elevated leukocytes leukocytes \>11 indication for a differential causes of elevation: INFECTION →should always look at previous CBCw and trends steroids (mild elevation) cancers catastrophic events (trauma, MI surgery)

Polymorphonuclear neutrophils (PNMs) "Polys" fight bacteria and fungus attracted by chemokines de-granulate antimicrobial proteins Two forms: bands and segs segmented: senior/mature cell bands: baby/immature cell Left shift! → recruits the immature band form Absolute #: 1.8-7.7K

40-52 percentage of packed RBC to total volume of blood HCT is approx HGB x 3 calculated RBC x MCV

Mean Cell Volume ( SIZE ) 80-100 fL microcytic \ 100fL

CBC Flashcards by Gillian Collom

Reticulocyte

immature RBCs

elevated in hemolytic anemia

measures the effectiveness of erythropoiesis

reticular network of ribosomal RNA visible when stained with methylene blue on microscopy

**not part of the CBC

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differential CBC vs CBC

Regular CBC does not break down the #’s and Types of WBCs

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Leukocytosis

elevated leukocytes

leukocytes >11

indication for a differential
causes of elevation:
- INFECTION →should always look at previous CBCw and trends
- steroids (mild elevation)
- cancers
- catastrophic events (trauma, MI surgery)

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Leukopenia

decreased leukocytes

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agranular leukocytes

lymphocytes and monocytes

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granular leukocytes

basophil, neutrophil, eosinophil

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Neutrophils

Polymorphonuclear neutrophils (PNMs) “Polys”

fight bacteria and fungus
attracted by chemokines
de-granulate antimicrobial proteins
Two forms:
- bands and segs
  - segmented: senior/mature cell
  - bands: baby/immature cell
Left shift! → recruits the immature band form
Absolute #: 1.8-7.7K

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Segmented Neutrophil

Senior/mature cell

normal = 50-62% of WBCs

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Banded Neutrophil

Baby/immature cell

normally only 3-5% of WBCs

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WBC count

4.5-11K

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RBC

4.5-5.9M

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Hgb

14-18g/dL

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Hematocrit

40-52

percentage of packed RBC to total volume of blood
HCT is approx HGB x 3
calculated RBC x MCV

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MCV

Mean Cell Volume ( SIZE )

80-100 fL

microcytic <80fL

macrocytic >100fL

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MCH

Mean Corpuscular Hgb (average hgb/RBC)

27-33pg

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MCHC

Mean Corpuscular Hgb Concentration (REDNESS)

32-36%

normochromic= normal redness

hypochromic = less red

hyperchromic = more red

Platelet count

1.30-4.00K/MM³

RDW

Ratio of Distribution Wide

how variable is the size of the RBCs

0.0-14.7%

MPV

mean platelet volume

6.8-10.0fL

ANC

Absolute Neutrophil Count

1.8-7.7K/MM

mild neutropenia 1000-1500 cells/MM
- increased risk of infection
ANC < 500 cells/MM severe neutropenia
- pt will fail to control local flora/common pathogens
  - lots of infections!
includes both bands and segs!

What can trigger demargination of neutrophils aside from infection?

steroids
major trauma
both will cause a small increase in ANC (absolute neutrophil count)

Lymphocytes

1.0-4.8K/MM³ (16-45%)
fight viral infections
important in antibody formation
types of Lymphocytes:
- B cells
- helper T cells
- cytotoxic T cell
- regulatory T cell
- natural killer cell

Monocytes

0.1-0.8K/MM³

3-10% of WBCs
attracted by chemokines and differentiate into macrophages and dendritic cells
fight both viral and bacterial infections
in TB:
- form wall around the MTB= create a granuloma

Eosinophils

0.0-0.5K/MM³

Normal range: 0-7%
present in tissues and mucous membranes
fight parasites and helminths
elevated in allergic response
release toxic granules that can cause extreme reaction

Basophils

**0.0-0.2K/MM³** * 0-2% * contain **heparin** and **histamine** * large dark granules * **allergy** and **stress** response * can be elevated in **leukemia**

how to remember the WBCs

Never Let Monkeys Eat Bananas * Neutrophils: 1.8-7.7K * Lymphocytes: 1.0-4.8K * Monocytes: 0.1-0.8K * Eosinophils: 0.0-0.5K * Basophils: 0.0-0.2K

Thrombocytopenia

low plateletes increased bleeding risk caused by decreased production, increased destruction or sequestration

Thrombocytosis

high platelets increased clotting risk * _reactive_: overproduction after infection, traumatic event, splenectomy * _essential_: myeloproliferation (blood cancer)

Echinocytes

Burr Cells small blunt projections, **uniformly** spaced over the red cells ccells maintain the central pallor liver disease uremia

Acanthocytes

Spur Cells irregular projections associated with cirrhosis

Sickle Cell Anemia

* inherited HbS gene from both parents * abnormally shaped cells that cause stacking or sticking * chronic low level anemia due to hemolysis hbg 8-10 * impaired splenic function * small infarcs in the spleen * Howell-Jolly Bodies on smear * fragment of nucleus left over in RBC (usually cleaned out by the spleen)

Rouleaux Formation

stacked RBCs in linear distrubtion appearance of stacked coins indication of multiple myeloma

WBCs during acute bacterial infx vs later bacterial infx

acute bacterial: PMNs, bands later stages: lymphocytes increase overall: WBC = high

WBCs during acute viral infx

lymphocytes are predominant * overall WBC may be normal or decreased * can also be slightly elevated but not as high as bacterial

CRP

not part of CBC, **c-reactive protein** **direct measurement** * higher CRP = more inflammation in your body * isn't unique to one disease * can help monitor disease progress and flares * Shows up before ESR * produced by the **liver** when it is exposed to i**mmune complexes** * peaks at 36-50 hours * half life of 5-7 hours

ESR

erythrocyte sedimentation rate (not part of CBC) increased ESR = sinking faster **indirect measurement:** indicator of inflammatory process * high ESR signals high levels of inflammation in the body * can help to evaluate how well tx is working * pts with autoimmune disease will have a high ESR * associated with **fibrinogen** * peaks at 7-10 days * half-life measured in weeks

Procalcitonin

produced by cells in the body often in response to bacterial infx or tissue injury can be used to identify systemic bacterial infections and sepsis * \<0.5micrograms/L = systemic infection unlikely