Physiological Blood Count

Hemoglobin (Hb) Male: 134-175 g/l

Female: 120-165 g/l
Hematocrit (Ht) Male: 0.38-0.49
Female: 0.35-0.45
Erythrocytes (RBC) Male: 4.0-5.3 x 1012/l
Female: 3.8-5.2 x 1012/l
Mean corpuscular volume (MCV) 80-95 fl
Mean corpuscular hemoglobin (MCH) 27-32 pg
Mean corpuscular hemoglobin concentration 320-370 g Hb/l rbc
(MCHC)
Red blood cell distribution width (RDW) 11.6-15.2 %
Reticulocytes 0.5-2%
Thrombocytes (PLT) 140-440 x 109/l
Mean platelet volume (MPV) 7.8-11 fl
Platelet distribution width (PDW) 15.5-17.1%
Leukocytes (WBC) 3.8-10.0 x 109/l

Differential count WBC

Neutrophil granulocytes (segments) 50-75%

2500-7500 x 109/l
“bands” – less mature neutrophils 1-5%
100-500 x 109/l
Eosinophil granulocytes 1-5%
100-500 x 109/l
Basophil granulocytes To 1%
0-150 x 109/l
Lymphocytes 15-40%
1500-4000 x 109/l
Monocytes 3-10%
200-900 x 109/l

Basic Terminology
Cell type Increasing Decreasing
Erythrocytes Polyglobulia/polycythemia Anemia
Leukocytes Leukocytosis Leukopenia
Lymphocytes Lymphocytosis Lymphocytopenia
Granulocytes Granulocytosis Granulocytopenia
Agranulocytosis
Neutrophils Neutrophilia Neutropenia
Eosinophils Eosinophilia Eosinopenia
Thrombocytes Thrombocytosis Thrombocytopenia
All cells Pancytopenia
RBC
Increasing Decreasing
Polyglobulia/polycythemia Anemia
Increased production in marrow Aplasia or damaged bone marrow
- primary polycythemia vera Lack of:
- secondary cardial or pulmonary distress - Fe
- high altitude - B12
- smoking - Folic acid
- stress Chronic diseases
- increase epo in kidneys Hemolysis
- tumor production of epo Blood loss
- dehydration Inborn defect of Hb production
Renal insufficiency
pregnancy

Mean volume of RBC (MCV) = 80-95 fl

Macrocytes Microcytes
- lack of B12 - lack of Fe
- lack of folic acid - defect of Hb production (thalasaemia)
- liver diseases - sideroblastic anemia
- ethylism - anemia of chronic diseases
- myxedema - lead intoxication
- aplasia of marrow
- drug intake (metformin, steroid
contraception)

WBC
Leukocytosis Leukopenia
- increased production - low production in marrow
- increased output from marrow - decreased output WBC
- lowered retire from blood to tissues - increased consumption

Neutrophils
Neutrophilia Neutropenia
Increased output Damage of marrow
- inflammation - inborn
- hypoxia, stress - drug related (immunosuppression,
- malignancy radiation, infiltration by tumor)
- drug intake (corticosteroids, epinephrine, change of distribution of neutrophils
lithium) - splenomegaly
lowered retire from blood to tissues - viral infection
- long term intake of steroids increased consumption of neutrophils
- myeloproliferative diseases - autoimmune diseases (SLE)
- necrosis - drug intake
- chronic inflammation (RA, IBD, etc)
Lymphocytes
Lymphocytosis Lymphopenia
- viral infection (EBV, CMV) - damage of marrow (chemotherapy,
- pertussis, TB, toxoplasmosis radiation)
- lymphatic leukemia - corticosteroids
- lymphoma - hypercorticalism (?)
- adrenal insufficiency - viral infection, TB
- Whipple disease
- AIDS
- Malignancy
- Siderosis multiplex (?)

Thrombocytes
Thrombocytosis Thrombocytopenia
1. asymptomatic 1. asymptomatic
2. symptomatic – bleeding in case of 2. symptomatic – bleeding
thrombocytopathy or increased blood
clotting - damage of marrow (chemotherapy,
radiation)
- ethylism
- myeloproliferation - lack of B12
- chronic inflammation (crohn, RA) - infection
- infection - increased consumption – artificial valves,
- splenectomy hemangiomas, DIC, autoimmunity (ITP,
- tumors SLE)
- sepsis, hypersplenisms
- pregnancy

Examination of coagulation – indications

- screening – before operations, biopsy, invasive procedures
- suspicion of defect of coagulation, thrombophil state
- measure of liver proteosynthesis
- monitoring of anticoagulation therapy

Examination of coagulation
- Common:
o Quick test
o APTT
o Fibrinogen
o Thrombin time
o Anti-thrombin
o D-dimer
- Special:
o Protein C
o Protein S
o APCR
o Factor V
o Factor VIII
o Factor X
o Factor XII
APTT: activated partial thromboplastin time
- test of factors XII, XI, IX, VIII and factors X, V, II, I
- physiology: 8-40s, comparison with normal plasma APTT
- prolonged:
o heparin intake
o hemophilia A (fVIII), B(fIX), C(fXI)
o antiphospholipid syndrome
o consumption coagulopathy – DIC
o von Willebrand disease
- shortened
o prothrombotic state

Quick Test: prothrombin time, TT (thromboplastin time)

- test of prothrombin complex
- physiology: 12-15s, INR 0.8 1.2 (80-120%)
- prolonged:
o newborns (lack of fVIII
o warfarin – INR 2-3
o K hypovitaminosis
o Defect of liver proteosynthesis
o DIC
o Deficiency of fV or vitamin K dependent f II, VII, X

Other coagulation examinations

- D-dimers
o Markers of activated fibrinolysis
o Markers of thrombotic disease
o High sensitivity, low specificity
- Antithrombin III
o Deficit – risk of thrombophilia
o Primary, secondary (DIC)