CBC

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CBC
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The CBC interpretation are useful in the
diagnosis of various types of anemia. It can
reflect acute or chronic infection, allergies,
and problems with clotting.
objective
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CBC- complete blood count

• Component of the CBC
• Red Blood Cells (RBCs) Hematocrit (Hct)
  Hemoglobin (Hgb) Mean Corpuscular Volume
  (MCV) Mean Corpuscular Hemoglobin
  Concentration (MCHC)
• - Red cell distribution width (RDW)
• White Blood Cells (WBCs) Platelet

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RBC
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RBC

• RBC (varies with altitude)
• M 4.7 to 6.1 x1012 /L
• F 4.2 to 5.4 x1012 /L
• Biconcave disc shape with diameter
• of about 8 µm
• Function - transport hemoglobin which carries
  oxygen from the lung to the tissues
• -acid base buffer.
• Life span 100-120 days.

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Hemoglobin Hematocrit
Hemoglobin M 13.8 to 17.2 gm/dL F 12.1 to
15.1 gm/dL Hematocrit (packed cell volume) It
is ratio of the volume of red cell to the volume
of whole blood. M 40.7 to 50.3 F 36.1 to
44.3
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MCVMCHC

• MCV mean corpuscular volume HCT/RBC count
  80-100fL
• small microcytic
• normal normocytic
• large macrocytic
• MCHC mean corpuscular hemoglobin concentration
  HB/RBC count 26-34
• decreased hypochromic
• normal normochromic

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MCH RDW

• MCH (mean corpuscular hemoglobin)
• HB/HCT 27-32 pg
• RDW (red cell distribution width)
• It is correlates with the degree of anisocytosis
• _ Normal range from 10-15

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The Reticulocyte Count

• This important value is needed in the evaluation
  of any anemia.
• Normal range 1-2 
• Retic count goes up with
• Hemolytic anemia
• Retic goes down with 
• Nutritional deficiencies
• _ Diseases of the bone marrow itself

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Abnormal result of RBC

• - Increased number called polycythemia , two
  types
  
• 1-primary polycythemia
• - Polycythemia
  vera
• 2-secondary polycythemia
• e.g. high
  attitude, smoking, heart
• disease
  or pulmonary fibrosis
• - Decreased numbers of RBCs called anemia may
  indicate
• 1) Blood loss
• Acute (normocytic normochromic)
• Chronic (microcytic hypochromic)
• 2) Decreased production
• 
  e.g._ nutritional anemia
• 3) Increased destruction
• 
  e.g._ hemolytic anemia

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Manifestation of polycythemia

• Headache.
• Hypertension.
• Hemorrhage or thrombosis
• Fatigue ability.
• Splenomegaly

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Manifistation of anemia

• fatigue
• weakness
• skin nail changes
• Compensatory
• ? heart rate
• ? blood pressure
• ? resp. rate

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WBC

• WBCs are involved in the immune response.
• The normal range 4 11x109 /L
• Two types of WBC
• 1) Granulocytes consist of
• Neutrophils 50 - 70
• Eosinophils 1 - 5
• Basophils up to 1
• 2) Agranulocytes consist of
• - Lymphocytes 20 - 40
• Monocytes 1 - 6

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WBC
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WBC

• The type of cell affected depends upon its
  primary function
• In bacterial infections, neutrophils are most
  commonly affected
• In viral infections, lymphocytes are most
  commonly affected
• In parasitic infections, eosinophils are most
  commonly affected.

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Neutrophil

• polymorphneuclear leukocytes (PMN,s)
• Nucleus 3-5 lobes.
• Diameter 10-14 µm
• 50-70 WBC
• 2.5-7.5x109/ L
• Function Phagocytosis of bacteria and cell
  debris
• Numbers rise with all manner of stress,
  especially bacterial infections

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Neutrophil

• Neutrophil disorders
• Neutrophilia an increase in neutrophils
• Conditions associated with neutrophilia are
• 1-Bacterial infections (most common cause)
• 2-Tissue destruction
• e.g. tissue infarctions, burns.
• 3- leukemoid reaction
• 4-Leukemia

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Neutrophil

• Neutropenia this may result from
• 1-Decreased bone marrow production
• e.g. BM hypoplasia.
• 2-Ineffective bone marrow production
• E.g. megaloblastic anemias and myelodysplastic
  syndromes.
• 3- post acute infection
• _ e.g. typhoid fever, brucellosis.

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Eosinophil

• Bilobed nucleus
• 1-5 of WBC
• 0.04-0.4x109/L
• Diameter about 10-14 µm
• Function Involved in allergy, parasitic
  infections
• Contains eosinophilic granules

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Eosinophil

• Eosinophilia may be found in
• Parasitic infections
• Allergic conditions and hypersensitivity reaction

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Basophile

• Circulating form of mast cells
• lt1 WBC
• 0.01-0.1x109/L
• Diameter 10-14 µm
• Contains basophilic
• Granules
• Granules contain histamine and heparin
• IgE receptors
• Involved in allergy

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Basophile

• Basophilia
• Is associated with chronic myeloproliferative
  disorders
• Inflammatory bowel disease e.g. ulcerative
  colitis
• Radiation exposure

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Monocyte

• Monocyte
• 3-8 WBC 0.2-0.8x109/L
• 8-10 µm in diameter.
• Circulating form of tissue macrophages
• Life span 10-20 h in blood,
• months in tissues as macrophage.
• Macrophages
• Phagocytosis, bacterial killing, antigen
  presentation
• Peritoneal cavity peritoneal macrophages
• Lung alveolar macrophages
• Spleen splenic macrophages
• Liver Kupffer cells

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Monocyte

• Monocytosis associated with
• 1) certain bacterial Infection
• e.g active TB , sebticemia.
• 2) Protozoal and rickettsial infection
• e.g. malaria
• 3) Collagen vascular diseases
• e.g. Lupus erythromatosis ,rheumatoid
  arthritis.

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Lymphocyte

• No specific granules
• 20-40 of WBC
• 1.55-3.5x109/ L
• Diameter 8-10 µm
• T cells cellular
• (for viral infections)
• B cells humoral (antibody)
• Natural Killer Cells

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Lymphocyte

• Lymphocytosis may indicate
• _ Viral infection
• e.g. Infectious mononucleosis, CMV or pertussis.
  
• _ Bacterial infection
• e.g. TB
• Lymphopenia caused by
• _Stress.
• _Steroid therapy
• _ Irradiation

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Abnormal result of WBC

• (Leukocytosis) may indicate
• _ Infectious diseases
• _Inflammatory disease (such as rheumatoid
  arthritis or allergy)
• _Leukemia
• _Severe emotional or physical stress
• _Tissue damage (e.g. necrosis,or burns)
• (Leukopenia) may result from
• _ Decreased WBC production from BM.
• _ Irradiation.
• _ Exposure to chemical or drugs.

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Manifestation of leukocytosis

• Fever
• Malaise
• Weakness
• Others depend on each system which is involved
• e.g. chest cough, SOB and chest pain
• abdomen diarrhea, vomiting,
  dehydration.
• CNS headache, visual disturbance,
  
• Neck stiffness
• and so 0n.

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Manifestation of leukopenia

• Infection of the mouth and throat.
• Painful skin ulceration.
• Recurrent infection.
• Septicemia.

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Platelets

• Small granular non-nucleated discs.
• Diameter about 2-4 µm
• Normal range 150-300x109 /L
• Destroyed by macrophage cells in the spleen.
• Function involved in coagulation and blood
  haemostasis.
• Life span 7-10 days

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Platelets
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Platelets

•  
• Numbers of platelets
• Increased (Thrombocythemia)
• Pregnancy.
• Exercise.
• High attitudes.
• splenectomy
• Decreased (Thrombocytopenia)
• Menstruation.
• Haemorrhage.
• Bone marrow destruction or suppression e.g.
  leukemia
•  
• The values have to fit the clinical situation.

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Manifestaton of thrombocytopenia

• Petechial hemorhage.
• Easy bruising.
• Mucosal bleeding
• e.g. _ epistaxes.
• _ gum bleeding

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Sickling Test

• Sickle cell anemia. Hemoglobin S
• 2 Types of Tests- Screening test for HBs
• Confirmation done by Hemoglobin Electrophoresis.
• HB AS is Trait- Mild type of disease
• HB SS is disease severe condition.

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Screening Test

• Sodium Meta Bisulphite- reducing agent.
• Mixed with RBcs- to produce Sickle RBCS
• HB S in not soluble in Metabisulphite so it
  appears as insoluble precipitate or floculum.
• All screening test must be confirmed by
  Electrophoresis.

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