2. CBC?
• Complete blood count (CBC)
• Determine whether or not the patient is anaemic.
• If anaemia is present the MCV is likely to provide clues as to the cause of
the anaemia.
• The white cells are often raised in infection neutrophilia in bacterial
infections and lymphocytosis in viral (but not always so).
• Platelets (size or number) may be abnormal either as a direct effect of
underlying hematological disorder.
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3. Dr S P srinivas Nayak, Clinical Pharmacy LAB
DATA INTERPRETATION
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HAEMATOLOGICAL TESTS
• Main parameters measured
• 1. Hb concentration.
• 2. Red blood cell count.
• 3. MCV (Mean cell volume)
• 4. MCH (Mean corpuscular hemoglobin).
• 5. MCHC (Mean corpuscular hemoglobin concentration).
• 6. Haematocrit (Hct) or PCV.
• 7. Red cell distribution width (RDW).
• 8. White cell count.
• 9. WBC differential count.
• 10.Platelet count.
4. 1. HAEMOGLOBIN CONCENTRATION (HB)
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• HEMOGLOBIN
1. Hemoglobin is the protein molecule in red blood cells
2. Carries oxygen from the lungs to the body's tissues
3. Returns carbon dioxide from the tissues back to the lungs.
4. Hemoglobin is made up of four protein molecules (globulin chains)
that are connected together.
•Normal values:
• Male: 14 – 18 g/dl
• Female: 12 - 16 g/dl
• Values differ between males and females since androgens drive
RBC production and
• Hence adult males has higher Hb, PCV and RCC than adult
females.
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2. RED CELL COUNT (RCC).
Normal values:
Male: 4.5 – 5.5 × 1012/L or 4.5 – 5.5 × 106/ml
Female: 4 – 5× 1012/L or 4 – 5 × 106/ml
• Useful in the diagnosis of polycythaemic disorders and thalassaemias
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ABNORMALITIES IN RBC COUNT
CAUSES OF A LOW RED CELL
COUNT INCLUDE
• HYPOPROLIFERATIVE
ANAEMIAS, e.g. iron, vitamin
B12 and folate deficiencies.
• APLASIAS e.g. idiopathic or
drug-induced
(chemotherapy).
• PARVOVIRUS B19 INFECTION-
induced red cell aplasia
resulting in transient
marked anaemia.
CAUSES OF HIGH RED CELL
COUNT INCLUDE
• PRV
(Polycythaemia Rubra Vera)
• Thalassaemia.
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3. MCV. (MEAN CELL VOLUME)
• Mean cell volume or Mean corpuscular volume (MCV)
• is the average volume of red cells in a specimen.
• MCV is elevated or decreased in accordance with average red cell
size
• A normal MCV range is roughly 80–100 fl
LOW MCV
indicates microcytic (small average RBC size),
NORMAL MCV
indicates normocytic (normal average RBC size),
HIGH MCV
indicates macrocytic (large average RBC size).
9. Mean cell haemoglobin concentration (MCHC)
MCHC is High in
• Severe prolonged dehydration.
• Hereditary spherocytosis.
• Cold agglutinin disease.
MCHC is Low in
• Iron deficiency anaemia.
• Thalassaemia.
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10. 6. HAEMATOCRIT (HCT) OR PCV.
Measuring the proportion of red blood cells in
whole sample of anticoagulated blood centrifuged.
Hct = 3 X Hb
There are two methods for estimation of PCV:
1. Macro method (Wintrobe method) and Micro method
(microhematocrit method).
2. Micro method is preferred because it is rapid, convenient,
requires only a small amount of blood, capillary blood
from skin puncture can be used, and a large number of
samples can be tested at one time
3. High PCV is seen in Polycythaemia (any cause).
4. Low PCV is seen in Anaemia (any cause).
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12. 7. RED CELL DISTRIBUTION WIDTH (RDW).
• Measures the range of red cell size in a sample
of blood, providing information about the
degree of red cell anisocytosis, i.e. how much
variation there is between the size of the red
cells. Of value in some anaemias:
• EXAMPLE:
• Low MCV with normal RDW
suggests Thalassaemia trait.
• Low MCV with high RDW
suggests iron deficiency.
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13. 8. WHITE CELL COUNT.
• Quantitative estimation of total WBC in human - by manual method -
using Hemocytometer.
• Total WBC count is increased (Leukocytosis) transiently in bacterial,
viral, protozoal infections parasitic infections such as Filaria, and also
in severe hemorrahage.
• The degree of leukocytosis depends on the severity and type of
infection.
• Leukopenia (decrease in leukocyte count) occurs in certain
Viral infections such as Hepatitis, Influenza and Measles,
Protozoal infections such as Malaria and
Bacterial infections such as Typhoid fever
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14. WHITE CELL COUNT.
• REFERENCE RANGE
• Adults
• : 4,000 – 11000 cells/cu.mm
The 5 main white cell subtypes in peripheral blood which
include:
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2. Lymphocytes.
4. Eosinophils.
1. Neutrophils.
3. Monocytes.
5. Basophils
15. 1. Neutrophils :
(40–75% of white blood cells)
INCREASED IN (IE. NEUTROPHILIA) DECREASED IN (IE NEUTROPENIA)
• Bacterial infections.
• Inflammation, eg: myocardial
infarction, polyarteritis
nodosa.
• Myeloproliferative disorders.
• Drugs (steroids).
• Disseminated malignancy.
• Stress, eg trauma, surgery,
burns, haemorrhage, seizure
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• Viral infections.
• Drugs, eg post chemotherapy,
cytotoxic agents, carbimazole,
sulfonamides.
• Severe sepsis.
• Neutrophil antibodies (SLE,
haemolytic anaemia)
• INCREASED destruction.
• Hypersplenism eg Felty’s
syndrome
• Bone marrow failure
REDUCED production
16. 2. LYMPHOCYTES.
Normal range: (20–45%)
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Increased (lymphocytosis) in:
Acute viral infections.
Chronic infections, eg TB, Brucella, hepatitis, syphilis.
Leukaemias and lymphomas, especially chronic lymphocytic
leukaemia.
Decrease (lymphopenia) in:
Steroid therapy,
Uraemia,
SLE;
Legionnaire’s disease;
HIV infection, marrow infiltration post chemotherapy or
radiotherapy.
17. MONOCYTES:
• Monocytosis is the state of excess monocytes in the peripheral blood. It may be
indicative of various disease states.
Examples of processes that can increase a monocyte count include:
• chronic inflammation
• diabetes
• stress response
• Cushing's syndrome (hyperadrenocorticism)
• immune-mediated disease
• granulomatous disease
• atherosclerosis
• necrosis
• red blood cell regeneration
• viral fever
• sarcoidosis
• chronic myelomonocytic leukemia (CMML)
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18. EOSINOPHILS
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• In normal individuals, eosinophils make up about 1–3% of
white blood cells, and are about 12–17 micrometres in size
with bilobed nuclei
• Along with mast cells and basophils, they also control
mechanisms associated with allergy and asthma.
• In normal individuals, eosinophils make up about 1–3%
of white blood cells
19. EOSINOPHILIC DISORDERS
EOSINOPHILIA
• An increase in eosinophils, i.e., the
presence of more than 500
eosinophils/microlitre of blood is called
an eosinophilia,
IT IS TYPICALLY SEEN IN PEOPLE WITH
• A parasitic infestation of the intestines;
• Autoimmune and collagen vascular
disease (such as rheumatoid arthritis)
and
• Systemic lupus erythematosus;
• malignant diseases such as eosinophilic
leukemia, clonal hypereosinophilia, and
Hodgkin's disease; lymphocyte-variant
hypereosinophilia.
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EOSINOPENIA
• Eosinopenia is a form of
agranulocytosis where the
number of eosinophil
granulocytes is lower than
NORMAL RANGE
• Leukocytosis with eosinopenia
can be a predictor of bacterial
infection.
• It can be induced by stress
reactions,Cushing's syndrome,
or the use of steroids.
• Pathological causes include
burns and acute infections.
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BASOPHILS
• Basophils are responsible for inflammatory
reactions during immune response, as well as in
the formation of acute and chronic allergic
diseases, including anaphylaxis, asthma, atopic
dermatitis and hay fever.
• They also produce compounds that co-ordinate
immune responses, including histamine and
serotonin that induce inflammation, heparin that
prevents blood clotting.
