Entendiendo el CBC

Entendiendo el CBC

Enid Rivera MDCatedrática

Escuela de Medicina, [email protected]

787-758-7910787-777-3535 xt 7013,14,15

mailto:[email protected]

04/22/23 Enid Rivera MD2

Entendiendo el CBC


Complete Blood Count (CBC)


WBC : Leukocytes

• With cytoplasmic granules– have a multi-lobed nucleus– Neutrophils (segmented, polys)– eosinophils, and basophils

• Without granules – lymphocytes and monocytes– have non-lobular nuclei


Different WBC


Leukopenia : WBC <5,000

• Infectious related (dengue, others)• Congenital, or hereditary• Collagen-vascular diseases (SLE)• Diseases of the liver or spleen• Presence of cytotoxic substance• Bone marrow failure (malignancy, tumor, fibrosis)• Radiation exposure


Lymphocytes

• 25-40% of WBC, lifespan years

• immune competence achievement– bone marrow, B cells– thymus, T cells– Both produce lymphokines

• B cells: differentiate into plasma cells & secrete specific antibodies

• T cells: recognize cell associated antigens, lyse foreign or virus infected cells, regulate other immune cells


Lymphopenia and neutropenia

• Classification– Mild (1500-1000)– Moderate(999-500)– Severe (499-0)

• Lymphopenia– Virus, fungal,

intracellular parasites, Tb

– Decreased immunoglobulins

• Neutropenia– Bacterial infections


• A 12 year old white female was taken to the ER because of generalized body aches, and fever since 3 days ago. Any cytopenia?

• WBC 3,000 Neu 63%, Lym 20%, Mo 8%

• RBC 4.3 – Hg 15.9, Hct 48.0

• Plt 100,000


• A 2 year old white female was taken to the ER because of pain in her arms and legs and she was complaining of a sore throat. The child was pale and had fever. PE revealed a well nourished but listless child. The child had both lymphadenopathy and hepatosplenomegaly. Has she any cytopenia?

• WBC 3,000 RBC 2.3

• Segs 3% Hgb 6.9Lymphs 2% Hct 18.0 Blasts 95% Plt 10,000


Peripheral Smear: Diagnosis?


Leukocytosis: High WBC #

• Infection

• Inflammation (RA)

• Medications: steroids

• Malignancy: leukemia

• Tissue damage (burns)

• Severe stress : cortisol


Neutrophilia: Increased neutrophil count


“patient with acute appendicitis”

• WBC 15,000– 65% mature neutrophils– increase in stabs or band cells to 10%".

• typical report of a "shift to the left“

• "shift to the left" " means that bands or stabs have increased, indicating an infection in progress.


Neutropenia: decreased neutrophil count

• Viral illness ( lymphocytes)• Cyclic (neutrophil drop q 21d)• Chronic benign (asymptomatic, monocytes)• Familial• Severe & symptomatic • Drug related• Syndrome related


Monocytes• about 4% of circulating leukocytes

• Circulate in the peripheral blood prior to emigration into the tissues.

• Scavenge debris, present antigen to lymphocytes

• Names: liver Kupfer cells, brain microglia, kidney mesangial cells, and bone osteoclasts.

• Lifespan: days in blood, years in tissues as macrophages


Monocytosis

• >4% or >600 AMC (all monocyte count)

• Viral infection

• Monocytosis assoc to neutropenia

• Leukemia, very rare


Eosinophils


Eosinophils (1-4%)

• Kill large parasites, as helminths• Helminths activate alternative complement pathway and

C3b is produced. • Eos attach C3b receptors, and release their granules.• Lifespan: < 1 day in blood, weeks in tissues. • The granule contents damage parasite membrane.

– peroxidase, arylsulphatase B, phospholipase D and histaminase


Eosinophilia

• >4% or >600 AEC (all eosinophil count)• Allergies• Sinusitis• Asthma• Eczema• parasites


Red blood cells, or erythrocytes


Hemoglobin:critical low and high values

• A hemoglobin value < 5 gm may cause heart failure

• A hemoglobin value > 20 gm may cause clogging of capillaries due to hemo-concentration.


RBC count

• # RBC per cubic millimeter of blood

• Adults: males: 4.6 - 5.9 million females: 4.2 - 5.4 million

• Pregnancy: slightly lower than normal adult

• Newborn: 5.5 - 6 million

• Children: 4.6 - 4.8 million


Normal hemoglobin values

• Adult males: 14 - 18 gm• Adult females:12 - 16 gm• Pregnancy: 11 - 12 gm• Children: 11 - 16 gm• Newborn: 17 - 19 gm


Increase in red blood cells # : polycythemia

Cyanotic heart disease


Polycythemia: Increase in RBC#

hgb and hct

• Physiological polycythemia– neonatal period– at high altitudes – after strenuous physical training


Pathological polycythemia

• Primary: HIF mutation, RBC over-production does not result from hypoxia

• Secondary : occurs in response to hypoxia– cyanotic heart disease– high oxygen binding hemoglobins– chronic lung disease – smokers


Factitious polycythemia

• Dehydration• Diarrhea• Severe Burns• Hypovolemic shock • Eclampsia


Anemia


Anemiaanisocytosis: normal appearance, different sizes poikilocytosis: abnormal appearance


A 3 year old black female was admitted to the emergency room complaining of joint pain. The child had a right knee that was swollen and painful to the touch. The

following laboratory data was observed.

WBC 10.5 Segs 24, Lymphs 62, Monos 10, Eosins 4

RBC 2.22 Hgb 7.0 Hct 21.5 MCV 90Plt. 340,000

15 NRBC’s /100 WBC marked poikilocytosis - moderate anisocytosis


normocytic anemia


Normocytic anemia

Hemolysis (SS, Sphero, G6PD)

Autoimmune disorders ( SLE, RA, thyroid )

Anemia of chronic disease / inflammation

Acute blood loss

Erythropoietin deficiency

Bone marrow failure (malignancy radiation, toxin)


On a routine health supervision visit, a 1y/o boy has this CBC


Microcytic anemia

• Iron deficiency • thalassemia• lead intoxication• sideroblastic anemia• Anemia of chronic disease / inflamation


Normocytic anemia

• Hemolysis• Chronic disease/inflamation• Hormone deficiency (thyroid, adrenal)• Marrow failure• Malignancies• Renal failure


Normocytic anemia evaluation


Macrocytic anemia

• B12 deficiency (pernicious anemia)

• folic acid deficiency

• Syndromes (Fanconi)


Platelets

• normal range 150,000 - 450,000

• Thrombocytopenia < 150,000.

• < 20,000 may have spontaneous bleeding

• Should be reported in # & MPV

• A report of "adequate platelets" is not adequate

• implies there is at least one platelet for 20 RBC


Critical low value for platelets

• fewer than 50,000 platelets– risk for bleeding with even trauma

• under 20,000 – may cause spontaneous bleeding


Thrombocytopenia

• Infection

• Autoimmune

• Factitious

• Sequestration

• Marrow problem

• Syndrome related


Pseudo thrombocytopenia Platelet clumping

• Frequent collection problem • Minimized by draw from large peripheral vein

• Mix blood with the anticoagulant ASAP after collection, by gentle rotation or inversion.

• Platelet clumping increases with time, so analyze CBC soon.


• A 13 y/o girl was admitted through the emergency room with a fever and was disoriented. She had been suffering from a viral infection during the previous week. There was bruising on the arms and legs.

WBC 5,000 RBC 2.80 Segs 85 Hgb 10.5 Lymphs 8 Hct 30.0 Monocyte 2 MCV 82 Eos 5 Plt 10,000 Poikilocyte - moderate

Helmet cells, burr cells, spherocytes, microcytes Polychromasia - moderate


In TTP and DIC, platelets are used up rapidly, and the platelet count falls significantly.


Thrombocytosis

• Reactive, Reactive, Reactive• Anemia• Infections• Surgery• Burns• others


Entendieron el CBC? Muchas gracias, Enid Rivera


WBC interaction


reticulocyte count

• immature forms of erythrocytes, circulating in the

bloodstream

• 0.5% to 1.5% of the total RBC in men

• 0.5% to 2.5% in women


• low reticulocyte count– bone marrow failure/dysfunction– folic acid deficiency– cirrhosis

• high reticulocyte count – bone marrow responding to the need for increased

rbc cell production– responding to treatment for anemia– hemolytic anemia– recent donation of whole blood

reticulocyte count


MCV/MCH


MCV/MCH

• MCV= RBC size• MCH= hg concentration in RBC• If low hemoglobin, you need to know if RBC

are of normal size and if they have a normal concentration of hemoglobin.

• These measurements, provide important information about various types of anemias.


Mean corpuscular volume (MCV)

• MCV: hematocrit is divided by the total RBC count

• low MCV: cells are smaller than normal – iron deficiency anemia, lead poisoning – thalassemia major and thalassemia minor

• high MCV cells are macrocytic, or larger than normal– pernicious anemia and folic acid deficiencies

• normal MCV cells are referred to as normocytic– renal failure, endocrine disorders, acute hemorrhage


MCV: Mean cell volumeNormal values for erythrocyte indices

Neonate100-120 fl

Children 1-10y/o70 + age in years to 90fl (3rd percentile)

Adolescents 11-17 y/o 78-95 fl

Adults >18y/o 78- 98 fl


Mean corpuscular hemoglobin (MCH)

• Measures the amount of hemoglobin present in one RBC.

• divides 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)

• Proportion of hemoglobin in the RBC.• The hemoglobin is divided by the

hematocrit and multiplied by 100 to obtain the MCHC.

• MCHC - 32-36% MCH- 27-31 picomoles


MCH and the MCHC

• Used to assess whether RBC are normochromic, hypochromic, or hyperchromic.

• An MCHC of less than 32% or an MCH under 17 pg. indicates that are RBC deficient in hemoglobin concentration.

• This situation is most often seen with iron deficiency anemia.


Platelets• major coagulation role

• adhere to underlying tissue exposed by any gaps in the endothelial lining of injured vessels

• form plugs that prevent further blood loss while healing takes place

• lifespan 9 to 12 days


platelets granule contents

• adhesive glycoproteins (fibrinogen, von Willebrand factor, thrombospondin, and fibronectin)

• growth stimulators (as platelet derived growth factor = PDGF)

• vasoactive substances (such as serotonin, a potent vasoconstrictor), and adenine nucleotides, which

stimulate platelet aggregation.

Thrombocytopenia


Thrombocytopenia

• platelet destruction• impaired platelet production• ITP• HIV • radiation• chemotherapy• drugs that damage the bone marrow• Malignancies of the bone marrow, such as leukemia


bleeding due to a low plt count (<20k)

• Easy bruising• Unusual or heavy nosebleeds• Hematuria• Black, tar-like stools or frank bleeding with BM• Hematemesis

Syncope or visual disturbances due to intracranial bleeding

• Gingival bleeding• Heavy vaginal bleeding

Entendiendo el CBC

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