLATELET COUNT
 Normal platelet counts are in the range of 150,000
to 400,000 per microliter (or 150 - 400 x 109 per
lite...
THROMBOCYTOPENIA
 Immune Thrombocytopenias (ITP) – formerly known as immune
thrombocytopenia purpura and idiopathic throm...
THROMBOCYTOSIS
 Reactive
 Chronic infection
 Chronic inflammation
 Malignancy
 Hyposplenism (post-splenectomy)
 Iron...
MEAN PLATELET VOLUME
 Typical range of platelet volumes is 9.7–12.8 fL
 Low value indicates average size of platelets is...
PLATELET DISTRIBUTION WIDTH
 A high PDW means increased variation in the size
of the platelets, which may mean that a con...
LOW BLOOD COUNTS
 All three lines depressed in
 Aplastic Anemia, Myelodysplastic Syndrome,
Chemotherapy
HIGH BLOOD COUNTS
 Polycythemia Vera (Secondary)
THANK YOU
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Complete Blood Count, Interpretations Slide 1 Complete Blood Count, Interpretations Slide 2 Complete Blood Count, Interpretations Slide 3 Complete Blood Count, Interpretations Slide 4 Complete Blood Count, Interpretations Slide 5 Complete Blood Count, Interpretations Slide 6 Complete Blood Count, Interpretations Slide 7 Complete Blood Count, Interpretations Slide 8 Complete Blood Count, Interpretations Slide 9 Complete Blood Count, Interpretations Slide 10 Complete Blood Count, Interpretations Slide 11 Complete Blood Count, Interpretations Slide 12 Complete Blood Count, Interpretations Slide 13 Complete Blood Count, Interpretations Slide 14 Complete Blood Count, Interpretations Slide 15 Complete Blood Count, Interpretations Slide 16 Complete Blood Count, Interpretations Slide 17 Complete Blood Count, Interpretations Slide 18 Complete Blood Count, Interpretations Slide 19 Complete Blood Count, Interpretations Slide 20 Complete Blood Count, Interpretations Slide 21 Complete Blood Count, Interpretations Slide 22 Complete Blood Count, Interpretations Slide 23 Complete Blood Count, Interpretations Slide 24 Complete Blood Count, Interpretations Slide 25 Complete Blood Count, Interpretations Slide 26 Complete Blood Count, Interpretations Slide 27 Complete Blood Count, Interpretations Slide 28 Complete Blood Count, Interpretations Slide 29 Complete Blood Count, Interpretations Slide 30 Complete Blood Count, Interpretations Slide 31 Complete Blood Count, Interpretations Slide 32 Complete Blood Count, Interpretations Slide 33 Complete Blood Count, Interpretations Slide 34 Complete Blood Count, Interpretations Slide 35 Complete Blood Count, Interpretations Slide 36 Complete Blood Count, Interpretations Slide 37 Complete Blood Count, Interpretations Slide 38 Complete Blood Count, Interpretations Slide 39 Complete Blood Count, Interpretations Slide 40 Complete Blood Count, Interpretations Slide 41 Complete Blood Count, Interpretations Slide 42 Complete Blood Count, Interpretations Slide 43 Complete Blood Count, Interpretations Slide 44
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A presentation made by Dr Gauhar Mahmood Azeem on the interpretations of a simple CBC and the information it can give us, Various conditions which may cause derangement are mentioned,

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Complete Blood Count, Interpretations

  1. 1. COMPLETE BLOOD COUNT INTERPRETATIONS Dr. Gauhar Mahmood Azeem House Officer, Medical Unit 4 Services Hospital Lahore
  2. 2. ‘COMPLETE’ BLOOD COUNT
  3. 3. COMPLETE BLOOD COUNT  A complete blood count (CBC) is an important and readily available investigation that focuses on Red Blood Cells, White Blood Cells and Platelets, and their various parameters. It can help to serve as a screening test for many disorders and as a prognostic or follow up tool.
  4. 4. COMPONENTS  WBC  RBC  Hemoglobin  Hematocrit  MCV  MCH  MCHC • RDW • Platelets • Neutrophils • Lymphocytes • Monocytes • Basophils • Immature Granulocytes • Reticulocyte count
  5. 5. RBC  Normal Values  Males 4.7 to 6.1 million cells per microliter  Females 4.2 to 5.4 million cells per microliter
  6. 6. LOW RBC COUNT  Known as anemia  Acute or chronic bleeding  RBC destruction (e.g., hemolytic anemia, etc.)  Nutritional deficiency (e.g., iron deficiency, vitamin B12 or folate deficiency)  Bone marrow disorders or damage  Chronic inflammatory disease  Kidney failure
  7. 7. HIGH RBC COUNT  Known as polycythemia  Dehydration  Pulmonary disease  Kidney or other tumor that produces excess erythropoietin  Smoking  Genetic causes (altered oxygen sensing, abnormality in hemoglobin oxygen release)  Polycythemia vera
  8. 8. HEMOGLOBIN  Is the protein molecule that carries oxygen in the Red Blood Cells.  13.0-18.0 g/dl in males  11.5-16.5 g/dl in females  We can have N HB in N RBC  We can have N HB in D RBC  We can have D HB in D RBC  Thus the other indices MCH and MCHC come into play.
  9. 9. HEMATOCRIT OR PCV  Males normal 45%  Females normal 40% • High Hct • Increased risk of Dengue Shock Syndrome • Polycythemia Vera • COPD • EPO or Erythropioten use • Dehydration • Capillary leak syndrome • Sleep apnea • Anabolic Steroid use • Low Hct • Due to anemia • Anemia can be characterised by using the indices
  10. 10. MEAN CORPUSCULAR VOLUME  Normal 77-95fL  Low MCV indicates RBCs are smaller than normal (microcytic); caused by iron deficiency anemia, or thalassemias, Congenital sideroblastic Anemia, Lead Poisoning, pyridoxine deficiency, anemia of chronic disease  High MCV indicates RBCs are larger than normal (macrocytic)
  11. 11. MEGALOBLASTIC MACROCYTIC ANEMIA  Macrocytes in bone marrow smear  Medications affecting folate metabolism  Vit B12 deficiency (Pernicious Anemia)  Folate deficiency (Alcohol related often)  Atrophic Gastitis  Gastrointestinal malabsorption  Nitrous oxide abuse  Primary Bone marrow disorders
  12. 12. NON MEGALOBLASTIC MACROCYTIC ANEMIAS  Alcohol Abuse  Emphysema  Hypothyroidism  Accelerated Erythropoiesis (High Reticulocyte Index)  Hemolytic Anemia  Post-hemorrhagic Anemia  Increased RBC membrane surface area  Obstructive Jaundice Hepatic disease Post-splenectomy  Bone Marrow disorders Myelophthisic Anemia Myelodysplastic Anemia (Myelodysplastic Syndrome) Aplastic Anemia  Acquired Sideroblastic Anemia
  13. 13. COULDN’T GET PAST THE SPLEEN!
  14. 14. MCH AND MCHC  Mean corpuscular hemoglobin (MCH) measures the amount, or the mass, of hemoglobin present in one RBC. The weight of hemoglobin in an average cell is obtained by dividing the hemoglobin by the total RBC count. The result is reported by a very small weight called a picogram (pg). Mean corpuscular hemoglobin concentration (MCHC) measures the proportion of each cell taken up by hemoglobin. The results are reported in percentages, reflecting the proportion of hemoglobin in the RBC. The hemoglobin is divided by the hematocrit and multiplied by 100 to obtain the MCHC
  15. 15. MCH AND MCHC  Less in Microcytic Anemias  Normal in Macrocytic Anemias  Elevated in hereditary spherocytosis, sickle cell disease and Honozygous Hemoglobin C disease
  16. 16. RED CELL DISTRIBUTION WIDTH  Low value indicates uniformity in size of RBCs  High value indicates mixed population of small and large RBCs; immature RBCs tend to be larger. For example, in iron deficiency anemia or pernicious anemia, there is high variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis), causing an increase in the RDW
  17. 17. RETICULOCYTE COUNT  Absolute reticulocyte count = # or % retics X (pt’s Hct/ Normal Hct)  Can be absolute or %  In the setting of anemia, a low reticulocyte count indicates a condition is affecting the production of red blood cells, such as bone marrow disorder or damage, or a nutritional deficiency (iron, B12 or folate)  In the setting of anemia, a high reticulocyte count generally indicates peripheral cause, such as bleeding or hemolysis, or response to treatment (e.g., iron supplementation for iron deficiency anemia)
  18. 18. RETICULOCYTE INDEX  Reticulocyte Index= Absolute Retic Count/Maturition Factor  Maturation Factor  Hct > 35% : 1.o  Hct 25-35% : 1.5  Hct 20-25% : 2.0  Hct <20% : 2.5
  19. 19. WHITE BLOOD CELL COUNT  The normal number of WBCs in the blood is 4,500-11,000 white blood cells per microliter (mcL). Normal value ranges may vary slightly among different labs.
  20. 20. LEUKOPENIA  Low white cell count may be due to acute viral infections, such as with a cold or influenza. It can be associated with chemotherapy, radiation therapy, myelofibrosis and aplastic anemia (failure of white cell, red cell and platelet production). HIV and AIDS are also a threat to white cells.  Other causes of low white blood cell count include systemic lupus erythematosus, Hodgkin's lymphoma, some types of cancer, typhoid, malaria, tuberculosis, dengue, rickettsial infections, enlargement of the spleen, folate deficiencies, psittacosis, sepsis and Lyme disease. Many other causes exist, such as deficiency in certain minerals, such as copperand zinc.
  21. 21. PSEUDOLEUKOPENIA  Pseudoleukopenia can develop upon the onset of infection. The leukocytes (predominately neutrophils, responding to injury first) start migrating towards the site of infection and can be scanned at the site of infection. Their migration causes bone marrow to produce more WBCs to combat infection as well as to restore the leukocytes in circulation, but as the blood sample is taken upon the onset of infection, it contains low amount of WBCs, which is why it is called "pseudoleukopenia".
  22. 22. DRUGS CAUSING LEUKOPENIA  LOADS!!!  Clozapine, buproprion, valproic acid, minocycline, lamotrigine.  Immunosuppressive drugs, such as sirolimus, mycophenolate mofetil, tacrolimus, cyclosporine, Leflunomide (Arava) and TNF inhibitors.[2] Interferonsused to treat multiple sclerosis, such as Rebif, Avonex, and Betaseron, can also cause leukopenia.  Chemotherapeutic drugs.  Lots of others.
  23. 23. GIVE AUGMENTIN!!!
  24. 24. LEUKOCYTOSIS  Known as leukocytosisInfection, most commonly bacterial orviral  Inflammation  Leukemia, myeloproliferative disorders  Allergies, asthma  Tissue death (trauma, burns, heart attack)  Intense exercise or severe stress  Will mention in detail in respective cell line.
  25. 25. DIFFERENTIAL COUNTS
  26. 26. ABSOLUTE NEUTROPHIL COUNT  {(% of Neutrophils+ % of Bands) X WBC}/100
  27. 27. NEUTROPENIA  Decreased production in the bone marrow due to:  aplastic anemia  arsenic poisoning  cancer, particularly blood cancers  certain medications  hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia)  radiation  Vitamin B12, folate or copper deficiency  Increased destruction:  autoimmune neutropenia  chemotherapy treatments, such as for cancer and autoimmune diseases  Marginalisation and sequestration:  Hemodialysis Medications Flecainide (a class 1C cardiac antiarrhythmic drug) Phenytoin Indomethacin Propylthiouracil Carbimazole Chlorpromazine Trimethoprim/sulfamethoxazole (cotri moxazole) Clozapine Ticlodipine Often, a mild neutropenia is seen in viral infections. Additionally, a condition called morning pseudoneutropenia might be a side effect of certain antipsychotic medications.
  28. 28. NEUTROPHILIA  Post splenectomy  Cigarette smoking  Hypoxia  Epinephrine  Exercise • Acute or Chronic Infection • Myeloprofilerative disorders • Acute stress • Lukemoid reactions • Drugs (steroids) • Chronic Inflammation • Tumors • Myelophthisis • Hyperactive marrow
  29. 29. LYMPHOCYTOPENIA  Autoimmune disorders (e.g., lupus, Rheumatic Arthritis)  Infections (e.g., HIV, viral hepatitis, typhoid fever, inluenza)  Bone marrow damage (e.g., chemotherapy, radiation therapy)  Corticosteroids
  30. 30. LYMPHOCYTOSIS  Acute viral infections (e.g., chicken pox, cytomegalovirus (CMV),Epstein-Barr virus (EBV), herpes,rubella)  Certain bacterial infections (e.g. pertussis, whooping cough, tuberculosis (TB))  Toxoplasmosis  Chronic inflammatory disorder (e.g., ulcerative colitis)  Lymphocytic leukemia, lymphoma  Stress (acute)
  31. 31. LOW MONOCYTES  Usually, one low count is not medically significant.Repeated low counts can indicate:  Bone marrow damage or failure  Hairy cell leukemia
  32. 32. MONOCYTOSIS  Chronic infections (e.g., TB, Fungal Infections)  Infection within the heart (bacterial endocarditis)  Collagen vascular diseases (e.g., lupus, scleroderma, rheumatoid arthritis, vasculitis)  Monocytic or myelomonocytic leukemia (acute or chronic)
  33. 33. LOW EOSINOPHILS  Numbers are normally low in the blood. One or an occasional low number is usually not medically significant
  34. 34. EOSINOPHILIA  Asthma, allergies such as hay fever  Drug reactions  Parasitic infections  Inflammatory disorders (celiac disease, inflammatory bowel disease)  Some cancers, leukemias or lymphomas
  35. 35. BASOPENIA :D  As with eosinophils, numbers are normally low in the blood; usually not medically significant
  36. 36. BASOPHILIA  Rare allergic reactions (hives, food allergy)  Inflammation (rheumatoid arthritis, ulcerative colitis)  Some leukemias
  37. 37. PLATELET COUNT  Normal platelet counts are in the range of 150,000 to 400,000 per microliter (or 150 - 400 x 109 per liter), but the normal rangefor the platelet count varies slightly among different laboratories.
  38. 38. THROMBOCYTOPENIA  Immune Thrombocytopenias (ITP) – formerly known as immune thrombocytopenia purpura and idiopathic thrombocytopenic purpura  Cirrhosis  Splenomegaly  Gaucher’s disease  Familial thrombocytopenia  Chemotherapy, radiotherapy  Babesiosis, Dengue, Onyalai, Rocky mountain spotted fever  Thrombotic Thrombocytopenic Purpura  HELLP Syndrome  Hemolytic Uremic Syndrome  Drug Induced Thrombocytopenia (Heparin Induced Thrombocytopenia, acetaminophen, quinidine, sulfa drugs)  Pregnancy associated  Neonatal alloimmune associated  Aplastic Anemia, leukemia, lymphoma  Transfusion associated
  39. 39. THROMBOCYTOSIS  Reactive  Chronic infection  Chronic inflammation  Malignancy  Hyposplenism (post-splenectomy)  Iron deficiency  Acute blood loss  Myeloprofirative disorders – platelets are both elevated and activated  Essential Thrombocytosis  Polycythemia Vera  Associated with other myeloid neoplasms  Congenital  Cancer (lung, gastrointestinal, breast,ovarian, lymphoma) Kawasaki disease Soft tissue sarcoma Osteosarcoma Dermatitis (rarely) Inflammatory bowel disease Rheumatoid arthritis Nephritis Nephrotic syndrome Bacterial diseases, including pneumonia, sep sis, meningitis, urinary tract infections, and septic arthritis
  40. 40. MEAN PLATELET VOLUME  Typical range of platelet volumes is 9.7–12.8 fL  Low value 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.  High volume 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.
  41. 41. PLATELET DISTRIBUTION WIDTH  A high PDW means increased variation in the size of the platelets, which may mean that a condition is present that is affecting platelets
  42. 42. LOW BLOOD COUNTS  All three lines depressed in  Aplastic Anemia, Myelodysplastic Syndrome, Chemotherapy
  43. 43. HIGH BLOOD COUNTS  Polycythemia Vera (Secondary)
  44. 44. THANK YOU
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A presentation made by Dr Gauhar Mahmood Azeem on the interpretations of a simple CBC and the information it can give us, Various conditions which may cause derangement are mentioned,

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