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CBC

PROF / ABDUL HAMID ABDUL MONEM , MD

1B A S I C S

BA

SIC

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

BA

SIC

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

BA

SIC

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

NADIR

BA

SIC

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)

HCT

BA

SIC

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)

MCV

BA

SIC

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

MCH

MEAN CORPUSCULAR HAEMOGLOBIN

BA

SIC

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%

BA

SIC

S 1 Reticulocytes

Reticulocytosis • Hemolytic anemia • Hemorrhagic anemia • IDA

Reticulocytopenia

• Aplasia • Leukemia

• Infiltration

Bone Marrow Mirror Image

Normal : (0.5 – 2%)

BA

SIC

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 reticsRetics. Count × HCT/Normal

HCT

BA

SIC

S 1 WBCS

B A S I C

TLC below 10 years : 6000 – 14000TLC above 10 years : 4000 - 12000Normal

• Infection • Inflammation• Malignancy

Leuk

ocyt

osis

• Aplastic anemia

• Malignancy• Infiltration Le

ukop

enia

↑14000

↓4000

BA

SIC

S 1 Differential

TLC

B A S I C

Neutrophils: 60% Lymphocytes : 35%Esinophils: 2%Monocytes : 3-7%Basophils : 0 – 1%

Differential

BA

SIC

S 1 Neutropenia

B A S I C

• Sever infection • Autoimmune • Hypersplensim• BM failure• Cyclic

neutropenia • Congenital

Neut

rope

nia

BA

SIC

S 1 Eosinophilia

B A S I C

Eosinophili

a

AsthmaEczemaParasiticIBD(UC)Malignancy

↑50%

BA

SIC

S 1 Lymphocytosis

B A S I C

Lymphocytosi

s

Viral infectionTBALLWhooping cough

↑60%

BA

SIC

S 1 Abnormal cells

B A S I C

Band cellsN: less than 20% of total neutrophilsBandemia :↑ band cells (bacterial infection).

Metamylocytes & myleocytes in prepheripheral blood is abnormal & denotes bacterial infection .

BA

SIC

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

2ANEMIA

APPROACH

A

NE

MIA

A

PP

RO

AC

H

2 Lab. Approach To Anemia

↓ RBCS , HB & HCT

↓MCVMICROCYTIC

ANEMIA

NORMAL MCVNORMOCYTIC

ANEMIA

↑MCVMACROCYTIC

ANEMIA

DIFFERENCATE EACH TYPE

1

2

3

A

NE

MIA

A

PP

RO

AC

H

2 DD Of Microcytic Anemia • Iron deficiency

anemia • Thalassemia• Chronic illness

o Chronic infection o Chronic inflammationo Chronic renal failure

• Lead poisoning • Sideroblastic

anemia

By far the

commonest

is IDA &

Thalassemi

a

A

NE

MIA

A

PP

RO

AC

H

2 Microcytic anemia (DO SERUM IRON)

↓serum iron

Consider IDA OR Chronic illness

Do serum ferritin

IDA ↓ferrit

in ↓TS%↑IBC↑FEP

Chronic illnessNormal ferritin

Infection Inflammatio

n CRF

Normal serum iron

Blood film(basophilic stippling )

Positive Consider

Lead poisionig

Do serum lead

Negative

Do HB electrophore

sis

Abnormal Thalassemi

a

Normal Do BM

SIDEROBLASTIC ANEMIA

A

NE

MIA

A

PP

RO

AC

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

Ther

ape

utic

te

st

Stag

e of

IDA

A

NE

MIA

A

PP

RO

AC

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 N

B2

A

NE

MIA

A

PP

RO

AC

H

2 DD Of Normocytic

Anemia • Hemolytic anemia except for thalassemia • Aplastic anemia • Hemorrhagic anemia

A

NE

MIA

A

PP

RO

AC

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

PositiveAHA

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

A

NE

MIA

A

PP

RO

AC

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

A

NE

MIA

A

PP

RO

AC

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

Coom

bs

test

A

NE

MIA

A

PP

RO

AC

H

2 Normocytic anemia Amount Of Enzyme Activity Depend On The Age Of RBCS G

6PD

• 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

Alph

a th

alas

sem

iaSk

elet

al

surv

ey

A

NE

MIA

A

PP

RO

AC

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

3BLOOD FILM

B

LOO

D F

ILM

3Heinz

Bodies

B

LOO

D F

ILM

3Spherocyt

osis

B

LOO

D F

ILM

3SICKLE

CELLS

B

LOO

D F

ILM

3SCHISTOC

YTES

B

LOO

D F

ILM

3Basophilic

Stippling

B

LOO

D F

ILM

3TARGET

CELL

B

LOO

D F

ILM

3ACANTHOC

YTOSIS

CREDITAHMAD SOLIMMAN ADUL

HALIMAHMAD MOHMOD ATTIA