Complete Blood Count

CBC
HB WBC, leukocytes Platelet x1000
11.5-14 g/dl (x1000) 4-11
150-450
Hct 35-45% • Neutr (segm)PNL
40-60% MPV
MCV 75-86 fl
• Lymph 20-40%
MCHC 27-33%
• Band (stab, staff)
Retics 0.5-2% <5% (immature)
RDW 11-15 • Basophil 0.5-1 %
• Eosinophil 1-4%
• Monocytes 2- 8%
• Shift to left, I/T
ratio
• Toxic granulation
• Blast cell
• Hb>16 gm/dl, Hct>60% polycythemia
• Low Hb, low Hct, Low plat, Low WBC.
Pancytopenia as aplastic anemia, fanconi anemia,
leukemia, B12 def, hypersplenism (??retics), (??
MCV)
• Low Hb, low Hct only = Anemia
 low MCV <75, low MCHC ;microcytic hypochromi
An ( Fe def an, hemolytic An thalas, An of ch
infecion)
 nor MCV 75-86 fl , normocytic An ( aplastic,
leukemia, blood loss)
 high MCV > 90 Fl, macrocytic An ( folic acid def,
B12 def)
RDW ( 11-15) measure variation in size of RBS (MCV), the
higher RDW indicates more variation in size (anisocytosis),
Fe def. anemia, B12, folic acid def. increase RDW
Retics high >2% in hemolytic An, hypersplenism
 If pancytopenia & low retics < 0.5 %= aplasic An
 if pancytopenia & high retics= hypersplenism
 If only anemia & high retics = hemolytic An.
 (Fe def. after 3 days of iron ttt has high retics)
Platelets <150,000= thrombocytopenia, ITP
Megakaryocyte seen in blood film , bone marrow
has defective budding

HSP is vasculitis nor plat.

If >450,000/mm3 (thrombocytosis
Kawasaki disease, reactive thrombocytosis with
hem An, infection)
Mean platelet volumes MPV 9.4–12.3 fL (femtoliter)
low platelet count, low MPV (bone marrow disorders
that slow down or decrease platelet production e.g.
aplastic anemia. 
high platelet count, low MPV (infection, inflammation)

low platelet count , high MPV (large platelets )

suggests that bone marrow is producing platelets and
releasing them into circulation rapidly.(ITP,
Hypersplenism)
Normal platelet count, high MPV  (hyperthyroidism or
chronic myelogenous leukemia (CML)
• WBC if <4,000 =leucopenia in bone marrow suppression,
leukemia
• WBC >11,000 = leucocytosis in
infections ~20-30,000, high band cell>5% (Bandemia)
( if >20%= septicemia). Shift to left, toxic granulation & neutrophelia =
Bact infecion
If lymphocytosis > 50% of WBC = viral infection, CMV, EBV,
lymphocytic leukemia, TB

leukomoid reaction > ~50,000 The major causes of leukemoid

reactions are severe infections, intoxications, malignancies,
severe hemorrhage, or acute hemolysis.
presence of Blast cells = leukemia
Proved by bone marrow sample
Band cell Toxic granulation

Toxic vacuoles
Shift to left, immature /total (I/T) ratio
Blast cells in leukemia
HB 11.5-14 g/dl
Hct 35-45%
MCV 75-86 fl
MCHC 27-33%
Retics 0.5-2%
WBC (x1000) 4-11
Band <5%
Platelet (x1000) 150-450
 Evaluation of a CBC Report
• Hb

• RBCs count
• WBC count
• Platelet count
• RBC indices :MCV, MCH
• Reticulocyte count as % of RBCs

• Percentage of band cells

 Evaluation of a CBC Report
• Hb (as a general indicator of anemia)
• MCV (a key parameter for the classification of
anemias)
• Platelet count (to detect either
thrombocytopenia or thrombocytosis)
• WBCs with differential count (for diagnosis of
infection, acute leukemia)
 Approach to anemia in Children
• Is anemia associated with other hematologic
abnormalities? (pancytopenia)
• If Yes, consider
Aplastic anemia
Leukemia
Other bone marrow replacement disorders
 Approach to Anemia (continue)
• Are red blood cells Microcytic (decrease MCV)?
• If Yes, consider
Iron deficiency anemia (IDA)
Thalassemias
Lead poisoning
• The most common cause of the microcytic
anemias is IDA. Checking serum iron, serum ferritin
and TIBC are indicated.
• Hb elecrophoresis is indicated in doubtful cases.
 Approach to Anemia (continue)

• Is anemia associated with Reticulocytosis?

• If yes, consider
Hemolysis
Bleeding
 Approach to Anemia (continue)
• Are red blood cells normocytic (normal MCV)?
• If yes, consider
Bacterial sepsis Or
Anemia of chronic disease e.g. renal failure
Microcytosis MCV <80 fL
Causes:
• Iron Deficiency

• Thalassemia

• Lead poisoning
 Macrocytosis MCV >100 fL
Macrocytic cells (large cells), and are found with
such conditions as
- Megaloblastic anemia,
- Folate or Vitamin B12 deficiency,

- liver disease,

- Post-splenectomy,
- Chemotherapy or hypothyroidism.