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Basic Examination of Blood

Provides important information about the kinds and numbers of RBC, WBC and platelet. Part of routine physical examination Help :

Evaluate symptoms (weakness, fatigue, bruising, fever, or weight loss) Diagnose conditions (anemia, infection) Diagnose diseases of the blood (leukemia) Monitor the response to some types of drug or radiation treatment



Hemoglobin Hematocrit Blood cell counting:

WBC count/WBC differential RBC count/RBC indices (MCV, MCH, MCHC)/RDW Platelet count



Blood film examination* ESR*

Main component of RBC Conjugated protein Serves as a vehicle for the transportation of O2 and CO2. Gives blood cell its red color Hemoglobin test measures the amount of hemoglobin in blood. Decrease anemia

Hemiglobincyanide (HiCN) method Principle:

Blood is diluted in a solution of K3Fe(CN)6 and KCN.




KCN Hemiglobin HiCN The absorbance of the solution is measured in a spectrophotometer at 540 nm and compared with that of a standard HiCN solution.

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Errors inherent in the sample Errors inherent in the method Errors inherent in the equipment Operators errors

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Hemiglobin (Methemoglobin/Hi) Sulfhemoglobin Carboxyhemoglobin (HbCO)

Ratio of a volume of RBCs to that of the whole blood. Expressed as a:

percentage (conventional) Decimal fraction (SI units) L/L

Ex : Ht 38% means that 38% of the bloods volume is composed of RBCs.

Measurement :

Direct centrifugation (micromethod & macromethod) Indirect automated instrument MCV X RBC count

Sources of error:

Centrifugation Sample other

Expressed as concentration cells per unit volume of blood (mm3/L)


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Leucocytes counts Leucocyte differential counts Erythrocytes counts Erythrocytes indices Platelets counts Reticulocytes counts*

Manually :

Hemocytometer Calculate from other CBC results (RBC indices)

Semiautomatically Automatically (hematologic analyzer)

Is expressed as concentration cells per unit volume of blood (mm3). No distinction is made among the six normal cell types (PMN, band neutrophils, lymphocytes, monocytes, eosinophils, basophils). Increase WBC count leucocytosis Decrease WBC count leucopenia

6 major kinds of WBC (Band Netrophil, PMN Netrophil, Lymphocyte, Monocyte, Basophil, Eosinophil) Immature neutrophil (band neutrophil) include to the test. Each type of cell plays a different role in protecting the body. Number of each type give important information about the immune system. Expressed as a percentage of each type

Increase/decrease number of each type help to identify :

infection (neutrophilia,

lymphocytosis) Allergic or toxic reaction to certain medication (eosinophilia) Malignancy (leukemia)

Is expressed as concentration cells per unit volume of blood (mm3). Decrease anemia Increase polycythaemia

There are 3 RBC indices : 1. MCV (Mean Corpuscular Volume) 2. MCH (Mean Corpuscular Hemoglobin) 3. MCHC (Mean Corpuscular Hemoglobin Concentration). Their values are determined from other measurements noted during CBC

Calculation for determining the size, content, and Hb concentration of RBC Useful for morphologic characterization of anemia Maybe calculated from:

Red cell count Hemoglobin concentration Hematocrit

3 indices: MCV, MCH, MCHC

Shows the size of RBCs. Calculated from the Ht and RBC count Ht X 1000 MCV = ----------------------------------RBC (in million per L) Expressed in femtoliter (fL) or cubic micrometers

Average volume of RBC size Counted from hct and RBC count

Normocyte Microcyte Macrocyte

Ht (%) MCV = -------------------- fL RBC count (L)

Is the content (weight) of Hb of the average RBCs. Calculated from the Hb concentration and RBC count. Expressed in picograms (g) Hb (g/L) MCH = ---------------------------------- pg RBC (in million per L) Normochrom, hypochrom. Hyperchrom reticulocyte

Is the average concentration of Hb in a given volume of packed red cells. Calculated from Hb concentration and the hematocrit. Expressed in g/dL Hb (g/dL) MCHC = ----------------- g/dL Ht

Deviation of the RBC indices from the reference value (normal value) useful in characterizing morphologic type of anemia

Hb Ht RBC Count

-Decrease microcyter




-Increase macrocyter -Decrease hypochrom




Is expressed as concentration cells per unit volume of blood (mm3). Decrease thrombocytopenia Increase thrombocytosis

To evaluate the numbers, size, and shape of RBC, WBC and platelet in a stained smear of peripheral blood.

Red Cell Distribution width Reports whether all the red cells are about the same width, size, and shape. This helps further classify the types of anemia.

Measures the settling of erythrocytes in diluted human plasma over a specified time period (1 hour) Measuring the distance from the bottom of the surface meniscus to the top of erythrocyte sedimentation in a vertical column containing diluted whole blood. Not very specific/diagnostic test still use in many institutions as a screening test for inflammation

RBC size & shape Plasma fibrinogen & globulin levels Mechanical Technical

Increase : 1. Rouleaux formation 2. Fibrinogen (elevated) 3. Immunoglobulin (excess)

Decrease : 1. Microcytes 2. Sickle cells 3. Spherocytes

Manual :

Westergren Method Wintrobe & Landsberg Method


Adult men Adult women

0-15 mm/h 0-20 mm/h


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6. 7.

Rheumatoid arthritis Multiple Myeloma Cryoglobulinemia Temporal arteritis Inflammatory diseases Pregnancy Anemia


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Malignant neoplasms Paraproteinemias Macroglobulinemia Hyperfibrinogenemia Chronic infections Collagen disease Polymyalgia rheumatica

Normal value can vary from lab to lab Normal value for CBC tests vary, depending on age, sex, elevation above sea level, and type of sample.