The document provides a comprehensive overview of blood components, including red blood cells (RBCs), white blood cells (WBCs), hemoglobin, hematocrit, and platelet counts, including their normal ranges and implications for anemia diagnosis. It details approaches to different types of anemia based on RBC counts, hemoglobin levels, and additional lab results, distinguishing between microcytic, normocytic, and macrocytic anemias. The document also covers various blood disorders, diagnostic tests, and the significance of reticulocyte counts in assessing anemia causes.

1. DISCOVER
PROF / ABDUL HAMID ABDUL MONEM , MD
108 takes
AHMED
SOLIMAN
MD

2. 1
B A S I C S

3. B
A
S
I
C
S
1 CBC Report
Contents
• RBCS count
• HB (gm/dl)
• HCT
• Blood indices
⁻ MCV
⁻ MCH
⁻ MCHC
• WBCS count
₋ Netrophils
₋ Segmented
₋ Staff
₋ Lymphocytes
₋ Esinophils
₋ Monocytes
₋ Abnormal cells
• Platelets
B A S I C

4. B
A
S
I
C
S
1 RBCS
• It is a circular non nucleated biconcave disc
with dense rim & clear contents
• RBCS count : 4-5 million /mm3
• RBCS formation take place in bone marrow
B A S I C

5. B
A
S
I
C
S
1
• It Is An O2 Carrier
• It Is Intracorpscular Components
• It Is Main Parameter Used To Diagnose Anemia
• Anemia Is Diagnosed According To Age Group
― New born : ↓13 gm/dl
― 3months: ↓9.5 gm/dl
― 3-12months : ↓10 gm/dl
― 1-12years:↓11gm/dl
― >12years: ↓12gm/dl
HEMOGLOBIN
B A S I C

6. B
A
S
I
C
S
1
• It is volume of RBCS as regard to the whole blood
• Average in newborn : 50%.
• Infant & child : 35% - 40% .
• Decrease HB & HCT : Anemia
• Increase HB & HCT : Polycythemia
HEMATOCRIT
(HCT)

7. B
A
S
I
C
S
1
• MCV = HCT % × 10 / RBCS
• ↓MCV : Microcytosis
• ↑MCV: Macrocytosis
• Normal MCV : Normocytosis
• Average : 90 + 9 FL
• Lower Limit = 70 Age/Year
• Upper Limit
(↓10 Years →90 Fl , ↑10 Years →95 Fl)
MEAN CURPSCULAR VOLUME
(MCV)

8. B
A
S
I
C
S
1
MCH = Average quantity of hemoglobin in RBCS
MCH = HB (gm%)×10 / RBCS = 32+ 2 pgm
It ↓ in iron deficiency & thalassemia
B A S I C
MEAN CORPUSCULAR
HAEMOGLOBIN

9. B
A
S
I
C
S
1 RDW
• RDW : red cell distribution width
• It denotes size variability of RBCS
• It is quantification of ansiocytosis
• Normal : 10 – 15%
• Used in DD between IDA & Thalassemia
• It is markedly increased in IDA up to 30 – 40%

10. B
A
S
I
C
S
1 Reticulocytes
Bone Marrow Mirror Image
Normal : (0.5 – 2%)

11. B
A
S
I
C
S
1 Reticulocytes
B A S I C
Example :
anemic pt with HB of 9 gm% , retics was 5 % , & HCT was 7%
Corr, retics = 5× 7/35= 1%
Corrected retics
Retics. Count × HCT/Normal HCT

12. B
A
S
I
C
S
1 WBCS
B A S I C
TLC below 10 years : 6000 – 14000
TLC above 10 years : 4000 - 12000
Normal
• Infection
• Inflammation
• Malignancy
Leukocytosis
• Aplastic anemia
• Malignancy
• Infiltration
Leukopenia

13. B
A
S
I
C
S
1 Differential TLC
B A S I C
Neutrophils: 60%
Lymphocytes : 35%
Esinophils: 2%
Monocytes : 3-7%
Basophils : 0 – 1%
Differential

14. B
A
S
I
C
S
1 Neutropenia
B A S I C
• Sever infection
• Autoimmune
• Hypersplensim
• BM failure
• Cyclic neutropenia
• Congenital
Neutropenia

15. B
A
S
I
C
S
1 Eosinophilia
B A S I C
Eosinophilia
Asthma
Eczema
Parasitic
IBD(UC)
Malignancy

16. B
A
S
I
C
S
1 Lymphocytosis
B A S I C
Lymphocytosis
Viral infection
TB
ALL
Whooping
cough

17. B
A
S
I
C
S
1 Abnormal cells
B A S I C
Band cells
N: less than 20% of total neutrophils
Bandemia :↑ band cells (bacterial infection).
Metamylocytes & myleocytes
in prepheripheral blood is abnormal & denotes
bacterial infection .

18. B
A
S
I
C
S
1 Platelets
B A S I C
Platelets are produced by bone marrow
Normal count : (150,000 – 450,000)
Function
Hemostasis
• Platelets aggregation
• Platelets adhesion
• Clot formation
Disorders
• Thrombocytopenia
• Thromboasthenia
• Thrombocytosis

19. 2
ANEMIA APPROACH

20. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Lab. Approach To Anemia
↓ RBCS , HB & HCT
↓MCV
MICROCYTIC
ANEMIA
NORMAL MCV
NORMOCYTIC
ANEMIA
↑MCV
MACROCYTIC
ANEMIA
DIFFERENCATE EACH TYPE
1
2
3

21. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 DD Of Microcytic Anemia
• Iron deficiency anemia
• Thalassemia
• Chronic illness
o Chronic infection
o Chronic inflammation
o Chronic renal failure
• Lead poisoning
• Sideroblastic anemia

22. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Microcytic anemia (DO SERUM IRON)
↓serum iron
Consider IDA OR
Chronic illness
Do serum ferritin
IDA
↓ferritin
↓TS%
↑IBC
↑FEP
Chronic illness
Normal ferritin
Infection
Inflammation
CRF
Normal serum iron
Blood film
(basophilic stippling )
Positive
Consider
Lead
poisionig
Do serum
lead
Negative
Do HB
electrophoresis
Abnormal
Thalassemia
Normal
Do BM
SIDEROBLASTIC
ANEMIA

23. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 IRON DEFFECIENCY ANEMIA
Therapeutic Trail Of 4-6 Mg/KG /d Of Elemental Iron Can Be
Initial Step In Diagnosing Of Microcytic Anemia , Response
To Test By Reticulocytosis By The 5th – 7th Day And Increase
HB I Gm With In 1- 2 Weeks Is Diagnostic , If No Response
You Can Evaluate The Other Causes Of Microcytic Anemia .
Iron depletion Iron deficiency Anemia
↓ferritin ↓ferritin
↓transferrin saturation
↑EEP
↓ferritin
↓transferrin saturation
↑EEP
↓HB
↓MCV
Therapeuti
c
test
Stage
of
IDA

24. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 IRON DEFFECIENCY ANEMIA
Decrease ferritin is early lab. Sign for IDA as it a
mirror for iron stores however it is an acute phase
reactant and it can increased by inflammation
even with URTI.
NB1
RDW and corrected retics can hepps in DD
between IDA & thalassemia
NB2

25. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 DD Of Normocytic Anemia
• Hemolytic anemia except for thalassemia
• Aplastic anemia
• Hemorrhagic anemia

26. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Normocytic anemia (DO reticulocyte count)
Low retics
PLT & WBCS
Normal
Consider
Pure red
cell
anemia
BLAST CELLS
High retics
Serum bilirubin
Normal
History of
acute
hemorrhage
& investigate
for bleeding
High
comb's test
Positive
AHA
Negative
Pancytopenia
YES NO
LEUKEMIA
Aplastic
anemia
A leukemic
leukemia
BM
infiltration
Bone Marrow Aspiration
Do blood film
Heinz bodies Sickle Sphrocyte
SCA
HB
electro
Spherocytosis
OFT
G6PD
ENZYME ESSAY

27. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Normocytic anemia
At what time the retics count is normal or
decreased in hemolytic anemia ?
• Aplastic crisis : parvo virus infection
• Decrsed erythropoietin : CKD
• Decreased micronutrient for erythropoiesis : decrees iron &
folate
• Autoimmune hemolytic anemia when the autoantibodies
reacts with antigens that are presently on reticulocytes which
increase clearance of the cells

28. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Normocytic anemia
• Direct : coombs reagent + patient RBCS if agglutination
(positive)
• Indirect : coombs reagent + patient serum + known
RBCS if agglutination (positive)
• Coombs test is negative in about 10% of patients with
AHA the patient should be treated for AIHA if the
disease is strongly suspected even direct coombs is
negative
Coombs
test

29. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 Normocytic anemia
Amount Of Enzyme Activity Depend On The Age Of RBCS
G6PD
• It is difficult to be diagnosed by HB electrophoresis
• It should requested for HbH & hb Bart , Hb HPLC ,high performance liquid
chromatography
May needed in diagnosis of anemia with bone
marrow failure in cases of osteoporosis
Alpha
thalassemia
Skeletal
survey

30. A
N
E
M
I
A
A
P
P
R
O
A
C
H
2 DD Of Macrocytic Anemia
• Pernicious anemia (do serum B12)
• Folic acid deficiency ( Do serum folic acid)
• Aplastic anemia (bone marrow )
• WBCS ,platelets may also decreased in
megaloblastic anemia (pancytopenia)
• Hypersegmented neutrophils are characterstic >3
lobes
• Schilling test : help to diagnose the the cause of B12
deffeciency

31. 3
BLOOD FILM

32. B
L
O
O
D
F
I
L
M
3

33. B
L
O
O
D
F
I
L
M
3

34. B
L
O
O
D
F
I
L
M
3

35. B
L
O
O
D
F
I
L
M
3

36. B
L
O
O
D
F
I
L
M
3

37. B
L
O
O
D
F
I
L
M
3

38. B
L
O
O
D
F
I
L
M
3

39. CREDIT
AHMAD SOLIMMAN ADUL HALIM
AHMAD MOHMOD ATTIA