Complete Blood Count (CBC)/Hemoglobin/Erythrocyte sedimentation rate (ESR)/Hematocrit (HCT)/Red cell count (RCC)/Total and Different WBC count/Platelet count/Thrombocytosis/thrombocytopenia/leukocytosis& leukopenia

 

Complete Blood Count (CBC)

Main parameters measured

1. Hb concentration.

2. ESR

3. Haematocrit (Hct) or PCV.

4. White cell count.

5. WBC differential.

6. Red cel count (RCc)

7. MCV 

8. MCH

9. MCHC

10. Red cell distribution width (RDW).

11. Platelet count.

Hemoglobin

• Interpretation

Increased Hb:

(18.5 in Male & 16.5 in Female)

• PRV (Polycythaemia Rubra Vera)

Decreased Hb:

• Anaemia

Spurious low Hb:

• Improper sample mixing

• Blood taken from vein into which an

infusion is flowing

 

Erythrocyte sedimentation rate (ESR)

• Interpretation

Increased ESR

1. Acute bacterial, fungal or viral

infection

2. Necrotising bacterial infection

3. Acute inflammatory diseases, e.g.

Crohn's disease, polymyalgia

rheumatic

4. Chronic bacterial or fungal infection,

e.g. localized abscess, bacterial

endocarditis or tuberculosis

5. SLE, Sjögren's syndrome

6. Multiple myeloma

7. Pregnancy, old age, end-stage renal

disease 

Decreased ESR

1. Polycythaemia

2. Hypofibrinogenaemia

3. CCF

4. Poikilocytosis

5. Spherocytosis

6. Sickled cells 

Hematocrit (HCT)

• Interpretation

Increased HCT

1. Plasma Leakage (eg. In Dengue)

2. Polycythaemia Rubra Vera (> 0.52

males, > 0.48 females)

3. True' polycythaemia (=Absolute

erythrocytosis)

Males > 0.60

Females > 0.56

4. Relative erythrocytosis

Diuretics

Smoking

Obesity

Alcohol excess

Gaisbock's syndrome

Decreased HCT

Anaemia

Red cell count (RCC)

• Interpretation

Decreased Red cell count

         1. Hypoproliferative anaemias, e.giron,

vitamin B12 and folate deficiencies.

2. Aplasias e.g. idiopathic or drug-

induced (don't forget chemotherapy).

      3. Parvovirus B19 infection-induced red

cell aplasia resulting in transient

marked anaemia.

Increased Red cell count

1. PRV

                   2. Thalassaemia.

Total White Cell Count

• Interpretation

Increased WBCS (Leucocytosis)

• Infection (esp. Bacterial)

• Leukaemia

• Myocardial Infarction

Decreased WBCS (Leucopenia)

• Infection (eg. Typhoid,Viral, Protozoal)

• Pancytopenia due to any cause

Differential White Cell Count

• Interpretation

Increased Neutrophils (Neutrophilia)

• Infection: bacterial, fungal

• Trauma: Surgery, burns

• Infarction: myocardial infarct,

pulmonary embolus, sickle-cell crisis

• Inflammation: gout, rheumatoid

arthritis, ulcerative colitis, Crohn's

disease

• Malignancy: solid tumours, Hodgkin

lymphoma

• Myeloproliferative disease:

polycythaemia, chronic myeloid

leukaemia

• Physiological: exercise, pregnancy

Decreased Neutrophils (neutropenia)

• Infection: viral, bacterial (e.g.

Salmonella), protozoal (e.g. malaria)

• Drugs: Carbimazole, propylthiouracil,

captopril, nifedipine, pyrimethamine,

sulfadoxine, chloroquine,

sulphonamides, penicillins,

cephalosporins

Autoimmune: connective tissue

disease

• Alcohol

• Bone marrow infiltration: leukaemia,

myelodysplasia

• Congenital: Kostmann's syndrome

• Constitutional: Afro-Caribbean and

Middle Eastern descent

Increased Eosinophils: (eosinophilia)

• Allergy: hay fever, asthma, eczema

• Infection: parasitic

• Drug hypersensitivity: e.g. gold,

sulphonamides

• Vasculitis-

• Churg-Strauss syndrome

• Granulomatosis with polyangitis

(Wegener's granulomatosis)

• Polyarteritis nodosa

• Malignancy: solid tumours,

Iymphomas

• Primary bone marrow disorders:

• Myeloproliferative disorders,

• Hypereosinophilic syndrome (HES)

• Acute myeloid leukaemia

Increased Basophils (Basophilia)

• Myeloproliferative disease:

polycythaemia, chronic myeloid

leukaemia

• Inflammation: acute hypersensitivity,

ulcerative colitis, Crohn's disease

• Iron deficiency

Increased Monocytes (Monocytosis)

• Infection: bacterial (e.g. tuberculosis)

• Inflammation: connective tissue

disease, ulcerative colitis, Crohn's

disease

• Malignancy: solid tumours, chronic

myelomonocytic leukaemia

Increased Lymphocytes (Lymphocytosis)

• Infection: viral, bacterial (e.g.

Bordetela pertussis)

• Lymphoproliferative disease: chronic

lymphocytic leukaemia, lymphoma

• Post-splenectomy

Decreased Lymphocytes (Lymphopenia)

• Inflammation: connective tissue

disease

• Lymphoma

• Renal failure

• Sarcoidosis

• Drugs: corticosteroids, cytotoxics

• Congenital: severe combined

immunodeficiency

• HIV infection 

Platelet count

Interpretation

Decreased Platelet count(Thrombocytopenia)

Marrow hypoplasia

• Childhood bone marrow failure

syndromes, e.g. Fancon's anaemia,

dyskeratosis congenita,

amegakaryocytic thrombocytopenia

• Idiopathic aplastic anaemia

• Drug-induced: cytotoxics,

antimetabolites

• Transfusion-associated graft-versus-

host disease

Marrow infiltration

• Leukaemia

• Myeloma

• Carcinoma (rare)

• Myelofibrosis

• Osteopetrosis

• Lysosomal storage disorders, e.g.

Gaucher's disease

Haematinic deficiency

• Vitamin B12 and/or folate deficiency

Familial (macro-) thrombocytopathies

• Myosin neavy chain abnormalities, e.g.

Alport's syndrome, Fechner's

syndrome

• Bernard Soulier disease

• Montreal platelet syndrome

• Wiskott-Aldrich syndrome (small

platelets)

Immune mechanisms

• Idiopathic thrombocytopenic purpura*

• Neonatal alloimmune

thrombocytopenia

• Post-transfusion purpura

• Drug-associated, especially quinine

and vancomycin

Coagulation activation

• Disseminated intravascular

coagulation

Mechanical pooling

• Hypersplenism

Thrombotic microangiopathies

• Haemolytic uraemic syndrome

Liver disease

• Thrombotic thrombocytopenic purpura

Pre-eclampsia

Infection with Thrombocytopenia

• Malaria, kala-azar

VHF including Dengue, Yellow fever,

Ebola fever

• Meningococcaemia

• Enteroviruses

• Leptospirosis

• Rubella

• Epstein-Barr virus, Cytomegalovirus,

HIV

• Louse-borne relapsing fever

• Primary toxoplasmosis and secondary

syphilis.

Others

• Gestational thrombocytopenia

• Type 2B von Willebrand disease

Note: Spuriously low due to clot in

sample, platelet clumping.

Increased Platelet count (Thrombocytosis)

Reactive thrombocytosis

• Chronic inflammatory disorders

• Malignant disease

• Tissue damage

Haemolytic anaemias

• Post-splenectomy

• Post-haemorrhage

Clonal thrombocytosis 

• Primary thrombocythaemia

PRV

• Chronic myeloid leukaemia

• Myelofibrosis

• Myelodysplastic syndromes (RARS

with thrombocytosis, 5 q- syndrome)