The ABC of CBC: Interpretation of Complete Blood Count and Histograms DP Lokwani, Sunit Lokwani
INDEX
A
Abciximab 51
Abetalipoproteinemia 6, 21
ABO incompatibility 22
Acanthocytes 24
Acquired immunodeficiency syndrome 36
Acquired storage pool deficiency 53
Acridine orange 29
Acute coronary syndrome 57
Afibrinogenemia, congenital 53
African sleeping sickness 34
Aggregation defects 53
Agranulocytes 35
Alcoholism 13, 20, 53
Allergic disorders 149
Allergic reactions 36
Allergy 36
Alpha thalassemia, heterozygous 128
Alpha-granule deficiency 54
Amino acids 5
Amyloidosis, systemic 21
Anabolic metabolism 6
Androgens 5
Anemia 10, 13, 17
advanced megaloblastic 88
aplastic 6, 10, 13, 36, 40, 45, 51, 55, 56, 94, 136, 137, 148
autoimmune hemolytic 14, 22
chronic macrocytic 132
diagnosis of 3
dimorphic 13, 100
drugs-induced chronic macrocytic 132
dual deficiency 106
dyserythropoietic 23, 25
early megaloblastic 88
hemolytic 3, 5, 10, 24, 38, 133
hypochromic microcytic 14
hypoplastic 148
hypoproliferative 16
macrocytic 6, 13, 14, 26
megaloblastic 6, 10, 13, 22, 23, 25, 55, 56, 8890, 106, 130, 131, 148
microangiopathic hemolytic 6, 21, 22, 51
microcytic 14
mixed nutritional deficiency 133
nonmegaloblastic macrocytic 13
normocytic 13, 14
pernicious 6, 13, 26, 130
schistocytic hemolytic 21
severe 26
Anisocytosis 20, 79, 141, 145
Antibiotics 53
Antibody-synthesizing lymphocytes 49
Anticonvulsants 13
Anti-inflammatory agents 53
Antimicrobials 13
Antiplatelet antibodies 53
Antitumor agents 13
Aorta, coarctation of 21
Aplasia 12
Auer bodies 41
Auer rod 41
Autoagglutination 14
Autoimmune disease 53
Automated cell counters, advantage of 70
B
Babesiosis 34
Bacterial infection 35, 38, 118
Baso channel 119
Baso cytogram 118, 120122, 143147
method 118
Basophils 1, 44, 117
Bell cells 21
Bernard-Soulier
disease 54, 55
syndrome 52, 53
Beta thalassemia
heterozygous 75
major 106, 126
minor 127
trait 106
Bite cell 23
Bleeding
disorders 3
manifestation 51
peptic ulcer 22
severe 51
Blood
cell 6, 66
dyscrasias 16
films 27, 28
examination 33
loss 5, 6, 12
acute 6, 16, 53
chronic 6
low oxygen level in 12
transfusion 75, 106
Bone marrow 36, 144
aplasia 3
aspirate 141
failure 12, 56
hypoplasia 51
infiltration 51
production defect 16
replacement 25
stimulation 25
studies 16
Brugia
malayi 33
timori 33
Burns 21, 22, 40
injury 38
Burr cells 22
C
Cabot rings 26
Calcium mobilization 53
Cancer, metastatic 38
Capillary blood method 33
Capillary tube method 33
Carboxyhemoglobin 7
Carcinomatosis, disseminated 21
Cardiac patch 21
Cardiac valve, abnormal 21
Cathodal proteins 26
Celiac disease 13
Cell
counts 161
cytogram, cell distribution of 116
size 68
structure density 68
volume 68
Chagas disease 34
Chédiak-Higashi syndrome 41, 53
Chemotherapy 36, 51, 55, 56, 124
Chromatin 37, 38, 44, 46
Chronic disease, anemia of 10, 13, 20, 87, 128
Cirrhosis 10, 53
Clonal overproduction 53
Coagulopathy 153
Cobalt 5
Cold agglutinin 14, 52, 106, 135
disease 75
Collagen
diseases 45
vascular disease 12, 38
Comma-shaped cytogram 96, 127
Complete blood
cell 61
count 13, 31
Composite platelet index 58
Conductivity 68, 115
Connective tissue
diseases 26
disorder 21
Cor pulmonale 12
Corticosteroids 38
COVID-19 49
Crohn's disease 45
Cyanmethemoglobin method 7
Cyclooxygenase deficiency 53
Cyclophosphamide 13
Cytochemistry 144, 145
Cytogram 2, 80, 101, 126, 127, 131, 133, 135, 138, 146, 150
Cytomegalovirus 25, 51
Cytoplasm 37, 38, 4446
Cytotoxic chemotherapy 129, 148
D
Dacryocyte 21
Degmacyte 23
Dehydration 6, 12, 22
Dengue 36, 55, 57, 122
hemorrhagic fever 12
Di Guglielmo disease 13
Diabetes mellitus 26
Diarrhea
bloody 51
severe 12
Disseminated intravascular coagulation 6, 21, 51, 52, 57
Döhle body 40
Dracunculus medinensis 33
Drugs 36, 53
allergy 149
reactions 40
Dysproteinemias 53
E
Echinocytes 22
Eclampsia 38
Electronic impedance 68
Coulter's concept of 64
Elliptocytosis, hereditary 6, 22
Emphysema 6
Endocarditis, subacute bacterial 45
Endocrine disorders, anemia of 6
Enzyme deficiencies 6
Eosinopenia 44
Eosinophil 44, 117
Eosinophilia 44, 119, 149
Epinephrine 53
Epstein-Barr virus 51
Erythroblastosis fetalis 10
Erythroblasts, maturation of 6
Erythrocyte 5
fragmented 56
volume
fraction 11
histogram for 76
Erythroid hyperplasia 16
Erythropoiesis, ineffective 16
Erythropoietin deficiency 6, 12
Ethanol 51
Ethylenediaminetetraacetic acid 52, 61, 150
Exercise 53
F
Fanconi anemia 6
Ferritin 16
Fever 51
Fibrosis 51
pulmonary 6, 12
Filaria 3
Filariasis 33
subcutaneous 33
Fistula 13
Flow cytometry 80, 145
fluorescent dyes augmentation of 67
role of 66, 70
Fluid overload 5
Fluorescence flow cytometry 115
Fluorescent microscopy 29
after centrifugation 29
Folate 5
deficiency 13, 20, 36
anemia 75, 129
nutritional deficiencies of 12
Folic acid 3, 10
Free plasma hemoglobin 163
Fungal infection 25
G
Gametocyte 28, 29
Gastrointestinal tract lesions 6
Gaucher disease 53
Gaussian
curve 159
distribution 73, 159
Giant platelets 52, 162
Giemsa stain 27
Glanzmann thrombasthenia 53
Glomerulonephritis 21
Glucose-6-phosphate dehydrogenase deficiency 6, 21, 23
Glycolysis, defective 6
Golgi apparatus 47
Gram-negative bacterial infection 53
Granular lymphocyte 47
Granulocytes 35
immature 43, 120
Granulomas 6, 51
Gray platelet syndrome 53, 54
Guinea worm 33
Gynecologic disturbances 6
H
Hairy cell leukemia 36, 45
Heart
diseases 6, 12
failure 6
surgery 6
valve prosthesis 55
Heinz bodies 23, 24
HELLP syndrome 59
Hematinic treatment 75
Hematocrit 11, 14, 64
calculation of 2
normal range 11
Hematological scoring system 39
interpretation of 39
Hematology 1, 73
automated cell analyser, basic components of 65
automation 63
general principles of 63
Hematopoiesis, extramedullary 25
Heme synthesis 6
Hemocytometer 62
Hemodilution 5
Hemoglobin 7, 9, 14, 64, 102
concentration 7
distribution width 2, 17
measurement of 2, 8
normal range 7
Hemoglobinopathies 3, 6, 13, 20, 21, 26
Hemolysis 12, 14, 53
Hemolytic
disease 6, 134
disorders 6
uremic syndrome 21, 51
Hemoparasites 27
Hemorrhage 10, 12, 13, 38, 53
Heparin 51
Hepatitis 49, 51
Heterozygote 21
Hexokinase deficiencies 6
High fluorescence reticulocyte 10
High heparin concentration 14
High red blood cell count, causes of 6
High white blood cell counts, causes of 35
High-frequency radio wave 67
Histogram 2, 71, 73, 101, 126, 127, 139, 140
generation, general principles of 71
interpretation of 72
review of 162
Hodgkin's lymphoma 36
Homozygote 21
Howell-Jolly bodies 23
Human immunodeficiency virus infection 36, 51
Hydroxyurea 13
Hyperadrenocorticism 45
Hypereosinophilic syndrome 40, 149
Hyperglycemia 105, 163
Hyperlipidemia 8
Hypersegmentation 40
Hypersensitivity reaction 38
Hypersplenism 22, 52, 53, 55
Hypertension
malignant 21
portal 53
Hyperthyroidism 55
Hypervolemia 6
Hypoadrenalism 13
Hypochromic cell 20, 84
Hypogonadism 13
Hypopituitarism 13
Hypoplasia 12
megakaryocytic 55
Hyposplenia 23
Hypothyroidism 13, 20, 24
anemia of 13
Hypoxia 10, 25
I
Idiopathic thrombocytopenic purpura 55, 152
Immature platelet fraction 2, 56, 57
benefits of 57
Immature reticulocyte fraction 11
Immune
hemolytic anemia 92, 93, 129
thrombocytopenia purpura 52, 57
Impaired red blood cell production 5
Infections 6, 42, 5153
acute 26
chronic 13, 26, 35
congenital 25
malarial 31
mycobacterial 25
parasitic 149
severe 40
Inflammation 38
chronic 6, 45
non-infectious 53
Inflammatory disorders 151
Influenza 36
International Council for Standardization in Hematology 7
Intestinal resection 13
Iron 3, 5, 10
deficiency 85, 86
advanced 84
anemia 6, 20, 22, 23, 53, 75, 106, 125, 128, 151
early 83
severe 21
nutritional deficiencies of 12
serum 16
J
Jaundice, alcoholic 26
K
Ketoacidosis 38
Kidney disease 10, 12
L
Laser
light
application of 66
scatter 67
technology 68, 80
Lead
poisoning 24, 26
toxicity 26
Leishman stain 34
Leishmania 3
Leishmaniasis 33
Leukemia 10, 12, 26, 36, 51
acute
lymphatic 145
lymphoblastic 139
lymphocytic 36, 121, 139
myelogenous 121
myeloid 36, 142, 143
chronic
granulocytic 53, 151
lymphocytic 36, 53, 102, 122, 143
myelogenous 36, 56
myeloid 53
myelocytic 38
promyelocytic 121
Leukemoid reaction, causes of 42
Leukocyte
alkaline phosphatase score 42
maturation, stages of 36
mononuclear 35
Leukocytosis 14, 35, 38, 118
Leukoerythroblastic reaction 21, 22, 25
Leukopenia 35, 119
Levey Jennings chart 156
Light absorption 68
Lipemia 14
Lipoxygenase deficiency 53
Lithium 38
Liver
cirrhosis 21
disease 13, 2022, 25, 26, 129
disorders 53
Low fluorescence reticulocyte 10
Low white cell counts, causes of 36
Lung diseases 6
Lupus erythematosus 12
Lymphatic filariasis 33
Lymphoblast 46
Lymphocyte 46, 47, 117, 163
activation 49
atypical 48
reactive 49
Lymphocytosis 49
Lymphoma 48
spillage 36
Lymphopenia 49
Lymphoproliferative
disorders 51
solid tumors, spillage of 3
M
Macrocytes 99
Macrocytic red cells 20
Macroglobulinemia 26
Malabsorption 24
Malaria 3, 6, 22, 27, 36, 51, 55
antigen detection 31
detection, automation based 31
diagnosis of 27
parasite 27
serology-antibody detection 30
Malignancy 26, 40, 51, 53, 149
metastatic 3
Malignant cells 36
Malnutrition 12
Manganese 5
Mansonella
ozzardi 33
perstans 33
streptocerca 33
Manual reticulocyte count 9
Marrow
aplasia 16
depression, drugs-induced 148
Maturation disorder 16
May-Hegglin
anomaly 51, 55
disease 54
Mean cell hemoglobin concentration 64
Mean corpuscular
hemoglobin 13, 14
concentration 13, 14
volume 13, 15, 76
normal range 13
Mean platelet
component 57
mass 57
volume 2, 52, 55, 57, 64, 113
Measles 36
Mediterranean macrothrombocytopenia, benign 52
Medium fluorescence reticulocyte 10
Megathrombocyte 52
Membrane
filtration 33
lipids 6
skeleton proteins 6
Mentzer index 85
Metamyelocyte 37
Metastasis 51
Methemoglobin 7
Methotrexate 13
Microcytes 99
Microfilaria, appearance of 33
Microhematocrit tube 33
Mismatch transfusion reactions 6
Monoclonal gammopathy 141
Monoclonal proteins 14
Monocytes 117
Monocytopenia 45
Monocytosis 45
Mononuclear cells, positions of 118
Mononucleosis, infectious 45, 146
Multiple angle polarized scatter separation 66
Myeloblast 36
Myelocyte 37
Myelodysplasia 52, 55, 133, 147
Myelodysplastic syndrome 3, 6, 13, 16, 20, 24, 51, 53, 57, 120
Myelofibrosis 36, 104, 133
idiopathic 53
Myeloid metaplasia 38
Myeloma, multiple 12, 26, 48, 141
Myelophthisic anemia 6, 13
Myelophthisis 6
Myeloproliferative disorders 16, 21, 38, 52, 53, 55
Myocardial infarction 38, 50
N
Neonatal sepsis, early diagnosis of 39
Neoplasms 13, 42
Neutropenia, causes of 39
Neutrophil 117, 120
apparent absence of 139
dysplasia 118
granularity
index 43
intensity 43
reactivity intensity 43
volume 43
Neutrophilia 38, 45
Nonmegaloblastic macrocytosis 106
Normal red blood cells values 5
Nuclear chromatin 45
Nuclear density analysis 118
Nucleus 44
Nutritional deficiencies 3, 12
O
Onchocerca volvulus 33
Oral contraceptives 13
Organ failure 16
Ovarian tumor 124
Oxidative stress 6
P
Packed cell volume 11
Pantothenic acid 5
Pappenheimer bodies 24
Parasitemia 3, 27
Paroxysmal nocturnal hemoglobinuria 6
Pelger-Huët anomaly 41
Penicillins 51
Peripheral blood smear 141
examination 18, 27
preparation 18
Peripheral smear 63, 132, 143, 147
examination 58
Perox cytogram 117, 120122, 144, 147
method 117
Peroxidase
activity 118
staining 115, 117
Phenytoin 13
Plasma
cell 47
protein 8
Plasmacytoid lymphocyte 48
Plasmodium
antigens, detection of 30
falciparum 27
malariae 27
ovale 27
vivax 27
appearance of 28
Platelet 50, 124153, 163
adhesion defects 53
agglutination 52, 150
clumps 162
component distribution width 58
count 2, 50, 51, 63
derived histograms 113
destructions 52
disorders of 54
distribution
curves 113
width 56, 113
function defects 53
histogram 107, 113, 162
index 113
lineage 58
parameters 3, 4
production 51
selective marrow suppression of 51
satellitism 52, 162
scattergram 122
volume histogram for 113
Pleomorphic plasma cells 141
Poikilocytosis 20
Polychromasia 25
Polychromatophilia 25
Polycythemia vera 6, 12, 36, 38, 53, 151
Polymerase chain reaction 31
Polymorphonuclear
cells 118
leukocytes 35
Polymorphs 38
Postradiation marrow depression 148
Post-splenectomy 13, 21, 2325
Post-therapy megaloblastic anemia 131
Post-transfusion 22
purpura 51
sample 138
Pregnancy 10, 16, 58
macrocytic anemia of 13
Prematurity, anemia of 6
Primidone 13
Progranulocyte 37
Prolymphocyte 46
Promyelocyte 37
Prosthetic
cardiac valve 21
valve surgery 6
Pseudoleukopenia 36
Pseudo-Pelger-Huët anomaly 41
Pseudothrombocytopenia 52, 150
Psittacosis 36
Pure red cell aplasia 6
Pyrimethamine 13
Pyruvate kinase deficiency 6, 22
Q
Quality control 154, 162
data, analysis of 159
direct 155
external 158
indirect 154
internal 154, 155
methods 158
monitoring 154
purpose of 154
Quantitative buffy coat 29
Quinine 51
R
Radiation 51
therapy 36
Radiofrequency 1, 68, 115
Real-time polymerase chain reaction 31
Red blood cell 2, 5, 62, 124153
anisocytosis 79
count 2
cytogram 75, 80, 83, 84, 91, 92, 94, 98, 104, 125, 129, 136
fragmentation 90, 91
histogram 75, 82, 125, 162
abnormal 77
hyperchromia 80
lineage 58
macrocytosis 78
maturation defect 16
microcytosis 78
morphology 145
clinical importance of 19
nucleated 25, 162
parameters 3, 4
Red cell
agglutination 163
agglutinins 101
count 63
cytogram 88, 100, 130, 132
distribution width 2, 15, 17
double populations of 75
fragmentation 91, 133, 163
Renal disease, end-stage 10
Renal failure 16, 22, 51
acute 38
anemia of 6
Renal insufficiency 51
Renal neoplasia 6
Reticulocyte 9
count 10, 69
automated 9
normal range of 9
hemoglobin 2
measurement 10
production 16
proliferation index 10
Rheumatoid
arthritis 12, 36, 53
disease 45
Riboflavin 5
Rickettsial infections 36
Rouleaux formation 26, 141
Rubella 25
Rule of three 12
S
Sahli acid hematin method 8
Sarcoidosis 45
Schistocytes 21
Sepsis 25, 36, 55, 57, 118
postoperative 140
severe 148
Septicemia 140
Serum immunoglobulin electrophoresis 141
Sickle cell 25
anemia 3, 6, 14, 55, 97, 129
Sickle crisis 129
Sideroblastic anemia 13, 20, 24, 99, 133
Siderotic granules 24
Small lymphocyte 46
Smudge cell 48, 143
Spherocytes 22
Spherocytosis 106
causes of 22
hereditary 6, 14, 22, 23
Spheroschistocytes 21
Spleen
enlargement of 36
hyperfunction 12
Splenectomy 24, 38, 53, 55, 151
Spur cell 24
Steatorrhea 13
Stem cells 6
Stomach cancer 22
Stomatocyte 23
Storage pool disease 53, 55
Stress 35, 45
physical 35
Sulfamethoxazole 13
Sulfasalazine 13
Syphilis, congenital 25
Systemic lupus erythematosus 21, 36, 45, 51, 53
T
Tear drop cells 21
Thalassemia 3, 6, 10, 21, 25, 26
heterozygous 96, 128
major 21, 22
minor 20
trait 128
Thiamine 5
Thrombasthenia 53
Thrombocytes 50
Thrombocythemia
essential 53, 54, 56, 57, 151
primary 53, 54, 151
Thrombocytopenia 3, 5153, 57, 58
absent radii syndrome 51, 55
amegakaryocytic 51
causes of 51, 58
drugs-induced 51
gestational 59
idiopathic 51
infection-related 55
mild 53
severe 51
Thrombocytopenic purpura 152
Thrombocytosis 53
reactive 57
Thrombopoiesis 56
Thrombotic thrombocytopenic purpura 21, 51, 52, 54, 57
Thromboxane
A2 receptor deficiency 53
synthetase deficiency 53
Thyroid hormone 5
Tissue
damage 35
injury 38
Toxic granulation 40, 145
Toxins 51
Transfusion therapy 24
Trauma 6
Trimethoprim 13
Trophozoite 27, 28
Trypanosoma
brucei 34
cruzi 34
Tuberculosis 36, 45
Tubular necrosis, acute 21
Tumors, malignant 6
Typhoid 36
U
Ulcerative colitis 45
Uremia 13, 21, 25, 53
V
Vasculitis 51
Venous blood method 33
Viral infections 35, 45, 48, 53, 122
Vitamin
B12 3, 5, 10, 13, 20, 75, 129
deficiency 6, 130, 131
impaired absorption of 6
B6, nutritional deficiencies of 12
E deficiency 24
Volume conductivity scatter technology 115
von Willebrand disease 51, 53
W
Waldenström's macroglobulinemia 48
Water-dilution hemolysis 22
Westgard rules 156158
White blood cell 2, 31, 35, 107, 124153
count 2, 35, 63
histogram
abnormal 108
types of 111
lineage 58
parameters 3, 4
volume histogram for 107
Wiskott-Aldrich syndrome 51, 53, 55
Wuchereria bancrofti 33
X
X-linked lymphoproliferative disease 49
Y
Y-axis 80
Z
Zidovudine 13
×
Chapter Notes

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Introduction and Significance of CBCCHAPTER 1

 
INTRODUCTION
The subject of Hematology (the Greek word “haima” meaning “blood”) has grown by leaps and bounds ever since the invention of the microscope. Hematology is a unique super-specialty in Medicine that encompasses the fields of Pathology, Physiology, Molecular Biology, Biochemistry, Obstetrics and Gynecology, Medicine, and Pediatrics.
The era of diagnosis has changed from simple microscopy and manual methodologies to complex automated counters, application of cytogenetics, flow cytometry, and molecular technology.
The basic test performed on the peripheral blood – “Complete Blood Count” (CBC) is one of the most informative single investigations, expressing the health and disease status of the body, in the whole menu of laboratory medicine. A long journey is travelled by this single investigation from the era of only hematocrit/hemoglobin as a diagnostic tool to the most sophisticated multi-parts multi-parameters automation.
Automation, because of its accuracy, has changed the principles and methodologies, approaches, and conclusions of various disciplines of medicine. Few branches are modified to the extent that their entire philosophy is so much reoriented that it needs to be rewritten and hematology is one of them. Although the fact remains that, automation is no replacement for the study of a peripheral smear, it just compliments manual microscopy, just like ECG and X-ray chest compliments manual auscultation in clinical medicine.
Over the past 5 decades, hematology analyzers have evolved from semiautomated to fully automated ones. Many additional parameters have become available now. From the earlier instruments that used electrical impedance as the sole counting principle for blood cells, modern-day analyzers, also, use conductivity differences, cytochemical staining, light scatter, and flow cytometric principles. While enhancing the speed, accuracy, and precision of test results, these have also added a new dimension to hematology reporting. However, even in the wake of much technological advancement, the attention to numerical data with regards to the interpretation of test results has not changed.
As the automated analyzers become more advanced, their precision has shown enormous improvement and manual blood smear review rates have been on a steady decline. Still, many hematologists and trainee residents in laboratories have been performing a validation function rather than an interpretative one. An experienced reviewer can weigh the relative significance of observed findings and assess their importance within the context of other clinical data. A trained eye will also appreciate other morphological abnormalities that may be undetected by automated review.
Hematology analyzers are marketed by multiple instrument manufacturers with varying levels of sophistication and technical complexity. These analyzers are equipped to produce, not only the traditional RBC, WBC, Platelet parameters but also many research and clinically important reportable parameters, along with three part, five-part, or six-part differential leukocyte count in less than one minute with a micro-volume of whole blood. Leucocyte positional parameters, which may diagnose specific diseases (e.g. differentiate between abnormal lymphocytes in leukemia and viral conditions and may also detect malarial infection) are now available.
Automated analyzer principles of operation, vary technologically. Electronic impedance and optical scatter are used by most of the analyzers. Sometimes Radiofrequency (RF) is used in conjunction with other methods. RF signals are proportionate to cell interior density or conductivity. Impedance and conductivity plotted against two-dimensional distribution cytogram or scatterplot, to evaluate cell populations with cluster analysis technology.
Flow cytometers with optical scatter system detect interference in a laser beam or light source to differentiate and evaluate cell types. The use of peroxidase (PEROX) and basophil - lobularity (BASO) channels, further improvises the generated results. Most of the sophisticated cell counters perform reticulocyte analysis using either fluorescent or other dyes. Limitations of the instruments result in specific flagging, which warrants evaluation with an alternative methodology.
There is a need for hematologists to give more clinically useful diagnostic opinions and further evaluation guidelines on blood samples run on automated analyzers instead of signing out a parameter-littered automated report printout.2
In automation generated CBC reports, graphical representation of results in the form of histograms or scatter plots, red cell distribution width (RDW), hemoglobin distribution width (HDW), and reticulocyte hemoglobin, immature platelet fraction, etc., have been largely ignored in favor of traditional numerical parameters over the years. These CBC parameters are very important as they provide useful information for the precise diagnosis and management of the patient.
 
What is CBC?
A complete blood count (CBC) is a series of tests used to evaluate the composition and concentration of the various cellular components of blood. It consists of the following tests:
  • Red blood cell (RBC) count, white blood cell (WBC) count, and platelet count.
  • Measurement of hemoglobin and calculation of hematocrit and red blood cell indices.
  • White blood cells (WBC) total and differential count.
  • Platelet count, mean platelet volume, plateletcrit, PDW, etc.
  • Histograms, cytograms, scatterplots of RBC, WBC and platelets, etc.
zoom view
 
Why CBC?
CBC is a comparatively inexpensive but powerful diagnostic tool in a variety of hematological and non-hematological conditions. It provides a myriad of valuable information about blood and to some extent the bone marrow, and also some direct or indirect shreds of evidence of health and disease status of various systems of the body. CBC is a window into the functional status of the bone marrow, the factory producing all blood elements. It is easily obtained, easily performed, relatively cheap, and serial measurements can evaluate response to therapy. The CBC may be used as informative tool for various sets of situations like:
  • Diagnosis of anemia (Etiological and morphological types)
  • Hemoglobinopathies (Thalassemia, sickle cell anemia, and hemolytic anemia)
  • Bone marrow aplasia (Single lineage and multilineage)
  • Nutritional deficiencies (Iron, vitamin B12, folic acid)
  • Parasitemia (Malaria, filaria, leishmania)
  • Thrombocytopenia [Primary (due to nonproduction), secondary (due to peripheral destruction) and bleeding disorders]
  • Various viral fevers, and autoimmune conditions
  • To diagnose infections, leukocytosis, leukopenia, eosinophilia, monocytosis, lymphocytosis, etc.
  • Various hematopoietic malignancies like leukemias, various dysplasias like myelodysplastic syndrome, spillage of lymphoproliferative solid tumors, metastatic malignancies
  • To diagnose the effect of various drugs including chemotherapy and radiation therapy and effects of various toxins and chemicals
  • To diagnose effect of various types of stresses like traumatic, metabolic, neoplastic, and surgical stresses.
To conclude, it may be emphasized that not all hematological and nonhematological disorders can be diagnosed after an automated analysis of CBC but some direct or indirect, indicative, or diagnostic feature may be picked up by the instrument or on a peripheral smear. Along with numerical data, the histograms and scattergrams from automated hematology analyzers provide valuable information regarding common hematological conditions. It is important that operators and the end-users must have a basic understanding of the graphical output while interpreting their numerical data. This can enhance the diagnostic utility of automated data, ultimately benefiting the patient with better diagnosis and outcome.
 
Various Parameters of CBC
About 33 parameters can be obtained by most sophisticated counters (observed and calculated), which include:
RBC parameters
WBC parameters
Platelet parameters
  • rBC count
  • Hgb
  • Hct
  • MCV
  • MCH
  • MCHC
  • RDW-SD
  • RDW-CV
  • NRBC
  • NRBC#
  • RET%
  • RET#
  • IRF (Immature Reticulocyte Fraction)
  • RET-He
  • Fragmented Red Cells
  • Reticulocyte hemoglobin content (CHr)
  • RBC Hemoglobin Content (RBC He)
  • Mean Reticulocyte Volume (MCVr)
  • %MACRO
  • %MICRO
  • %HYPER
  • %HYPO
  • Low Fluorescence Reticulocytes (LFR)
  • Medium Fluorescence Reticulocytes (MFR)
  • High Fluorescence Reticulocytes (HFR)
  • WBC count
  • NEUT%
  • LYMPH%
  • MONO%
  • EO%
  • BASO%
  • NEUT#
  • LYMPH #
  • MONO#
  • EO#
  • BASO#
  • Immature Granulocyte Count (IG)%
  • Immature Granulocyte Count (IG)#
  • Neutrophil volume (NV)
  • Neutrophil granularity index.
  • Neutrophil reactivity intensity (Neut-Ri)
  • Neutrophil granularity intensity (Neut-Gi)
  • Reactive lymphocytes (Re-lymp)
  • Antibody-synthesizing lymphocytes (As-lymp)
  • Large Immature Cells
  • Large Undifferentiated Cells (LUC)
  • PLATELET count
  • MPV
  • Pct
  • PDW
  • IPF-Immature platelet fraction (measurement of reticulated platelets) to monitor thrombopoietic activity of the marrow
  • HPC-Quantitative hematopoietic progenitor cell count as a screen for the optimal presence of hematopoietic progenitor cells in peripheral blood and cord blood samples
  • Mean platelet component (MPC).
  • Platelet larger cell ratio (P-LCR).
  • Platelet component distribution width (PCDW)
  • Mean platelet component (MPC)
(# = absolute count, % = percent count)
4
 
Normal Values of Various Parameters of CBC
CBC values vary by age, sex, race, and demography. Normal values (reference range) are ultimately determined by the laboratory performing the test in the particular population. As a guide, the normal values for men and women are as follows:
 
Various Indices by Age Group and Conditions
Newborn
Normal range
SI unit
Hematocrit
42–68%
0.42–0.68%
Hemoglobin
15.4–24.5 g/dL
9.6–15.3 mmol/L
RBC count
4.1–6.2 million/µL
4.1–6.2 × 1012/L
MCV
103–106 µ3
103–106 fL
MCH
36–38 pg
2.24–2.37 fmol
MCHC
34–36 %
21.10–22.34 mmol/L
Platelets
100000–300000/µL or mm3
100–300 × 109/L
Up to one year of age
Normal range
SI unit
Hematocrit
29–41%
0.29–0.42%
Hemoglobin
9.0–14.5 g/dL
5.6–9.1 mmol/L
RBC count
3.6–5.5 million/µL
3.6–5.5 1012/L
MCV
78 µ3
78 fL
MCH
25 pg
1.55 fmol
MCHC
32%
19.86 mmol/L
Pregnancy
Normal range
SI unit
Hematocrit
Trimester 1
35–46 %
0.35–0.46%
Trimester 2
30–42 %
0.30–0.42%
Trimester 3
34–44 %
0.34–0.44%
RBC count
Trimester 1
4.0–5.0 million/µL
4.0–5.0 × 1012/L
Trimester 2
3.2–4.5 million/µL
3.2–4.5 × 1012/L
Trimester 3
3.0–4.9 million/µL
3.0–4.9 × 1012/L