How to interpret Complete Blood Counts
- 1. INTERPRETATION OF CBC DR.VAIBHAV SHAH CONSULTANT PEDIATRIC HEMATOLOGIST-ONCOLOGIST M.D.(Ped), FIAP-PHO +91-9998631700
- 2. WHY? 4
- 3. SingleVs Multiple lineage involvement To assess details of involved lineage To aid in the diagnosis 5
- 4. WHAT? 6
- 5. Hemoglobin Hematocrit MCH MCHC MCV RDW RBC counts WBC counts DLC Platelet counts MPV PDW 7
- 7. Hemoglobin:- Defines Anemia Age wise criteria AcuteVs Chronic Rule of 3’s 9
- 8. MCV Defines type of anemia Indicates towards possible etiology 10 MCV = PCV in 100 ml of blood x 10 RBC count in million per cc
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- 10. MCHC Mean Corpuscular Hemoglobin Concentration Average concentration of hemoglobin in red blood cells Normal value 30 %-38 % 14 MCHC = Hb% in 100 ml of blood x 100 PCV IN 100 ml of blood
- 11. Hypocromic microcytic anemia MCHC increased in Heridietery spherocytosis Infant and newborns Autoagglutinations Interference in MCHC Marked leukocytosis Haemolysis Cold aggutinins Rouleaux 15 MCHC decreased in
- 12. RDW 16 Red cell distribution is a quantative measure or numerical expression of anisocytosis. It is a coefficient of variation of the distribution of individual RBC volume
- 13. 17 RDW-SD: It is the actual measurement of the width of the RBC distribution curve Value 35-45 fL RDW-CV: It is the ratio of standard deviation to the mean corpuscular volume RDW-CV = standard deviation of RBC volume/ mean MCV x 100 Value 11.5%-14.5%
- 14. Reticulocyte Normal value 0.5% - 1.5%. Hence 0.5% - 1.5% RBCs are replaced per day Uses To evaluate anemia Response to treatment of anemia Note If the disease causing the anemia is inside the marrow, the reticulocyte count is decreased If the disease causing the anemia is outside the marrow, the reticulocyte count is increased 18
- 15. Increased reticulocyte count Haemolytic anemia Recent haemorrhage Thalassemia Pregnancy Response to treatment Hypoxia Leukamia 19 Decrease reticulocyte count Aplastic anemia Megaloblastic anemia Anemia of chronic disease Cirrhosis Radiation Decrease ACTH and pitutary hormones
- 16. Corrected Reticulocyte Count Corrected retic count= Retic count X Observed HCT Corrects for degree of anemia Corrected retic counts of more than 2 suggestive of hemolytic anemia 20 Expected HCT
- 17. Reticulocyte Production index RPI= Corrected retic count For the correction of degree of shift 21 Maturation factor HCT Maturation Factor 45 1 35 1.5 25 2 15 2.5
- 18. 23 Normal RBC histogram Normal RBC distribution curve is Gaussian bell shaped curve Peak of curve should fall within the normal MCV range of 80-100 fl MCV is perpendicular line from peak of the curve to base There are two flexible discriminators LD (25-75 fl) and UD (200-250fl)
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- 20. RL flag When lower discriminator exceeds the preset height by 10 % 25 Possible causes of RL flag Giant platelets Microerythrocytes Fragmented RBCs Platelet clumps In case of fragmented RBC and extreme microerythrocytosis the there is no clear separation in volume between platelets and erythrocytes. Due to high numbers of RBC the platelet result might be false high and should be checked with alternative methods.
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- 22. 27 RU flag Cold agglutination RBC aggluatination Rouleax formation RBC agglutination might cause a low incorrect RBC count and effect also the parameter Hct, MCV, MCH and MCHC. In case of cold agglutinates warm the sample up to 37°C. (MCHC should trop back to normal value if the problem is solved)
- 23. 28 Multiple peaks (MP) RDW SD shows the MP flag
- 24. 29 Possible causes • Iron defiecieny anemia in recovery • Post transfusion • Extreme leucocytosis
- 25. 30 WBC histogram Lower discriminator in this fluctuates between 30 -60 fl Upper discrminator is fixed at 300 fl The number of cells between LD and UD is WBC count
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- 27. 32 WBC histogram consists of two troughs, valley discriminators, T1 (78-114 fl) and T2 (<150 fl) Peak between LD and T1 represents small cells i.e. lymphocytes Peak between T1 and T2 includes eosinophils, monocytes, blasts, promyelocytes, myelocytes and metamyelocytes Peak after T2 represents neutrophils
- 28. 33 Thrombocyte histogram Parameters of platelet histogram MPV ( 8 - 12 fl) P-LCR - ratio of large platelets Reference range 15 - 35 % PDW – Platelet distribution width curve (9-14 fl)
- 29. 34 Possible causes • High blank value • Cell fragments • High numbers of bacteria • Contaminated reagent • Platelet aggregation
- 30. 35 Possible causes • PLT clumps EDTA-incombatibility Clotted sample • Giant Platelets • Microerythrocytes • Fragmentocytes or dysplastic RBC
- 31. Immature platelet fraction IPF measures platelets newly released from bone marrow Therefore IPF is a measure of the rate of thrombopoiesis
- 32. Uses of the IPF Evaluation of thrombocytopenic patients Distinguish between increased platelet destruction and decreased platelet production Prediction of the recovery phase of thrombocytopenia Regeneration after chemotherapy Engraftment after bone marrow transplant
- 33. Cases 39
- 34. Case 1 40 Diagnosis:- Early IDA
- 35. Case 2 41 Diagnosis:- Severe IDA
- 36. Case 3 42 BETATHALASSEMIATRAIT Hb 10.1 RBC Count 5.56 MCV 68.1 MCH 18.2 MCHC 30.3 RDW 15.2 TLC 6900 Platelets 366000
- 41. CASE 8 ACUTE ITP
- 42. Key diagnostic feature of various common haematological conditions Condition Hb MCV MCH MC HC RDW RBC plot on Cystogram Normal Normal Normal Normal Normal Normal In normocytic normochromic zone Iron deficiency anemia Low Low Low Normal or low High Microcytic hypochromic zone (triangular spread) Beta thalassemia trait (minor) Normal or low Low Low Normal or low Normal or near normal Narrow clustering in the microcytic hypochromic zone (comma-shaped) Beta thalassemia (major) Very low Low Low Low Very high Widespread in the micro-cytic hypochromic zone (simulates an exaggerated version of the cystogram seen in iron deficiency) Non- megaloblastic macrocytosis Normal or low High Normal Normal Normal Closely clustered in macro-cytic zone
- 43. Key diagnostic feature of various common haematological conditions Condition RBC plot on Cystogram Megaloblas tic anemia Hb MCV MCH MC HC RDW Low High Normal Normal High Widespread in the macrocytic zone Dual deficiency anemia Low Low variable (depends on the type of anemia) Variable (depends on the type of anemia) Variable High Wide cystogram extending in both macrocytic and microcytic zones Blood transfu- sion of anemia) Norma Variable Variable l or (de- pends (depend low on the type s on the type of anemia) Variable High Double plot of patient's and transfused cells Cold agglutinins Norma l or low Bizarre Bizarre Bizarre Bizarre Most RBC plots in the high macrocytic zone; cytogram and red cell parameters return to normal after incubating blood sample at 37o C Spherocytosis Low Normal Normal Usuall y high l Norma Variable population in the hyperchromic zone
- 44. 50 Thanks! Any questions? You can contact me at: AARVI Hospital, 504-506 Copper Leaf, Bhuyangdev Cross Road, Sola,Ahmedabad drshahvaibhav8@gmail.com +91-9998631700 ALSOVISITING MEHSANA EVERY 4TH WEDNESDAY AT NAVJIVAN HOSPITAL & LIONS HOSPITAL