entendiendo el cbc
DESCRIPTION
Entendiendo el CBCTRANSCRIPT
Entendiendo el CBC
Enid Rivera MDCatedrática
Escuela de Medicina, [email protected]
787-758-7910787-777-3535 xt 7013,14,15
04/22/23 Enid Rivera MD2
Entendiendo el CBC
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Complete Blood Count (CBC)
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WBC : Leukocytes
• With cytoplasmic granules– have a multi-lobed nucleus– Neutrophils (segmented, polys)– eosinophils, and basophils
• Without granules – lymphocytes and monocytes– have non-lobular nuclei
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Different WBC
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Leukopenia : WBC <5,000
• Infectious related (dengue, others)• Congenital, or hereditary• Collagen-vascular diseases (SLE)• Diseases of the liver or spleen• Presence of cytotoxic substance• Bone marrow failure (malignancy, tumor, fibrosis)• Radiation exposure
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Lymphocytes
• 25-40% of WBC, lifespan years
• immune competence achievement– bone marrow, B cells– thymus, T cells– Both produce lymphokines
• B cells: differentiate into plasma cells & secrete specific antibodies
• T cells: recognize cell associated antigens, lyse foreign or virus infected cells, regulate other immune cells
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Lymphopenia and neutropenia
• Classification– Mild (1500-1000)– Moderate(999-500)– Severe (499-0)
• Lymphopenia– Virus, fungal,
intracellular parasites, Tb
– Decreased immunoglobulins
• Neutropenia– Bacterial infections
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• A 12 year old white female was taken to the ER because of generalized body aches, and fever since 3 days ago. Any cytopenia?
• WBC 3,000 Neu 63%, Lym 20%, Mo 8%
• RBC 4.3 – Hg 15.9, Hct 48.0
• Plt 100,000
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• A 2 year old white female was taken to the ER because of pain in her arms and legs and she was complaining of a sore throat. The child was pale and had fever. PE revealed a well nourished but listless child. The child had both lymphadenopathy and hepatosplenomegaly. Has she any cytopenia?
• WBC 3,000 RBC 2.3
• Segs 3% Hgb 6.9Lymphs 2% Hct 18.0 Blasts 95% Plt 10,000
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Peripheral Smear: Diagnosis?
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Leukocytosis: High WBC #
• Infection
• Inflammation (RA)
• Medications: steroids
• Malignancy: leukemia
• Tissue damage (burns)
• Severe stress : cortisol
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Neutrophilia: Increased neutrophil count
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“patient with acute appendicitis”
• WBC 15,000– 65% mature neutrophils– increase in stabs or band cells to 10%".
• typical report of a "shift to the left“
• "shift to the left" " means that bands or stabs have increased, indicating an infection in progress.
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Neutropenia: decreased neutrophil count
• Viral illness ( lymphocytes)• Cyclic (neutrophil drop q 21d)• Chronic benign (asymptomatic, monocytes)• Familial• Severe & symptomatic • Drug related• Syndrome related
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Monocytes• about 4% of circulating leukocytes
• Circulate in the peripheral blood prior to emigration into the tissues.
• Scavenge debris, present antigen to lymphocytes
• Names: liver Kupfer cells, brain microglia, kidney mesangial cells, and bone osteoclasts.
• Lifespan: days in blood, years in tissues as macrophages
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Monocytosis
• >4% or >600 AMC (all monocyte count)
• Viral infection
• Monocytosis assoc to neutropenia
• Leukemia, very rare
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Eosinophils
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Eosinophils (1-4%)
• Kill large parasites, as helminths• Helminths activate alternative complement pathway and
C3b is produced. • Eos attach C3b receptors, and release their granules.• Lifespan: < 1 day in blood, weeks in tissues. • The granule contents damage parasite membrane.
– peroxidase, arylsulphatase B, phospholipase D and histaminase
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Eosinophilia
• >4% or >600 AEC (all eosinophil count)• Allergies• Sinusitis• Asthma• Eczema• parasites
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Red blood cells, or erythrocytes
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Hemoglobin:critical low and high values
• A hemoglobin value < 5 gm may cause heart failure
• A hemoglobin value > 20 gm may cause clogging of capillaries due to hemo-concentration.
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RBC count
• # RBC per cubic millimeter of blood
• Adults: males: 4.6 - 5.9 million females: 4.2 - 5.4 million
• Pregnancy: slightly lower than normal adult
• Newborn: 5.5 - 6 million
• Children: 4.6 - 4.8 million
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Normal hemoglobin values
• Adult males: 14 - 18 gm• Adult females:12 - 16 gm• Pregnancy: 11 - 12 gm• Children: 11 - 16 gm• Newborn: 17 - 19 gm
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Increase in red blood cells # : polycythemia
Cyanotic heart disease
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Polycythemia: Increase in RBC#
hgb and hct
• Physiological polycythemia– neonatal period– at high altitudes – after strenuous physical training
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Pathological polycythemia
• Primary: HIF mutation, RBC over-production does not result from hypoxia
• Secondary : occurs in response to hypoxia– cyanotic heart disease– high oxygen binding hemoglobins– chronic lung disease – smokers
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Factitious polycythemia
• Dehydration• Diarrhea• Severe Burns• Hypovolemic shock • Eclampsia
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Anemia
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Anemiaanisocytosis: normal appearance, different sizes poikilocytosis: abnormal appearance
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A 3 year old black female was admitted to the emergency room complaining of joint pain. The child had a right knee that was swollen and painful to the touch. The
following laboratory data was observed.
WBC 10.5 Segs 24, Lymphs 62, Monos 10, Eosins 4
RBC 2.22 Hgb 7.0 Hct 21.5 MCV 90Plt. 340,000
15 NRBC’s /100 WBC marked poikilocytosis - moderate anisocytosis
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normocytic anemia
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Normocytic anemia
Hemolysis (SS, Sphero, G6PD)
Autoimmune disorders ( SLE, RA, thyroid )
Anemia of chronic disease / inflammation
Acute blood loss
Erythropoietin deficiency
Bone marrow failure (malignancy radiation, toxin)
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On a routine health supervision visit, a 1y/o boy has this CBC
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Microcytic anemia
• Iron deficiency • thalassemia• lead intoxication• sideroblastic anemia• Anemia of chronic disease / inflamation
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Normocytic anemia
• Hemolysis• Chronic disease/inflamation• Hormone deficiency (thyroid, adrenal)• Marrow failure• Malignancies• Renal failure
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Normocytic anemia evaluation
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Macrocytic anemia
• B12 deficiency (pernicious anemia)
• folic acid deficiency
• Syndromes (Fanconi)
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Platelets
• normal range 150,000 - 450,000
• Thrombocytopenia < 150,000.
• < 20,000 may have spontaneous bleeding
• Should be reported in # & MPV
• A report of "adequate platelets" is not adequate
• implies there is at least one platelet for 20 RBC
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Critical low value for platelets
• fewer than 50,000 platelets– risk for bleeding with even trauma
• under 20,000 – may cause spontaneous bleeding
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Thrombocytopenia
• Infection
• Autoimmune
• Factitious
• Sequestration
• Marrow problem
• Syndrome related
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Pseudo thrombocytopenia Platelet clumping
• Frequent collection problem • Minimized by draw from large peripheral vein
• Mix blood with the anticoagulant ASAP after collection, by gentle rotation or inversion.
• Platelet clumping increases with time, so analyze CBC soon.
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• A 13 y/o girl was admitted through the emergency room with a fever and was disoriented. She had been suffering from a viral infection during the previous week. There was bruising on the arms and legs.
WBC 5,000 RBC 2.80 Segs 85 Hgb 10.5 Lymphs 8 Hct 30.0 Monocyte 2 MCV 82 Eos 5 Plt 10,000 Poikilocyte - moderate
Helmet cells, burr cells, spherocytes, microcytes Polychromasia - moderate
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In TTP and DIC, platelets are used up rapidly, and the platelet count falls significantly.
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Thrombocytosis
• Reactive, Reactive, Reactive• Anemia• Infections• Surgery• Burns• others
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Entendieron el CBC? Muchas gracias, Enid Rivera
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WBC interaction
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reticulocyte count
• immature forms of erythrocytes, circulating in the
bloodstream
• 0.5% to 1.5% of the total RBC in men
• 0.5% to 2.5% in women
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• low reticulocyte count– bone marrow failure/dysfunction– folic acid deficiency– cirrhosis
• high reticulocyte count – bone marrow responding to the need for increased
rbc cell production– responding to treatment for anemia– hemolytic anemia– recent donation of whole blood
reticulocyte count
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MCV/MCH
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MCV/MCH
• MCV= RBC size• MCH= hg concentration in RBC• If low hemoglobin, you need to know if RBC
are of normal size and if they have a normal concentration of hemoglobin.
• These measurements, provide important information about various types of anemias.
04/22/23 Enid Rivera MD53
Mean corpuscular volume (MCV)
• MCV: hematocrit is divided by the total RBC count
• low MCV: cells are smaller than normal – iron deficiency anemia, lead poisoning – thalassemia major and thalassemia minor
• high MCV cells are macrocytic, or larger than normal– pernicious anemia and folic acid deficiencies
• normal MCV cells are referred to as normocytic– renal failure, endocrine disorders, acute hemorrhage
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MCV: Mean cell volumeNormal values for erythrocyte indices
Neonate100-120 fl
Children 1-10y/o70 + age in years to 90fl (3rd percentile)
Adolescents 11-17 y/o 78-95 fl
Adults >18y/o 78- 98 fl
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Mean corpuscular hemoglobin (MCH)
• Measures the amount of hemoglobin present in one RBC.
• divides the hemoglobin by the total RBC count.
• The result is reported by a very small weight called a picogram (pg).
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Mean corpuscular hemoglobin concentration (MCHC)
• Proportion of hemoglobin in the RBC.• The hemoglobin is divided by the
hematocrit and multiplied by 100 to obtain the MCHC.
• MCHC - 32-36% MCH- 27-31 picomoles
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MCH and the MCHC
• Used to assess whether RBC are normochromic, hypochromic, or hyperchromic.
• An MCHC of less than 32% or an MCH under 17 pg. indicates that are RBC deficient in hemoglobin concentration.
• This situation is most often seen with iron deficiency anemia.
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Platelets• major coagulation role
• adhere to underlying tissue exposed by any gaps in the endothelial lining of injured vessels
• form plugs that prevent further blood loss while healing takes place
• lifespan 9 to 12 days
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platelets granule contents
• adhesive glycoproteins (fibrinogen, von Willebrand factor, thrombospondin, and fibronectin)
• growth stimulators (as platelet derived growth factor = PDGF)
• vasoactive substances (such as serotonin, a potent vasoconstrictor), and adenine nucleotides, which
stimulate platelet aggregation.
Thrombocytopenia
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Thrombocytopenia
• platelet destruction• impaired platelet production• ITP• HIV • radiation• chemotherapy• drugs that damage the bone marrow• Malignancies of the bone marrow, such as leukemia
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bleeding due to a low plt count (<20k)
• Easy bruising• Unusual or heavy nosebleeds• Hematuria• Black, tar-like stools or frank bleeding with BM• Hematemesis
Syncope or visual disturbances due to intracranial bleeding
• Gingival bleeding• Heavy vaginal bleeding