INTERPRETATION OF COMPLETE BLOOD COUNT

DR AHEL BADAWY CONSULTANT PAEDIATRICAIN DR.ERFAN & BAGEDO HOSPITAL

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Complete Blood Count interpretation

The CBC is a bargain; its cost can be much less

than modern imaging studies, but like modern imaging studies, its value is lost without appropriate analysis. The CBC is a deceptively simple test to order and interpret. In most cases, the primary assessment of interest are whether the patient is anemic, whether the total and differential white counts supports the diagnosis of infection, and whether the platelet count is in a range that has impact on hemostasis.
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CBC

WBC 8/cmm RBC 5.5/cmm HGB 15 g/dl HTC 45 % MCV 80 MCH 29 MCHC 34 RDW 12.8 PLATELET COUNT 300 DIFFERENTIAL COUNT CELL MORPHOLOGY RETICULOCYTE COUNT**

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Measurements
The CBC consists of hemoglobin concentration, mean

corpuscular hemoglobin( MCH), MCH concentration ( MCHC), mean corpuscular volume( MCV), erythrocyte count, leukocyte count, and platelet count. MCH = Hb (g/L)/RBC MCHC = Hb ( g/dl)/HCT(%) HCT = MCV X RBC RDW ( red cell distribution width ): measure of dispersion of the erythrocyte size distribution, the coefficient of variation of the erythrocyte volume distribution expressed as percentage. Mentzer formula: MCV / RBC = more than 13.5 or less than 11.5 RDW Index=MCV/RBCXRDW: 220 or more less than 220

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Anemia in Children
Definition. Causes. History and physical

examination. Interpretation of complete blood count and the peripheral blood smear. Additional tests.
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Definition
Reduction in the hemoglobin concentration,

hematocrit, or number of red blood cells (RBC).

Functional consideration is important.

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Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Causes
Ineffective red cell production.

Accelerated destruction or loss of red blood

cells.

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Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

History and physical examination

A detailed history and physical examination

are helpful in further defining the cause of anemia. A maternal history should be included in evaluation of anemic infants from birth to six months of age. The relative frequency of the various causes of anemia with age should be considered. Physical examination can give clue to the possible cause or duration of the anemia.

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Important features in the history of the anemic child

1-Maternal History
a- Pregnancy/delivery complications b- Drug ingestion c- Pica, non-food product ingestion d- Anemic during pregnancy

2-Family History
a- Ethnicity b- Anemia c- Jaundice d- Splenomegaly e- Gallstones f- Bleeding disorders g- Cancer h- Transfusion

3-Patient History
a- Hyperbilirubinemia b- Prematurity c- Diet history d- Medication e- Activity level f- Acute or recent infection g- Evidence of chronic infection/disease h- Evidence of endocrinopathy i- Evidence of liver disease Copyright 1982 - 2009 Dr. Erfan &j- Easy bruising/blood loss Bagedo Hospital

Evaluating Anemia: MCV, RDW, Reticulocytic count

MCV in children is lower than adults:

Between 2-10 years, the lower limit for MCV is approximately 70 + age ( in years ) The upper limit is 84+ 0.6 per year (beyond first year of life) till the upper limit of 96 in adults. Reticulocyte count is a measure of erythrocyte production, normal value 0.5 to 1.5 %. Rticulocyte Production Index = Observed Retic % X Patient Hematocrit 0.45 _____________________________________ Maturation time in peripheral blood in days ( 1 day when hct. Is 45 % to 2.5 days when hct. Is 15% )

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

RBC 4.53 HB 11.6 HTC 30.1 MCV 66.5 MCH 25.5 MCHC 38.4 RDW 21.1 ANISOCYTOSIS 2++ POLYCHROMASIA 1+ MICROCYTES 3+++ SPHEROCYTES 1+ SCHISOCYTES 1+ IRON 43, TIBC 250 , % IRON SAT 17.2

Abdominal US : large spleen for the age

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 OSMOTIC FRAGILITY TEST

PATIENT: start of hemolysis 0.55% NACL complete hemolysis 0.40%NACL CONTROL: start of hemolysis 0.45% NACL complete hemolysis 0.30% NACL

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Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

WHITE BLOOD CELLS

Low sensitivity and specificity. Highly variable response to infection. Astute clinical judgment is needed for

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

proper interpretation. Leukopenia is associated with a wide variety of viral and bacterial infections. Leukocytosis is part of the bodys acute phase response to many conditions including infections. Band cell count. Peripheral blood smear is very important to characterize white cell abnormalities.

Classification of Neutropenia
Neutropenia Caused by Intrinsic Defect in Myeloid cells or Their Progenitors

Reticular dysgenesis Severe congenital neutropenia ( Kostmans syndrome ) Cyclic neutropenia Myelokathexis Schwachmans syndrome Dyskeratosis congenita Chediak-Higashi syndrome Familial benign neutropenia Fanconis anemia Bone marrow failure syndromes

Neutropenia Caused by Extrinsic Factors Infection Drug- induced neutropenia Autoimmune neutropenia Chronic benign neutropenia of childhood Immune neonatal neutropenia Neutropenia associated with immune dysfunction Neutropenia associated with metabolic disease Nutritional deficiencies Reticuloendothelial sequestration Bone marrow infiltration Chronic idiopathic neutropenia Nathan and Oski Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

 CBCs

11/9/05 3 4.48 12.3 35 123 59.3 29.5 10.6 0.1 0.5

13/9

14/9 8.7 6.74 18.5 52.5 26 42 30 11

15/9 7.8 5.32 14.5 40.8 29 38 50 02 02

16/9 6.3 4.88 13.2 37.3 48 44 39 12

17/9 8.6 4.76 13 36.9 106 25 58 10 02 01 04 10 4.31 11.9 33.5 184 35 49 04 05

WBC RBC HGB HTC PLATELETS NEUT% LYMPH MONO EOS BASO ATYPICAL LYMPH

17

08

05

06

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Classification of Neutrophilia
Increased Production
Chronic infection Chronic inflammation Ulcerative colitis Rheumatoid arthritis Tumors (perhaps with necrosis) Postneutropenia rebound Myeloproliferative disease Drugs (lithium, occasionally ranitidine ) Chronic idiopathic neutrophilia Familial cold uricaria Leukomoid reaction

Enhanced Release from Marrow Storage Pool

Corticosteroids Stress Hypoxia Acute infection Endotoxin

Decreased Egress from Circulation

Corticosteroids Splenectomy Leukocyte Adhesion Deficiency

Reduced Margination
Stress Infections Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital Exercise

Causes of Lymphocytopenia
Aquired Causes

Infectious diseases AIDS Viral hepatitis Infleunza Tuberculosis Typhoid fever Sepsis Iatrogenic Immunosuppressive therapy Coricosteroids High dose PUVA therapy Cytotoxic chemotherapy Radiation Thoracic duct drainage Systemic and other diseases Systemic lupus erythematosus Myasthenia gravis Hodgkin disease Protein- losing enteropathy Renal failure Sarcoidosis Thermal injury Aplastic anemia Copyright 1982 deficiency associated with ethanol abuse Dietary - 2009 Dr. Erfan & Bagedo Hospital

Inherited Causes Aplasia of lymphopoietic stem cell Severe combined immunodeficiency Ataxia-telangiectasia Wiskott-Aldrich syndrome Immunodeficiency with thymoma Cartilage-hair hypoplasia Idiopathic CD4T lymphocytopenia

Causes of Eosinophilia
Allergic Disorders

Hereditary Disorders

Asthma Hereditary eosinophilia Hay fever Gastrointestinal Disorders Acute urticaria Radiation therapy for intra-abdominal Drug reaction neoplasms Allergic bronchopulmonary aspergillosis Regional enteritis Dermatitis Milk precipitin disease Pemphigus Chronic active hepatitis Pemphegoid Atopic dermatitis Hypereosinophilic Syndromes Parasites and Other Infections Lfflers syndrome Metozoon infection Eosinophilc leukemia Pneumocystis carnii infection Polyarteritis nodosa Toxoplasmosis Amebiasis Malaria Scabies Coccidiodomycosis

Miscellaneous
Immunodeficiency disorders Peritoneal dialysis Thrombocytopenia with absent radii Familial reticuloendotheliosis Episodic angioedema associated with eosinophilia

Tumors Brain tumors Hodgkins and non-Hodgkins lymphoma Myeloproliferative disorders

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Nathan and Oski

Disorders associated with Basophilia and Basophilopenia

Basophilia
Hypersensitivity reactions Drug and food hypersensitivity Urticaria Inflammation and infection Ulcerative colitis Rheumatoid arthritis Infleunza Chickenpox Smallpox Tuberculosis Myeloproliferative diseases Chronic myelogenous leukemia Myeloid metaplasia

Basophilopenia
Glucocorticoid adminstration Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital Thyrotoxicosis Nathan and Oski

Disorders associated with Monocytosis and Monocytopenia

Monocytosis Hematologic disorders and lymphomas
Preleukemia Acute myelogenous leukemia Lymphoma Chronic neutropenia Histiocytic medullary reticulosis Collagen vascular disease Systemic lupus erythematosus Rheumatoid arthritis Myositis

Granulomatous diseases
Ulcerative colitis Regional enteritis Sarcoidosis

Infection Subacute bacterial endocarditis Tuberculosis Syphilis Protozoal and rickettisial infections Fever of unknown origin Malignant disease Miscellaneous disorders Postsplenectomy state Tetrachlorethane poisoning Monocytopenia Glucocorticoid administration Infections associated with endotoxemia
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Nathan and Oski

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

PLATELETS
THROMBOCYTOSIS Rarely causes complications in children Primary causes as polycythemia vera or

essential thrombocytosis are unusual in children

Thrombocytosis in children is almost always reactive

or secondary

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PLATELETS CONT.
THROMBOCYTOPENIA

Bone marrow failure Bone marrow infiltration Increased peripheral

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CONCLUSION
CBC provides much more information

than is routinely used. When anemia is present, the CBC contains considerable information regarding its cause and assist in formulating a differential diagnosis and directing further evaluation. WBCs and platelet counts may similarly direct practitioners to consider or dismiss
Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

CONCLUSION
Backup with a good laboratory services and

full-time hematologist capable of pursuing the final diagnosis from data gathered by CBC and history and clinical examination is of utmost importance; if you do not have it, look for it!

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital

Copyright 1982 - 2009 Dr. Erfan & Bagedo Hospital