South College AVL Lab Med: CBC,WBC - Lecture 1

CBC (complete blood count) with differential (DIFF)

what is the most common lab ordered?

annual physicals, ED and IM workups, trend/follow in the hospital

What are some other important uses of CBC?

CBC (complete blood count)

a set of tests that include all WBC, RBC and platelet measurements.

CBC with differential

look at differential count of WBCs - monocytes, lymphocytes, neutrophils, eosinophils, band cells

peripheral blood smear: wright stain

RBC, WBC, and platelet morphologies accessed

identifies abnormal cells

No - vary with age, gender, and pregnancy status

Are all CBC ranges the same for everyone?

shorthand lab diagram

what does this picture show?

HGB, HCT, WBC, PLT

What does the top value represent? bottom? left? right?

Na, Cl, BUN, GLu

K, HCO3, Cret

Top left? Top middle? top right? farthest right?

bottom left? bottom middle? bottom right?

Neutrophils (55-70% WBCs)

what is the most common WBC? what percentage does it make up in differential?

~20-40%

what percentage does lymphocytes make up in differential?

~2-8%

what percentage does monocytes make up in differential?

~1-4%

what percentage does eosinophils make up in differential?

~0.5-1%

what percentage does basophils make up in differential?

at birth (mean of 25,000/mm^3), puberty

When are WBC at their highest? When do WBC fall to adult levels?

Lymphocytes

What is the predominant WBC from the 2nd week of life until 5-7 years?

neutrophils

What is the predominant WBC after 5-7 years of age?

age, sex, race, pregnancy status, +/- spleen

What do normal ranges of WBC depend on?

evaluating infections, neoplasms, inflammation, and allergies

When is WBC w/ DIFF most helpful?

<2,000/mm^3 OR >40,000/mm^3

what are some critical values of WBC?

Leukocytosis

Abnormally high WBC count

Infections (pneumonia), inflammation, smoking, medications such as steroids and lithium, exercise, stress/trauma, leukemia/cancer (>100,000 per mm^3), thyroid storm, dehydration

what are some causes of leukocytosis?

Neutrophilia

increase in neutrophils (>55-70%)

bacterial infections, cushing syndrome, ketoacidosis, RA, thyroiditis, gout, Myelocytic leukemia, trauma

what are some causes of neutrophilia?

Lymphocytosis

increase in lymphocytes (>20-40%)

childhood viral illnesses - mumps/rubella, infectious hepatitis, mono, lymphocytic leukemia, multiple myeloma, radiation

what are some causes of lymphocytosis?

Monocytosis

increase in monocytes (>2-8%)

chronic inflammatory disorders, UC, malaria, TB, mono

what are some causes of monocytosis?

Eosinophilia

increase in eosinophils (>1-4%)

allergic conditions, asthma, eczema, parasite infections, autoimmune diseases

what are some causes of eosinophilia?

Basophilia

increase in basophils (>0.5-1%)

allergic conditions, myeloproliferative diseases (ex: myelofibrosis), PV, leukemias

what are some causes of basophilia?

Leukopenia

deficiency of white blood cells

after bacterial/viral infections, medications (chemo, RA), autoimmune diseases (systemic lupus), vitamin deficiency (B12, iron), bone marrow failure, leukemia/cancer, hypersplenism

what are some causes of leukopenia?

Neutropenia

deficiency of neutrophils

(<55-70%)

aplastic anemia, overwhelming bacterial infections (esp. elderly), viral infections, radiation therapy, chemo, Addison disease

what are some causes of neutropenia?

lymphocytopenia

deficiency of lymphocytes (<20-40%)

leukemia, sepsis, SLE and other immune diseases, late stage HIV, adrenocorticosteroids, radiation therapy

what are some causes of lymphocytopenia?

Monocytopenia

deficiency of monocytes (<2-8%)

aplastic anemia, hairy cell leukemia, prednisone

what are some causes of monocytopenia?

eosinopenia

deficiency of eosinophils

(<1-4%)

increased adrenosteroid production

what are some causes of eosinopenia?

Basopenia

deficiency of basophils

(<0.5-1%)

acute allergic reaction, hyperthyroidism, stress

what are some causes of basopenia?

Neutrophils (PMNs)

which WBC has the function of phagocytosis?

produced in 7-14 days, circulate for ~6 hours

what is the life cycle of neutrophils?

Absolute Neutrophil Count (ANC)

helpful in determining the patients risk for infection

WBC x (%neutrophils + %bands or immature neutrophils)

how do we calculate ANC?

1000

An ANC value of what would indicate severe immunocompromised/high risk for infection?

band cells

immature neutrophils, unsegmented nuclei

~0-3%

what is the normal value of band cells?

left shift

neutrophil production is stimulated, early immature forms of neutrophils enter circulation

(Band/stab cells)

increased number of band cells = ?

ongoing acute bacterial infection

toxemia, hemorrhage, myeloproliferative disorders

what would a left shift indicate?

right shift

increased numbers of hypersegmented neutrophils (bone marrow issue), 5+ nuclear lobes, reduced number of bands or stab cells (folic acid or B12 deficiency)

increased number of neutrophils = ?

Megaloblastic anemia (fat RBCs), liver disease, chronic infections/inflammation, glucocorticoid use/Cushing's syndrome, radiation, chemo

what would a right shift indicate?

megaloblastic anemia

red blood cells are larger than normal

Hypersegmented neutrophils

in megaloblastic anemia, these cells have six or more lobes, and tapering chromatin strands

hemoglobin (HGB), hematocrit (HCT), RBCs, mean corpuscular volume (MVC), RBC distribution width (RDW), WBCs, platelets

What are the components of a CBC test that we care about?

neutrophil, lymphocyte, monocyte, eosinophil, basophil

What are the components of the differential test that we care about?

carry oxygen to remove CO2 from cells

how to explain RBCs to patients?

fight infections

how to explain WBCs to patients?

clot the blood, stop bleeding

how to explain platelets to patients?

iron that carries oxygen in the blood

how to explain hemoglobin to patients?

a measure of the amount of space that RBCs take up in the blood

how to explain hematocrit to patients?

average volume/size of RBCs

how to explain mean corpuscular volume (MCV) to patients?

anemia, dehydration, bleeding

what can abnormal RBC numbers mean?

infection, blood cancer, immune system issue

what can abnormal WBC numbers mean?

bleeding, clotting disorder

what can abnormal platelets mean?

blood disorders

what can abnormal hemoglobin levels mean?

blood, bone marrow disorders

what can abnormal hematocrit levels mean?

anemia, thalassemia

what can abnormal mean corpuscular volume (MCV) levels mean?