Good CBC Principle, Interpretation PDF
Good CBC Principle, Interpretation PDF
Good CBC Principle, Interpretation PDF
Thanyaphong Na Nakorn, MD, PhD Division of Hematology Department of Medicine Chulalongkorn University
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The most common test used in clinical medicine Determine type and severity of blood cell abnormalities Nowadays, CBC is fully automated and highly reproducible. Correct interpretation of automated CBC can reduce rate of unnecessary blood smear examination Provide useful information for provisional diagnosis of RBC and WBC diseases
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Electrical impedance: Coulter Counter , CellCell-Dyn Dyn Optical impedance and light scatter: TechniconTechnicon-H series
VCS (volume, conductivity, light scatter) technology BeckmanBeckman-Coulter VCS, MAXM, STKS
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Coulter Technology
Cell count and size can be measured by
electrical impedance
Hydrodynamic Focusing
Sheath fluid Laminar Coaxial Flow
Lower pressure
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Technicon Technology
VCS Technology
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Instrument Coulter STKS Coulter GENGEN-S Sysmex SESE-9000 Cobas Argos 55-diff (Roche) Technicon H-3 (Bayer) Advia 120 (Bayer) Cell Dyn 4000 (Abbott)
Methodology features Impedance, conductivity, laser technology Impedance, flow cytometry, cytometry, conductivity, laser light scatter (reticulocyte analysis) Direct current (resistance to cell volume); radioradio-frequency (cell density, size) Impedance, light absorption (halogen light source) Cytochemistry, Cytochemistry, flow technology (reticulocyte analysis) Cytochemistry, Cytochemistry, flow technology (reticulocyte analysis) Impedance, laser light scatter
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Direct Measurement
6/ml (RBC ) (RBC) Erythrocyte Concentration (RBC) x 106 Mean Corpuscular Volume (MCV) (MCV ) Femtolitre (fl) (MCV) (Hb ) (Hb) Gram/decilitre (g/dl) Hemoglobin (Hb) Gram/decilitre
Indirect Measurement
(Hct) Hct) = RBC x MCV/10 Hematocrit (Hct) % (MCH ) = HB x 10 / RBC (MCH) RBC (pg) Mean Corpuscular Hemoglobin (MCH) (MCHC ) Hemoglobin Concentration Concentration (MCHC) (MCHC) Mean Corpuscular Hemoglobin = Hb/Hct x 100 (g/dl) (RDW ) Red Cell Distribution Width (RDW) (RDW) % %
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20th percentile
80th percentile
RDW
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RDW =
X constant
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CellCell-Dyn 1700CS
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Coulter VCS
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(LUC)
Technicon*H2 Technicon*H2
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Technicon*H2 Technicon*H2
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Platelet parameters
z z z z z z z z
Platelet count Mean Platelet Volume (MPV) Platelet Distribution Width (PDW) Plateletcrit (Pct)
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Reticulocyte count
z z
z z z z
nonnon-nucleated RBC Reticulocyte = non-nucleated with polyribosomal RNA as stained by supravital stain (new methylene blue or brilliant cresyl blue) Polychromasia underestimates reticulocytes Three methods of reticulocyte enumeration Manual count on slide per 1,000 RBC Automated CBC with counter (Coulter reticulocyte counter VCS, Cell-Dyne CellCell-Dyne 4000, TechniconTechniconH3) Flow cytometry with fluorescent dyes
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z z
Assess quality of smears Specimen preparation & staining Estimate cell numbers RBC: evenly dispersed with minimal intercellular space 10-20/LPF WBC: 10-20/LPF 7-20/OF Platelets: 7-20/OF Determine predominant cell populations Carefully examine cellular morphology
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RBC disorders
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Hypochromic microcytic anemia Iron deficiency anemia Thalassemia and hemoglobinopathy Macrocytic anemia Megaloblastic anemia Non Non-megaloblastic Non-megaloblastic macrocytic anemia Hemolytic anemia Immune hemolytic anemia: AIHA, DHTR Microangiopathic hemolytic anemia (MAHA) G Red cell enzymopathies: enzymopathies: G-6-PD G-6-PD deficiency RBC membrane defects: spherocytosis, spherocytosis, ovalocytosis, elliptocytosis, elliptocytosis, stomatocytosis ovalocytosis, RBC inclusion bodies and parasites
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WBC disorders
Leukopenia with absolute neutropenia: neutropenia: bone marrow failure, agranulocytosis with atypical lymphocytes: viral infection, chronic lymphoproliferative disorders with immature myeloid cells: acute leukemia, MDS or myelopthisis z Leukocytosis z Reactive leukocytosis: leukocytosis: leukemoid reaction Acute leukemia: AML vs. ALL Chronic myeloproliferative disorders disorders Chronic lymphoproliferative lymphoproliferative disorders disorders z Leukoerythroblastosis z
z z
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Platelet disorders
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Quantitative disorders non Isolated thrombocytopenia: Immune vs. non-immune non-immune Thrombocytopenia Thrombocytopenia associated associated with with other other hematologic abnormalities Thrombocytosis Qualitative disorders (megathrombocytes ) Giant platelets (megathrombocytes) (megathrombocytes) Platelet inclusion or granule abnormality Bizarre in shape and size Megakaryocytes or megakaryoblasts megakaryoblasts
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