A presentation made by Dr Gauhar Mahmood Azeem on the interpretations of a simple CBC and the information it can give us, Various conditions which may cause derangement are mentioned,

1. COMPLETE BLOOD COUNT
INTERPRETATIONS
Dr. Gauhar Mahmood Azeem
House Officer, Medical Unit 4
Services Hospital Lahore

2. ‘COMPLETE’ BLOOD COUNT

3. COMPLETE BLOOD COUNT
 A complete blood count (CBC) is an important and
readily available investigation 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.

4. COMPONENTS
 WBC
 RBC
 Hemoglobin
 Hematocrit
 MCV
 MCH
 MCHC
• RDW
• Platelets
• Neutrophils
• Lymphocytes
• Monocytes
• Basophils
• Immature
Granulocytes
• Reticulocyte count

5. RBC
 Normal Values
 Males 4.7 to 6.1 million cells per microliter
 Females 4.2 to 5.4 million cells per microliter

6. LOW RBC COUNT
 Known as anemia
 Acute or chronic bleeding
 RBC destruction (e.g., hemolytic anemia, etc.)
 Nutritional deficiency (e.g., iron deficiency, vitamin B12
or folate deficiency)
 Bone marrow disorders or damage
 Chronic inflammatory disease
 Kidney failure

7. HIGH RBC COUNT
 Known as polycythemia
 Dehydration
 Pulmonary disease
 Kidney or other tumor that produces excess
erythropoietin
 Smoking
 Genetic causes (altered oxygen sensing,
abnormality in hemoglobin oxygen release)
 Polycythemia vera

8. HEMOGLOBIN
 Is the protein molecule that carries oxygen in the
Red Blood Cells.
 13.0-18.0 g/dl in males
 11.5-16.5 g/dl in females
 We can have N HB in N RBC
 We can have N HB in D RBC
 We can have D HB in D RBC
 Thus the other indices MCH and MCHC come into
play.

9. HEMATOCRIT OR PCV
 Males normal 45%
 Females normal 40%
• High Hct
• Increased risk of Dengue
Shock Syndrome
• Polycythemia Vera
• COPD
• EPO or Erythropioten use
• Dehydration
• Capillary leak syndrome
• Sleep apnea
• Anabolic Steroid use
• Low Hct
• Due to anemia
• Anemia can be
characterised by using
the indices

10. MEAN CORPUSCULAR VOLUME
 Normal 77-95fL
 Low MCV indicates RBCs are smaller than normal
(microcytic); caused by iron deficiency anemia,
or thalassemias, Congenital sideroblastic Anemia,
Lead Poisoning, pyridoxine deficiency, anemia of
chronic disease
 High MCV indicates RBCs are larger than normal
(macrocytic)

11. MEGALOBLASTIC MACROCYTIC ANEMIA
 Macrocytes in bone marrow smear
 Medications affecting folate metabolism
 Vit B12 deficiency (Pernicious Anemia)
 Folate deficiency (Alcohol related often)
 Atrophic Gastitis
 Gastrointestinal malabsorption
 Nitrous oxide abuse
 Primary Bone marrow disorders

12. NON MEGALOBLASTIC MACROCYTIC ANEMIAS
 Alcohol Abuse
 Emphysema
 Hypothyroidism
 Accelerated Erythropoiesis (High Reticulocyte Index)
 Hemolytic Anemia
 Post-hemorrhagic Anemia
 Increased RBC membrane surface area
 Obstructive Jaundice Hepatic disease Post-splenectomy
 Bone Marrow disorders Myelophthisic Anemia
Myelodysplastic Anemia (Myelodysplastic Syndrome)
Aplastic Anemia
 Acquired Sideroblastic Anemia

13. COULDN’T GET PAST THE SPLEEN!

14. MCH AND MCHC
 Mean corpuscular hemoglobin (MCH) measures the
amount, or the mass, of hemoglobin present in one
RBC. The weight of hemoglobin in an average cell is
obtained by dividing the hemoglobin by the total RBC
count. The result is reported by a very small weight
called a picogram (pg).
Mean corpuscular hemoglobin concentration (MCHC)
measures the proportion of each cell taken up by
hemoglobin. The results are reported in percentages,
reflecting the proportion of hemoglobin in the RBC. The
hemoglobin is divided by the hematocrit and multiplied
by 100 to obtain the MCHC

15. MCH AND MCHC
 Less in Microcytic Anemias
 Normal in Macrocytic Anemias
 Elevated in hereditary spherocytosis, sickle cell
disease and Honozygous Hemoglobin C disease

16. RED CELL DISTRIBUTION WIDTH
 Low value indicates uniformity in size of RBCs
 High value indicates mixed population of small and
large RBCs; immature RBCs tend to be larger. For
example, in iron deficiency anemia or pernicious
anemia, there is high variation (anisocytosis) in
RBC size (along with variation in shape –
poikilocytosis), causing an increase in the RDW

17. RETICULOCYTE COUNT
 Absolute reticulocyte count = # or % retics X (pt’s Hct/ Normal
Hct)
 Can be absolute or %
 In the setting of anemia, a low reticulocyte count indicates a
condition is affecting the production of red blood cells, such as
bone marrow disorder or damage, or a nutritional deficiency
(iron, B12 or folate)
 In the setting of anemia, a high reticulocyte count generally
indicates peripheral cause, such as bleeding or hemolysis, or
response to treatment (e.g., iron supplementation for iron
deficiency anemia)

18. RETICULOCYTE INDEX
 Reticulocyte Index= Absolute Retic
Count/Maturition Factor
 Maturation Factor
 Hct > 35% : 1.o
 Hct 25-35% : 1.5
 Hct 20-25% : 2.0
 Hct <20% : 2.5

19. WHITE BLOOD CELL COUNT
 The normal number of WBCs in the blood is
4,500-11,000 white blood cells per microliter
(mcL). Normal value ranges may vary slightly
among different labs.

20. LEUKOPENIA
 Low white cell count may be due to acute viral infections, such
as with a cold or influenza. It can be associated
with chemotherapy, radiation
therapy, myelofibrosis and aplastic anemia (failure of white
cell, red cell and platelet production). HIV and AIDS are also a
threat to white cells.
 Other causes of low white blood cell count include systemic
lupus erythematosus, Hodgkin's lymphoma, some types
of cancer, typhoid, malaria, tuberculosis, dengue, rickettsial
infections, enlargement of
the spleen, folate deficiencies, psittacosis, sepsis and Lyme
disease. Many other causes exist, such as deficiency
in certain minerals, such as copperand zinc.

21. PSEUDOLEUKOPENIA
 Pseudoleukopenia can develop upon the onset of
infection. The leukocytes (predominately neutrophils,
responding to injury first) start migrating towards the site
of infection and can be scanned at the site of infection.
Their migration causes bone marrow to produce more
WBCs to combat infection as well as to restore the
leukocytes in circulation, but as the blood sample is
taken upon the onset of infection, it contains low amount
of WBCs, which is why it is called "pseudoleukopenia".

22. DRUGS CAUSING LEUKOPENIA
 LOADS!!!
 Clozapine, buproprion, valproic acid, minocycline,
lamotrigine.
 Immunosuppressive drugs, such
as sirolimus, mycophenolate
mofetil, tacrolimus, cyclosporine, Leflunomide
(Arava) and TNF inhibitors.[2] Interferonsused to
treat multiple sclerosis, such as Rebif, Avonex,
and Betaseron, can also cause leukopenia.
 Chemotherapeutic drugs.
 Lots of others.

23. GIVE AUGMENTIN!!!

24. LEUKOCYTOSIS
 Known as leukocytosisInfection, most
commonly bacterial orviral
 Inflammation
 Leukemia, myeloproliferative disorders
 Allergies, asthma
 Tissue death (trauma, burns, heart attack)
 Intense exercise or severe stress
 Will mention in detail in respective cell line.

25. DIFFERENTIAL COUNTS

26. ABSOLUTE NEUTROPHIL COUNT
 {(% of Neutrophils+ % of Bands) X WBC}/100

27. NEUTROPENIA
 Decreased production in
the bone marrow due to:
 aplastic anemia
 arsenic poisoning
 cancer, particularly blood
cancers
 certain medications
 hereditary
disorders (e.g. congenital
neutropenia, cyclic neutropenia)
 radiation
 Vitamin B12, folate
or copper deficiency
 Increased destruction:
 autoimmune neutropenia
 chemotherapy treatments, such
as for cancer and autoimmune
diseases
 Marginalisation and
sequestration:
 Hemodialysis
Medications
Flecainide (a class 1C cardiac
antiarrhythmic drug)
Phenytoin
Indomethacin
Propylthiouracil
Carbimazole
Chlorpromazine
Trimethoprim/sulfamethoxazole (cotri
moxazole)
Clozapine
Ticlodipine
Often, a mild neutropenia is seen in viral
infections. Additionally, a condition
called morning pseudoneutropenia might
be a side effect of certain antipsychotic
medications.

28. NEUTROPHILIA
 Post splenectomy
 Cigarette smoking
 Hypoxia
 Epinephrine
 Exercise
• Acute or Chronic
Infection
• Myeloprofilerative
disorders
• Acute stress
• Lukemoid reactions
• Drugs (steroids)
• Chronic Inflammation
• Tumors
• Myelophthisis
• Hyperactive marrow

29. 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

30. 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
 Stress (acute)

31. LOW MONOCYTES
 Usually, one low count is not medically
significant.Repeated low counts can indicate:
 Bone marrow damage or failure
 Hairy cell leukemia

32. 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)

33. LOW EOSINOPHILS
 Numbers are normally low in the blood. One or an
occasional low number is usually not medically
significant

34. EOSINOPHILIA
 Asthma, allergies such as hay fever
 Drug reactions
 Parasitic infections
 Inflammatory disorders (celiac
disease, inflammatory bowel disease)
 Some cancers, leukemias or lymphomas

35. BASOPENIA :D
 As with eosinophils, numbers are normally low in
the blood; usually not medically significant

36. BASOPHILIA
 Rare allergic reactions (hives, food allergy)
 Inflammation (rheumatoid arthritis, ulcerative colitis)
 Some leukemias

37. PLATELET COUNT
 Normal platelet counts are in the range of 150,000
to 400,000 per microliter (or 150 - 400 x 109 per
liter), but the normal rangefor the platelet count
varies slightly among different laboratories.

38. THROMBOCYTOPENIA
 Immune Thrombocytopenias (ITP) – formerly known as immune
thrombocytopenia purpura and idiopathic thrombocytopenic purpura
 Cirrhosis
 Splenomegaly
 Gaucher’s disease
 Familial thrombocytopenia
 Chemotherapy, radiotherapy
 Babesiosis, Dengue, Onyalai, Rocky mountain spotted fever
 Thrombotic Thrombocytopenic Purpura
 HELLP Syndrome
 Hemolytic Uremic Syndrome
 Drug Induced Thrombocytopenia (Heparin Induced Thrombocytopenia,
acetaminophen, quinidine, sulfa drugs)
 Pregnancy associated
 Neonatal alloimmune associated
 Aplastic Anemia, leukemia, lymphoma
 Transfusion associated

39. THROMBOCYTOSIS
 Reactive
 Chronic infection
 Chronic inflammation
 Malignancy
 Hyposplenism (post-splenectomy)
 Iron deficiency
 Acute blood loss
 Myeloprofirative disorders – platelets are
both elevated and activated
 Essential Thrombocytosis
 Polycythemia Vera
 Associated with other myeloid neoplasms
 Congenital
 Cancer (lung,
gastrointestinal, breast,ovarian,
lymphoma)
Kawasaki disease
Soft tissue sarcoma
Osteosarcoma
Dermatitis (rarely)
Inflammatory bowel
disease
Rheumatoid arthritis
Nephritis
Nephrotic syndrome
Bacterial diseases,
including pneumonia, sep
sis, meningitis, urinary
tract infections, and
septic arthritis

40. MEAN PLATELET VOLUME
 Typical range of platelet volumes is 9.7–12.8 fL
 Low value indicates average size of platelets is
small; older platelets are generally smaller than
younger ones and a low MPV may mean that a
condition is affecting the production of platelets by
the bone marrow.
 High volume indicates a high number of larger,
younger platelets in the blood; this may be due to
the bone marrow producing and releasing platelets
rapidly into circulation.

41. PLATELET DISTRIBUTION WIDTH
 A high PDW means increased variation in the size
of the platelets, which may mean that a condition is
present that is affecting platelets

42. LOW BLOOD COUNTS
 All three lines depressed in
 Aplastic Anemia, Myelodysplastic Syndrome,
Chemotherapy

43. HIGH BLOOD COUNTS
 Polycythemia Vera (Secondary)

44. THANK YOU