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Interpreting Clinical Lab Data
Robert L. Wilkins, PhD, RRT
Professor of CPS
Loma Linda University
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Divisions of the Clinical Lab
Microbiology
Sputum gram stain
Sputum culture and sensitivity
Pleural fluid culture and sensitivity
Blood Bank
- blood typing and storage
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CELL MORPHOLOGY
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Cell Morhphology (neutrophil)
Segmented neutrophil
(40-70% of WBCs)
Life span of about 10
days
Moves from bone marrow
to blood to tissues
Mature more quickly
under stressful conditions
Primary defense for
bacterial infections
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The Neutrophil
Once in the peripheral blood, it can be inthe circulating pool (CP) or the marginated
pool (MP) (approx. 50%)cells in MP not counted in CBC
Shift from the MP to the CP can occur with
stress, trauma, catecholamines, etc.This results in a transient leukocytosis
Such leukocytosis can last 4 to 6 hours
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The Neutrophil
Present in band and segmented forms
Bands make up < 5 % of circulating
neutrophils normallyLeft shift is seen as an increase in the
number of bands and is common with
acute infectionMain function is to locate, ingest, and kill
bacteria and other foreign invaders
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Cause of Neutrophilia
Pathologic
Bacterial infection
Certain viruses and fungi Inflammatory responses to tissue death
Burns
Snake bites
Drugs steroids
lithium
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Causes of Neutrophilia (cont.)
Physiologic
Pseudoneutrophilia (shift of cells from the MP
to CP) Catecholamines
Acute stress
Other inflammatory responsesNeoplastic growth
Metabolic disorders
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Pools of Neutrophils
1. Bone marrow: many banded forms are
present; neutrophilia with lots of bands
suggest bone marrow was source
2. Circulating Pool: used to deal with day to
day invasion of the body by organisms
3. Marginated Pool: no bands; respond tophysiologic stimulation
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Causes of Neutropenia
Decreased Production of WBCs
bone marrow diseases
malignancies that affect the bone marrow
Increased Neutrophil Destruction
overwhelming infection
certain bacteria
immune reactionsPseudoneutropenia (shift of cells from CP to MP)
viral infections
hypothermia
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Cell morphology (Eosinophil)
Segmented eosinophil
Life span = 14 days
Spends little time in theblood before it locates in
the skin, GI tract, or
respiratory tract
Only 1% of mature cells
are located in blood
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The Eosinophil
Also function as phagocytes but appear to
be less potent than neutrophil
Drawn to sites of hypersensitivity reactions
by mast cell chemotactic factors
Often found in sputum of asthmatics
May play a role in pathogenesis of lung dz
Play a role in parasitic infections
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The Basophils
Mature basophil
Least common of
WBCs (< 2%)Nucleus does not
always segment
Increase in response
to same conditionsthat cause eosinophilsto respond
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The Monocytes
Also not common in
circulating blood
Stay in blood forabout 70 hours
Become macrophages
in tissue and live for
several months or
longer
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The Monocytes
Primary role is phagocytosis
Play large role in ingesting cellular debris
Become activated when direct contact
with microorganisms occurs
Activated cell has greater motility, enzyme
activity and killing capacity (causes fever)
Also play a role in immunity
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The Lymphocytes
May mature into B or Tcells
Main function isantigen recognition andimmune response
Life span quite varied
(up to two years)Can pass back and forth
between blood andtissues
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Lymphocytes: B & T types
B cells are not only produced in the bone
marrow but also mature there.
However, the precursors of T cells leavethe bone marrow and mature in the thymus
(which accounts for their designation)
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Types of Lymphocytes
B lymphocytes (or B cells) are most effective
against bacteria & their toxins plus a few viruses
T lymphocytes (or T cells) recognize & destroybody cells gone awry, including virus-infected
cells & cancer cells.
T cells come in two types: helper cells and
suppressor cells; normally the helper cells
predominate.
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Lymphocyte Count: Decreased
I. DecreasedA. AIDSB. Bone Marrow suppressionC. Aplastic AnemiaD. SteroidsE. Neurologic Disorders
1. Multiple Sclerosis2. Myasthenia Gravis
3. Gullain Barre Syndrome
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Lymphocyte count: Increased
a. Influenza
b. Pertussis
c. Tuberculosisd. Mumps
e. Cytomegalovirus Infection
f. Infectious Mononucleosisg. Infectious Hepatitis
h. Viral pneumonia
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Interpreting the CBC
What is total white cell count?
If elevated (>11,000), what type of WBC is
the culprit?
Is it the neutrophils, eosinophils,
lymphocytes, basophils, or monocytes?
Marked leukocytosis is usually due to
neutrophils or lymphocytes.
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Interpreting the CBC
Normal
Values
% Absolute
Neutrophils 40
70 1800
7500
Eosinophils 06 0600
Basophils 01 0100
Lymphocytes 2045 9004500
Monocytes 26 90 - 1000
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Interpreting the CBC
If the neutrophils are causing the
leukocytosis, compare the neutrophil % to
total WBC.The % neutrophils indicates the severity of
the infection; the total WBC reflects the
quality of the immune system
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Interpreting the CBC (Case # 1)
85 yr old female with pneumonia:
Total WBC is: 11,500
Neutrophil % = 80% (9200) bands = 5%
This indicates that a severe infection is
present but the immune system is unable to
respond appropriately.
Prognosis poor.
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Interpreting the CBC (Case # 2)
5 yr old male with pneumonia
WBC = 18,000
Neutrophils = 60% (10,800)
Marked leukocytosis and normal range for
neutrophils indicates moderate infection
but excellent immune system response
Excellent prognosis
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Interpreting the CBC (Case #3)
10 yr old male admitted for pneumonia:
WBC: 16,000
neutrophils = 75% (12,000) (1800-7500)Bands = 5% (800) (0-100)
Eosinophils = 1% (160) (0-600)
Lymphocytes = 10% (1600) (900-4500)Basophils = 0% (0) (0-100)
Monocytes = 3% (480) (90-1000)
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Interpreting the CBC (Case #3)
Interpretation
neutrophilia probably due to bacterial
pneumonia
left shift indicative of severe infection
the source of the neutrophils is the bone
marrow since many bands are present
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Case Study # 4
20 yr old male admitted following MVA
WBC 14,500 75% neutrophils 1% bands
Leukocytosis due to neutrophilia
History and low per cent of bands suggest
pseudoneutrophilia
Due to liberation of marginated neutrophils
in the intravascular system
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Interpreting the CBC
What is indicated by leukopenia?
1. Bone marrow failure
cancer e.g. leukemia, lymphoma2. Overwhelming infection
severe pneumonia pt who has poor immune
system and cant produce enough WBCs3. Shift of neutrophils to MNP (viral infections
and hypothermia)
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Platelet Count
Normal count is 140,000 to 440,000/mm3
Life span of about 10 days
Low platelet counts (thrombocytopenia)
cause excessive bleeding
Thrombycytopenia is common with the use
of heparin, DIC, bone marrow disease,
liver failure and sepsis
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Platelet
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Platelet (Activated)
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Red Blood Cells
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Red Blood Cells (Erythrocytes)
Produced in the bonemarrow
Life span of about120 days
Primary function isgas transport
Immature version hasnucleus and is called areticulocyte
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Interpreting the RBC count
1. Normal values:Men: 4.25.4 million/mm3
Women: 3.65.0 million/mm3
2. AnemiaabnormalDecrease in RBC count
- decreased production
- increased destruction (hemolysis)
- blood loss
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Interpreting the RBC count
3. Increased RBC count = Polycythemia
A. Primary
B. Secondaryliving at altitude
chronic lung/heart disease
tobacco use/carbon monoxideC. Relative Polycythemia
dehydration
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Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Volume occupied by a singleRBC
Increase in MCV is known asMacrocytic anemia.
Decrease in MCV is known asMicrocytic anemia.
Mean Corpuscular Hemoglobin Concentration
(MCHC)
Measure of the concentration of hemoglobin in anaverage RBC
Decrease in MCHC is known as Hypochromic anemia
Normal is known asNormochromic anemia.
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Red Blood Cell Indices
Normocytic anemias
Blood loss
Hemolytic anemia
Microcytic anemias (100 fL)
Folic acid deficiency Vitamin B12 deficiency
Some COPD patients*femtoliters
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Red Blood Cell Indices
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Hematocrit
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The RULE of Three
Applies to normocytic, normochromic
erythrocytes only
Useful to detect laboratory error inmeasuring the Hb, HCT, and RBC count
3 times the RBC count should = Hb
3 times Hb should = Hct
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RBC = 3.0 x 1012 3 x 3 = 9
Hb = 9.2 g/dL 3 x 9.2 = 27.6
Hct = 28%
The RULE of Three
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Interpreting the Red Blood Cells
CBC: Results Normals
RBC (x1012/L) 4.2 4.2-5.4
Hgb (g/dL) 10.6 11.5-15.5Hct 34.9% 38%-47%MCV (m3) 77.0 80-96MCHC 30.4% 32-36%Interpretation: Microcytic, hypochromic anemia; rule of 3
does not apply
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Reticulocyte Count
Normal values:
0.51.5% of RBC
Helpful to identify cause
ofAnemia
Increase indicates
Anemia is due toBlood
loss
Decrease indicatesAnemia is due toBone
marrow disease
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Bibliography
Steine-Martin: Clinical Hematology, 2nd
edition, Lippincott, Philadelphia, 1998.
Kaplan: Clinical Chemistry, 4th edition,Mosby, St. Louis, 2003.
Wilkins: Clinical Assessment in
Respiratory Care, 5th edition, Mosby, St.Louis, 2005.