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Interpretationofcbc 140424111626 Phpapp02
Interpretationofcbc 140424111626 Phpapp02
OF CBC
DR. N. BAJAJ
TERMS
Anisopokilocytosis: variation in size and shape
Cytometry: measurment of the cell either visual or automated
Cluster analysis: analysis that is based upon the instrument‟s ability to cluster
different populations, together based upon size, staining, absorption or other
parameter
Contour grating: analysis where information is plotted three dimentionally, that can
be separate subpopulation of cells
Coulter principle (electrical impedence): sizing and counting cells by detecting and
measuring changes in electrical resistance when cell passes through small aperture.
Dimorphic : two population of cells in single blood sample
Forward angle light scatter: light from laser source is scatter in forward direction (0
degree) when it strike a cell or particle, larger object more forward light scatter
Forward high angle light scatter: similar to forward angle light scatter, but angle is 5
to 15 degree variation
Forward low angle light scatter: similar to forward angle light scatter, but angle is 2
to 3 degree variation
Introduction
Haematology comprise of
„Haima‟ = blood in Greek
„Logos‟ = study
Haematology is a unique super speciality in medicine
which encompasses the fields of
pathology, physiology, biochemistry, molecular
biology, obstetrics and gynecology, medicine and
paediatrics
CBC
To diagnose
1. Anemia
2. Haemoglobinopathies
3. Bone marrow aplasia
4. Nutritional deficiencies
5. Thrombocytopenia
6. Autoimmune conditions
7. Infections and Parasitemia
8. Malignancies, response to drug, chemotherapy etc.
Red blood cells
RBC produced in marrow and requires
Iron, copper, magnease, cobalt
Vitamins; especially B12, folic acid
Regulated by erythropoietin, thyroid
hormone, androgens
Counts depend upon
age, sex, altitude, exercise, drug, tobacco
use etc.
Life span - 120 days
Clinical importance of assessment of RBC is to: measures oxygen
carrying capacity of blood
Normal values
Newborn 4.1-6.1 million/mm3
Children 3.6-5.5 million/mm3
Adult (M) 4.6-6.0 million/mm3
Adult (F) 4.2-5.0 million/mm3
Decreased RBCs
Blood loss Impaired production Increased destruction
• Trauma • Pure red cell aplasia Intra-corpuscular
• Surgery • Pernicious anemia • Hereditary spherocytosis
• GI bleed • Megaloblastic anemia • Sickle cell anemia
• Gynecological • Iron deficiency anemia • Abetalipoprotienimia
disturbance • Thalassemia • G6PD
• Anemia of prematurity • Pyruvate kinase deficiency
• Anemia of chronic • PNH
disorder Extra-corpuscular
• Autoimmune
• Haemolytic disease of newborn
• Mismatch transfusion
• Microangiopathic haemolytic
anemia TTP, HUS
• DIC
• infections
• Increased RBCs
• Polycethemia vera
• High altitude
• chronic obstructive pulmonary disease(COPD,
emphysema, chronic bronchitis),
• pulmonary hypertension,
• Hypoventilation syndrome,
• congestive heart failure
• obstructive sleep apnea,
• poor blood flow to the kidneys, and
Haemoglobin
Traditional chemistry tests used for iron assessment (serum iron, Tsat,
ferritin) are indirect measurements.
Normal values
Newborn 42-68%
Upto 1 year age 29-41%
Adult Male 39-47%
Adult female 36-44%
Normal values
Newborn 103-106fL
Child upto 1 year 78 fL
Adult 79-98fL
Classified accordingly as
Microcyte – MCV <79
Macrocytic – MCV >98
Presence of microcytic and macrocytic cells in same sample may result
in normal MCV
MCV <72 without heterogeneity, is a sensitive and specific predictor
of thalassemia trait
Microcytic MCV • Normocytic MCV Macrocytic MCV
Hypochromic • Acute haemorrhage Megaloblastic
• Diamorphic anemia anemia
Iron deficiency
• Haemoglobinopathi Pernicious anemia
Thalessemia es
Sprue
Lead poisoning • Endocrinopathies
Di Gulielmo disease
Porphyria
MDS
Normochromic
Post spleenectomy
Anemia of chronic
disease Alcoholism
Normal range
Newborn 36-38%
Upto 1 year age 23-27%
Adult 26.7-31.9%
MCH decreased in
Microcytic and normocytic anemias
MCH increased in
Macrocytic anemias
Infants and newborns
Interference in MCH
Lipemia
Marked leukocytosis
Cold agglutinin
Monoclonal protein in blood
Mean corpuscular
haemoglobin concentration
MCHC = haemoglobin/ haematocrit x 10
Normal range
Newborn 34-36%
Upto 1 year age 31-33%
Adult 32-36%
MCHC decreased in
Hypocromic microcytic anemia
MCHC increased in
Heridietery spherocytosis
Infant and newborns
Autoagglutinations
Interference in MCHC
Marked leukocytosis
Haemolysis
Cold aggutinins
Rouleaux
Red cell distribution width
(RDW)
Red cell distribution is a quantative measure or numerical
expression of anisocytosis. It is a coefficient of variation of the
distribution of individual RBC volume
In microcytes, RDW increased in iron deficiency anemia but in
thalessemia it is not raised
RDW-CV:It is the ratio of standard deviation to the
mean corpuscular volume
RDW-CV = standard deviatiom of RBC volume/ mean MCV x
100
value 11.5%-14.5%
Causes
Vitamin B 12 and folic acid deficiency
Alcoholism
Liver disease
Myleodysplastic syndrome
Hypothyroidism
Drug that impair DNA synthesis
Oval macrocytes
Vitamin B 12 and folic acid deficiency
Pernicious anemia
Myleodysplastic syndrome
Hypothyroidism
Drug that impair DNA synthesis
Round hypochromic macrocytes
Alcoholism
Hypothyroidism
Liver disease
Post splenectomy
Blue tinged macrocytes
Neonate
Response to anemic stress
Target or bell cell
They have a characteristic ringed
appearance. This is because of the
“increase surface area to volume ratio”
i.e. increase in red cell membrane which
get pooled at the centre of cells
Causes
Thalessemia
Haemoglobinopathies Hb AC or CC,
HbSS,SC
Liver disease
Post spleenectomy
Severe iron deficiency anemia
abetalipoprotenimia
Schistocytes
„Schisto‟ = split or cleft
Physical assault to erythrocytes with in the
blood stream creates these cells
which include
Helmet cells
Triangles
Crescents
Microspherocytes
Horns
Purse
Causes
DIC
Severe haemolytic anemia
Microangiopathic haemolytic anemia
HUS &TTP
Prosthetic cardiac valves
Connective tissue disorders
Burns
Acute tubular necrosis, glomerulonephritis
Malignant hypertension
Tear drop cells(Dacrocytes)
Seen in
Newborn
Thalassemia major
Myleoproliferative disorder
Leukoerythroblastic reaction
Spherocytes
Ball shaped red cells, decreased surface: volume
ratio, hyperdense (> MCHC)
Seen in
Hereditary spherocytes
ABO incompatibility
Autoimmune haemolytic anemia
Microangiopathic haemolytic anemia
SS disease
Hyperspleenism
Burns
Posttransfusion
Elliptocytes
Elliptical and normochromic cells, seen normally in
less than 1% of RBCs
Causes
Hereditary elliptocytosis
Iron deficiency anemia (increased with severity)
SS disease and SA trait
Thalassemia Major
Leukoerythroblastic reaction
Malaria
Megaloblastic anemia
Burr cells (Echinocytes)
Acantho = thorn
Cells with 5-10 specules of varying length, irregular in
shape, thickness, with wide bases and appear smaller than normal
cell because they assume spheroid shape
Result from changes in membrane lipid content
Seen in
Spur cell anemia
Alcoholism
Hypothyroidism
Abetalipoprotinemia
Vitamin E deficiency
Malsbsorption
Postsplenectomy
Bite cell (Degmacyte)
Appear as a cookie with a bite taken
out
Seen in G6PD
When spleen removes the Heinz bodies
from RBCs
Stomatocyte
When examined on dry smear, it has a central slit or stoma
Seen in
Few may be seen normally
Various cardiovascular
and pulmonary disorders
Hereditary
Alcoholism
Liver disease
Malignancies
Howell – Jolly bodies