presentation 2006 rcsw cbc-lecture-wa

8/3/2019 Presentation 2006 RCSW CBC-Lecture-Wa

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Interpreting Clinical Lab Data

Robert L. Wilkins, PhD, RRT

Professor of CPS

Loma Linda University
http://images.google.com/


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Divisions of the Clinical Lab

Microbiology

Sputum gram stain

Sputum culture and sensitivity

Pleural fluid culture and sensitivity

Blood Bank

- blood typing and storage


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CELL MORPHOLOGY


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Cell Morhphology (neutrophil)

Segmented neutrophil

(40-70% of WBCs)

Life span of about 10

days

Moves from bone marrow

to blood to tissues

Mature more quickly

under stressful conditions

Primary defense for

bacterial infections


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The Neutrophil

Once in the peripheral blood, it can be inthe circulating pool (CP) or the marginated

pool (MP) (approx. 50%)cells in MP not counted in CBC

Shift from the MP to the CP can occur with

stress, trauma, catecholamines, etc.This results in a transient leukocytosis

Such leukocytosis can last 4 to 6 hours


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The Neutrophil

Present in band and segmented forms

Bands make up < 5 % of circulating

neutrophils normallyLeft shift is seen as an increase in the

number of bands and is common with

acute infectionMain function is to locate, ingest, and kill

bacteria and other foreign invaders


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Cause of Neutrophilia

Pathologic

Bacterial infection

Certain viruses and fungi Inflammatory responses to tissue death

Burns

Snake bites

Drugs steroids

lithium


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Causes of Neutrophilia (cont.)

Physiologic

Pseudoneutrophilia (shift of cells from the MP

to CP) Catecholamines

Acute stress

Other inflammatory responsesNeoplastic growth

Metabolic disorders


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Pools of Neutrophils

1. Bone marrow: many banded forms are

present; neutrophilia with lots of bands

suggest bone marrow was source

2. Circulating Pool: used to deal with day to

day invasion of the body by organisms

3. Marginated Pool: no bands; respond tophysiologic stimulation


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Causes of Neutropenia

Decreased Production of WBCs

bone marrow diseases

malignancies that affect the bone marrow

Increased Neutrophil Destruction

overwhelming infection

certain bacteria

immune reactionsPseudoneutropenia (shift of cells from CP to MP)

viral infections

hypothermia


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Cell morphology (Eosinophil)

Segmented eosinophil

Life span = 14 days

Spends little time in theblood before it locates in

the skin, GI tract, or

respiratory tract

Only 1% of mature cells

are located in blood


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The Eosinophil

Also function as phagocytes but appear to

be less potent than neutrophil

Drawn to sites of hypersensitivity reactions

by mast cell chemotactic factors

Often found in sputum of asthmatics

May play a role in pathogenesis of lung dz

Play a role in parasitic infections


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The Basophils

Mature basophil

Least common of

WBCs (< 2%)Nucleus does not

always segment

Increase in response

to same conditionsthat cause eosinophilsto respond


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The Monocytes

Also not common in

circulating blood

Stay in blood forabout 70 hours

Become macrophages

in tissue and live for

several months or

longer


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The Monocytes

Primary role is phagocytosis

Play large role in ingesting cellular debris

Become activated when direct contact

with microorganisms occurs

Activated cell has greater motility, enzyme

activity and killing capacity (causes fever)

Also play a role in immunity


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The Lymphocytes

May mature into B or Tcells

Main function isantigen recognition andimmune response

Life span quite varied

(up to two years)Can pass back and forth

between blood andtissues


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Lymphocytes: B & T types

B cells are not only produced in the bone

marrow but also mature there.

However, the precursors of T cells leavethe bone marrow and mature in the thymus

(which accounts for their designation)


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Types of Lymphocytes

B lymphocytes (or B cells) are most effective

against bacteria & their toxins plus a few viruses

T lymphocytes (or T cells) recognize & destroybody cells gone awry, including virus-infected

cells & cancer cells.

T cells come in two types: helper cells and

suppressor cells; normally the helper cells

predominate.


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Lymphocyte Count: Decreased

I. DecreasedA. AIDSB. Bone Marrow suppressionC. Aplastic AnemiaD. SteroidsE. Neurologic Disorders

1. Multiple Sclerosis2. Myasthenia Gravis

3. Gullain Barre Syndrome
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Lymphocyte count: Increased

a. Influenza

b. Pertussis

c. Tuberculosisd. Mumps

e. Cytomegalovirus Infection

f. Infectious Mononucleosisg. Infectious Hepatitis

h. Viral pneumonia
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Interpreting the CBC

What is total white cell count?

If elevated (>11,000), what type of WBC is

the culprit?

Is it the neutrophils, eosinophils,

lymphocytes, basophils, or monocytes?

Marked leukocytosis is usually due to

neutrophils or lymphocytes.


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Normal

Values

% Absolute

Neutrophils 40

70 1800

7500

Eosinophils 06 0600

Basophils 01 0100

Lymphocytes 2045 9004500

Monocytes 26 90 - 1000


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If the neutrophils are causing the

leukocytosis, compare the neutrophil % to

total WBC.The % neutrophils indicates the severity of

the infection; the total WBC reflects the

quality of the immune system


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Interpreting the CBC (Case # 1)

85 yr old female with pneumonia:

Total WBC is: 11,500

Neutrophil % = 80% (9200) bands = 5%

This indicates that a severe infection is

present but the immune system is unable to

respond appropriately.

Prognosis poor.


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Interpreting the CBC (Case # 2)

5 yr old male with pneumonia

WBC = 18,000

Neutrophils = 60% (10,800)

Marked leukocytosis and normal range for

neutrophils indicates moderate infection

but excellent immune system response

Excellent prognosis


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Interpreting the CBC (Case #3)

10 yr old male admitted for pneumonia:

WBC: 16,000

neutrophils = 75% (12,000) (1800-7500)Bands = 5% (800) (0-100)

Eosinophils = 1% (160) (0-600)

Lymphocytes = 10% (1600) (900-4500)Basophils = 0% (0) (0-100)

Monocytes = 3% (480) (90-1000)


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Interpreting the CBC (Case #3)

Interpretation

neutrophilia probably due to bacterial

pneumonia

left shift indicative of severe infection

the source of the neutrophils is the bone

marrow since many bands are present


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Case Study # 4

20 yr old male admitted following MVA

WBC 14,500 75% neutrophils 1% bands

Leukocytosis due to neutrophilia

History and low per cent of bands suggest

pseudoneutrophilia

Due to liberation of marginated neutrophils

in the intravascular system


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What is indicated by leukopenia?

1. Bone marrow failure

cancer e.g. leukemia, lymphoma2. Overwhelming infection

severe pneumonia pt who has poor immune

system and cant produce enough WBCs3. Shift of neutrophils to MNP (viral infections

and hypothermia)


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Platelet Count

Normal count is 140,000 to 440,000/mm3

Life span of about 10 days

Low platelet counts (thrombocytopenia)

cause excessive bleeding

Thrombycytopenia is common with the use

of heparin, DIC, bone marrow disease,

liver failure and sepsis


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Platelet


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Platelet (Activated)


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Red Blood Cells


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Red Blood Cells (Erythrocytes)

Produced in the bonemarrow

Life span of about120 days

Primary function isgas transport

Immature version hasnucleus and is called areticulocyte


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Interpreting the RBC count

1. Normal values:Men: 4.25.4 million/mm3

Women: 3.65.0 million/mm3

2. AnemiaabnormalDecrease in RBC count

- decreased production

- increased destruction (hemolysis)

- blood loss


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Interpreting the RBC count

3. Increased RBC count = Polycythemia

A. Primary

B. Secondaryliving at altitude

chronic lung/heart disease

tobacco use/carbon monoxideC. Relative Polycythemia

dehydration


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Red Blood Cell Indices

Mean Corpuscular Volume (MCV)

Volume occupied by a singleRBC

Increase in MCV is known asMacrocytic anemia.

Decrease in MCV is known asMicrocytic anemia.

Mean Corpuscular Hemoglobin Concentration

(MCHC)

Measure of the concentration of hemoglobin in anaverage RBC

Decrease in MCHC is known as Hypochromic anemia

Normal is known asNormochromic anemia.


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Normocytic anemias

Blood loss

Hemolytic anemia

Microcytic anemias (100 fL)

Folic acid deficiency Vitamin B12 deficiency

Some COPD patients*femtoliters


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Hematocrit


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The RULE of Three

Applies to normocytic, normochromic

erythrocytes only

Useful to detect laboratory error inmeasuring the Hb, HCT, and RBC count

3 times the RBC count should = Hb

3 times Hb should = Hct


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RBC = 3.0 x 1012 3 x 3 = 9

Hb = 9.2 g/dL 3 x 9.2 = 27.6

Hct = 28%

The RULE of Three


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Interpreting the Red Blood Cells

CBC: Results Normals

RBC (x1012/L) 4.2 4.2-5.4

Hgb (g/dL) 10.6 11.5-15.5Hct 34.9% 38%-47%MCV (m3) 77.0 80-96MCHC 30.4% 32-36%Interpretation: Microcytic, hypochromic anemia; rule of 3

does not apply


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Reticulocyte Count

Normal values:

0.51.5% of RBC

Helpful to identify cause

ofAnemia

Increase indicates

Anemia is due toBlood

loss

Decrease indicatesAnemia is due toBone

marrow disease


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Bibliography

Steine-Martin: Clinical Hematology, 2nd

edition, Lippincott, Philadelphia, 1998.

Kaplan: Clinical Chemistry, 4th edition,Mosby, St. Louis, 2003.

Wilkins: Clinical Assessment in

Respiratory Care, 5th edition, Mosby, St.Louis, 2005.

presentation 2006 rcsw cbc-lecture-wa

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