Sjvc-Pa Diag/stud T1/hemat

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Reason to order CBC

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Basic Screening; To determine #, %, conct'n, variety & quality of Blood Cells

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Components of CBC

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WBC/c,Diff WBC/c, RBC/c, Platelet/c, HCT,Hb & RBC indices

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Types of WBC/Leukocytes

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Granulocytes-Neutro,Eosino,Basophils
Agranulocytes-Lympho & Monocytes

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Granulocytes

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AKA Polymorphonuclear Leukocytes because they contain Multilobed Nucleus.

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Differential White Cell Count

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A %age of diff types of WBCs

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Normal value of WBC

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4000-11000/mm3; WBCs fight infect'n via Phagocytosis

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Leukocytosis-Increase in WBCs

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WBC>11000/mm3
Acute infections; ie bact'l infec'n, Leukemia, stress

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Leukopenia-Decrease in WBCs

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WBC<4000/mm3
Viral infections, bone marrow depression, overwhelming bact'l infect'n

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Neutrophils

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50% of total WBC
For Pyogenic Infect'n; specially bacterial infec'n via phagocytosis

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Immature PMNs

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Stab/Band cells
0-3% of total PMNs

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Neutrophilia-Increase in Neutrophils

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>8000/mm3
In acute,localized & gen bact'l infect'n; leukemia; acute hemorrhage
L&D,stress,ext cold/heat

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Neutropenia-Decrease in Neutrophils

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<1800/mm3
Septicemia; acute overwhelming bact'l infect'n (poor prognosis); pregnancy

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Neutrophils; Degenerative Shift to Left

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Increased Bands w/o Leukocytosis; in overwhelming bact'l infect'n-Poor prognosis

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Neutrophils; Regenerative-Shift to Left

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Increased Bands w/ Leukocytosis; in some bact'l infect'n-Good prognosis

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Neutrophils; Shift to Right

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Only few band cells w/ increased Neutrophils-Bad thing; In Liver diz, cancer

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Eosinophils

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1-4% of total WBCs
Respond to Allergic/Parasitic diz

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Eosinophillia->5%

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Allergies,Asthma,Addison's diz; hodgkin's diz/Lymphoma

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Eosinopenia<1%

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Cushing's synd'm (acute adrenal fail), certain drugs

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Basophils

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0-1% of total WBC
In chronic Inflam'n & Allerg Rxn;
They release Histamine, Serotonin & Heparin

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Basophillia

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Hodgkin's diz,leukemia, inflam'n, allergy

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Basopenia

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Hyperthyroidism, stress

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Monocytes

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3-7% of total WBC; Largest blood cell; 2nd line of defense for infect'n; Phagocytosis (engulfment and digestion of cellular debris & pathogen) & Immunity

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Monocytosis

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Leukemia, Hodgkin's diz, recovery state of acute infect'n; TB

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Monocytopenia

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HIV, Malnutrition, Aplastic anemia (Bone marrow inj); prednisone TX

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Lymphocytes

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20-40% of total WBC; B & T cells, Natural Killer
In Viral Infect'n & Lymphoma

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B cells & T cells

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All Lymphcytes mfg in Bone marrow; B-cells mature in Bone marrow; T cells mature in Thymus

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Lymphocytosis

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>4000/mm3
Viral diz, Lymphoma, Pertusis, Crohn's diz

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Lymphocytopenia

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<1000/mm3
Chemotherapy, CHF, Renal Fail, Hodgkin's diz

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RBC

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4.5+_0.5 million/mm3
Transport of o2 & co2
To determine Anemia & polycythemia

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Anemia-decreased RBC,Hb,HCT

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Blood loss, iron deff, decreased marrow prod'n; age, pregnancy

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Polycythemia-increased RBC,Hb,HCT/Erythrocytosis

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Inceased B/Marrow prod'n, Renal diz, high altitude, pul diz, cardiovascular diz, dehydrat'n

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Anemia

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Decrease in RBC, Hb & HCT

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HCT

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%age of packed RBC in whole blood.
45+_5%; Men 42-52%;Women 36-48%
To determine Anemia/Polycythemia
To determine RBC mass;

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Decreased HCT

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Indicat'n of Iron deff anemia/Microcytic anemia
HCT<20% to cardiac fail/death

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Increased of HCT

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Polycythemia, dehydration
HCT>60% leads to spont's clotting

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Hb=Globin (protein)+Heme (Iron)

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To bind o2 & co2; 15+_3g/dl; F 12-16;
M 14-17.4g/dl
o2 binding capacity is dir prop'l to Hb conct'n rather than RBC#

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Causes of Hb reduct'n

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Liver cirrhosis,hemorrhage,hemolytic rxns, hyperthyroidism, pregnancy, excessive fluid intake
Hb<5g/dl can lead to heart fail/death

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Causes of Inc'd Hb

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Polycythemia, COPD, CHF, high altitude
Hb>20g/dl leads to clogging of capillaries

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RBC indices

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Used in differentiating Anemias
MCV, MCH & MCHC

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MCV-Mean Corpuscular Volume

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Volume occupied by a single RBC;
82-98um3;
Microcytic=MCV<82um3
Macrocytic=MCV>98um3

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MCH-Mean Corpuscular Hb

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The average wt of Hb/RBC;
26-34pg/RBC; used in severe anemias;
Inc'd MCH=Macrocytic anemia
Decr'd MCH=Microcytic anemia

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MCHC-Mean Corpuscular Hb Conct'n

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Average conct'n of Hb/RBC; used in monitoring therapy of anemias
32-36% of RBC; it uses both Hb & HCT

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Anisocytosis

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Abnormal variation in size of RBC

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RDW-Red cell size distribut'n width

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An indicat'n of the degree of Anisocytosis; Helps to distinguish Chronic anemia from Early iron deff anemia; RDW incr's w/ iron & vit B12 deff

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Schistocytes RBC

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Helmet cells (Severe Poikilocytosis); irregularly contracted & fragmented RBCs; seen in Vasculitis, artificial Heart valves

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Poikilocytosis

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Abnormal variation in shape of RBC

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Peripheral RBC abnormalities

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Poikilocytes, Schistocytes, Spherocytes, Target Cells, Howel Jolly/ Heinz Bodies

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Spherocytes RBC

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Small spherical RBC w/o pale center; caused by heredity & hemolytic anemia

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Target Cells RBC

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RBC w/ a dark center & a periphery ring; caused by liver diz, iron deff

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Howell Jolly Bodies-RBC

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Spherical purple bodies w/n or on the RBC; seen in s/p spleenectomy, sickle cell anemia

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Heinz Bodies-RBC

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Small round inclusions of denatured Hb; seen in congenital hemolytic anemia

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Reticulocyte

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Young immature RBC
0.5-1.5% of total RBC

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Reticulocytosis

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Incr's in Reticulocyte
Indicates Incr'd RBC prod'n in B/marrow

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Reticulocytopenia

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Decr'd Reticulocyte
Indicates depressed B/marrow prod'n of RBCs

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Sed Rate/ESR

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Rate @ which RBCs settle out of Anticoagulated blood in 1 hr.
0-20mm/hr

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Incr'd ESR

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Indicative of Inflammat'n & Necrotic processes; CAs, PNA, TB & Syphilis

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HbF-Fetal Hemoglobin

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Is normal in Fetal/Infant RBCs
0-2% of total Hb; incr'd HbF is indicative Thalassemia (Inherited abnormality of Hb prod'n)

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HbM-Methemoglobin

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iron oxidizes to Ferric rather than Ferrous; it reduces o2 binding capacity of iron; 0.5-1.5%; >40% is critical; occurs w/ meds like sulfonamides or inhalat'n of Nitrates

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HbCO-Carboxyhemoglobin

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Hb is exposed to CO; reduces Hb's o2 binding capacity by 240 times; Normally <2% of total Hb

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Platelets/Thrombocytes

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Smallest formed elements in blood; vital in Coagulation, vascular integrity & vasoconstr'n; life span is 7.5days;
140,000-400,000 /mm3

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Platelet Count

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Useful in Bleeding disorders, anticoagulating therapy & B/marrow fail

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Thrombocytopenia causes--what?

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Spont bleeding, prolonged bleeding time, petechiae, eccymosis; often before winter, liver diz

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Bleeding Time

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Time to form a clot
3-10 minutes; >15 mins is critical

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Thrombocytosis

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Occurs in high altitude, after exercise, during winter; 50% of patients w/ Malignancies