CBC Combo

What do you look at on a CBC to decide if there is an anemia?

Hgb, RBC, HCT

Normal HgB, RBC, HCT

Normal not anemic

High HgB, RBC, HCT

Polycythemia

Low HgB and/or RBC, and/or HCT

Anemia

Anemias are classified by what 2 things?

Cell size, Cell color

Color really is a measure of what content?

HgB

How do you determine cell size and color?

RCB indices

What do RBC indices consist of?

MCV, MCH, MCHC

What is MCV

Cell size

What is MCH?

Cells color (HgB)

What is MCHC?

Cell color (HgB)

Decreased MCV indicates what?

Microcytic anemia

Normal MCV indicates what?

Normocytic anemia

Decreased MCH (MCHC) indicates what?

Microchromic anemia

Increased MCV indicates what?

Macrocytic anemia

Normal MCH (MCHC) indicates what?

Normochromic anemia

Increased MCH (MCHC) indicates what?

Hyperchromic anemia

What is the aka for hyperchromic anemia?

Polychromasia

Anemias will have what in regard to RBC &/or Hgb &/or HCT?

Levels will be decreased

MC anemia in the world is

Iron deficiency anemia

MC anemia based on cell size is

Microcytic

MC microcytic anemia is

Iron deficiency anemia

MC etiology of IDA is

Chronic blood loss

MC cause of CBL is

GI tract blood loss; in pre menopausal → menses

MCV, MCH, MCHC in Microcytic Hypochromic Anemias?

Decreased

What is the most common microcytic hypochromic anemia?

IDA

What are the types of microcytic hypochromic anemias?

IDA, CBL(truly an IDA), Thalassemia, ACD, ARD-kidney disease

Differential dx of the MCHC anemias?

History, Clinical presentation, iron parameters, nationality, x-ray

What are the iron parameters?

Iron, ferritin, TIBC

What is the best parameter to differentiate the MCHC anemias?

TIBC

IDA has _____ TIBC?

Increased

CBL has ____ TIBC (really and IDA)

Increased

ACD has _____ TIBC

Decreased

Thalassemia has ______ TIBC

Normal

ARD has ____ TIBC (really a specialized ACD)

Decreased

Normocytic Normochromic Anemias will have MCV, MCH, MCHC

Normal

What are the types of normocytic normochromic anemias?

Hemolytic/sickle cell, Aplastic, Acute blood loss, ACD, ARD

Differential dx of the MCHC anemias

History, clinical presentation, cell morphology, x-ray (H-shaped vert. AVN), race-sickle cell

Macrocytic normochromic/Hyperchromic Anemias MCV, MCH, MCHC

Increased MCV

Normal/Increased MCH

Normal/Increased MCHC

Macrocytic Normochromic MCV, MCH/MCHC

Increased, MCV and normal MCH/MCHC

Macrocytic Hyperchromic MCV, MCH/MCHC

Increased, MCV and increased MCH/MCHC and is polychromasia

Macrocytic anemias have increased _______ and with big cells we don’t care about the ____

MCV; Color

MC anemias have the same list of differentials:

B12 and Folic acid (equally likely) , alcoholism, liver disease

Megaloblastic anemia are the ____ 50% and ______ 50%

B12, B9

Nonmegaloblastic anemias are the _______ and ________

Liver disease, alcoholism

What is the most common macrocytic anemia?

Megaloblastic

Differential dx of the macrocytic anemias?

Hx, clinical presentation, vitamin assay, bone marrow biopsy

If it is a B12 deficiency anemia then it is most likely due to

Lack of intrinsic factor

Lack of intrinsic factor due to B12 deficiency is called what?

Pernicious anemia

¼ of patients with Pernicious anemia die from what?

Stomach cancer

Normal WBC count is

5-10,000

Less than 5,000 WBCs is commonly due to what?

Viral infx

10-18k WBCs is most commonly due to what?

Infection/inflammation, bacterial MC, viral parasite

20-30k WBCs with S/S of abdominal complain most likely due to?

A hot abdomen → Pancreatitis, peritonitis

30-50k (20-50k) is most likely due to?

Leukemoid reaction or leukemia

If it is a leukemia most likely it is

Chronic

Greater than 50k WBCs most likely it is a

Leukemia

Segs primarily respond to

Bacteria

Bands primarily respond to

Bacteria

Lymphocytes primarily respond to

Viruses

Eosinophils primarily respond to

Parasites and allergens

Basophils primarily respond to

Hypersensitivities/ allergies

Monocytes respond to help

Neutrophils

Increase in immature cells is called

A shift to the left

Presence of blasts and or pros indicates what?

Acute Leukemia

Absence of blasts and pros makes it

Chronic leukemia

Although WHO < ____% Blasts chronic > ______ Blasts acute

20%, 20%; FAB 30%

WBC differential count should be equal to how many cells?

100

What are the bone marrow cells that should stay in the bone marrow?

Metas, Myelos, Pros, Blasts

Bone marrow cells in the peripheral blood is?

Bad

Metas, Myelos, Pros and Blasts listed on a differential belong to the

Neutrophils/Segs unless they are designated by a letter

L-Blasts would belong to

Lymphocytes

L-Pros would belong to

Lymphocytes

B-Blasts would belong to

Basophils

B-Metas would belong to

Basophils

Greater than 50,000 WBC

Blah, blah, blah…..5 metas, 5 myelo, 5 pros, and 10 blasts

AML

Acute myeloid leukemia

Greater than 50,000 WBC

blah, blah, blah…….5 E-metas, 5 E-myelo, 5 E-pros and 10 E-blasts

AEL

Acute Eosinophilic Leukemia

Greater than 50,000 WBC

BLah, blah, blah…..15 L-Blasts

ALL

Acute lymphocytic Leukemia

Must have letter to designate bone marrow cells, no letter it belongs to?

Segs

Greater than 50,000 WBCs is

Leukemia

30-50k WBC is

CML (chronic myeloid leukemia) or Leukemoid reaction

42 WBC

Blah blah blach, predominate segs is

CML or neutrophilic leukemoid

Differential for CML is

Bone marrow biopsy and Philadelphia chromosome

Neutrophilic leukemoid reactions resemble

CML (chronic myelocytic leukemia)

Lymphocytic leukemoid reactions resemble

CLL (chronic lymphocytic leukemia)

42 WBCs

yada, yada, yada…..10 blasts

AML (acute myeloid leukemia)

42 WBC

yada, yada, yada…. 10 L-Blasts

ALL (acute lymphocytic leukemia)

Presence of Reed-Sternberg Cells equals

Hodgkin’s lymphoma

Malignant proliferation of plasma cells is

MM

H shaped vertebra are associated with?

Sickle cell anemia

Hair on end calvarium is most likely associated with

Thalassemia

List the microcytic hypochromic anemias

IDA, CBL (really and IDA), ACD/ARD, and Thalassemia

What would be the expected TIBC associated with an IDA?

Increased

Describe secondary polycythemia

An erythropoietin mediated increase of RBC’s and hemoglobin due to hypoxia, often associated with pulmonary, cardiac or kidney disorders

Relative polycythemia

Cause of RBC increase: Decreased plasma volume

Erythropoietin levels: ???

Normal

Secondary polycythemia

Cause of RBC increase: Hypoxia

Erythropoietin levels: ????

Decreased

Primary polycythemia

Cause of RBC increase: Overproduction by bone marrow

Erythropoietin levels: ????

Decreased

Your patient had as CBC and they have been told they have a microcytic anemia. What follow up testing would be helpful?

History, clinical presentation, iron parameters, fecal occult blood test

What are the iron parameter levels in thalassemia?

Normal iron, ferritin and TIBC

Your pt has signs and symptoms of a pneumonia. The pt’s CBC result show 14.4 WBCs, 80 neutrophils, 12 bands and 8 lymphocytes. The diagnosis is most likely an/ a

Bacterial pneumonia