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INTRODUCTION
OUTLINE
1. Terms
• Haematology comprise of
2. Introduction o ‘Haima’ = blood in Greeks
3. Complete Blood Count o ‘Logos’ = study
4. Red Blood Cells • Haematology is a unique super speciality in medicine
5. Haemoglobin which encompasses the fields of pathology
6. Reticulocyte
(hematopathology), physiology, biochemistry, molecular
7. Haematocrit
8. RBC Indices biology, obstetrics and gynecology, medicine and
9. Peripheral Blood Smear pediatrics
10. White Blood Cell Count
11. Platelet Count COMPLETE BLOOD COUNT (CBC)
12. Low Blood Counts
• A complete blood count is a series of tests used to
13. High Blood Counts
evaluate the composition and concentration of the
various cellular and fluid components of the blood
Recording; old file • Is a basic test
TERMS • Most informative single investigation of blood
• Anisopoikilocytosis • Test consists of
o Variation in size and shape of the erythrocytes o Counts of RBC, WBC, Platelets
• Cytometry o Haemoglobin, haematocrit, and red cell indices
o Measurement of the cell either visual or o TLC, DLC
automated o Platelet count, mean platelet volume, platelet
• Cluster Analysis count, PDW
o Analysis that is based upon the instrument’s o Histogram of RBC, WBC, Platelets
ability to cluster different populations, together
based upon size, staining, absorption or other HOW IMPORTANCT IS CBC?
parameter • To know the importance of CBC, we need to know…
• Contour Grafting o What is CBC?
o Analysis where information is plotted three o Why to request for a CBC?
dimensionally, that can be separate o What are various parameters of CBC?
subpopulation of cells o What are variations in parameter of CBC?
o Quantitative analysis o What these variations can tell us?
• Coulter Principle (Electrical Impedance) o How these variations affect the assessment and
o Sizing and counting cells by detecting and care of patients?
measuring changes in electrical resistance when
cell passed through small aperture WHY CBC?
• Dimorphic • CBC is an inexpensive too and powerful too which
o Two population of cells in single blood sample provide information about
• Forward Angle Light Scatter o Blood (primarily), also about
o Light from laser source is scatter in forward o Marrow
direction (0 degree) when it strike a cell or o Health or disease state of other organs of body
particle, larger object more forward light scatter
• Forward High Angle Light Scatter CBC USES
o Similar to forward angle light scatter, but angle • To diagnoses
is 5 to 15 degree variation o Anemia
• Forward Low Angle Light Scatter o Haemoglobinopathies
o Similar to forward angle light scatter, but angle o Bone marrow aplasia
is 2 to 3 degree variation o Nutritional deficiencies
o Thrombocytopenia
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
INCREASED RBCs
• Polycythemia vera
• High altitude
• Chronic obstructive pulmonary disease (COPD,
emphysema, chronic bronchitis)
• Pulmonary hypertension
• RBC produced in marrow and requires • Hypoventilation syndrome
o Iron, copper, manganese, cobalt • Congestive heart failure
o Vitamins: especially B12, Folic Acid • Obstructive sleep apnea
• Regulated by ERYTHROPOIETIN, THYROID HORMONE, • Poor blood flow to the kidneys
and ANDROGENS.
• Counts depend upon age, sex (gender), altitude, exercise, HEMOGLOBIN
drug, tobacco use, etc.
• Life span: 120 days reason for blood donation every 3
months
• Clinical importance of assessment of RBC is to:
MEASURES OXYGEN CARRYING CAPACITY OF BLOOD
NORMAL VALUES
Newborn 4.1 – 6.1 million/mm3
Children 3.6 – 5.5 million/mm3
Adult (Male) 4.6 – 6.0 million/mm3 • Oxygen carrying component of blood
Adult (Female) 4.2 – 5.0 million/mm3 • Synthesize in polychromatic normoblast stage of red cell
development (review the stages of erythropoiesis)
DECREASED RBCs
Blood Loss NORMAL VALUES
• Trauma Newborn 15.5 – 24.5 g/L
• Surgery Adult (Male) 13.5 – 16.5 g/L
• GI bleeding Adult (Female) 12.0 – 15.5 g/L
• Gynaecological disturbance • Hb is higher in newborns due to physiologic changes
happening
Impaired Production
• Pure red cell aplasia
• Pernicious anemia
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
Spherocytes
Elliptocytes
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
Heinz Bodies
Stomatocyte
• Inclusion of denatured hemoglobin caused by
oxidation of globin portion of haemoglobin
• Removal of Heinz body leads to formation of “bite
cells”
• Causes
o Drugs
o Certain foods like fava beans and onion
• Cell of origin of bite cells
Cabot Ring
Basophilic Stippling
• A stack like arrangement of red blood cells where the
biconcave surface of RBCs are next to each other.
• Seen in
o Increase in cathodal protein, such as
immunoglobulins and fibrinogen
o Multiple myeloma
o Macroglobulinemia
o Acute and chronic infections
o Connective tissue disease
o Diabetes mellitus
o Malignancies
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
MONOCYTOSIS THROMBOCYTOSIS
• Chronic infections (e.g., TB, fungal infections) • Reactive
• Infection within the heart (bacterial endocarditis) o Chronic infection
• Collagen vascular diseases (e.g., lupus, scleroderma, o Chronic inflammation
rheumatoid arthritis, vasculitis) o Malignancy
• Monocytic or myelomonocytic leukemia (acute or o Hyposplenism (post splenectomy)
chronic) o Iron deficiency
o Acute blood loss
LOW EOSINOPHILS • Myeloproliferative disorders – platelets are both
• Numbers are normally low in the blood. One or an elevated and activated
occasional low number is usually not medically significant o Essential thrombocytosis
o Polycythemia vera
EOSINOPHILIA • Associated with other myeloid neoplasms
• Asthma, allergies such as hay fever • Congenital
• Drug reactions • Cancer (lung, gastrointestinal, breast, ovarian,
• Parasitic infections lymphoma)
• Inflammatory disorders (celiac disease, inflammatory • Kawasaki disease
bowel disease) • Soft tissue sarcoma
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CLINICAL PATHOLOGY – CBC Interpretation and Peripheral Blood Smear
• Osteosarcoma
• Dermatitis (rarely)
• Inflammatory bowel disease
• Rheumatoid arthritis
• Nephritis
• Nephrotic Syndrome
• Bacterial diseases, including pneumonia, sepsis,
meningitis, urinary tract infections, and septic arthritis.
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