The document provides an overview of the Complete Blood Count (CBC), outlining its components and their significance in diagnosing various medical conditions, including anemias and infections. It details the normal ranges for red blood cells, hemoglobin, hematocrit, platelets, and white blood cells, as well as their implications for health, such as dehydration and blood disorders. The document also discusses specific blood cell types and their associated abnormalities, incorporating the significance of indices like MCV and MCHC in assessing anemia and other hematological conditions.

1. Complete Blood Count (CBC)
Dr.SAIMA SHAHID
e Blood Count (CBC)

2. objective
• The CBC interpretation are useful in the diagnosis of various
types of anemias.
• It can reflect acute or chronic infection, allergies, and problems
with clotting.

3. Common Components of the CBC
• Red blood cell count
• Hemoglobin (Hgb)
• Hematocrit (Hct) { packed cell vol }
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin Concentration (MCHC)
• Platelets (PLT)
• White blood cell count
• White blood cell differential

4. Red Blood Cells (RBCs)
• RBC count range: 3.6-5.4
• RBCs transport oxygen to body tissues. Body tissues that are
adequately oxygenated are said to be well-perfused
• High levels may indicate dehydration. This is because the blood
becomes less diluted with dehydration, so the number of RBCs will be
more concentrated
• Low levels indicate a lack of oxygen, malnutrition, or blood loss. Low
RBCs levels from blood loss results in hypovolemia (low fluid volume
in the vasculature) secondary to hemorrhage. Common causes of
hemorrhage include trauma, post-operative complications, and
adverse effects from certain medications that reduce the viscosity of
the blood (such as heparin and warfarin)

5. • Routine use of IV fluid replacement commonly leads to low levels that
are unrelated to a pathology. This is because the blood becomes
hypervolemic (high fluid volume in the vasculature). Small alterations
are usually not concerning. However, risks exists when IV fluids are
used excessively, causing fluid overload. This can be particularly
dangerous to patients with heart disease as increased fluid volume
may raise the blood pressure, leading to elevated systemic vascular
resistance (SVR) and increasing the cardiac preload, making the heart
work harder to pump blood. Furthermore, hypervolemia from
overhydration can also cause crucial electrolyte values to become
deficient in comparison (such as sodium and potassium)

6. Hemoglobin (Hgb)
• Index of O2 - carrying capacity of blood
• in anemia, hemorrhage
• Hemoglobin (Hgb) range: ♥ 12-16 gm/dL; ♠ 13.8-17.2 gm/dL
• Criteria for anemia for both boys and girls that are 3-12 years of age:
hemoglobin level less than 11.0 g/dL

7. Hemoglobin (Hgb)
• Hemoglobin is the oxygen-carrying pigment found in RBCs. Each
hemoglobin contains a heme group that binds with iron molecules
(up to 4).
• Although hemoglobin levels are evaluated to predict oxygen
transport, they only reveal the number of molecules available to bind
to red blood cells, rather than the actual number of red blood cells
that are saturated in oxygen.
• Anemia is linked to low hemoglobin levels.
• Anemia, which is a symptom of a condition rather than an actual
disease in of its own right, is characterized by low red blood cell levels
but is actually measured by the hemoglobin values.

8. Hemoglobin (Hgb)
• Broad causes of anemia include poor nutritional status (either from
diet or secondary to an absorption issue), an acute disease state, or a
chronic pathology that either renders the baseline hemoglobin levels
low (as in the hemoglobin is always low in the patient) or can cause
acute exacerbations that temporarily affect levels (such as cases of
sickle cell anemia, when the individual experiences a “sickle cell
crisis” or another exacerbation).
• The underlying cause of anemia is determined by analyzing
a combination of hematological findings. These include hemoglobin,
mean corpuscular volume (MCV), mean corpuscular hemoglobin
(MCH), and the mean corpuscular hemoglobin concentrate (MCHC)

9. Classification of anemias
• Classify by:
• − RBC size = by MCV - microcytic, normocytic, macrocytic
• − RBC colour = by MCHC - hypochromic = low hemoglobin
• e.g., microcytic hypochromic anemia - may be due to iron deficiency
macrocytic normochromic anemia - associated with folic acid
deficiency

10. haemoglobin
• Hemoglobin levels are often used to determine if a patient needs a
blood transfusion. The cut-off point varies between facility policies,
but most mandate transfusion for values under 7-8 gm/dL
• Low hemoglobin values are seen in patients
with hemoglobinopathies, or inherited blood disorders that
either affect hemoglobin structure or synthesis. The most common
include thalassemia syndromes, including alpha-thalassemia and
beta-thalassemia (β-thalassemia), and structural hemoglobin variants
(abnormal hemoglobins), including HbS (sickle cell anemia), HbE, and
HbC. As expected, a major symptom of hemoglobinopathies is anemia

11. Hematocrit
• Hematocrit (Hct): ♥ 37-47%; ♠ 41-50%
• It is ratio of the volume of red cell to the volume of whole blood
• Hct is the percentage of red blood cells present in the blood (the
‘composition’). Testing is an important indicator in diagnosing anemia
and narrowing down the type of etiology in which it originates
• A high hematocrit can suggest fluid deficit or dehydration
• A low hematocrit can suggest fluid overload. Patients on intravenous
fluids often experience a slightly decreased hematocrit as their blood
becomes ‘diluted.’ It may also be present in anemia related to poor
nutrition, renal insufficiency, or bone marrow suppression

12. THE INDICES (MCV & MCHC)
• These give information regarding the type of anemia, if present. They
indicate if the anemia is due to B12, folic acid, iron, B6, zinc or copper
deficiency, blood loss or genetic origin.
• MEAN CORPUSCULAR VOLUME (MCV)
• MCV Optimal levels are 86 - 90 fl.
• This test describes the individual red blood cell size. Increased levels, as
seen in macrocytic anemia, result from a nutritional deficiency of folic acid
or vitamin B12 and may also be associated with digestive complaints, lack
of Hydrochloric acid, celiac sprue, alcohol related diseases or after certain
types of cancer chemotherapy. Decreased levels may indicate a deficiency
of iron, B6, zinc, copper or molybdenum.
• small = microcytic
• normal = normocytic
• large = macrocytic

13. THE INDICES (MCV & MCHC)
• MEAN CORPUSCULAR HEMOGLOBIN (MCH)
• Normal levels are 27.5 – 33.0 pg.
• Increases levels indicate B12 or Folic Acid deficiency. Decreased levels are found
with parasites, iron anemia, Vit C deficiency, lack of hydrochloric acid, B6 anemia,
rheumatoid arthritis, or lead toxicity.
• MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)
• MCHC Optimal level are 330 - 345 g/L.
• MCHC is a most valuable test in evaluating anemia therapy as it measures the
concentration of hemoglobin in an average red blood cell. Increased levels
indicate that the red blood cells are shaped like "spheres" instead of "donuts".
Decreased levels indicate that the red blood cells contain less hemoglobin than
normal and will require specific nutritional therapy.

14. Platelets
• Platelet count range: 130,000-400,000 per microliter
• Platelets are the most abundant yet smallest type of blood cell. They are
actually cellular fragments that originate from megakaryocytes. They have a 8-10
day life span and play a vital role in coagulation
• Thrombocytopenia, or a low platelet count, may be related to failure of the bone
marrow to produce enough platelets or can indicate an infection, vitamin
deficiency, or a medication that affects coagulation, such as heparin (an
anticoagulant that’s often administered following surgery as prophylaxis for deep
vein thrombosis). Heparin induced thrombocytopenia (HIT) is seen in patients
that develop an immune reaction to heparin use; therefore, patients that are
given heparin should have their platelet counts monitored. Acquired
thrombocytopenia may occur following chemotherapy due to bone marrow
destruction

15. platelets
• High platelet counts can increase blood viscosity and place a patient
at risk for stroke
• Inherited low platelet counts, such as those seen in genetics blood
disorders, places the patient at risk for excessive bleeding

16. • Petechial (localized skin )
hemorhage.
• Easy bruising.
• Mucosal bleeding
e.g. _ epistaxes.
_ gum bleeding

17. Mean Platelet Volume (MPV)
• MPV range: 9.4-12.3 FL
• The MCV is a platelet marker
• High levels of MCV have been linked to an increased risk of risk of
thrombosis. High-grade inflammatory diseases are often associated
with low levels.

18. Differential leucocyte count (WBC’s)
• defence
• leukocytosis = increased # WBC - suggests invading organism, tissue destruction •
WBC count changes with age, stress, exercise, diurnal rhythm
• WBC differential:
•− Calculate % of each of the 5 types of WBC.
•− lymphocytosis - commonly due to viral infection
•− eosinophilia - associated with allergic conditions, parasites
•− immature band neutrophils - appear if prolonged heavy demand for
neutrophils results in release of immature cells = “shift to the left” -
referring to usual left to right illustration of neutrophil development

19. White Blood Cells (WBCs)
• WBC count range: 5.0-10 mm3
• Standard evaluation included in the CBC to assess for signs of infection or
to determine a baseline
• The two components include the overall WBC count and the differential.
The differential looks at the composition of each individual type of cell in
the overall WBC population
• WBCs are more diagnostically valuable by considering the individual cell
types that compose the WBC count
• White blood cells are also called leukocytes
• Leukopenia, a low WBC count, can result from chemotherapy, antibiotics,
or bone marrow dysfunction

20. White Blood Cells (WBCs)
• Severe infections can result in leukemoid reaction in which the WBC
count becomes incredibly high
• Absolute lymphopenia is defined as WBC count less than 1,500 mm3;
it’s most common in immunocompromised viral infections such as
AIDS
• A “shift to the left” is a term used to denote that an increase in
leukocytes, especially neutrophils, meaning that the cellular
population is characterized by immature precursors, rather than
segmented or matured neutrophils

21. Neutrophils
• Neutrophil range: 48-73%
• Neutrophilia (+) is often present with certain acute infections that
form pus
• It can also be related to mental stress
• Neutropenia (-) is seen in aplastic anemia, following chemotherapy
for certain malignancies such as acute myeloid leukemias, extreme
dietary deficiencies, or during severe infections, signaling a long and
overwhelming battle with pathogen that may possibly have gone
septic

22. Lymphocytes
• Lymphocytes range: 20-40%
• Lymphocytes include B cells and T cells
• Lymphocytosis (+) is present in acute infections, such as
mononucleosis or hepatitis, and during radiation exposure
• Lymphocytopenia (-) often occurs with sepsis and in leukemia
• This test is ordered to evaluate T-Cells, B-Cells, and to monitor for
signs of infection

23. Monocytes
• Monocyte range: 0-9%
• Monocytosis (+) is seen in cases of tuberculosis, viral infections, and
chronic inflammatory disorders
• Monocytopenia (-) can occur as the result of prednisone use

24. Eosinophils
• Eosinophil range: 0-5%
• Eosinophilia (+) is common during parasitic infections, eczema,
allergic reactions, and some immune diseases
• Eosinopenia (-) could be related to the increase of adrenosteroid
production
• Ordered to evaluate for the presence of an infection, especially
parasitic, or immune diseases and allergies

25. Basophils
• Basophils 0-2%
• Basophilia (+) is seen with myeloproliferative diseases and leukemia
• Basopenia (-) is common in cases of allergic responses, stress, and
hyperthyroidism
• An increase is seen in the recovery phase of an infection

26. • (Leukocytosis) may indicate:
_ Infectious diseases
_Inflammatory disease (such as rheumatoid
arthritis or allergy)
_Leukemia
_Severe emotional or physical stress
_Tissue damage (e.g. necrosis,or burns)
• (Leukopenia) may result from:
_ Decreased WBC production from BM.
_ Irradiation.
_ Exposure to chemical or drugs.

27. • Fever
• Malaise
• Weakness
• Others depend on each system which is involved
e.g. » chest: cough, and chest pain
» abdomen: diarrhea, vomiting,
dehydration.
»CNS: headache, visual disturbance,
Neck stiffness
and so 0n.

28. • Infection of the mouth and throat.
• Painful skin ulceration.
• Recurrent infection.
• Septicemia.