Clinical pathology: Complete Blood count GENERAL OBJECTIVE: After finishing lab activity of CBC, the student will be able to describe the CBC in the DMS case problem SPECIFIC OBJECTIVE: At the end of lab activity of CBC , the student will be able to interprete: - the normal of CBC - the abnormal of CBC

Complete Blood Count (CBC)

Being part of routine physical examination Help : Providing important information about the kinds and numbers of RBC, WBC and platelet. Being part of routine physical examination Help : To evaluate symptoms (weakness, fatigue, bruising, fever, or weight loss) To diagnose conditions (anemia, infection) To diagnose diseases of the blood (leukemia) To monitor the response to some types of drug or radiation treatment

CBC usually includes : WBC count WBC differential RBC count Hematocrit Hemoglobin RBC indices (MCV, MCH, MCHC) Platelet count Blood smear ** RDW ESR

CBC can be performed : Manually : Automatically (hematologic analyzer) Hemocytometer Calculate from other CBC results (RBC indices) Automatically (hematologic analyzer)

WBC count To express WBC concentration per unit volume of blood (mm3). No distinction is made among the six normal cell types (band neutrophils,segmented neutophils, lymphocytes, monocytes, eosinophils, basophils). Increase WBC count  leucocytosis Decrease WBC count  leucopenia

WBC Differential 5 major kinds of WBC Immature neutrophil, band neutrophil  include to the test. Each type of cell plays a different role in protecting the body. Number of each type  give important information about the immune system. Expressed as a percentage of each type

Increase/decrease number of each type  help to identify : infection (neutrophilia, lymphocytosis) Allergic or toxic reaction to certain medication (eosinophilia) Malignancy (leukemia)

Hemoglobin Main component of RBC Conjugated protein Serves as a vehicle for the transportation of O2 and CO2. Gives blood cell its red color Hemoglobin test measures the amount of hemoglobin in blood. Decrease  anemia

RBC indices There are 3 RBC indices : MCV (Mean Corpuscular Volume) MCH (Mean Corpuscular Hemoglobin) MCHC (Mean Corpuscular Hemoglobin Concentration). Their values are determined from other measurements noted during CBC

Platelet count expressed as concentration – platelet cells per unit volume of blood (mm3). Decrease  thrombocytopenia Increase  thrombocytosis

RDW Red Cell Distribution width Reports whether all the red cells are about the same width, size, and shape. This helps further classify the types of anemia.

Erythrocyte Sedimentation Rate Measuring the sedimentation of erythrocytes in diluted human plasma over a specified time period (1 hour) Measuring the distance from the bottom of the surface meniscus to the top of erythrocyte sedimentation in a vertical column containing diluted whole blood. Not very specific/diagnostic test  still use in many institutions as a screening test for inflammation

Factors affecting ESR RBC size & shape Plasma fibrinogen & globulin levels Mechanical Technical

Factors affecting the ESR : Increase : Rouleaux formation Fibrinogen (elevated) Immunoglobulin (excess) Decrease : Microcytes Sickle cells Spherocytes

Methods performing ESR : Manual : Westergren Method Wintrobe Method Automatic

Normal values : Adult men 0-15 mm/h Adult women 0-20 mm/h

Diseases associating with an elevated ESR : 1. Chronic infections(Tb) 2. Multiple Myeloma 3. Cryoglobulinemia 4. Temporal arteritis 5. Inflammatory diseases 6. Pregnancy 7. Anemia Malignant neoplasms Paraproteinemias Macroglobulinemia Hyperfibrinogenemia Rheumatoid arthritis Collagen disease Polymyalgia rheumatica

Results Normal value can vary from lab to lab Normal value for CBC tests varies, depending on age, sex, elevation above sea level, and type of sample.