This document provides information on normal ranges and significance of components of a complete blood count (CBC) and their relevance to pulmonary conditions. It discusses red blood cell measurements, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and their associations with anemia, polycythemia, and other disorders. White blood cell types and counts are also covered, along with significance of leukocytosis, neutrophilia, lymphocytes, eosinophilia, and thrombocytopenia. Pulmonary manifestations of disseminated intravascular coagulation are summarized.

1. Pulmonary Significance
Of CBC
Prepared by;
Mahmoud E. Abo El-Magd

2. RBC measurments
– M: 4.7 to 6.1 x10^12 /L
– F: 4.2 to 5.4 x10^12 /L
Hemoglobin :
– M: 13.8 to 17.2 gm/dL
– F: 12.1 to 15.1 gm/dL
Hematocrit : (packed cell volume)
It is ratio of the volume of red cell to the volume of whole blood.
– M: 40.7 to 50.3 %
– F: 36.1 to 44.3 %

3. MCV&MCHC
– MCV = mean corpuscular volume
80-100 mm3
• decreased = microcytic
• normal = normocytic
• Increased = macrocytic
– MCHC= mean corpuscular hemoglobin
concentration 26-34 g /dl
• decreased = hypochromic
• normal = normochromic

4. WBC
• WBCs are involved in the immune response.
• The normal range: 4 – 11x10^9 /L
• Two types of WBC:
1) Granulocytes consist of:
– Neutrophils: 50 - 70% 3000 – 7000 cell / mm3
– Eosinophils: 1 - 5% up to 450 cell / mm3
– Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40% 1000 – 4000 cell / mm3
– Monocytes: 1 - 6%

5. ANEMIA
anemia has been defined as a reduction in one or more of the
major red blood cell (RBC) measurements: hemoglobin
concentration, hematocrit, or RBC count.
WHO criteria for anemia in men and women are <13 and <12
g/dL, respectively.
Falling HB level .

6. Polycythemia
Polycythemia in the adult patient is suspected when the HCT is
>48 or >52 percent in women and men, respectively.
Polycythemia in the adult is suspected when the HGB is >16.5
or >18.5 g/dL in women and men, respectively.

7. Disseminated Intravascular Coagulation

8. leukocytosis
leukocytosis to values in excess of 50,000 cells/microL, when
due to causes other than leukemia, is termed a leukemoid
reaction or hyperleukocytosis.
Neutrophilic leukocytosis is defined as a total WBC greater than
11,000/microL plus an absolute neutrophil count (ANC) more
than 7700/microL in adults.

9. Neutrophilia
Any active inflammatory condition or infection
Cigarette smoking
Pregnancy
Previously diagnosed hematologic disease (such as acute and
chronic leukemias, chronic myeloproliferative or myelodysplastic
disease)
Recent vigorous exercise
Recent thermal burn, electric shock, surgery, or trauma
Prior splenectomy or known asplenia
Recent vaccination or snake bite

10. Lymphocytes
 lymphocytosis may indicate
_ Viral infection
e.g. Infectious mononucleosis, CMV .
_ Bacterial infection
e.g. TB
 Lymphopenia – caused by
_Stress.
_Steroid therapy

11. Eosinophilia
The degree of eosinophilia can be categorized into mild (500 to
1500 cells/microL), moderate (1500 to 5000 cells/microL) or
severe (>5000 cells/microL).
Asthma .
Fungal infections — Aspergillosis.

12. Pulmonary eosinophilia
Drug- and toxin-induced eosinophilic lung diseases . Nonsteroidal
antiinflammatory drugs (NSAIDs) Antimicrobials (Nitrofurantoin ,
sulfonamides, ampicillin, ) Phenytoin .
Helminthic and fungal infection-related eosinophilic lung diseases
(Loffler's syndrome) Ascaris lumbricoides .
Pulmonary parenchymal invasion , eg, paragonimiasis
Tropical pulmonary eosinophilia
Acute eosinophilic pneumonia
 Chronic eosinophilic pneumonia
Other Idiopathic hypereosinophilic syndrome

13. Disseminated Intravascular Coagulation

14. Thrombocytosis
thrombocytosis is defined as a platelet count >500,000/microL.
Reactive thrombocytosis (RT) . Examples are recent surgery,
bacterial infection, and trauma.

15. Thrombocytopenia
Certain drugs, most notably heparin
Disseminated intravascular coagulation (DIC)
The antiphospholipid syndrome
The HELLP syndrome (hemolytic anemia, elevated liver function
tests, and low platelet count) in pregnant women

16. Thrombocytopenia in the ICU patient
Infection, sepsis, septic shock
Massive blood transfusion
Cardiopulmonary resuscitation
Adult respiratory distress syndrome
Pulmonary embolism
Use of intravascular catheters

17. Heparin-induced thrombocytopenia
overall incidence of 2.6 percent .
Although there are several mechanisms associated with drug-
induced thrombocytopenia, HIT is distinct among them in being
associated with platelet activation. This may explain why HIT is
uniquely associated with thrombosis rather than bleeding.

18. Among patients receiving heparin for thromboprophylaxis or
treatment, the initial sign of HIT usually is the development of
thrombocytopenia. If such a patient develops an initial or
recurrent thrombotic event, the presence of thrombocytopenia
suggests that it is due to HIT rather than failure of
anticoagulation .

19. Onset of otherwise unexplained thrombocytopenia.
Venous or arterial thrombosis associated with
thrombocytopenia.
A platelet count which has fallen 50 percent or more from a prior
value, even if absolute thrombocytopenia is not present .
Necrotic skin lesions at heparin injection sites .
Acute systemic (anaphylactoid) reactions occurring after IV
heparin bolus administration.

20. The first intervention in a patient with HIT should be immediate
cessation of all exposure to heparin, including heparin-bonded
catheters and heparin flushes .
Fondaparinux .
Platelet transfusions ("add fuel to the fire").

21. The most frequently reported drugs associated with
thrombocytopenia include :
Heparin
Quinine and quinidine
Trimethoprim-sulfamethoxazole
Vancomycin
Rifampin
Piperacillin
Beta-lactam antibiotics
Measles-mumps-rubella vaccine
Carbamazepine
Phenytoin

23. Disseminated Intravascular Coagulation
consumption coagulopathy
defibrination syndrome
systemic process producing both thrombosis and
hemorrhage.
A secondary group of symptoms that is always triggered
by a primary condition that does not necessarily involve
coagulation.

24. Pathophysiology
Disseminated Intravascular Coagulation
Inflammation
Clotting Factor Activated
Uncontrolled thrombin formation
Depletion of clotting factor
Massive
Hemorrhage

25. Disseminated Intravascular Coagulation
Bleeding signs and symptoms
Petechiae
Purpura
Arterial line oozing
Venipuncture site
bleeding
Clinical manifestation

26. Disseminated Intravascular Coagulation
Bleeding (64 percent)
Renal dysfunction (25 percent)
Hepatic dysfunction (19 percent)
Respiratory dysfunction (16 percent)
Shock (14 percent)
Thromboembolism (7 percent)
Central nervous system involvement (2 percent)

27. Disseminated Intravascular Coagulation

28. Clinical manifestation
Disseminated Intravascular Coagulation
Organ damage
Skin, bone and bone
marrow necrosis may be
seen

29. International Society of Thrombosis and
Haemostasis Scoring System for Diagnosis of DIC

30. Significant Laboratory Findings in DIC
Disseminated Intravascular Coagulation
Test Normal Range DIC
D- dimer 0- 100 ng/ mL > 500 ng/ mL
Fibrinogen 200- 400 mg/ dL < 200 mgl dL
Platelet count 150 - 450 × 109/ L <150 - 450 × 109/ L
Peripheral blood smear------ Fragmented RBC
Platelet Count--------------------------- Decreased
Fibrinogen ------------------------------- Decreased
Thrombin time ------------------------- Prolonged

31. treatment
Disseminated Intravascular Coagulation
Elimination of the precipitating factor if
possible
Replacement of coagulation factors and
platelets
Inhibition of the clotting process with
heparin or other agents.

32. Thank
you!!!