COMPLETE BLOOD COUNT

INTERPRETATION

ARIKOD DANIEL
Sample interpret
How Important is CBC?
• To know the importance of CBC, we need to know……..
1. What is CBC?
2. Why CBC?
3. What are various parameters of CBC?
4. What this variations can tell us?
5. How these variations affect the assessment and care of patients?
CBC
• Is an important haematological, most informative and readily
available investigation used to evaluate the composition and
concentration of various cellular components of blood. It focuses on
Erythrocytes, White blood cells, and platelets plus their various
parameters.
• It can help to serve as a screening test for many disorders and as a
prognostic or follow up tool.
Why CBC?
• CBC is an inexpensive tool and powerful tool which provides
information about;

• Blood
• Bone marrow
• Health or disease state of other organs of the body.
CBC Uses
• To diagnose
 Anemia
 Hemoglobinopathies
Bone marrow aplasia
Nutritional deficiencies
Thrombocytopenia
Autoimmune conditions
Infections &parasitaemia
Malignancies, response to drugs, chemotherapy, allergic reactions etc
COMPONENTS
• Tests consist of counts for: • RDW
• WBCs • Platelets
• RBCs • Neutrophils
• Hemoglobin • Lymphocytes
• Haematocrit • Monocytes
• MCV • Basophils
• MCH • Immature granulocytes
• MCHC • Reticulocyte count
Red Blood Cells
• Erythrocytes produced in marrow • Normal values
&requires iron, copper,
manganese, cobalt, vitamins(b12
&folic acid) Adults: M- 4.7 to 6.1 million
• Regulated by erythropoietin, cells/ml
thyroid hormone &androgens F- 4.2 to 5.4million
• Counts depend on: sex, age, cells/microliter.
altitude, exercise, drugs, smoking Children: 3.6 to5.5 million/mm3
etc. New-born: 4.1 to 6.1million/mm3
• Life span - 120 days
• Clinical importance: measures
blood oxygen carrying capacity.
Low RBCs Count (Anemia)

Blood loss Increased destruction

• Trauma Intracapsular
• Surgery • Hereditary spherocytosis
• SCD
• GI bleeding
• G6PD
• Gyn/ obs disturbances
• Pyruvate kinase deficiency
Impaired production Extra corpuscular
• Red cell aplasia • Autoimmune
• Anaemias (pernicious, megaloblastic, • Haemolytic ds of new born
iron deficiency, prematurity, chronic ds) • Mismatch BT
• Thalassemia's. • Microangiopathic haemolytic anemia, TTP, HUS,DIC
• BM disorders/damage, kidney failure • Infections.
Increased RBCs (polycythemia)
• Polycythemia Vera
• High altitude
• COPD( emphysema, chronic
bronchitis &chronic asthma).
• Pulmonary HTN
• Hypoventilation syndrome.
• CCF
• Obstructive sleep apnoea
• Dehydration
• Kidney/other tumor producing
excess erythropoietin
• Smoking
• Genetics(abnormal Hb oxygen
release & sensing)
Haemoglobin
• Is the protein molecule that is main
component of RBCs &transports
oxygen & Carbon dioxide in RBCs.
• Synthesized in polychromatic stage of
red cell devt.
• Great predictor of anaemic states
• Measured by automated blood cell
counters & cyanhemoglobin
method.(principle..
spectrophotometry).
• Critical values: <5.0g/gl or >20g/dl
• Newborn:14-24g/dl
• Indications
Determine anemia presence
Determine polycythemia
Determine increase after RBC
Transfusion(1g/dl/1unit of pRBCs)
• Reference range
Adults M:14-18g/dl
Adults F: 12-16g/dl
Pregnant F:>11g/dl
Elderly: slight decrease.
Interpretation

Low haemoglobin High Hemoglobin

• Absolute anaemia: RBC mass
decreased.
Decreased pdtn, increased
destruction or loss. i.e. nutritional
def, chronic ds anemia, BM
infiltration,hemorrhage
• Relative: ass with plasma volume
increase i.e. over hydration,
pregnancy, post flight astronauts.
• Polycythaemia: Hb >18.5g/dl(M)
& >16.5g/dl(F).
• Absolute (increased RBC mass)
Hypoxia
Inappropriate erythropoietin pdtn.
Genetics & Vera
• Relative: i.e. dehydration, shock,
diuretics, etc.
Haematocrit(PCV)
• Ratio of the volume of erythrocytes High
to whole blood.
• Most precise for determining degree • Polycythaemia Vera, Dehydration,
of anemia/ polycythemia Low oxygen in blood, congenital
• Rule of 3: RBC X3 =Hb heart ds, cor pulmonale, smoking,
Hb x3 =Hct hemoconcentration(dengue).
• Normal values Low
• Adult(M) 39-47% • Anemia, blood loss, Haemolysis,
• Adult(F) 36-44% BM aplasia, leukemia
&malnutrition.
NB: elevated Hct could be hyper spleen
ftn, Reduced Hct may indicate low
thymus ftn.
Mean corpuscular volume
• Measures average vol of RBCs. • Low MCV
• MCV= Hct/ RBC X100 indicates small RBCs caused by:
• Normal values iron def, thalassemia, pyridoxine
def, anaemia of chronic ds.
Adult: 79-98fl
Classified : Microcytic MCV<79
• High MCV
macrocytic MCV>98
indicates RBCs larger than
NB: MCV <72 without normal(macrocytic)
heterogenicity, sensitive &specific
predictor of thalassemia trait.
Macrocytic Anemia
Megaloblastic macrocytic Anemia
• Macrocytes in BM smear
• Causes:
• Meds affecting folate metabolism.
• Vit B12 def(pernicious)
• Folate def(alcohol related)
• GI malabsorption
• NO abuse
• Primary BM disorders.
Non megaloblastic macrocytic anemia
• Alcohol abuse
• Emphysema
• Hypothyroidism
• Accelerated erythropoiesis
• Haemolytic anemia
• Post haemorrhage
• Post splenectomy
• BM disorders(aplastic)
Mean corpuscular Haemoglobin(MCH)
• Measures the amount of Hb
present in one RBC.
• MCH =Hb/RBC Count x100
• Normal values
Adult 32-36%
Up to 1yr 31-33%
New born 34-36%
• MCH low in:
Microcytic Anemia
Normocytic Anemia
• MCH increased in:
Macrocytic Anemia
Infants &new-borns.
Hereditary spherocytosis, SCD, etc.
• Interference in:
Lipemia
Marked leucocytosis
Monoclonal proteins in blood.
Cold agglutinin.
Mean corpuscular Haemoglobin
concentration(MCHC)
• Measures the proportion of each • Increased in;
cell taken up by Hb in % Hereditary spherocytosis
• MCHC =Hb/ Hct x100 Auto agglutinations
• Normal Range Infants & new-borns
Adult 32-36%
New-born 34-36% • Interference in:
Children 31-33% • Marked leucocytosis
• Haemolysis
• Decreased in:
Hypochromic microcytic anemia
Red cell distribution width(RDW)
• Quantitative/ numerical • For Example:
expression of anisocytosis i.e. • In iron def, there is high variation
coefficient of distribution in size(anisocytosis) & shape(
variation of individual RBC poikilocytosis) causing elevated
volume. RDW.
• Low value indicates uniformity
in size of RBCs
• High value indicates mixed
population of small & large
RBCs; immature RBCs are larger
Reticulocyte count
• Normal: 0.5-1.5% • Reticulocyte Index
Hence 0.5-1.5% RBCs are replaced daily. • Reticulocyte index= Absolute retic
• Uses: count/ Maturation Factor.
Evaluate anemia • Maturation Factor
Response to anemia Rx. Hct >35%:1.0
• NB: Hct 25-35%:1.5
If the ds causing the anemia is inside Hct 20-25%:2.0
the BM, the reticulocyte count is Hct <20%:2.5
decreased.
If the ds causing the anemia is outside
BM, the reticulocyte count is
increased.
White blood Cell Count
• The normal number of WBCs in the blood
is 4500- 11,000cells/microliter. Normal
value ranges may vary slightly among
different labs.
• WBCs play a major role in
immunopathogenesis of man human
diseases.
• Types
Granulocytes: are polymorphonucleated
contain membrane bound granules i.e.
Neutrophils, basophils & eosinophils
Agranulocytes( mononucleated):
Apparently absent granules but have non
specific azurophilic granules i.e.
lymphocytes, monocytes, macrophages
Leukopenia
Low WBC count may be due to:
 acute viral infections i.e. influenza
Ass with chemotherapy, radiation
therapy, myelofibrosis & aplastic anemia.
Hematopoietic stem cell abnormalities(
leukemia,
HIV/AIDS are also a threat to WBCs.
Others: SLE, Hodgkin's lymphoma, ca.,
typhoid, malaria, TB, Splenomegaly, folate
def, copper &zinc def.
Leukopenia……
Pseudo leukopenia
• Develops upon onset of infection.
Leukocytes start migrating towards
infection site &can be scanned at
infection site. Their migration
causes BM to produce more WBCs
to combat infection as well as
restore leukocyte circulation, but
as blood sample is taken upon
infection onset, it contains low
WBCs which is why is called
pseudoleukopenia
Drugs causing Leukopenia
• Loads of drugs!!!
• Clozapine, bupropion, valproic
acid, minocycline's, lamotrigine.
• Immunosuppressive drugs i.e.
cyclosporine, interferons,
corticosteroids, TNF inhibitors
• Chemotherapeutic drugs
• Etc., etc………..
Leukocytosis
• Elevated WBC is seen in response to infection
commonly bacterial or viral, severe stress &
intense exercise, inflammatory
disorders(reactive Leukocytosis), tissue
death(trauma, burns, heart attacks), Allergies,
Asthma or abnormal production in leukaemia.
• Leukocytosis can be due to an individual cell
component or combinations, depending on
cause.
• NB: Malaise, chills, fever, related to infection
are clinically seen in both leukopenia &
neutrophilic Leukocytosis
• Neoplastic proliferation of WBCs within BM
also cause Leukocytosis
• Reference range
 Leukocytes(Adults, >2yrs:5000-10000/mm3)
 Leukocytes(<2yrs 6200-17000/mm3)
 Neonates(9000 -30,000/mm3)
 Neutrophils(2500 -8000/mm3)
 Lymphocytes( 1000 -4000/mm3)
 Monocytes(100 – 700/mm3)
 Eosinophils(50 -500/mm3)
 Basophils(25 -100/mm3)
Will mention in detail respective cell
lines(differential counts).
Interpretation…
1. Neutrophilic Leukocytosis 3. Basophilic Leukocytosis
Neutrophils >7.5 x109/l Basophils: >0.1 x109/l
• Acute bacterial infections. • Rare allergic reactions( IgE mediated)
• Sterile inflammation/necrosis in Myocardial 4.Monocytic Leukocytosis
Infarcts, Burns, crush injuries. Monocytes: 0.8 x109/l
• Chronic infections i.e. TB
2. Eosinophilic Leukocytosis • Bacterial endocarditis
Eosinophils: >0.4 x109/l • Rickettsiosis
• Allergies, asthma, hay fever, atopic dermatitis
• Malaria, IBD
• Parasitic infections 5. Lymphocytosis: >3.5 x109/l
• Drug reactions • Viral infections: Hep A, CMV, EBV
• Bordetella pertussis, Accompanies
monocytosis
Differential Blood counts
• Gives relative percentage of each
type of WBC & also helps reveal
abnormal WBCs populations( eg,
blasts, immature granulocytes, or
circulating lymphoma cells in
peripheral blood).
• DBC is used along with leukocyte
count to generate absolute values
for each type of WBCs( eg,
absolute neutrophil count) which
usually gives more meaningful
information than relative
percentages(can be misleading)
• DBC is not part of CBC but its
interpreted together to help
support or exclude a suspected
diagnosis. For example, presence
of anemia along with
thrombocytopenia with low or high
WBC count suggest BM
involvement by leukemia.
• NB: Use of absolute values helps
identify conditions like
neutropenia, neutrophilia,
lymphopenia, lymphocytosis,
monocytopenia, monocytosis,
eosinophilia & basophilia
Neutrophils
Neutropenia
• Decreased pdtn in BM due to:
Aplastic Anemia, arsenic
poisoning, ca, certain drugs,
hereditary disorders, radiations,
and Vit def.
• Increased destruction:
Autoimmune, chemotherapy
• Marginalization& sequestration:
Haemodialysis
• Mild in viral infections
Neutrophilia
• Acute/chronic infection
• Myeloproliferative disorders
• Acute stress
• Lukemoid reactions
• Drugs(steroids)
• Chronic inflammations
• Tumours
• Hyperactive BM, post splenectomy,
hypoxia, exercise etc.
Lymphocytes

Lymphocytopenia Lymphocytosis
• Autoimmune disorders (eg, • Acute viral infections( eg, chicken
SLE,RA) pox, CMV, EBV, Herpes, rubella).
• Certain Bacterial infections( eg,
• Infections( eg, HIV, viral pertussis, whooping cough, TB).
hepatitis, enteric fever, influenza
• Toxoplasmosis
etc.)
• Chronic inflammatory disorders(
• BM damage( eg, chemotherapy, eg, IBD)
radiation therapy) • Lymphocytic leukaemia,
• Corticosteroids lymphoma, stress etc.
Eosinophils….
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, atopic dermatitis etc.
• Drug reactions.
• Parasitic infections
• Inflammatory disorders(IBD,
celiac ds).
• Some cancers, leukemias or
lymphomas.
Monocytes
Low monocytes
• Usually, one low count is not
medically significant.
• Repeated low counts can
indicate:
BM damage/failure
Hairy cell leukemia
Monocytosis
• Chronic infections(eg, TB, fungal
infections).
• Infection within the
heart(bacterial endocarditis)
• Collagen vascular diseases( eg,
lupus, scleroderma, RA,
Vasculitis)
• Monocytic or myelomonocytic
leukemia(acute or chronic).
Basophils

Basopenia Basophilia
• As with eosinophils, numbers • Rare allergic reactions(hives,
are normally low in the blood; food allergy)
usually not medically significant. • Inflammation( RA, ulcerative
colitis)
• Some leukemias… etc.
Platelet count
Nugget
• One of the most important component of
haemostatic system along with
coagulation factors &endothelial cells
lining blood vessels.
• Platelets arise from the fragmentation of
the cytoplasm of megakaryocytes in BM
&circulate in blood as disc shaped
anucleate particles for 7-10 days.
• Normal platelet counts are in the range
of 150,000- 400,000/microliter) but
normal ranges vary slightly among
different laboratories.
Thrombocytopenia
• Immune thrombocytopenias formerly
immune thrombocytopenic purpura(ITP)
& Idiopathic purpura.
• Cirrhosis, splenomegaly (gauchers ds)
• Familial thrombocytopenia, neonatal
alloimmune associated
• Chemotherapy, radiotherapy
• HELLP syndrome, Preg associated
• HUS, drug Induced( heparin, PCM)
• Aplastic anemia, leukemia, lymphoma
• Transfusion associated
Platelet count....

Thrombocytosis Thrombocytosis…
• Reactive: • Associated with; other myeloid
Chronic infection neoplasms
Chronic inflammation • Cancers(lung, GI, breast, ovarian,
Malignancy lymphoma).
Hyposplenism • Congenital
Iron deficiency • Others: Soft tissue sarcoma,
Acute blood loss osteosarcoma, IBD, RA, nephrotic
• Myeloproliferative syndrome, bacterial ds(pneumonia,
disorders…elevated &activated( Vera sepsis, meningitis, UTIs,& septic
& essential thrombocytosis) arthritis).
Mean platelet Volume
• Typical range :9.7 -12.8fl Platelet Distribution Width
• Low values indicate average size of
platelets is small; older platelets • A high PDW means increased
are smaller than young ones & low variation in the size of the
MPV may mean that a condition is platelets, which may mean that the
affecting the production of condition affecting platelets is
platelets by the BM. present.
• High volume indicates a high
number of larger, younger platelets
in blood; could be due to BM
producing & releasing platelets
rapidly to circulation.
Pancytopenia
• A decrease in all three cell lines • High blood counts
is the common manifestation of
BM failure.
• Elevation in all the three lines is
• Causes a common manifestation of
Aplastic or hypoplastic anemia polycythaemia Vera(secondary):
can be idiopathic or from a stem cell disorder
secondary causes characterized by a
Myelodysplastic anemia panhyperlastic, malignant and
syndrome neoplastic BM disorder
chemotherapy
CBC Histograms
• Are graphical representations of
the blood cell populations.
• Cells separated according to type
based on their size with each peak
representing a different cell type.
• Helps in:
Verifying differential counts
Identify uncommon disease
process
Indicate sample integrity.
Serves as quality control check.
• Area under curve= relative count
for specific sample run.
• Histograms vary from pt to pt.
Examples of uncommon process
Lymphocytosis
Leukemia
Stress leukocytosis
Clumped platelets(false LYM)
Regenerative anemia
Histogram….
Egs of histograms
WBCs( lymphocytes,monocytes
& granulocytes)
Eosinophils
RBCs
Platelets
THANK YOU.