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Complete Blood Count Interpretation
The document provides an extensive overview of complete blood count parameters, including hematocrit, hemoglobin, white blood cells, and platelet counts, along with their normal ranges and various conditions leading to abnormalities. It discusses factors causing increased or decreased blood components, such as anemia, leukocytosis, and thrombocytopenia, as well as the clinical implications of these variations. Additionally, it details specific morphologies and their associations with different pathologies, emphasizing the significance of proper analysis in diagnosing hematological disorders.
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Complete Blood Count Interpretation
- 1. Complete Blood Count ChairPerson: Dr Chandrashekar K Student: Dr Kiran Revankar
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- 5. HEMATOCRIT HEMATOCRIT Normal Range: Males: 42-50 Females:36-46 HCT=HB x 3 HB= RBC x 3
- 6. Raised Haematocrit INCREASED REDBLOOD CELLS OR DECREASED PLASMA Dehydration (such as from severe diarrhea) Dengue shock syndrome Kidney disease with high erythropoietin production Cyanotic congenital heart disease COPD High altitude Polycythemia vera Smoking
- 7. Reduced Haematocrit DECREASED REDBLOOD CELLS OR HAEMODILUTION Blood loss (hemorrhage) Anaemia Erythropoietin deficiency (usually secondary to kidney disease) Hemolysis (RBC destruction of varied etiology) Leukemia Multiple myeloma Autoimmune/collagen-vascular diseases
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- 10. Normal RBC count(millioncells per microliter) Males = 4.5–6.0 Females= 4.1–5.1
- 11. Stem cells maturationdefect : Pure red cell aplasia Aplastic anaemia Fanconi anaemia Anaemia of renal failure Erythroblasts maturation defect: Megaloblastic Iron deficiency anaemia Thalassemia's Anaemia of renal failure Other causes Anemia of chronic inflammation Myelophthisic anemia A) Intrinsic abnormalities • Hereditary spherocytosis • Hereditary elliptocytosis • Abetalipoproteinemia • Enzyme deficiencies • Hemoglobinopathies •PNH Extrinsic abnormalities • Antibody-mediated • Mechanical trauma to red cells –TTP, HUS –(DIC) – Infections like malaria – Prosthetic valve/heart surgery
- 12. • Polycythemia vera •Excessive smoking • High altitudes • Renal neoplasia • congenial heart diseases • Lung diseases like emphysema, pulmonary fibrosis • Hemoglobinopathies • endocrine diseases like hypothyroid • Anabolic metabolism Raised RBC counts
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- 14. Haemoglobin Normal HB Males =14-16 g/dl Females= 12-15 g/dl
- 15. Haemoglobin,methemoglobin and carboxyhaemoglobinCyanmethemoglobin which absorbs light of 540nm Turbidity falsly increases the HB value High WBC High lipid High plasma protein
- 17. Hemoglobin is increasedin: • Polycythemia vera • High altitude adaptation • Pulmonary pathology • Splenic hypo function • Testosterone supplementation • Dehydration • Adrenal cortex over activity Haemoglobin is decreased in: Blood loss Deficiency (protein malnutrition, iron, copper, vitamin C, vitamin B1, folic acid, B12), Chronic disease (liver, kidney, RA, carcinoid, etc.) Bone marrow insufficiency) Endocrine causes like hypothyroid and adrenal hypo activity Hereditary anaemias like sickle cell and thalassemia's • Hemodilution (pregnancy, edema)
- 18. Mean Corpuscular Volume MCVis average volume of the red blood cell 80-100 fl >100 fl <80 fl The blood analyser >> microscopic observation Microcytic + macrocytic cells =normal MCV MCV = (hematocrit/red cell count) × 100
- 19. Poor vitamin B12intake (vegans) Pernicious Anemia Gastric Surgery Pancreatic insufficiency Small intestine absorption defect Crohn disease Sprue Lymphoma Diverticulosis blind loop with bacterial overgrowth Fish tapeworm Ileal resection Zollinger-EIIison syndrome HIV infection Causes of macrocytosis • Myelodysplastic syndromes • Myelophthisic anemia • Post splenectomy • Alcoholism • Liver disease • Anaemia of hypothyroidism • Drugs: – Anticonvulsants, (e.g. phenytoin, primidone, phenobarbital) – Antitumor agents, (e.g. methotrexate, hydroxyurea, cyclophosphamide) – Antimicrobials, (e.g. sulfamethoxazole, sulfasalazine, zidovudine, pyrimethamine).
- 21. Causes of Microcytosis Irondeficiency anemia Thalassemia Sideroblastic anaemia Anaemia of chronic disease Lead poisoning • Cold agglutinins (increased values) • Warm autoantibodies • Marked hyperglycemia (>600 mg/dL) (increases MCV) • Marked leukocytosis (>50,000/μL) (increased values) • In vitro hemolysis or fragmentation of RBCs (decreased values) • Methanol poisoning (increased values) • Marked reticulocytosis (>50%) from any cause (increases MCV) Interference in MCV
- 22. Mean Corpuscular Haemoglobin(MCH) MCH decreases in microcytic anemia MCH increases in macrocytic anaemia MCH = (hemoglobin/red cell count) × 100
- 23. MEAN CORPUSCULAR HEMOGLOBINCONCENTRATION (MCHC) The average haemoglobin concentration per unit volume (100 mL) of packed red cells is indicated by MCHC MCHC is expressed in grams of haemoglobin per decilitre of packed RBCs MCHC = hemoglobin (g/dl)/Hct (L/L) Normal value :32-36 g/dl .wont exceed >37 Spherocytosis
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- 25. Immature, non-nucleated RBCsthat still retain RNA Stained by supravital stains like New methylene blue Bone marrow capacity and its response to anemia Normal value: 0.5 to 1.5 % nearly 50,000 reticulocytes /50 lakh rbcs
- 26. •Absolute reticulocyte count=reticulocyte%X number of RBCs •Ex: ARC=1%x50 lac =50,000 Corrected reticulocyte count =reticulocyte % x patients HCT/45 Ex:6% x 22/45=3% Production Index: Corrected reticulocyte count/2
- 27. Red cell distributionwidth (RDW) Numerical expression of anisocytosis RDW-SD has better sensitivity RDW-CV reflects better regarding the size distribution Reference values: RDW-CV: 11.5–14.5% RDW-SD:35-45
- 28. Thalassemia Iron deficiencyanaemia Normal RDW Microcytosis Raised RDW Microcytosis Red cell fragmentation Agglutination Dimorphic cell populations
- 29. RBCs ON PERIPHERALSMEAR
- 31. Microcytic Hypochromic Anaemia Irondeficiency anaemia Thalassemia Anaemia of chronic disease Sideroblastic anaemia Lead toxicity Copper deficiency Pyridoxine deficiency
- 32. Megaloblastic anaemia Giant bandformsMacrovovalocytes Hypersegmented neutrophil
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- 34. Microcytic + hypochromic+basophilic stippling Lead toxicity
- 35. Thalassemia MINOR Major Pinch bottlecells (knizocyte) Target cells Tear drop cells Poikilocytosis (major>>minor)
- 37. Tear drop cellsand nucleated RBCs Myelofibrosis Hyposplenism
- 38. Heinz bodies- refractileintracellular haemoglobin precipitates detected in patients with unstable hemoglobins, thalassemias and G6PD defficiency
- 39. DNA inclusion bodiesseen in: Asplenism/hyposplenism Severe haemolytic anemia
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- 43. Acanthocyte(“Spur cell”) Abetalipoproteinemia Alcoholic liverdisease Postsplenectomy state Malabsorptive states
- 44. Echinocyte(“Burr cell”) Uremia, liver disease Low-potassiumred cells Carcinoma of stomach
- 45. Schistocytes Microangiopathic hemolytic anemia(TTP, DIC, vasculitis,glomerulonephritis, renal graft rejection) Carcinomatosis Heart-valve haemolysis (prosthetic or pathologic valves) Severe burns
- 46. RBC clumping inCold agglutination/PNH
- 47. Cabot’s rings areremenents of nuclear membranes • Pernicious anemia • Lead poisoning • Alcoholic jaundice • Severe anemia • Leukemia.
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- 50. Neutrophils(50-70%) Monocytes(2-6%) Basophills(0-1%) Eosinophils (0-3%) Total WBC count:4000 to 11,000/μL Lymphocytes (20-40%)
- 51. • Acute andchronic bacterial infections • Viral infections • Polycythemia vera • Rheumatoid arthritis • Allergy, especially severe allergic reactions • Acute lymphocytic leukemia • Acute myeloid leukemia (AML) • Smoking • Chronic lymphocytic leukemia • Chronic myelogenous leukemia • Hairy cell leukemia • Lymphoma spillage • Measles • Myelofibrosis. Leucocytosis
- 52. Leukocytopenia • Chemotherapy andradiation therapy • Sepsis • Typhoid • Malaria • Tuberculosis • Dengue • Enlargement of the spleen • Leukemia (as malignant cells overwhelm the bone marrow) • Folate deficiencies • Myelofibrosis • Aplastic anemia (failure of bone marrow production) • HIV and AIDS • Influenza • Systemic lupus erythematosus
- 53. Increased Neutrophil (Neutrophilia) Physiological:Stress,anxiety,seizure,exercise Acutebacterial infection Tissue injury and inflammation: MI,collagen vascular disease and burns Metabolic :DKA/Acute renal failure Myeloproliferative disorders Misc:Splenectomy,Haemolytic anemia
- 54. Decreased or ineffective production • Aplasticanemia • Vit B12 and Folate deficiency • Myelodysplastic syndrome Increased removal from circulation • Immunological like SLE • Hypersplenism • Sepsis
- 56. Mild (700–1500 permicroliter) • Allergic rhinitis, extrinsic asthma, mild drug reaction, long-term dialysis, immunodeficiency Moderate (1500–5000 per microliter) • Parasitic disease, intrinsic asthma, pulmonary eosinophilia syndrome Marked (> 5000 per microliter) Trichinella, hookworm, Toxocara canis, eosinophilic leukemia, severe drug reaction Eosinophilia
- 57. • Usually relatedto increased circulating steroids • Cushing’s syndrome • Drugs • ACTH, epinephrine, thyroxine, exogenous steroids • Acute bacterial infection • Normal diurnal pattern. Eosinopenia
- 58. • Hypothyroidism, myxedema •Chronic myeloid leukemia • Ulcerative colitis • Polycythemia vera • Urticaria • Hodgkin’s lymphoma/disease • Splenectomy BASOPHILIA – CAUSES
- 59. • Viral infections •Tuberculosis • Subacute bacterial endocarditis • Collagen diseases • Infectious mononucleosis • Sarcoidosis • Crohn’s disease • Rheumatoid disease • Ulcerative colitis. Monocytosis– CAUSES
- 60. • Infectious mononucleosis •Mycobacterium tuberculosis • Acute lymphoblastic leukaemia • Brucellosis • Burkitt’s lymphoma • Chronic lymphocytic leukaemia • Cytomegalovirus • Epstein-Barr virus • Hairy cell leukemia • Myeloma • Non-Hodgkin’s lymphoma • Syphilis • Toxoplasma • Waldenström macroglobulinemia • Whooping cough Lymphocytosis
- 61. • Viral infection •HIV • Drugs like vinblastine, chloramphenicol, doxorubicin • Marrow suppression Lymphocytopenias
- 62. Atypical lymphocytes ininfectious mononucleosis
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- 66. leukemoid reaction Any age 30000-50000 Absolutebasophilia absent Splenomegaly may not be present Increased LAP TOXIC granules Dhole bodies
- 67. Hand mirror blastsin ALL
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- 70. •Normal platelets areabout 1–3 μm in diameter •1 megakaryocyte produces about 4000 platelets •Lifespan of platelets is about 9–12 days •Production of platelet is regulated by hormone called thrombopoietin •Normal count : 150000–450000/μL
- 71. Myeloproliferative Disorders • Essentialthrombocytosis • Idiopathic Myelofibrosis • Polycythaemia Vera Transfer from extravascular pools into circulation • Splenectomy (Over 70% of platelets stored in spleen) • Exercise • Epinephrine Thrombocytosis Secondary to • Iron deficiency anemia • Acute blood loss • Hemolysis • Recovery from thrombocytopenia Thrombocytosis
- 72. Marrow failure • Aplasticanemia • Myelodysplastic syndrome (MDS) • Bone marrow hypoplasia due to – Chemotherapy – Radiation – Toxins – Immune. • Bone marrow infiltration by – Fibrosis – Malignancy – Granulomas.
- 73. Selective marrow suppressionof platelet production due to— – Drugs – Infections – Ethanol. Ineffective thrombopoiesis due to— – Folate or B12 deficiency. Hereditary disorders – May-Hegglin anomaly – Wiskott-Aldrich syndrome Dhole bodies
- 74. Immune mediated • Systemiclupus erythematosus • Lymphoproliferative disorders • Drugs including- heparin induced • Infections including HIV related • Post-transfusion • Idiopathic/immune thrombocytopenia (ITP) Nonimmune mechanisms • Severe bleeding • Disseminated intravascular coagulation (DIC) • Abnormalities in small vessels • Vasculitis • von Willebrand disease (vWD) • Thrombotic thrombocytopenic purpura • Hemolytic uremic syndrome.
- 75. Platelet Satellitism Plateletclumping EDTA induced
- 76. MEAN PLATELET VOLUME(MPV) • Average size of platelet in the blood • In general peripheral distruction with normal functioning marrow increases MPV And marrow failure decreases the MPV • Normal value: 7.4–10.4 fL