CBC complete blood count

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					The CBC interpretation are useful in
the diagnosis of various types of
anemia.

It can reflect acute or chronic
infection, allergies, and problems
with clotting.
• Component of the CBC:

 • Red Blood Cells (RBCs)
 • Hematocrit (Hct)
 • Hemoglobin (Hgb)
 • Mean Corpuscular Volume (MCV)
 • Mean Corpuscular Hemoglobin
 Concentration (MCHC)
   - Red cell distribution width (RDW)
 • White Blood Cells (WBCs)
 • Platelet
• RBC (varies with altitude):
          – M: 4.7 to 6.1 x10^12 /L
          – F: 4.2 to 5.4 x10^12 /L
• Biconcave disc shape with diameter
   of about 8 µm
• Function: - transport hemoglobin
  which carries oxygen from the lung to
  the tissues
         -acid –base buffer.
• Life span 100-120 days.
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 %
– MCV = mean corpuscular volume
  HCT/RBC count= 80-100fL
  • small = microcytic
  • normal = normocytic
  • large = macrocytic
– MCHC= mean corpuscular hemoglobin
  concentration HB/RBC count= 26-34%
  • decreased = hypochromic
  • normal = normochromic
• MCH (mean corpuscular
  hemoglobin)
  HB/HCT = 27-32 pg

• RDW (red cell distribution width)

• It is correlates with the degree of
  anisocytosis

   _ Normal range from 10-15%
• This important value is needed in the evaluation
  of any anemia.
• Normal range 1-2%
• Retic count goes up with
  – Hemolytic anemia

• Retic goes down with
  – Nutritional deficiencies
   _ Diseases of the bone marrow itself
- Increased number called polycythemia , two types:

          1-primary polycythemia
                - Polycythemia vera
          2-secondary polycythemia
                 e.g. high attitude, smoking, heart
                      disease or pulmonary fibrosis

- Decreased numbers of RBCs called anemia may indicate:
 1) Blood loss
  – Acute (normocytic normochromic)
  – Chronic (microcytic hypochromic)

 2) Decreased production
                         e.g._ nutritional anemia
 3) Increased destruction
                         e.g._ hemolytic anemia
       • Headache.
     • Hypertension.
• Hemorrhage or thrombosis
     • Fatigue ability.
     • Splenomegaly
• fatigue
• weakness
• skin & nail changes
• Compensatory
    heart rate
    blood pressure
    resp. rate
• 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%
  – Eosinophils: 1 - 5%
  – Basophils: up to 1%
  2) Agranulocytes consist of:
  - Lymphocytes: 20 - 40%
  – Monocytes: 1 - 6%
The type of cell affected depends upon its primary
function:

   In bacterial infections, neutrophils are most
   commonly affected

   In viral infections, lymphocytes are most
   commonly affected

   In parasitic infections, eosinophils are most
   commonly affected.
•    polymorphneuclear leukocytes
    (PMN,s)

• Nucleus 3-5 lobes.

• Diameter 10-14 µm

• 50-70% WBC
  =2.5-7.5x10^9/ L

• Function: Phagocytosis of bacteria
  and cell debris

• Numbers rise with all manner of
  stress, especially bacterial infections
• Neutrophil disorders
   – Neutrophilia – an increase in neutrophils
   – Conditions associated with neutrophilia are:
         1-Bacterial infections (most common cause)

         2-Tissue destruction
         e.g. tissue infarctions, burns.

         3- leukemoid reaction

         4-Leukemia
– Neutropenia – this may result from
   1-Decreased bone marrow production
    e.g. BM hypoplasia.

  2-Ineffective bone marrow production
      – E.g. megaloblastic anemias and
        myelodysplastic syndromes.

 3- post acute infection
     _ e.g. typhoid fever, brucellosis.
• Bilobed nucleus
• 1-5% of WBC
  =0.04-0.4x10^9/L

• Diameter about 10-14 µm

• Function: Involved in allergy, parasitic
  infections

• Contains: eosinophilic granules
– Eosinophilia may be found in
  • Parasitic infections
  • Allergic conditions and
    hypersensitivity reaction
• Circulating form of mast
  cells
• <1% WBC
  =0.01-0.1x10^9/L

• Diameter 10-14 µm
• Contains: basophilic
• Granules

• Granules contain:
  histamine and heparin
• IgE receptors

• Involved in allergy
Basophilia

  • Is associated with chronic
    myeloproliferative disorders
  • Inflammatory bowel disease e.g.
    ulcerative colitis
  • Radiation exposure
Monocyte
• 3-8% WBC = 0.2-0.8x10^9/L
• 8-10 µm in diameter.
• Circulating form of tissue
  macrophages
• Life span: 10-20 h in blood,
  months in tissues as macrophage.

Macrophages
• Phagocytosis, bacterial killing,
  antigen presentation
• Peritoneal cavity: peritoneal
  macrophages
• Lung: alveolar macrophages
• Spleen: splenic macrophages
• Liver: Kupffer cells
•   Monocytosis associated with

    1) certain bacterial Infection
       e.g active TB , sebticemia.
     2) Protozoal and rickettsial infection
       e.g. malaria
     3) Collagen vascular diseases
       e.g. Lupus erythromatosis ,rheumatoid arthritis.
• No specific granules
• 20-40% of WBC
  =1.55-3.5x10^9/ L
• Diameter 8-10 µm

• T cells: cellular
• (for viral infections)

•    B cells: humoral
    (antibody)

•   Natural Killer Cells
•   Lymphocytosis – may indicate
       _ Viral infection
       e.g. Infectious mononucleosis, CMV or pertussis.
       _ Bacterial infection
       e.g. TB

     • Lymphopenia – caused by
     _Stress.
     _Steroid therapy
     _ Irradiation
• (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.
•   Fever
•   Malaise
•   Weakness
•   Others depend on each system which is involved
     e.g. » chest: cough, SOB and chest pain
          » abdomen: diarrhea, vomiting,
    dehydration.
          »CNS: headache, visual disturbance,
          Neck stiffness

          and so 0n.
•   Infection of the mouth and throat.
•   Painful skin ulceration.
•   Recurrent infection.
•   Septicemia.
•Small granular non-nucleated
discs.
•Diameter about 2-4 µm
•Normal range; 150-300x10^9 /L
•Destroyed by macrophage cells in
the spleen.
•Function; involved in coagulation
and blood haemostasis.
•Life span 7-10 days
• Numbers of platelets
  – Increased (Thrombocythemia)
     •   Pregnancy.
     •   Exercise.
     •   High attitudes.
     •   splenectomy

  – Decreased (Thrombocytopenia)
     • Menstruation.
     • Haemorrhage.
     • Bone marrow destruction or suppression e.g. leukemia


• The values have to fit the clinical situation.
• Petechial hemorhage.
• Easy bruising.
• Mucosal bleeding
  e.g. _ epistaxes.
       _ gum bleeding
             Sickling Test
• Sickle cell anemia. Hemoglobin S
• 2 Types of Tests- Screening test for HBs
• Confirmation done by Hemoglobin
  Electrophoresis.
• HB AS is Trait- Mild type of disease
• HB SS is disease severe condition.
            Screening Test
• Sodium Meta Bisulphite- reducing agent.
• Mixed with RBcs- to produce Sickle RBCS
• HB S in not soluble in Metabisulphite so it
  appears as insoluble precipitate or
  floculum.

• All screening test must be confirmed by
  Electrophoresis.
THANK YOU

				
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posted:7/23/2011
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