L6: Interpreting the full blood count Flashcards

1
Q

What do we mean by abnormal results?

A

Results outside the ‘normal’ range
‘Normal’ only 95% population
–> some people outside will be normal, some people inside will be normal
Look for significant fall in value

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2
Q

What causes the normal range to change?

A

Age, sex, ethnicity, co-morbidities

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3
Q

What do abnormal results normally show?

A

Often reactive rather than reflective
Reactive–> to another physiological situation in the body
Reflective–> doesn’t usually reflect true haematological result

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4
Q

How would you know if the result is reactive or reflective?

A

Interpret–> clinical context and previous FBC if known

  • -> acute/ chronic change
  • -> is it explained by disease?
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5
Q

What errors can occur in pathology results?

A
  1. Specimen collection –> mix up, wrong bottle, pooling samples, poor technique, wrong blood in tube (incorrect labelling)
  2. Delivery of specimen to lab–> delayed/ not delivered, wrong delivery method
  3. Specimen analysis and result reporting–> Mix up, incorrect clinical details, wrong test requested/ perfomed, inherent variability (analysers not perfect), technical error
  4. Responsive action–> result not reviewed, reflex tests not carried out, right result wrong patient!
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6
Q

How is a full blood count performed?

A

Automated test–> high sample throughput, greater accuracy

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7
Q

What are the essential parameters?

A

Red cells–> indices, RCC, haemoglobin
Platelets–> Count
White cells–> count, full differential

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8
Q

What are the analyser techniques?

A

Spectrophotometry

Flow cytometry

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9
Q

How does spectrophotometry work?

A

Spectrophotometry–> amount of light absorbed proportional to amount of absorbent compound within–> measure amount of haemoglobin

  • -> hypotonic solution–> lyse cells
  • -> light of appropriate wavelength
  • -> calibration curve to determine sample concentration
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10
Q

How does flow cytometry work?

A

Hydrodynamic focussing –> single file line of cells

  • -> passes through light beam - perpendicular angle
  • -> impedance counting –> broken beam, one cell, stops beam hitting detector
  • -> forward scatter–> size of cell –> more scatter= bigger cell
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11
Q

How does flow cytometry differential work?

A

Same as normal flow cytometry
Look at side scatter–> bounces back >90 degree angle
Tells you complexity of environment–> mononucleated, polynucleated
Plot graph of forward scatter against side scatter–> shows size and complexity of cell–> work out what each cells is

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12
Q

What does myeloperoxidase activity show?

A

Present in granules (granulocytes)

If activity present –> granulocyte!

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13
Q

What does the packed cell volume (PVC/Hct) show?

A

The proportion of blood that is made up of RBC (L/L)
- centrifuge down
Assess anaemia and polycythemia (increased hematocrit)
Polycythemia reduced by venesection or drug treatment

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14
Q

What is the difference between true polycythemia and pseudopolycythemia?

A

True polycythemia–> increased red cell count

Pseudopolycythemia–> reduction in circulating plasma volume–> reduced plasma volume makes it look like more red cells

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15
Q

What other parameters can be tested to show if it is a true polycythemia or not?

A

Haemoglobin
RCC–> single RBC passed through detector
Mean cell volume –> amount of light scattered measured
Mean cell haemoglobin
Mean cell haemoglobin concentration
Red cell distribution width

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16
Q

What does haemoglobin show? What are the problems associated?

A

Amount of Hb mass/ plasma volume
Reference range–> varies sightly between labs but
>135g/L adult men
>115g/L adult women
>110g/L children (3/12- puberty)
>150g/L newborns
However not perfect as it is a concentration –> lower plasma level looks like increased RBC count therefore looks like more haemoglobin (Dehydration, acute bleed can affect result)
Turbidity of plasma–> affects amount of light absorbed–> over estimate
Heamolysis in vitro–> RBC destroyed whilst sample is being transported –> ↓ Heamoglobin

17
Q

What is red cell count (RCC)?

A

Number of red blood cells in a given volume of blood
(x10^12/L)
Assessment of anaemia, erythrocytosis etc
Microcytic anaemia
–> iron deficiency anaemia–> RCC reduced no iron less RBC produced
–> Thalassemia –> ↓ heamoglobin –> compensates by ↑RCC make more RBC to carry O2 (inherited)
Erythrocytosis
–> too many RBC made–> indicates true polycythemia

18
Q

What does the mean cell volume (MCV) show?

A

Mean size of RBC
High or low can give you lots of information
Most important parameter used to screen the cause of anaemia

19
Q

What does the mean cell haemoglobin (MCH) show?

A

Average amount of Hb in each RBC (pg)
MCH= Total amount of Hb/ Number fo RBC
Anaemia assessment

20
Q

What does the mean cell haemoglobin concentration (MCHC) show?

A

Mean concentration of Hb in RBC in a given volume
MCHC= (Hb/MCV) X RCC
Not common
Useful for cold agglutinins (RBC stick together when cold)

21
Q

What is the red cell distribution width (RDW) show?

A

Variation in size of the RBC
If increased = anisocytosis (patient RBC of unequal size)
Help assess cause of anaemia;
–> ↑ in iron deficiency
–> normal in thalassaemia trait
–> increased following transfusion (pt RBC and someone else RBC)

22
Q

What does the reticulocyte count show?

A

Measurement of the number of young erythrocytes (X10^9/L)
Identified using size and RNA count
Measure anaemia–> increased in lots of cases to compensate
decreases in haematinic deficiency–> not got what they need to make RBC and bone marrow deficiency

23
Q

What is a blood film? Why would it be done?

A

Thin layer of blood smeared onto a slide looked at under microscope

  • Significant result outside normal range
  • Significant change within normal range
  • Analysers think there are abnormal cells (immature cell, analyser unable to identify)
24
Q

What are some of the RBC terminology used to describe the size and colour of the RBC?

A
Microcytic --> MCV --> small
Macrocytic--> MCV --> large
Hypochromic--> MCH --> pale, less Hb
Hyperchromic--> MCH --> Dense, more Hb in given volume
more on slide 25!
25
What is the different terminology to describe the shaped of RBC?
1. Anisocytosis--> different sized cells 2. Dimorphism--> two distinct populations of cells 3. Poikilocytosis--> abnormally shaped 4. Spherocytosis--> Spherical RBC 5. Elliptocytosis--> Elliptical RBC 6. Irregular contracted cells--> Small dense RBC, not as round as spherocytosis 7. Echinocytes, acanthocytes, keratocytes, schistiocytes --> spiculated cells 8. Sickle cells--> crescent or sickle shaped 9. Target cells--> RBC with dark area in middle of the area of central pallor 10. Polychromasia--> ↑ immature RBC
26
What inclusions can be seen in erythrocytes?
DNA/ nuclear fragments --> Howell-Jolly bodies RNA Inclusions --> basophilic stippling Rare--> - Iron inclusion in cells --> Pappenheimer bodies - Denatured haemoglobin --> Heinz bodies - Golf ball cells - denatured Haemoglobin H --> Haemoglobin H inclusions
27
What results would you expect to see in iron deficiency?
FBC and RBC indices--> ↓ Hb, MCV, MCH and MCHC Reticulocyte count--> Low or normal (within the normal range) FBC and RBC indicies--> ↑ RDW Blood film --> Hypochromic, microcytic, pencil cells. few target cells
28
What would you expect to see in Vit B12 Deficiency?
↓ Hb, RCC, Hct/PCV, Reticulocyte count ↑ RDW, MCH, MCV macrocytic anaemia
29
Why might WBC be measured? What do you measure?
``` Increase sign of inflammation, infection, drugs etc Measure 5 parts differentials --> neutrophils --> eosinophils --> basophils --> lymphoytes --> monocytes nucleated RBC can be mistaken for lymphocytes ```
30
What can platelet count show?
Platelets levels change very quickly Can go higher or lower very quickly Abberant parameter Platelet clumping --> antibody activate in presence of EDTA used as anticoagulant in tubes Clots in tube will reduce platlet count number