how to interpret hematology cbc reports
TRANSCRIPT
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Managing CBC Services by 3 part differential cell counter
Dr A D Deshpande MD (Micro), MD (Patho)
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Cell Counters are every where
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3 Part Differential WBCs are counted as 3 Groups
NeutrophilsLymphocytes
E
M
B
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5 Part Differential WBCs are counted as 5 Groups
N L E M B
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Wallace Coulter
1960 Model
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Principle of Cell Counter
Volume of cell is basis of differentiation.
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Cells pass in one Line
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Cells are bad conductors of electricity
Electrical impedance is proportional to cell volume
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RBC chambers – RBCs and Platelets are counted
WBC chamber – WBCs and HB are estimated.
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2 – 25 FlPlatelets
30 - 250 flRBCs
>35 fl – WBCs (Separate chamber)
Volume separate them Volume separate them
femtolitre = 10 −15 litres
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Report in 2 formats
Numbers Graphs
We always look only
numbers
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Don’t ignore me..
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Normal Histogram
Platelet Graph
RBC Graph
30 200
Volume of cell
NUMBER
Of Cells
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Platelet Graph
RBC Graph
30 200
Giant platelets / Microcytes / Fragmented RBCs
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Platelet Graph RBC Graph
30 200
RBC Clumping / Cold Agglutinin / Clotted sample
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Platelet Graph RBC Graph
30 200
Macrocytic (Megaloblastic Anemia)
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WBC Graph
L PM
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Blood indices
MCVMCHMCHC
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80 – 100 flNormal range
MCV
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MCV80 100
NORMAL
706050 110Iron deficiencyThalassemia Anemia. of chronic disorders
B12 & Folic acid deficiencyLiver disease
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MCH27-32 pgmNormal range
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MCHC
32-36 %
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Red cell Distribution Width
(RDW)
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Rule of 3
RBC count X 3 = Hemoglobin %
Hemoglobin % X 3 = Hematocrit
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Hb 7.4 gm %
MCV 65 fl
MCH 18 pgm
RDW 19
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Low HbLow MCVHigh RDW
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Low HbLow MCVHigh RDW
This can be seen in Anemia due to chronic disorders
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Serum Iron Serum Ferritin TIBC % Saturation
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Low HbLow MCVNormal RDW
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Hb 8.2 gm %
MCV 105 fl
RDW 18
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Low HbHigh MCVHigh RDW
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Hypersegmented Neutrophil
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Hb 9.1 gm %
TLC # # # # Platelet count 24,000 / cmm
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Acute Leukemia
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What else we can see in PS
Malarial Parasite
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Sickle Cells
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WBC Counts
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LeukopeniaAplastic anemiaChemotherapyMalariaTyphoidDengue
<4000 WBCs / cmm
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Leukocytosis
>11,000 WBCs / cmm
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NeutrophilsBacterial infection
Trauma, Burn, SurgeryMyocardial infarctionMetabolic acidosisPregnancy
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LymphocyteAcute viral infections – Infectious mononucleosis, hepatitis, cytomegalovirus infectionTuberculosisCLL
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Eosinophilia Allergy –
Asthma, Urticaria, Rhinitis
Parasites – Filaria,
Trichinosis, Tropical
eosinophiliaEczema,
Dermatitis
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Platelets
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Normal range
1.5 Lakhs – 4.5 Lakhs/cmm
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Thrombocytopenia (common causes)
Falciparum malariaDengueHIVLeptospiraMegaloblastic anemiaDrug induced
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Errors in Platelet count
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Take home message
• Numerical data + Graphs Important
• PS exam is mandatory• MCV MCH & RDW are useful • Advise necessary further
investigations - Iron studies , Hb electrophoresis
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Thank you