1 complete blood counts.ppt

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Information about 1 complete blood counts.ppt

Published on September 26, 2018

Author: AbdulKaderSouid

Source: slideshare.net

1. Complete Blood Counts (CBC) Abdul-Kader Souid 9/26/2018 1 The erythrocytes, leukocytes & thrombocytes

2. CBC Describes the Tri-lineage Hematopoiesis 9/26/2018 Erythrocytes (red cells): (1) Hemoglobin (Hb) concentration (g/L) (2) Red blood cell (RBC) count (# of cells x1012/L) (3) Reticulocyte (Retic) count (# of cells x109/L) (4) Mean cell volume (MCV, fL) & Relative distribution width (RDW = SD/MCV, %) Leukocytes (white cells): (5) White blood cell (WBC) count (# of cells x109/L) (6) WBC differential = neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts (# of cells x109/L) Thrombocytes (platelets): (7) Platelet count (# of platelets x109/L) 2 Reticulocytes Tri-lineages Hematopoiesis

3. 9/26/2018 1. Normal leukocyte and platelet lineages. 2. Erythroid lineage: Microcytosis (low MCV), normal RDW and high RBC count, consistent with thalassemia trait. 3. Hematocrit, MCH, and MCHC are calculated values. 4. MPV = mean platelet volume. CBC in an 8-year-old girlWBCdifferential

4. 9/26/2018 4 Hemoglobin Concentration varies with age and gender Lower Limits (-2SD) of Normal Hemoglobin Concentrations (g/L) Birth 145 (↑due to low fetal oxygen) 2 to 6 mo 90 (physiologic anemia) 4 to 12 y 115 (pre-pubertal) 12-18 y (males) 140 (male puberty hormones) 12-18 y (females) 123 (female puberty hormones) Reference values are ± 2 standard deviation (SD) Lower limits of normal are -2SD Upper limits of normal are +2SD

5. • Normal RBC counts are 3.5 to 6.5 x1012/L (average, 5.0 x1012/L). Anemia is associated with ↓RBC count; thalassemia trait is associated with ↑RBC count. • Normal reticulocyte counts are 35 to 130 x109/L (1-2% of the RBC count). Values <35 x109/L are reticulocytopenia and >130 x109/L are reticulocytosis. 9/26/2018 5 RBC and Reticulocyte Counts Methylene blue stain

6. 9/26/2018 6 Mean Cell Volume (MCV) (Normal values are age-dependent.) • MCV is expressed in femtoliter (fL = 10-15 L). • MCV <70 fL is microcytosis at any age. Normal (Reference) Ranges Birth 98 – 116 fL 1 mo – 10 y “70 fL + years of age” – 100 fL > 10 y 80 – 100 fL RBCCountRBCCountRBCCount

7. RDW (relative SD) is a measure of the variation in red cell volume (= anisocytosis). RDW = SD ÷ MCV Normal RDW is ≤0.14 (or ≤14%) Relative Distribution Width (RDW) Example: Calculate RDW for MCV = 80 fL and SD = 8 fL. RDW = SD ÷ MCV = 8 ÷ 80 = 0.1 or 10%. RBCCountRBCCountRBCCount anisocytosis

8. Microcytosis • Microcytosis indicates impaired hemoglobin synthesis (low iron or low globin). • Causes of Microcytosis – Iron deficiency (↑RDW) – Thalassemia trait (normal RDW) – Inflammation (blocking iron delivery to erythrocytes) – Ineffective protoporphyrin synthesis (hereditary sidroblastic anemia) 9/26/2018 8 RBC should have the same size as a small lymphocyte (arrow). The red cells in this slide (e.g., the one pointed by arrow head) are small (microcytosis) Must know

9. Macrocytosis Macrocytosis indicates impaired erythroid replication (inadequate folate or vitamin B12). 9/26/2018 9 microcytosis macrocytosis anisocytosis Must know

10. Neutrophil and Lymphocyte counts Neutrophil counts should be >1.5 x109/L. Neutropenia is an immune deficient state. 9/26/2018 10 Lymphocyte counts should be >1.5 x109/L. The majority of peripheral lymphocytes are T cells. Thus, lymphopenia indicates T-cell immune deficiency. Platelet counts are 150 to 400 x109/L. Values <150 x109/L are thrombocytopenia and >400 x109/L are thrombocytosis. Must know

11. 9/26/2018 11 A 12-month-old boy 1. Normal leukocyte and platelet lineages, except for mild neutropenia. 2. Erythroid lineage: Mild anemia, microcytosis, and increased RDW, consistent with iron deficiency anemia.

12. 9/26/2018 12 An 18-year-old male Microcytic anemia with normal RDW, consistent with thalassemia trait.

13. An 18-year-old female Mild microcytic anemia (resolved) Reticulocytosis (resolved) Severe thrombocytopenia (resolved)

14. 9/26/2018 14 A 7-year-old girl Severe periodic neutropenia Mild normocytic anemia and thrombocytosis, consistent with inflammation (infection)

15. 9/26/2018 15 Leucopenia + neutropenia + lymphopenia Microcytic anemia with normal RDW Thrombocytopenia = Pancytopenia A 27-year-old male

16. 1. Anisocytosis 2. MCV <70 fL 3. Folate/ vitamin B12 deficiency 4. Iron deficiency 5. Thalassemia trait 6. Hemoglobin <115 g/L 7. Reticulocyte count >130 x109/L 8. Reticulocyte count <35 x109/L 9. Impaired hemoglobin synthesis 10. Impaired erythroid replication 11. Neutrophil count <1.5 x109/L 12. Lymphocyte count <1.5 x109/L 13. Adolescent males 14. Non-nucleated red cells containing ribonucleic acid 9/26/2018 16 A. Microcytosis B. Macrocytosis C. Anemia D. Neutropenia E. Lymphopenia F. Reticulocytopenia G. ↑RDW H. ↓MCV + ↑RDW I. ↓MCV + normal RDW J. Reticulocytes K. ↑Hemoglobin concentration L. Anisocytosis

17. “Must Know Pearls” • Anemia (↓hemoglobin) • Microcytosis = Impaired hemoglobin synthesis (iron deficiency vs. thalassemia trait) – Iron deficiency = ↓MCV + ↑RDW – Thalassemia = ↓MCV + normal RDW – RDW (= SD ÷ MCV) measures red cell size (volume) variation (anisocytosis). • Macrocytosis = Impaired erythroid replication (e.g., folic acid; vitamin B12 deficiency) • Neutropenia & lymphopenia = Immune deficiency • Thrombocytopenia (↓platelet count) 9/26/2018 17

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