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DISCOVER
CBC
PROF / ABDUL HAMID ABDUL MONEM , MD
1B A S I C S
BA
SIC
S 1 CBC Report
Contents• RBCS count • HB (gm/dl)• HCT• Blood indices
⁻ MCV⁻ MCH⁻ MCHC
• WBCS count₋ Netrophils₋ Segmented ₋ Staff₋ Lymphocytes₋ Esinophils₋ Monocytes₋ Abnormal cells
• Platelets
B A S I C
BA
SIC
S 1 RBCS
• It is a circular non nucleated biconcave disc with dense rim & clear contents • RBCS count : 4-5 million /mm3• RBCS formation take place in bone
marrow
B A S I C
BA
SIC
S 1
• It Is An O2 Carrier • It Is Intracorpscular Components • It Is Main Parameter Used To Diagnose
Anemia • Anemia Is Diagnosed According To Age
Group― New born : ↓13 gm/dl― 3months: ↓9.5 gm/dl― 3-12months : ↓10 gm/dl― 1-12years:↓11gm/dl ― >12years: ↓12gm/dl
HEMOGLOBIN B A S I C
NADIR
BA
SIC
S 1
• It is volume of RBCS as regard to the whole blood •Average in newborn : 50%.• Infant & child : 35% - 40% .•Decrease HB & HCT : Anemia • Increase HB & HCT : Polycythemia
HEMATOCRIT (HCT)
HCT
BA
SIC
S 1
• MCV = HCT % × 10 / RBCS • ↓MCV : Microcytosis • ↑MCV: Macrocytosis • Normal MCV : Normocytosis • Average : 90 + 9 FL • Lower Limit = 70 Age/Year• Upper Limit (↓10 Years →90 Fl , ↑10 Years →95 Fl)
MEAN CURPSCULAR VOLUME (MCV)
MCV
BA
SIC
S 1
MCH = Average quantity of hemoglobin in RBCS
MCH = HB (gm%)×10 / RBCS = 32+ 2 pgm
It ↓ in iron deficiency & thalassemia
B A S I C
MCH
MEAN CORPUSCULAR HAEMOGLOBIN
BA
SIC
S 1 RDW
• RDW : red cell distribution width • It denotes size variability of RBCS• It is quantification of ansiocytosis • Normal : 10 – 15%• Used in DD between IDA & Thalassemia• It is markedly increased in IDA up to 30 – 40%
BA
SIC
S 1 Reticulocytes
Reticulocytosis • Hemolytic anemia • Hemorrhagic anemia • IDA
Reticulocytopenia
• Aplasia • Leukemia
• Infiltration
Bone Marrow Mirror Image
Normal : (0.5 – 2%)
BA
SIC
S 1 Reticulocytes
B A S I C
Example : anemic pt with HB of 9 gm% , retics was 5 % , & HCT was
7%Corr, retics = 5× 7/35= 1%
Corrected reticsRetics. Count × HCT/Normal
HCT
BA
SIC
S 1 WBCS
B A S I C
TLC below 10 years : 6000 – 14000TLC above 10 years : 4000 - 12000Normal
• Infection • Inflammation• Malignancy
Leuk
ocyt
osis
• Aplastic anemia
• Malignancy• Infiltration Le
ukop
enia
↑14000
↓4000
BA
SIC
S 1 Differential
TLC
B A S I C
Neutrophils: 60% Lymphocytes : 35%Esinophils: 2%Monocytes : 3-7%Basophils : 0 – 1%
Differential
BA
SIC
S 1 Neutropenia
B A S I C
• Sever infection • Autoimmune • Hypersplensim• BM failure• Cyclic
neutropenia • Congenital
Neut
rope
nia
BA
SIC
S 1 Eosinophilia
B A S I C
Eosinophili
a
AsthmaEczemaParasiticIBD(UC)Malignancy
↑50%
BA
SIC
S 1 Lymphocytosis
B A S I C
Lymphocytosi
s
Viral infectionTBALLWhooping cough
↑60%
BA
SIC
S 1 Abnormal cells
B A S I C
Band cellsN: less than 20% of total neutrophilsBandemia :↑ band cells (bacterial infection).
Metamylocytes & myleocytes in prepheripheral blood is abnormal & denotes bacterial infection .
BA
SIC
S 1 Platelets
B A S I C
Platelets are produced by bone marrow Normal count : (150,000 – 450,000)
Function
Hemostasis• Platelets
aggregation• Platelets
adhesion• Clot formation Disorders
• Thrombocytopenia
• Thromboasthenia• Thrombocytosis
2ANEMIA
APPROACH
A
NE
MIA
A
PP
RO
AC
H
2 Lab. Approach To Anemia
↓ RBCS , HB & HCT
↓MCVMICROCYTIC
ANEMIA
NORMAL MCVNORMOCYTIC
ANEMIA
↑MCVMACROCYTIC
ANEMIA
DIFFERENCATE EACH TYPE
1
2
3
A
NE
MIA
A
PP
RO
AC
H
2 DD Of Microcytic Anemia • Iron deficiency
anemia • Thalassemia• Chronic illness
o Chronic infection o Chronic inflammationo Chronic renal failure
• Lead poisoning • Sideroblastic
anemia
By far the
commonest
is IDA &
Thalassemi
a
A
NE
MIA
A
PP
RO
AC
H
2 Microcytic anemia (DO SERUM IRON)
↓serum iron
Consider IDA OR Chronic illness
Do serum ferritin
IDA ↓ferrit
in ↓TS%↑IBC↑FEP
Chronic illnessNormal ferritin
Infection Inflammatio
n CRF
Normal serum iron
Blood film(basophilic stippling )
Positive Consider
Lead poisionig
Do serum lead
Negative
Do HB electrophore
sis
Abnormal Thalassemi
a
Normal Do BM
SIDEROBLASTIC ANEMIA
A
NE
MIA
A
PP
RO
AC
H
2 IRON DEFFECIENCY
ANEMIA Therapeutic Trail Of 4-6 Mg/KG /d Of Elemental Iron Can Be Initial Step In Diagnosing Of Microcytic Anemia , Response To Test By Reticulocytosis By The 5th – 7th Day And Increase HB I Gm With In 1- 2 Weeks Is Diagnostic , If No Response You Can Evaluate The Other Causes Of Microcytic Anemia .
Iron depletion Iron deficiency Anemia ↓ferritin ↓ferritin
↓transferrin saturation
↑EEP
↓ferritin↓transferrin saturation
↑EEP↓HB
↓MCV
Ther
ape
utic
te
st
Stag
e of
IDA
A
NE
MIA
A
PP
RO
AC
H
2 IRON DEFFECIENCY
ANEMIA Decrease ferritin is early lab. Sign for IDA as it a mirror for iron stores however it is an acute phase reactant and it can increased by inflammation even with URTI.
NB1
RDW and corrected retics can hepps in DD between IDA & thalassemia N
B2
A
NE
MIA
A
PP
RO
AC
H
2 DD Of Normocytic
Anemia • Hemolytic anemia except for thalassemia • Aplastic anemia • Hemorrhagic anemia
A
NE
MIA
A
PP
RO
AC
H
2 Normocytic anemia (DO reticulocyte count)
Low retics
PLT & WBCS
Normal
Consider Pure red
cell anemia
BLAST CELLS
High retics
Serum bilirubin
Normal
History of acute
hemorrhage & investigate for bleeding
High
comb's test
PositiveAHA
Negative
Pancytopenia
YES NO
LEUKEMIA
Aplastic anemia
A leukemic leukemia
BM infiltration
Bone Marrow Aspiration
Do blood film
Heinz bodies Sickle Sphrocyte
SCA
HB electro
Spherocytosis
OFT
G6PD
ENZYME ESSAY
A
NE
MIA
A
PP
RO
AC
H
2 Normocytic anemia At what time the retics count is normal
or decreased in hemolytic anemia ?• Aplastic crisis : parvo virus infection • Decrsed erythropoietin : CKD• Decreased micronutrient for erythropoiesis : decrees
iron & folate • Autoimmune hemolytic anemia when the
autoantibodies reacts with antigens that are presently on reticulocytes which increase clearance of the cells
A
NE
MIA
A
PP
RO
AC
H
2 Normocytic anemia • Direct : coombs reagent + patient RBCS if
agglutination (positive)• Indirect : coombs reagent + patient serum +
known RBCS if agglutination (positive)• Coombs test is negative in about 10% of
patients with AHA the patient should be treated for AIHA if the disease is strongly suspected even direct coombs is negative
Coom
bs
test
A
NE
MIA
A
PP
RO
AC
H
2 Normocytic anemia Amount Of Enzyme Activity Depend On The Age Of RBCS G
6PD
• It is difficult to be diagnosed by HB electrophoresis • It should requested for HbH & hb Bart , Hb HPLC ,high
performance liquid chromatography
May needed in diagnosis of anemia with bone marrow failure in cases of osteoporosis
Alph
a th
alas
sem
iaSk
elet
al
surv
ey
A
NE
MIA
A
PP
RO
AC
H
2 DD Of Macrocytic
Anemia • Pernicious anemia (do serum B12) • Folic acid deficiency ( Do serum folic
acid)• Aplastic anemia (bone marrow )• WBCS ,platelets may also decreased in
megaloblastic anemia (pancytopenia)• Hypersegmented neutrophils are
characterstic >3 lobes• Schilling test : help to diagnose the the
cause of B12 deffeciency
3BLOOD FILM
B
LOO
D F
ILM
3Heinz
Bodies
B
LOO
D F
ILM
3Spherocyt
osis
B
LOO
D F
ILM
3SICKLE
CELLS
B
LOO
D F
ILM
3SCHISTOC
YTES
B
LOO
D F
ILM
3Basophilic
Stippling
B
LOO
D F
ILM
3TARGET
CELL
B
LOO
D F
ILM
3ACANTHOC
YTOSIS
CREDITAHMAD SOLIMMAN ADUL
HALIMAHMAD MOHMOD ATTIA
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