Lecture 5.cbc
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The CBC provides information on red blood cells, white blood cells, and platelets that can help diagnose various medical conditions. It measures components like hemoglobin, hematocrit, and mean corpuscular volume to identify anemias and other abnormalities. Interpreting the CBC requires understanding how conditions like infections, allergies, and bleeding disorders can impact the results.
Lecture 5.cbc
- 3. Abstract Interpretation of different parameters reported on modern day analyzers is bit tricky and demand continuous monitoring and on-going learning. In present paper interpretation of different reported parameters has been discussed with approach to diagnosis of various abnormalities.
- 4. The CBC interpretation are useful in the diagnosis of various types of anemias. It can reflect acute or chronic infection, allergies, and problems with clotting.
- 5. • 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
- 6. • 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.
- 7. 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 %
- 8. – 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
- 9. • 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%
- 10. • 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
- 11. Screening Tests – Anaemia • Clinical Signs and symptoms • Routine Hemoglobin examination Cut off marks for Hb all possible sites • Look for the causes for anemia
- 12. PCV or Hematocrit • 57% Plasma • 1% Buffy coat – WBC • 42% Hct (PCV)
- 13. The Three Basic Measures Measurement Normal Range A. RBC count 5 million 4 to 6 B. Hemoglobin 15 g/dl 12 to 17 C. Hematocrit 45 % 38 to 50 Check whether this holds good in given results If not -indicates micro or macrocytosis or hypochromia.
- 14. The Three Basic Measures MeasurTHE RULE OF THUMB Normal R g% 12 to 17 A. Hematocrit 45 38 to 50 A x 3 = B x 3 = C - This is Check whether this holds good in given results If not -indicates micro or macrocytosis or hypochromia.
- 15. Anaemia RETICULOCYTE COUNT % Normal Less than 2%
- 17. Normal CBC
- 18. Workup – Second Test • The next step is ‘What is the size of RBC’ ? • MCV indicates the Red cell volume (size) • Both the MCH & MCHC tell Hb content of RBC • If the Retic count is 2 or less • We are dealing with either – Hypoproliferative anaemia (lack of raw material) – Maturation defect with less production – Bone marrow suppression (primary/ secondary)
- 19. Anaemia Workup - MCV Microcytic MCV Normocytic Macrocytic Iron Deficiency IDA Chronic Infections Thalassemias Hemoglobinopathies Sideroblastic Anemia Chronic disease Early IDA Hemoglobinopathies Primary marrow disorders Combined deficiencies Increased destruction Megaloblastic anemias Liver disease/alcohol Hemoglobinopathies Metabolic disorders Marrow disorders Increased destruction
- 20. Mean Cell Volume (MCV) • RBC volume (rather) is measured by • The Mean Cell Volume or MCV and RDW Microcytic < 80 fl MCV Normocytic Macrocytic 80 -100 fl > 100 fl
- 21. Red cell Distribution Width - RDW Normal Population Uniform RDW High Population Double
- 22. IDA -CBC
- 23. Microcytic Hypochromic - IDA
- 24. Anemia - Macrocytic (MCV > 100) Premature gray hair – consider MBA Mow as 6 grams MCV 100-110 fl must look for other causes of macrocytosis MCV > 110 fl almost always folate or B12 deficiency
- 25. MBA
- 27. MBA
- 28. Basophilic Stippling - MBA BS occurs in Lead poisoning also
- 29. RBC Size – Anisocytosis Different sizes of RBC
- 32. Target Cells
- 33. • 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%
- 34. 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.
- 35. • 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
- 36. • 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
- 37. – 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. fever, brucellosis.
- 38. • 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
- 39. Eosinophilia may be found in • Parasitic infections • Allergic conditions and hypersensitivity reaction
- 40. • 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)
- 41. • Lymphocytosis – may indicate _ Viral infection e.g. Infectious mononucleosis, CMV or pertussis. _ Bacterial infection e.g. TB • Lymphopenia – caused by _Stress. _Steroid therapy _ Irradiation
- 42. • (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.
- 43. • Fever • Malaise • Weakness • Others depend on each system which is involved e.g. » chest: cough, and chest pain » abdomen: diarrhea, vomiting, dehydration. »CNS: headache, visual disturbance, Neck stiffness and so 0n.
- 44. • Infection of the mouth and throat. • Painful skin ulceration. • Recurrent infection. • Septicemia.
- 45. •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
- 46. • 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.
- 47. • Petechial hemorhage. • Easy bruising. • Mucosal bleeding _gum bleeding