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CBC Basic Interpretation

The document provides information about the complete blood count (CBC) test, including what components are measured, how the test is performed, and how the results are interpreted. A CBC measures red blood cell, white blood cell, and platelet counts and characteristics. Modern instruments use electrical pulses to count and size cells, providing metrics like mean corpuscular volume. CBC results can indicate conditions like anemia, leukopenia/leukocytosis, and thrombocytopenia/thrombocytosis. The document outlines characteristics and common causes for different types of abnormalities.

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1K views39 pages

CBC Basic Interpretation

The document provides information about the complete blood count (CBC) test, including what components are measured, how the test is performed, and how the results are interpreted. A CBC measures red blood cell, white blood cell, and platelet counts and characteristics. Modern instruments use electrical pulses to count and size cells, providing metrics like mean corpuscular volume. CBC results can indicate conditions like anemia, leukopenia/leukocytosis, and thrombocytopenia/thrombocytosis. The document outlines characteristics and common causes for different types of abnormalities.

Uploaded by

pido29
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CBC

Basic Interpretation

Tanim I. Aziz, MBBS

CBC
is one of the most common laboratory tests in medicine.
Typically, it includes the following:
White blood cell count (WBC or leukocyte count)
WBC differential count
Red blood cell count (RBC or erythrocyte count)
Hematocrit (Hct)
Hemoglobin (Hb)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
Red cell distribution width (RDW)
Platelet count
Mean Platelet Volume (MPV)

How does CBC come ?

Circulating blood cells, including red blood cells


(RBCs), white blood cells (WBCs), and platelets, are
counted and sized electronically by modern instruments.
One such instrument, the Coulter counter, generates an
electrical pulse when a blood cell passes through a small
aperture surrounded by electrodes.
Each electrical pulse represents an individual cell, and
the pulse height indicates the cell volume. Therefore, the
electronic counter not only registers the total cell count
but also estimates the average cell volume and the
variation in cell size.
In the context of RBCs, these measurements are
referred to as the mean corpuscular volume (MCV) and
the RBC distribution width, respectively.

Modern electronic counters are also capable of


multimodal assessment of cell size and content,
thus providing additional information about the
various categories of WBCs including neutrophils,
lymphocytes, monocytes, eosinophils, and basophils
(ie, 5-part differential).
Two other measured variables of the complete
blood cell count (CBC) are hemoglobin (Hgb) and
hematocrit (Hct).
The Hg is computed by a spectrophotometer after
RBCs are lysed in a given volume of blood and the
Hgb is chemically converted into a stable pigment.

The Hct is determined by a microhematocrit


centrifuge and represents the percentage of a
given volume of whole blood that is occupied by
packed RBCs.
However, Hct also can be calculated by
multiplying the RBC count and the MCV.
Other calculated variables in the CBC include
the mean corpuscular Hg content (and mean
corpuscular Hg concentration; these 2 calculated
values are rarely used in routine clinical practice.

ANEMIA

Microcytic
(MCV <80 fL)

Normocytic
(MCV 80-100 fL)

Macrocytic
(MCV >100 fL)

MICROCYTIC ANEMIA
The 3 major diagnostic possibilities for
microcytic amaenia are :
Iron deficiency anemia (IDA),
Thalassemia,
Anemia of chronic disease (ACD)

IDA

RBC: normal or low


Hb: low
MCV: low
RDW: high

Thalassemia

RBC: normal or high


Hb: low
MCV: low
RDW: normal

Disproportionate !!!

An extremely low MCV may


suggest Alpha thalassemia !!!

The CBC count and peripheral blood film


examination results are usually sufficient to suspect
the diagnosis.
In the severe forms of thalassemia, the Hb level
ranges from 2-8 g/dL.
MCV and MCH are significantly low, but, unlike
thalassemia trait, thalassemia major is associated
with a markedly elevated RDW, reflecting the
extreme anisocytosis.
The WBC count is usually elevated in b thalassemia
major; this is due, in part, to miscounting the many
nucleated RBCs as leukocytes.
Platelet count is usually normal, unless the spleen is
markedly enlarged.

Mentzer index
Is used to differentiate IDA from Bthalassemia.
MCV / RBC : is < 13, thalassemia is more
likely.
If the result > 14, then iron-deficiency
anemia is more likely.

ACD

RBC: normal or low ?


Hb: low
MCV: normal
RDW: normal

Macrocytosis
Common causes:
Drug-induced
Nutritional
Liver disease, alcohol use
Hypothyroidism

Macrocytosis

RBC: normal
Hb: normal or low
MCV: high
RDW: normal or high

WBC
Leukopenia.
Leukocytosis.

Lots of differentials.do not forget to match


with the clinical features presented

Leucopenia
Common causes:
Chemotherapy
Radiation therapy
Leukemia (as malignant cells overwhelm the
bone marrow)
Myelofibrosis
Aplastic anema
Medications
Clozapine (anti-psychotic)
Immunosuppressive drugs
Interferons

Other causes :
Influenza
Systemic lupus erythematosus
Typhus
Malaria
HIV
Tuberculosis
Dengue
Rickettsial infections
Enlargement of the spleen
Folate deficiencies
Psittacosis
Sepsis

Pseudoleukopenia
It can develop upon the onset of infection.
The leukocytes are marginalized in the blood vessels so
that they can scan for the site of infection.
This means that even though there is increased WBC
production, it will appear as though it is low from a blood
sample, since the blood sample is of core blood and does
not include the marginalized leukocytes.
Valproic Acid

Leukocytosis
Neutrophil leucocytosis (neutrophilia >7.5x109/l):
Infection:

acute bacterial infection

Inflammation /
necrosis:

myocardial infarction or ischaemia


trauma
vasculitis

Myeloproliferative
disorders:

polycythaemia rubra vera


myelofibrosis
chronic granulocytic (myelomonocytic)
leukaemia

Metabolic:

uraemia / acidosis
gout
eclampsia

Malignancy:

any other malignancy

Drugs:

steroids

Blood loss:

acute haemorrhage or haemolysis

Lymphocytosis:
Acute viral infection (usually associated with

rubella
pertussis
mumps
infectious mononucleosis
most other acute viral illnesses

Chronic viral infection:

hepatitis B and C

Bacterial infections:

tuberculosis
brucellosis
whooping cough
acute bacterial infections in infants

Other causes:

thyrotoxicosis
autoimmune disorders
lymphoma
lymphocytic leukaemias

neutropaenia):

Thrombocytopenia
Decreased production
Vitamin B12 or folic acid deficiency
Leukemia
Decreased production of thrombopoietin
Sepsis, systemic viral or bacterial infection
Hereditary syndromes
Congenital amegakyrotic thrombocytopenia
Thrombocytopenia absent radius syndrome
Fanconi anemia
Bernard-Soulier syndrome associated with large platelets
Meg-Hegglin anomaly
Grey platelet syndrome
Alport syndrome

Increased destruction

Idiopathic thrombocytopenic purpura (ITP)


Thrombotic thrombocytopenic purpura (TTP)
Hemolytic-uremic syndrome (HUS)
Disseminated intravascular coagulation (DIC)
Paroxysmal nocturnal hemoglobinuria (PNH)
Antiphospholipid syndrome
Systemic lupus erythematosus (SLE)
Post-transfusion purpura
Neonatal alloimmune thrombocytopenia (NAITP)
Hypersplenism
Dengue fever
HIV

Thrombocytosis
Do not necessarily signal any clinical
problems, and are picked up on a routine
full blood count.
A full medical history must be elicited to
ensure that the increased platelet count is
not due to a secondary process.
Thrombopoetinan acute phase
reactant

Thrombocytosis
Essential (primary)
Essential thrombocytosis (a form of myeloproliferative
disease)
Other myeloproliferative disorders such as chronic
myelogenous leukemia, polycythemia vera,
myelofibrosis

Reactive (secondary)
Inflammation
Surgery (which leads to an inflammatory state)
Hyposplenism / spleenectomy

2.9
9.8
27
60

16.5

3.2

17.3

350

Thank You !!!

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