CBC: Basic haematologic and systemic evaluation
-It offers a comprehensive assessment of the cellular components that circulate within the bloodstream revealing wide range of medical conditions
We will discuss :
Blood, Blood components, Blood cells, Haematopoiesis
CBC parameters and clinical significance
Use in Clinical Practice
CBC analyser, Technical aspects
What next after analysing a CBC report
Futuristic aspects
Blood is a specialized body fluid
Transporting oxygen and nutrients to the lungs and tissues: RBCs
Forming blood clots to prevent excess blood loss: Platelets
Carrying cells (WBCs) and antibodies (Plasma) that fight infection
Bringing waste products to the kidneys and liver, which filter and clean the blood
Regulating body temperature
Plasma : a mixture of water, sugar, fat, protein, and salts. Transport blood cells throughout body along with nutrients, waste products, antibodies, clotting proteins, hormones, and proteins that help maintain the body's fluid balance.
Red blood cells (Erythrocytes): Controlled by erythropoietin. No nucleus and can easily change shape. Contain a special protein called haemoglobin. The percentage of whole blood volume that is made up of red blood cells is called the haematocrit.
White blood cells (Leukocytes): White blood cells protect the body from infection
Platelets (Thrombocytes): Platelets are not actually cells but rather small fragments of cells. Helps in blood clotting process
HEMOLYTIC ANEMIA
Hemo: Referring to blood cells
Poiesis: “The development or production of”
The word Hemopoiesis refers to the production & development of all the blood cells:
Erythrocytes: Erythropoiesis
Leucocytes: Leucopoiesis
Thrombocytes: Thrombopoiesis.
Begins in the 20th week of life in the fetal liver & spleen, continues in the bone marrow till young adulthood & beyond!
This presentation covers on complete blood cells count and it's differentials. Starting with RBC count, WBC count and Platelets interpretation as a whole.
HEMOLYTIC ANEMIA
Hemo: Referring to blood cells
Poiesis: “The development or production of”
The word Hemopoiesis refers to the production & development of all the blood cells:
Erythrocytes: Erythropoiesis
Leucocytes: Leucopoiesis
Thrombocytes: Thrombopoiesis.
Begins in the 20th week of life in the fetal liver & spleen, continues in the bone marrow till young adulthood & beyond!
This presentation covers on complete blood cells count and it's differentials. Starting with RBC count, WBC count and Platelets interpretation as a whole.
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
In the work-up of a disease, the peripheral smear gives a very good information of what disease the patient may be suffering from. It also gives direction for further evaluation, all impacting the treatment and well being of the patient.
Basic approach to a case of anemia. Investigations to do and to arrive at the diagnosis. (Management not discussed). Peripheral smear findings with pictures are included.
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Clinical case
Hemolytic Anemia
Intravascular vs extravascular hemolysis
Classification of hemolytic anemia
Approach to hemolysis
Patient history
Clinical features
Peripheral blood smear
Investigation
Treatment
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
In the work-up of a disease, the peripheral smear gives a very good information of what disease the patient may be suffering from. It also gives direction for further evaluation, all impacting the treatment and well being of the patient.
Basic approach to a case of anemia. Investigations to do and to arrive at the diagnosis. (Management not discussed). Peripheral smear findings with pictures are included.
An overview about approach to diagnosis of anemia for new learners. It is not all about approach to anemia, approach to anemia really needs a lot of knowledge about each groups of anemia such as microcytic, normocytic and macrocytic anemia.
This presentation is focused on diagnostic utility of Red blood cell indices which will be very useful for undergraduate and postgraduate of medical field.
Blood Transfusion Service
Complex organization, requiring careful designing and management.
Centralized, regionalized, hospital based or combined
Strategy for the screening of all donated blood for transfusion-transmitted infections
Effective legislation governing the operation of blood transfusion service.
Good LABORATORY PRACTICES in blood bank
To provide safe and adequate blood and its components to meet patients need
The maintenance of a register of voluntary non-remunerated blood donors.
ORGANIZATION OF OUT-DOOR BLOOD DONATION CAMPS
Blood donor organizer
Informative posters, brochures
Dealings with donors
Staff
Incentives
light refreshment and donors cards
Annual award ceremonies
Tumor Lysis Syndrome
The most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers
When tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy-
leading to the characteristic findings of
hyperuricemia, hyperkalemia, hyperphosphatemia, and
hypocalcemia
Electrolyte and metabolic disturbances- progress to clinical toxic effects- including
-renal insufficiency,
-cardiac arrhythmias,
-seizures, and
-death due to multiorgan failure
Laboratory tumor lysis syndrome : Requires that two or more of the metabolic abnormalities occur within 3 days before or up to 7 days after the initiation of therapy
Clinical tumor lysis syndrome: Laboratory tumor lysis syndrome is accompanied by an increased creatinine level, seizures, cardiac dysrhythmia, or death.
IN MALIGNANCIES
–high proliferative rate,
–large tumor burden,
–high sensitivity to treatment-
Initiation of cytotoxic chemotherapy,
Cytolytic antibody therapy,
Radiation therapy,
Sometimes glucocorticoid therapy alone
Rapid lysis of tumor cells!!!!!
Releases massive quantities of intracellular contents:
K+ , phosphate, and nucleic acids
Combination therapy of hydroxyurea and thalidomide in β-thalassemiaDibyajyoti Prusty
This study presents the findings of a single-arm nonrandomized trial to evaluate the efficacy of combination therapy of HU and thalidomide in children with β-thalassemia.
The angiogenesis process, the factors regulating it, different assays for it, a little about tumour angiogenesis, the drugs and new therapeutic approaches towards inhibiting or augmenting the process.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
CBC interpretation in routine clinical practice.pptx
1.
2. Introduction
We will discuss :
Blood, Blood components, Blood cells,
Haematopoiesis
CBC parameters and clinical significance
Use in Clinical Practice
CBC analyser, Technical aspects
What next after analysing a CBC report
Futuristic aspects
CBC: Basic haematologic and systemic evaluation
-It offers a comprehensive assessment of the cellular
components that circulate within the bloodstream
revealing wide range of medical conditions
4. Blood: Primary functions
Blood is a specialized body fluid
Transporting oxygen and
nutrients to the lungs and
tissues: RBCs
Forming blood clots to prevent
excess blood loss: Platelets
Carrying cells (WBCs) and
antibodies (Plasma) that fight
infection
Bringing waste products to the
kidneys and liver, which filter
and clean the blood
Regulating body temperature
5. Blood: Components
Plasma: a mixture of water, sugar,
fat, protein, and salts. Transport blood cells
throughout body along with nutrients, waste
products, antibodies, clotting proteins,
hormones, and proteins that help maintain
the body's fluid balance.
Red blood cells
(Erythrocytes): Controlled by
erythropoietin. No nucleus and can easily
change shape. Contain a special protein
called haemoglobin. The percentage of whole
blood volume that is made up of red blood
cells is called the haematocrit.
White blood cells
(Leukocytes): White blood cells
protect the body from infection
Platelets (Thrombocytes):
Platelets are not actually cells but rather
small fragments of cells. Helps in blood
15. Polycythemia Vs Anaemia
Congenital heart disease
Heart failure
Chronic obstructive pulmonary disease (COPD)
Pulmonary fibrosis, often due to smoking
Polycythemia vera
Performance-enhancing drugs that stimulate RBC
production, such as anabolic
steroids or erythropoietin
Renal cell carcinoma
Dehydration
Kidney failure
Thyroid problems
Bleeding, either internal or external
Leukemia
Drug side effects, including chemotherapy
Deficiency of erythropoietin
Deficiencies in iron, folate, vitamin B12, or vitamin B6
Hemolysis
Pregnancy
16. MCV
A low MCV may be seen with:
Iron deficiency
Thalassemia
Anaemia of chronic disease
Sideroblastic anemia
Lead poisoning
HbC and other haemoglobin hybrids
Spherocytosis
Common causes of high MCV:
Vitamin B12 deficiency
Folate deficiency
Liver disease
Hyperglycemia, or high blood sugar
Alcohol use disorder
Hypoplastic anaemia
The MCV may be falsely high.
This can occur when red blood cells clot.
Cold agglutinin disease,
Paraproteinemias
Blood sugar is very high.
18. MCH
A measurement of the amount of hemoglobin in red blood
cells.
An MCH level below 27 picograms/cell is considered
abnormally low. Anemia is the most common reason for this.
An MCH level above 31 picograms/cell is considered
abnormally high.
The average hemoglobin concentration in a given volume of
red blood cells.
MCHC
Possible causes of low MCHC include:
Iron deficiency (with or without anemia)
Lead poisoning
Thalassemias (beta thalassemia, alpha thalassemia, and
thalassemia intermedia)
Sideroblastic anemia
Anemia of chronic disease
Causes of a high MCHC with anemia include:
Autoimmune hemolytic anemia
Hereditary spherocytosis
Severe burns
Liver disease
Hyperthyroidism
Sickle cell disease (homozygous)
Hemoglobin C disease
19. RDW SD(Fl)
RDW CV (%),
The red cell distribution width
(RDW) measures how equal
your red blood cells are in size
and shape.
20. Normal RDW/low MCV
-Anaemia of chronic disease
-Thal Minor
-HbE trait
Normal RDW/High MCV
-Aplastic anaemia
-Chronic liver disease
-Chemotherapy/antivirals
Normal RDW/Normal MCV
-Anaemia of chronic disease
-Acute blood loss
High RDW/Normal MCV
-Early iron def, vit B12 or Folate
Defi
-Dimorphic anaemia
SCD
CLD
MDS
High RDW/Low MCV
-Iron Deficiency
- Sickle-B-Thal
High RDW /High MCV
Anaemia caused by vitamin B12
and folate deficiency
Immune Haemolytic anaemia
MDS
Mixed anaemias
Myelofibrosis
21. Nucleated RBCs
nRBC number
nRBC % (/100 WBC) Hemoglobinopathies
Brisk hemolysis
Rapid blood loss
Other conditions of hematopoietic stress such as sepsis
Damage or stress to bone marrow, for example in:
Chronic myeloid leukemia
Acute leukemia
Myelodysplastic syndromes
Chemotherapy
Myelophthisic conditions, including:
Metastatic cancer to bone marrow
Bone marrow fibrosis
LEUKOERYTHROBLASTI
C BLOOD PICTURE
22. Reticulocyte
Reticulocytes number
Reticulocyte % (/100 RBC)
IRF
Ret-Hb
Reticulocyte maturity indices
(LFR, HFR, MFR)
RPI (Reticulocyte Production Index)
Reticulocytes are "adolescent" red blood cells that have
just been released from the bone marrow into the
circulation
Reticulocyte Count (Percent):
= Number of Reticulocytes / Number of Red Blood Cells
The normal range for the reticulocyte count without
anaemia is:
Adults: 0.5 to 1.5%
Newborns: 3 to 6%
23. Corrections and RPI
Corrected Reticulocyte Count (CRC): First Correction
Corrected Reticulocyte Count (Percent)
= Absolute Reticulocyte Count x Patient's hematocrit /
Normal Hematocrit
For severe anemia (hemoglobin less than 12 or hematocrit
less than 36), a second correction is needed.
The reticulocyte
prodanahaemoglobinemiauction index (RPI)
takes into account the fact that
reticulocytes will be present in the blood
for a longer period of time. More than 2
days.
Reticulocyte Production Index :
= Corrected Reticulocyte Count /Maturation Correction(In
days).
24. The maturation correction depends on the
level of anemia:
1 day: for a hematocrit of 36 to 45 or
hemoglobin of 12 to 15
1.5 days: for a hematocrit of 16 to 35, or
hemoglobin of 8.7 to 11.9
2 days: for a hematocrit of 16 to 25, or
hemoglobin of 5.3 to 8.6
2.5 days: for a hematocrit less than 15, or
hemoglobin less than 5.2
An RPI of less than or equal
to 2 means the bone
marrow is not responding
as expected
(hypoproliferative anemia)
An RPI of more than 2 or 3
means the bone marrow is
trying to compensate for
the anemia
(hyperproliferative anemia)
25. If the reticulocyte count is low, possible tests may
include:
Iron and iron binding capacity and/or serum ferritin
if the MCV is low or RDW high
Vitamin B12 level if the MCV is high
Bone marrow biopsy if other abnormalities are seen
on the CBC (such as an abnormal white blood cell
count or platelet count)
Blood tests to evaluate liver, kidney, and thyroid
function
If the reticulocyte count is high, potential tests may
include:
A source of bleeding if one is not obvious (such as a
colonoscopy and more)
Tests to diagnose hemolytic anemias
To look for hemoglobinopathies
Autoimmune conditions, enzyme defects such as
glucose 6 phosphate dehydrogenase deficiency
(G6PD deficiency), and others
26. IRF
Ret-Hb
Reticulocyte maturity indices
(LFR, HFR, MFR)
Raja-Sabudin RZ, Othman A, Ahmed-Mohamed KA, Ithnin A, Alauddin H, Alias H, Abdul-Latif Z, Das S,
Abdul-Wahid FS, Hussin NH. Immature reticulocyte fraction is an early predictor of bone marrow recovery
post chemotherapy in patients with acute leukaemia. Saudi Med J. 2014 Apr;35(4):346-9. PMID: 24749130.
Young Jin Yuh, Sung Rok Kim, Tae Hee Han,
Immature Reticulocyte Fraction after Iron Therapy for Iron Deficiency Anemia.,
Blood, Volume 106, Issue 11, 2005, Page 3746, ISSN 0006-4971,
https://doi.org/10.1182/blood.V106.11.3746.3746.
(https://www.sciencedirect.com/science/article/pii/S0006497119786352)
28. WBC count
Normal WBC counts by age:
Babies 0 to 2 weeks old: 9,000 to
30,000 cells/mm3
Babies 2 to 8 weeks old: 5,000 to
21,000 cells/mm3
Children 2 months to 6 years old:
5,000 to 19,000 cells/mm3
Children 6 to 18 years old: 4,800
to 10,800 cells/mm3
Adults: 4,500 to 11,00 cells/mm3
29. Leukocytosis:
A bacterial, fungal, or parasitic infection
Inflammatory conditions
Burns
Corticosteroid use
Cigarette smoking
Pregnancy
Leukemia
Leukopenia:
A blood or bone marrow disorder
Autoimmune disorders
Medication side effects
Chemotherapy or radiation therapy
A viral infection
31. Neutrophilia
Infections
Inflammation,
Injuries, stress, and certain medications.
(The spike in neutrophils is generally short-term.)
Certain blood cancers can result in increased neutrophils .
Chronic myeloid leukemia, CNL and polycythemia vera or in variable
neutrophil counts (like primary myelofibrosis).
32. Neutropenia
Genetic conditions: Genetic abnormalities that cause neutropenia can be passed
from parents to their biological children.
Severe congenital neutropenia.
Infections: Viral, bacterial and parasitic infections.
Common causes include HIV, hepatitis, tuberculosis, sepsis, and Lyme disease,
among other infections.
Cancer: Cancer and other blood and/or bone marrow disorders, including leukemia
and lymphoma, causing neutropenia.
Medications: Cancer treatments such as chemotherapy and radiation therapy.
Medications for conditions unrelated to cancer may also cause low levels of
neutrophils.
Nutritional deficiencies: Not having enough vitamins or minerals such as vitamin
B12, folate or copper
Autoimmune: Antibodies that destroy healthy neutrophils. Autoimmune conditions
include Crohn's disease, lupus, and rheumatoid arthritis, HPA
33. Eosinophilia
Allergic reactions
Drug reactions
Parasitic infections
Certain cancers
A normal eosinophil count is
between 100 and 500 cells per
microliter of blood.
34. Basophilia
Polycythemia vera
Blood cancers, Chronic myeloid leukemia
Inflammatory bowel disease (IBD) like Crohn's disease
and ulcerative colitis
Autoimmune disease
Allergic reactions or inflammation related to infections
A normal count is between 0 to 200 basophils per
microliter of blood
35. IG (%)
At 1%-2%, the level is
considered high in evaluation of
neonatal sepsis
High IG counts can suggest :
an infection or may point to a
bone marrow condition.
Inflammatory diseases such as
vasculitis, affecting the blood
vessels
Rheumatoid arthritis
Cancer
36. Lymphocytosis
They play a key role in the immune system
Cytomegalovirus
Hepatitis
Mononucleosis (caused by the Epstein Barr
virus)
Pertussis ("whooping cough")
Syphilis (a sexually transmitted bacterial
infection)
Toxoplasmosis
Tuberculosis
Hypothyroidism
Leukemia, Lymphomas
37. Low Lymphocyte Levels
Aplastic anemia
Chemotherapy
Radiation therapy
Immunosuppressants (drugs commonly used to
treat autoimmune diseases and prevent organ
transplant rejection)
Malnutrition
Hodgkin lymphoma
Lupus
Severe combined immunodeficiency (a rare
inherited disorder characterized by a low immune
response)
Tuberculosis
Typhoid fever
HIV
38. Monocyte
They are larger than
most blood cells.
Monocytes compose
approximately 4% to
8% of white blood
cells.
From the bloodstream,
monocytes migrate
into different tissues,
where they
differentiate and
perform specialized
functions.
Dendritic cells: Monitor the
tissues that line the body,
identify infectious organisms
(like bacteria, viruses, and
fungi), and release chemicals
to activate an immune
response in the affected area
Macrophages: Contain
chemicals that directly destroy
pathogens (disease-causing
infectious organisms)
39. Monocytosis
Normal Levels of Monocytes and White
Cells
Per cmm Percent of
white blood
cells
Monocytes 200–800 4–8 %
The World Health Organization (WHO) defines
persistent monocytosis as an absolute
monocyte count of more than 1,000 per cu Mm,
with monocytes accounting for more than 10%
of white blood cells and persisting for longer
than three months.
Mangaonkar AA, Tande AJ, Bekele DI. Differential diagnosis and
workup of monocytosis: A systematic approach to a common
hematologic finding. Curr Hematol Malig Rep. 2021;16(3):267-275.
doi:10.1007/s11899-021-00618-4
Causes of increased monocytes include:
--Chronic infections (including tuberculosis, malaria, and
endocarditis). -Viral infections (including COVID)
-Autoimmune and inflammatory diseases
-Bone marrow recovery
-Some medications
-Due to splenectomy
-Myeloproliferative disorders
-Chronic stress
42. Thrombocytopenia
Symptoms include:
Nosebleeds
Bleeding from gums
Blood in urine or stool
Purpura, petechiae, ecchymoses
Easy bruising
Heavy periods
ICH, GI bleed
Platelet count of less than 150,000 platelets/mL, regardless
of age.
44. Thrombocytosis
A diagnosis of thrombocytosis is made when platelets are higher than
450,000 per mcL
Primary thrombocytosis happens as a result of the bone marrow making too
many platelets.
Secondary thrombocytosis happens as a reactive process to something, such
as infection, inflammation, or iron deficiency.
Symptoms: Blood clot/ Bleeding due to defective platelet function
45. PDW, MPV, P-LCR
Vagdatli E, Gounari E, Lazaridou E, Katsibourlia
E, Tsikopoulou F, Labrianou I. Platelet
distribution width: a simple, practical and
specific marker of activation of coagulation.
Hippokratia. 2010 Jan;14(1):28-32. PMID:
20411056; PMCID: PMC2843567.
Tzur I, Barchel D, Izhakian S, Swarka M, Garach-Jehoshua O,
Krutkina E, Plotnikov G, Gorelik O. Platelet distribution
width: a novel prognostic marker in an internal medicine
ward. J Community Hosp Intern Med Perspect. 2019 Dec
14;9(6):464-470. doi: 10.1080/20009666.2019.1688095.
PMID: 32002150; PMCID: PMC6968671.
Khatri S, Sabeena S, Arunkumar G, Mathew M. Utility of
Platelet Parameters in Serologically Proven Dengue Cases
with Thrombocytopenia. Indian J Hematol Blood Transfus.
2018 Oct;34(4):703-706. doi: 10.1007/s12288-018-0924-2.
Epub 2018 Jan 23. PMID: 30369744; PMCID: PMC6186260.
46. IPF %
Arshad A, Mukry SN, Shamsi TS.
CLINICAL RELEVANCE OF
EXTENDED PLATELET INDICES IN
THE DIAGNOSIS OF IMMUNE
THROMBOCYTOPENIA. Acta Clin
Croat. 2021 Dec;60(4):665-674.
doi: 10.20471/acc.2021.60.04.14.
PMID: 35734488; PMCID:
PMC9196221.
49. HaematologyAnalyzer
Technical Methods
Electrical impedance:
For Total Count, Differential count
Early 1950s, Mr. Coulter: Invented the
patent for particle counting technology and
manufactured the first haematology
analyser
Spectrophotometry: For Hb estimation
60. What next after
analysing a CBC
report
Further evaluation
Peripheral smear study
Pathologist/Haematol
ogist opinion
Bone marrow
evaluation
Haematology clinical
management
61. CBC: The basic investigation requirement in all
clinical settings
A Simple test providing >30 parameters to
understand the haematopoietic system status
3-5-6-7 part depends upon the requirement
and cost affordability. LIS should be upgraded
to include the histograms and scatter plots
Quality control is a must
Further evaluation of an abnormal CBC report
accordingly
Cons:
1. Often requires Peripheral blood morphology evaluation
2. Preanalytic errors and FLAGs
3. Expensive and high running costs of advanced analysers