Interpretation Of A Full Blood Count Flashcards
Increased reticulocytes
Blood loss
Haemolytic anaemia
Increased red cell count
Dehydration
Polycythaemia rubra Vera
Decreased red cell count
Diluted- Pregnancy
Production failure- Bone marrow failure
Loss- Bleeding
NB- any type of Anaemia
Microcytic anaemia
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead
Sideroblastic anaemia
Normocytic anaemia
Acute blood loss
Haemolytic anaemia
Renal failure
Pregnancy
Macrocyclic megaloblastic anaemia
Decreased folate
Decreased B12
Drugs ie. methotrexate, valproate, phenytoin
Non-megaloblastic macrocytic anaemia
Alcohol
Reticulocytosis
Liver disease
Hypothyroidism
Investigations for haemolytic anaemia
Urinalysis- urinary urobillinogen, haemoglobinura, urinary haemosiderrin
Blood- FBC (normocytic anaemia), lactate dehydrogenase and unconjugated bilirubin
Blood film- red cell fragments (schistocytes), sickle cells, Heinz bodies, reticulocytes, spherocytes
Coombs test
Osmotic fragility testing (membrane abnormalities)
Hb electrophoresis
Enzyme assays (G6PD)
Acquired causes of haemolytic anaemia
DIC
Lead poisoning
Metallic heart valves
Relative polycythaemia (decreased plasma volume)
Acute- dehydration
Chronic- obesity, HTN, alcohol, smoking
Absolute polycythaemia (increases red blood cells)
Primary- polycythaemia rubra vera (myeloproliferative neoplasm- increased RBC, WBC, platelets)
Secondary- chronic hypoxia leading to increased erythropoietin eg. COPD, altitude or renal cell carcinoma (EPO secreting tumour)
Thrombocytopenia causes
Decreased production- bone marrow infiltration, aplastic anaemia
Increased destruction/ consumption;
Non-immune- DIC, TTP, HUS, HIT, liver disease (hypersplenism)
Primary immune- ITP
Secondary immune- SLE, viruses, CLL
Investigations for thrombocytopenia
Blood film and bone marrow biopsy
Viral serology eg. HIV/ Hep C
LFT’s
Lactate dehydrogenase
Serum vitamin B12 and folate
Coagulation screen
Acute phase proteins- infection
Thrombocytosis causes
Primary- essential thrombocythaemia, myeloproliferative disorders
Secondary (reactive)- leading, inflammation, infection, malignancy, post splenectomy
Investigations for thrombocytosis
Blood film and bone marrow biopsy
Acute phase proteins
JAK2 mutation (myeloproliferative disease)
Ferritin- chronic bleed
Pancytopenia causes
Bone marrow infiltration- myeloma, lymphoma, TB, acute leukaemia etc.
Muelosuppression- chemotherapy, lead, irritation, infection eg. HIV
Impaired haematopoiesis- vitamin B12/ folate deficiency, aplastic anaemia
Peripheral destruction of blood cells- hyperslenism, PNH
Investigations for pancytopenia
Blood film and bone marrow biopsy
Lactate dehydrogenase (haemolysis and myeloproliferative disorders)
Serum vitamin B12/ folate (impaired haematopoesis)
Reticulocytes
Electrophoresis and immunoglobulins (myeloma)
Viral serology- HIV, EBV, CMV, parvovirus
Autoimmune profile
Serum direct antiglobulin test
Increased serum urea
Dehydration, GI bleeding, increased protein catabolism eg. Infection, high protein intake
Decreased serum urea
Malnutrition, liver disease, pregnancy
Acute kidney injury
Rise in serum creatinine >50% from baseline, or urine output <0.5ml/kg/hour for 6 hours
Haemanitics
B12
Folate
Ferritin (can be raised due to infection)
Iron studies
Look at table in gallery
Investigations for Polycythaemia
FBC- WCC and platelets (&RBC) raised in primary absolute polycythaemia (PRV)
EPO level- renal cell carcinoma
If PRV suspected- JAK2 mutation testing and bone marrow biopsy (PRV is a myeloproliferative neoplasm)
RCC vs Haematocrit
RCC- the concentration of red blood cells in the blood
HCT- percentage of the total blood volume accounted for by red blood cells (affected by the MCV- mean corpuscular volume)
Colour of red cells
Normocytic and macrocytic anaemia- most are normochromic
Microcytic anaemia- microchromic anaemia (except anaemia of chronic disease- normochromic)
Polycythaemia
Increased volume percentage of red blood cells in the blood
Causes of neutropenia
Viral- HIV, EBV
Drugs- cytotoxics eg. Chemotherapy, carbimazole, clozapine
Benign ethnic neutropaenia (African and Afro Caribbean, no treatment)
Haematological malignancy
Rheumatological conditions (SLE)
Severe sepsis
Haemodialysis
