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Hematology > Lecture 12 > Flashcards

Lecture 12 Flashcards

1
Q

CBC Parameters – WBC count

WBC Differential

Relative DifferentiaL

Absolute Differential

A

WBC Differential -Differentiates’ the five types of White blood cells

Relative DifferentiaL-Ratio of each type of WBC - % or Fraction of 1.0

Absolute Differential -Total number of each type of WBC reported in x10^9 /L

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2
Q

CBC Parameters – RBC count

Hemoglobin (HGB)

Hematocrit (HCT)

A

RBC Count -Total Number of RBC reported in x1012/L

Hemoglobin (HGB)-The total grams Hemoglobin in one liter of blood (g/L)

Hematocrit (HCT)-The total volume of RBC (%) in the whole blood
Reported as the volume in L per L of whole blood (L/L)

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3
Q

RBC Indices

Mean Cell Volume
(MCV)

Mean Cell Hemoglobin (MCH)

Mean Cell Hemoglobin Concentration (MCHC)

RBC Distribution Width
(RDW)

A

Mean Cell Volume (MCV) -The average size or volume of an RBC (fL)
*AVERAGE of macro/micro
* Used to classify anemias
* RI 80-100 fL
‒ Normal MCV = Normocytic RBCs
‒ MCV > 100 = Macrocytic RBCs
‒ MCV < 80 = Microcytic RBCs

Mean Cell Hemoglobin
(MCH)- The average weight/mass or amount of Hemoglobin per RBC (pg)
*does not look at cell size must be done with MCV
=HGB/RBC

Mean Cell Hemoglobin Concentration (MCHC) -The average concentration of Hemoglobin per RBC (g/L)
*classify anemia
MCHC 320-360 g/L
*less than 320 hypochromic
*over 360- hyper or hereditary spherocytosis
*over 380 specimen integrity - lipemia, icterus, high WBC , lysing
=HGB/HCT

RBC Distribution Width
(RDW) -The variation in size of all of the RBCs (expressed as %)
-11.5 – 14.5%

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4
Q

CBC Parameters – PLT count

Mean Platelet Volume (MPV)

Platelet Distribution Width
(PDW

A

Mean Platelet Volume (MPV) -Average size of platelets (fL)

Platelet Distribution Width
(PDW)-Variation in size of platelets (expressed as %)

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5
Q

Reference Interval (RI)

A

-results seen in the majority of healthy people

  • Specific RI given according to (where there is a difference):
    ‒ Sex
    ‒ Age
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6
Q

CBC Review & Interpretation

A

● All parameters within Action Limits – no smear needed
‒ Parameters may be outside RI, however, they are not significantly
abnormal
‒ CBC reported

● Any parameters outside Action Limits – make a smear
‒ Significantly abnormal
‒ CBC not reported

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7
Q

What will be PBF manual count if in automated

RBC - HIGH

WBC - HIGH

PLATELET - HIGH

A

RBC - cells close together - less white space in tail

WBC = increased WBC cytosis

PLT - increased PLT

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8
Q

What will be PBF manual count if in automated

RBC -low

WBC - low

PLATELET - low

A

RBC - Smear runs long less RBC more plasma
Excess white space showing
between cells

WBC = decreased WBC estimate - penia

PLT - decreased PLT estimate

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9
Q

What will be PBF manual count if in automated **
MCV -HIGH

MCV - LOW

MPV - HIGH

RDW - HIGH

A

MCV -Large RBC - Macrocytes

MCV - Small RBC - Microcytes

MPV - Giant PLTs

RDW - Anisocytosis:
* Macro, Micro, or both
(or with Retics)

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10
Q

What will be PBF manual count if in automated

MCH / MCHC -low

MCHC - HIGH

A

MCH / MCHC -Hypochromic RBC
* RBC have less hemoglobin
‒ Increased Central Pallor

MCHC - * RBC can only hold so much HGB
‒ Spherocytes present
‒ Interfering substance present

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11
Q

CBC – HGB, MCH & MCHC are all ↓

A

Low HGB due to decreased or
abnormal production:
* RBCs show increased central pallor
(hypochromasia)
* Some shape changes due to
decreased internal cell volume

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12
Q

HGB is Low
&
RBC is Low

MCH & MCHC
are Normal

A

Each individual RBC has a normal amount of hemoglobin but
there are less RB

Three main reasons:
1. Error in BM production
2. Early destruction
3. Loss of blood

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13
Q

RBC Distribution Width (RDW)

A

● Presence and degree of Anisocytosis (variation in RBC size)
‒ Increases are important, decreases are not clinically significant

  1. ‘Normocytes’ & Microcytes MCV Decreased
  2. ‘Normocytes’ & Macrocytes MCV Increased
  3. Microcytes & Macrocytes MCV -Normal
  4. Microcytes & Reticulocytes MCV- Normal

MCV normal but RDW is high

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14
Q

Anisocytosis – Dual Populations

A
  • When two distinct populations of RBCs are seen,-dual/dimorphic population
    ‒Typically, a normal population along with an abnormal population
    ▪ E.g., Normochromic /Normocytic and hypochromic/microcytic cell -in a
    treated Iron Deficiency anemia patient
  • reported as Dual Population
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15
Q

Systematic Approach to CBC Interpretation RBC Parameters

A

Anemia is suspected (low HGB value), we interpret our CBC as follows:

Step 1- look as HGB concentration and HCT size to assess the anemia

Step 2 - Look at MCV to assess cell volume - relate it with RDW and RI - normo, micro and macro

Step 3- Look at MCHC to see how well the RBC are filled up aka the HGB concentration
-relate it with RI-Normo/Hypo
Hyper spherocytes present, cold agglutinins or lipemic/hemolyzed

Step 4 - Look at RDW to assess anisocytosis or size variation and relate with MCV

Step 5 - Look at PBF for RBC morph and relate to CBC values also look for a Retic response

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16
Q

Purpose of the WBC Differential

A
  • Total WBC count per liter of whole blood
  • Differential determines proportion of each type of WBC per liter of whole blood (auto or manual)
  • Total WBC count is not always significant
    ‒ Normal WBC count could have abnormal Diff %
17
Q

WBC Differential

automated vs manual

A

-‘slot’ cells into 5 mature WBC types vs Visual interpretation of cells using morphological criteria

-Will ‘flag’ if there are any cells which do not fit any one type’s criteria vs Can identify 5 mature WBC and most immature forms

  • Will ‘guess’ at abnormal type vs Can detect morphological abnormalities

Counts 1000s of cells vs Counts 100 WBC

18
Q

WBC Differential Reporting
Relative Differential

Absolute Differential

A

Relative Differential
The ratio (% or fraction of 1) for each WBC type

The relative percentage is converted to the total number of that specific leukocyte by multiplying the ratio to the total WBC count

Relative Neutrophil 0.50 ratio
‒ WBC count of 20.0 x 10^9 /L

Relative x WBC = 0.50 x 20.0 = 10.0
therefore 10.0 x 10^9/L

19
Q

NEUTROPHILIA

NEUTROPENIA

LEFT SHIFT

A

NEUTROPHILIA-An increase in # of neutrophils

NEUTROPENIA -A decrease in # of neutrophils

LEFT SHIFT -increase in Band forms usually counted with segmented Neuts

20
Q

LYMPHOCYTOSIS

LYMPHOPENIA

MONOCYTOSIS

EOSINOPHILIA

BASOPHILIA

Thrombocytosis

Thrombocytopenia

A

LYMPHOCYTOSIS -An increase in the # of lymphocytes

LYMPHOPENIA -A decrease in the # of lymphocytes

MONOCYTOSIS -An increase in the # of monocytes

EOSINOPHILIA -An increase in the # of eosinophils

BASOPHILIA -An increase in the # of basophils

Thrombocytosis increase in PLT

Thrombocytopenia decrease in PLT

21
Q

Systematic Approach to CBC Interpretation WBC Parameters

A

Step 1- ensure the WBC count correct via histogram/scatterplot

Step 2 - compare total WBC with RI

Step 3/4 - look at relative and absolute counts . The sum of absolute and total WBC should match

Step 5 - note any premature cells and look at WBC histogram/scatterplot

Step 6 - Note morph abnormalities

22
Q

Systematic Approach to CBC Interpretation PLT Parameters

A

Step 1- look at total plt count. normal? cytosis? penia?

Step 2 look at MPV to asses platelet volume for example high MPV corresponds with increase PLT

Step 3 - Look at Plt morph and match with numeric values

Arrangement - clumped/aggregated
size - giant thrombo
granularity - agranular or hypo granular

Hematology (12 decks)

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