COMPLETE BLOOD

COUNT
 COMPLETE BLOOD C O U N T

¡ A complete blood count (CBC) is a test 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

¡ Hemoglobin ¡ MCH (Mean Corpuscular Hemoglobin)

¡ Hematocrit ¡ MCV (Mean Corpuscular Volume)

¡ Red Blood Cells ¡ MCHC (Mean Corpuscular

Hemoglobin Concentraiton)
¡ White Blood Cells

¡ Segmenters
¡ Lymphocyte
¡ Eosinophil
¡ Monocyte
¡ Basophil
THE COMPOSITION OF
BLOOD
 HEMOGLOBIN (120-160 g/L)

¡ Determines the oxygen carrying capacity.

¡ Produced in the bone marrow and stimulated by
erythropoietin which is made in the kidneys.

¡ High: Polycythemia vera, COPD, Emphysema, Bone

Marrow dysfunction
¡ Low: Malignancy, CKD, Iron deficiency, leukemia
HEMATOCRIT (0.36 – 0.46 L/L)

¡ Red cell concentration NOT mass

¡ Percentage of RBCs in plasma
¡ UNRELIABLE as estimate of anemia

¡ High Hct: Polycythemia Vera, COPD, EPO or

Erythropoieten use, Dehydration, Capillary leak
syndrome, Sleep apnea, Anabolic Steroid use
¡ Low Hct: Anemia
 RED BLOOD CELL (4.0-5.4
10^12/L)

¡ Concentration of red blood cells within the blood

¡ High: Polycythemia Vera, Smoking, Pulmonary Fibrosis,

(any illness that causes low oxygen levels)
¡ Low: Anemia, Bone marrow failure, hemolysis,
bleeding, leukemia, malnutirition
 WHITE BLOOD CELL (4.5-11.0
10^9/L)

¡ Develop from the stem cells in the bone marrow.

¡ Involved in response to inflammatory process or
injury.
Leukopenia
Low white cell
count may be due to
acute viral infections. It
can be associated with
chemotherapy, radiation
therapy, myelofibrosis and
aplastic anemia (failure of
white cell, red cell and
platelet production).
Pseudoleukopenia Leukocytosis
Develop upon the onset Infection and
of infection. Inflammation
Myeloproliferative
disorders
Allergies, asthma
Tissue death (trauma,
burns, heart attack)
Intense exercise or
severe stress
DIFFERENTIAL C O U N T
 NEUTROPHILS
Segmenters (0.55-0.65)
¡ Also known as PMNs
¡ Primary defense against bacterial
infection and physiological
stress.
¡ Mature form (segmented
nucleus)
Stab (0.02-0.05)
¡ Immature form of neutrophils (stab
or rod like nucleus)
¡ Released from the bone marrow
to the blood stream due to
overwhelming acute infection or
inflammation.
 LYMPHOCYTE (0.25-0.35)

¡ Primary components of the body’s immune system;

Source of serum immunoglobulins and cellular immune
response.
¡ Further maturation occurs becoming T-cells and B-cells

¡ 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
 MONOCYTE (0.03-0.08)

¡ Largest cells in normal blood

¡ Acts as phagocytes
¡ Body’s second line of defense

¡ Low Monocytes: Usually low, not medically signifcant.

-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)
 EOSINOPHIL (0.02-0.04)

¡ Associated with antigen-antibody reactions;

¡ Increase usually from allergic reactions and
drug hypersensitivity
¡ Parasitic infections
¡
Low Eosinophils: Normally low, 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
 BASOPHIL (0.00-0.01)

¡ Phagocytes that contain heparin, histamines and

serotonin;

¡ Basopenia: usually not medically significant

¡ Basophilia: Rare allergic reactions (hives, food allergy), Inflammation (rheumatoid arthritis,
ulcerative colitis), Some leukemias
RED CELL INDICES
 MCH (26-34 FMOL)

¡ Measure of the mass of hemoglobin contained by a

red blood cell. It is diminished in microcytic anemias,
and increased in macrocytic anemias.

M C H = (Hgb/total R B C count) x 10
 MCV (80 -100 Fl)

¡ Measures the mean or average SIZE of INDIVIDUAL RBC’s

M C V = (Hct/total R B C count) x 10

¡ MICROCYTOSIS & MACROCYTOSIS :

¡ Microcytosis is taken to mean the presence of RBCs with a
MCV less than normal(Iron deficiency anemia)
¡ Macrocytosis means the presence of RBCs with an MCV
greater than normal(Megaloblastic Anemia, vit B12 deficiency,
Folic acid deficiency).
 MCHC (31-37 g/L)

¡ A measure of the concentration of hemoglobin in a

given volume of packed red blood cell
¡ It is diminished ("hypochromic") in microcytic anemias,
and normal "(normochromic )”

M C H C = (Hct/Hct) x 100
 PLATELET (150-450 109/L)

¡ Are broken off from a very large cell in the bone

marrow called a megakaryocyte
¡ Primary function is to aid in blood clotting
 PLATELET

¡ Thrombocytopenia:
¡ Immune Thrombocytopenias (ITP) – formerly known as immune
thrombocytopenia purpura and idiopathic thrombocytopenic
purpura, Cirrhosis, Splenomegaly, Gaucher’s disease, Familial
thrombocytopenia, Chemotherapy, radiotherapy

¡ Thrombocytosis:
¡ Reactive, Chronic infection, Chronic inflammation, Malignancy,
Hyposplenism (post- splenectomy), Iron deficiency, Acute blood
loss, Myeloproliferative disorders – platelets are both elevated
and activated
INTERPRETATION OF CBC
1. Look at the Hgb, RBC and Hct if there is presence of
anemia/polycythemia

2. If there is anemia, look at the RBC indices

1. MCV (microcytic/macrocytic)
2. MC H (hypochromic or hyperchromic)
3. M C H C

3. Look at the R D W (red cell distribution width)

4. Check the W B C count

5. Check the differential count

6. Check the platelet count