COMPLETE BLOOD COUNT

INTERPRETATIONS
Dr. Gauhar Mahmood Azeem
House Officer, Medical Unit 4
Services Hospital Lahore
‘COMPLETE’ BLOOD COUNT
COMPLETE BLOOD COUNT
 A complete blood count (CBC) is an important
and readily available investigation that focuses
on Red Blood Cells, White Blood Cells and
Platelets, and their various parameters. It can
help to serve as a screening test for many
disorders and as a prognostic or follow up tool.
COMPONENTS
 WBC • RDW
 RBC
• Platelets
 Hemoglobin
• Neutrophils
 Hematocrit
• Lymphocytes
 MCV
• Monocytes
 MCH
• Basophils
 MCHC
• Immature
Granulocytes
• Reticulocyte
count
RBC
 Normal Values
 Males 4.7 to 6.1 million cells per microliter
 Females 4.2 to 5.4 million cells per microliter
LOW RBC COUNT

 Known as anemia

 Acute or chronic bleeding

 RBC destruction (e.g., hemolytic anemia, etc.)

 Nutritional deficiency (e.g., iron deficiency, vitamin

B12 or folate deficiency)

 Bone marrow disorders or damage

 Chronic inflammatory disease

 Kidney failure
HIGH RBC COUNT
 Known as polycythemia
 Dehydration

 Pulmonary disease

 Kidney or other tumor that produces excess

erythropoietin
 Smoking

 Genetic causes (altered oxygen sensing,

abnormality in hemoglobin oxygen release)
 Polycythemia vera
HEMOGLOBIN
 Is the protein molecule that carries oxygen in the
Red Blood Cells.
 13.0-18.0 g/dl in males

 11.5-16.5 g/dl in females

 We can have N HB in N RBC

 We can have N HB in D RBC

 We can have D HB in D RBC

 Thus the other indices MCH and MCHC come

into play.
HEMATOCRIT OR PCV
 Males normal 45%
 Females normal 40%

• High Hct • Low Hct

• Increased risk of Dengue • Due to anemia
Shock Syndrome
• Anemia can be
• Polycythemia Vera characterised by using
• COPD the indices
• EPO or Erythropioten use
• Dehydration
• Capillary leak syndrome
• Sleep apnea
• Anabolic Steroid use
MEAN CORPUSCULAR VOLUME
 Normal 77-95fL
 Low MCV indicates RBCs are smaller than
normal (microcytic); caused by iron deficiency
anemia, or thalassemias, Congenital sideroblastic
Anemia, Lead Poisoning, pyridoxine deficiency,
anemia of chronic disease

 High MCV indicates RBCs are larger than

normal (macrocytic)
MEGALOBLASTIC MACROCYTIC ANEMIA
 Macrocytes in bone marrow smear
 Medications affecting folate metabolism

 Vit B12 deficiency (Pernicious Anemia)

 Folate deficiency (Alcohol related often)

 Atrophic Gastitis

 Gastrointestinal malabsorption

 Nitrous oxide abuse

 Primary Bone marrow disorders

NON MEGALOBLASTIC MACROCYTIC
ANEMIAS
 Alcohol Abuse
 Emphysema
 Hypothyroidism
 Accelerated Erythropoiesis (High Reticulocyte Index)
 Hemolytic Anemia
 Post-hemorrhagic Anemia
 Increased RBC membrane surface area
 Obstructive Jaundice Hepatic disease Post-
splenectomy
 Bone Marrow disorders Myelophthisic Anemia
Myelodysplastic Anemia (Myelodysplastic Syndrome)
Aplastic Anemia
 Acquired Sideroblastic Anemia
COULDN’T GET PAST THE SPLEEN!
MCH AND MCHC
 Mean corpuscular hemoglobin (MCH) measures the
amount, or the mass, of hemoglobin present in one
RBC. The weight of hemoglobin in an average cell is
obtained by dividing the hemoglobin by the total RBC
count. The result is reported by a very small weight
called a picogram (pg).

Mean corpuscular hemoglobin concentration (MCHC)

measures the proportion of each cell taken up by
hemoglobin. The results are reported in percentages,
reflecting the proportion of hemoglobin in the RBC.
The hemoglobin is divided by the hematocrit and
multiplied by 100 to obtain the MCHC
MCH AND MCHC
 Less in Microcytic Anemias
 Normal in Macrocytic Anemias

 Elevated in hereditary spherocytosis, sickle cell

disease and Honozygous Hemoglobin C disease
RED CELL DISTRIBUTION WIDTH
 Low value indicates uniformity in size of RBCs

 High value indicates mixed population of small

and large RBCs; immature RBCs tend to be
larger. For example, in iron deficiency anemia or
pernicious anemia, there is high variation
(anisocytosis) in RBC size (along with variation
in shape – poikilocytosis), causing an increase in
the RDW
RETICULOCYTE COUNT
 Absolute reticulocyte count = # or % retics X (pt’s Hct/
Normal Hct)
 Can be absolute or %
 In the setting of anemia, a low reticulocyte count indicates
a condition is affecting the production of red blood cells,
such as bone marrow disorder or damage, or a nutritional
deficiency (iron, B12 or folate)
 In the setting of anemia, a high reticulocyte count
generally indicates peripheral cause, such as bleeding
or hemolysis, or response to treatment (e.g., iron
supplementation for iron deficiency anemia)
RETICULOCYTE INDEX
 Reticulocyte Index= Absolute Retic
Count/Maturition Factor
 Maturation Factor

 Hct > 35% : 1.o

 Hct 25-35% : 1.5

 Hct 20-25% : 2.0

 Hct <20% : 2.5

WHITE BLOOD CELL COUNT
 The normal number of WBCs in the blood is
4,500-11,000 white blood cells per microliter
(mcL). Normal value ranges may vary slightly
among different labs.
LEUKOPENIA
 Low white cell count may be due to acute viral infections,
such as with a cold or influenza. It can be associated
with chemotherapy, radiation
therapy, myelofibrosis and aplastic anemia (failure of white
cell, red cell and platelet production). HIV and AIDS are
also a threat to white cells.

 Other causes of low white blood cell count include systemic

lupus erythematosus, Hodgkin's lymphoma, some types
of cancer, typhoid, malaria, tuberculosis, dengue, rickettsia
l infections, enlargement of
the spleen, folate deficiencies, psittacosis, sepsis and Lyme
disease. Many other causes exist, such as deficiency
in certain minerals, such as copperand zinc.
PSEUDOLEUKOPENIA
 Pseudoleukopenia can develop upon the onset of
infection. The leukocytes (predominately neutrophils,
responding to injury first) start migrating towards the
site of infection and can be scanned at the site of
infection. Their migration causes bone marrow to
produce more WBCs to combat infection as well as to
restore the leukocytes in circulation, but as the blood
sample is taken upon the onset of infection, it
contains low amount of WBCs, which is why it is
called "pseudoleukopenia".
DRUGS CAUSING LEUKOPENIA
 LOADS!!!
 Clozapine, buproprion, valproic acid, minocycline,
lamotrigine.
 Immunosuppressive drugs, such
as sirolimus, mycophenolate
mofetil, tacrolimus, cyclosporine, Leflunomide
(Arava) and TNF inhibitors.[2] Interferonsused to
treat multiple sclerosis, such as Rebif, Avonex,
and Betaseron, can also cause leukopenia.
 Chemotherapeutic drugs.

 Lots of others.
GIVE AUGMENTIN!!!
LEUKOCYTOSIS
 Known as leukocytosisInfection, most
commonly bacterial orviral
 Inflammation

 Leukemia, myeloproliferative disorders

 Allergies, asthma

 Tissue death (trauma, burns, heart attack)

 Intense exercise or severe stress

 Will mention in detail in respective cell line.

DIFFERENTIAL COUNTS
ABSOLUTE NEUTROPHIL COUNT
 {(% of Neutrophils+ % of Bands) X WBC}/100
NEUTROPENIA
 Decreased production in Medications
the bone marrow due to:
 aplastic anemia
Flecainide (a class 1C cardiac
 arsenic poisoning antiarrhythmic drug)
 cancer, particularly blood Phenytoin
cancers Indomethacin
 certain medications
 hereditary
Propylthiouracil
disorders (e.g. congenital Carbimazole
neutropenia, cyclic Chlorpromazine
neutropenia)
 radiation Trimethoprim/sulfamethoxazole (cot
 Vitamin B12, folate rimoxazole)
or copper deficiency Clozapine
 Increased destruction: Ticlodipine
 autoimmune neutropenia
 chemotherapy treatments,
Often, a mild neutropenia is seen in viral
such as for cancer and infections. Additionally, a condition
autoimmune diseases called morning pseudoneutropenia might
 Marginalisation and be a side effect of certain antipsychotic
sequestration:
 Hemodialysis
medications.
NEUTROPHILIA
• Acute or Chronic  Post splenectomy
Infection
 Cigarette smoking
• Myeloprofilerative
disorders  Hypoxia
• Acute stress  Epinephrine
• Lukemoid reactions  Exercise
• Drugs (steroids)
• Chronic Inflammation
• Tumors
• Myelophthisis
• Hyperactive marrow
LYMPHOCYTOPENIA
 Autoimmune disorders (e.g., lupus, Rheumatic
Arthritis)
 Infections (e.g., HIV, viral hepatitis, typhoid
fever, inluenza)
 Bone marrow damage (e.g., chemotherapy,
radiation therapy)
 Corticosteroids
LYMPHOCYTOSIS
 Acute viral infections (e.g., chicken
pox, cytomegalovirus (CMV),Epstein-Barr virus
(EBV), herpes,rubella)
 Certain bacterial infections (e.g. pertussis,
whooping cough, tuberculosis (TB))
 Toxoplasmosis

 Chronic inflammatory disorder (e.g., ulcerative

colitis)
 Lymphocytic leukemia, lymphoma

 Stress (acute)
LOW MONOCYTES
 Usually, one low count is not medically
significant.Repeated low counts can indicate:
 Bone marrow damage or failure

 Hairy cell leukemia

MONOCYTOSIS
 Chronic infections (e.g., TB, Fungal Infections)
 Infection within the heart (bacterial endocarditis)

 Collagen vascular diseases (e.g.,

lupus, scleroderma, rheumatoid
arthritis, vasculitis)
 Monocytic or myelomonocytic leukemia (acute or
chronic)
LOW EOSINOPHILS
 Numbers are normally low in the blood. One or
an occasional low number is usually not
medically significant
EOSINOPHILIA
 Asthma, allergies such as hay fever
 Drug reactions

 Parasitic infections

 Inflammatory disorders (celiac

disease, inflammatory bowel disease)
 Some cancers, leukemias or lymphomas
BASOPENIA :D
 As with eosinophils, numbers are normally low in
the blood; usually not medically significant
BASOPHILIA
 Rare allergic reactions (hives, food allergy)
 Inflammation (rheumatoid arthritis, ulcerative
colitis)
 Some leukemias
PLATELET COUNT
 Normal platelet counts are in the range of
150,000 to 400,000 per microliter (or 150 - 400 x
109 per liter), but the normal rangefor the
platelet count varies slightly among different
laboratories.
THROMBOCYTOPENIA
 Immune Thrombocytopenias (ITP) – formerly known as immune
thrombocytopenia purpura and idiopathic thrombocytopenic purpura
 Cirrhosis
 Splenomegaly
 Gaucher’s disease
 Familial thrombocytopenia
 Chemotherapy, radiotherapy
 Babesiosis, Dengue, Onyalai, Rocky mountain spotted fever
 Thrombotic Thrombocytopenic Purpura
 HELLP Syndrome
 Hemolytic Uremic Syndrome
 Drug Induced Thrombocytopenia (Heparin Induced
Thrombocytopenia, acetaminophen, quinidine, sulfa drugs)
 Pregnancy associated
 Neonatal alloimmune associated
 Aplastic Anemia, leukemia, lymphoma
 Transfusion associated
THROMBOCYTOSIS
 Reactive
 Chronic infection Kawasaki disease
 Chronic inflammation Soft tissue sarcoma
 Malignancy Osteosarcoma
 Hyposplenism (post-splenectomy)
 Iron deficiency
Dermatitis (rarely)
 Acute blood loss Inflammatory bowel
 Myeloprofirative disorders – platelets disease
are both elevated and activated Rheumatoid arthritis
 Essential Thrombocytosis Nephritis
 Polycythemia Vera Nephrotic syndrome
 Associated with other myeloid Bacterial diseases,
neoplasms
including pneumonia, se
 Congenital
psis, meningitis, urinary
 Cancer (lung,
gastrointestinal, breast,ovarian, tract infections, and
lymphoma) septic arthritis
MEAN PLATELET VOLUME
 Typical range of platelet volumes is 9.7–12.8 fL

 Low value indicates average size of platelets is

small; older platelets are generally smaller than
younger ones and a low MPV may mean that a
condition is affecting the production of platelets
by the bone marrow.

 High volume indicates a high number of larger,

younger platelets in the blood; this may be due to
the bone marrow producing and releasing
platelets rapidly into circulation.
PLATELET DISTRIBUTION WIDTH
 A high PDW means increased variation in the
size of the platelets, which may mean that a
condition is present that is affecting platelets
LOW BLOOD COUNTS
 All three lines depressed in
 Aplastic Anemia, Myelodysplastic Syndrome,
Chemotherapy
HIGH BLOOD COUNTS
 Polycythemia Vera (Secondary)
THANK YOU