How to Interpret HEMATOLOGY Test Results

Complete blood count basically consists of the

concentrations of the three major cells found in the blood :

= RED BLOOD CELLS OR ERYTHROCYTES

= WHITE BLOOD CELLS OR LEUKOCYTES
= PLATELETS OR THROMBOCYTES.
Complete Blood Count test performed :
= Submit blood sample to a medical laboratory
= The lab technician will draw a few milliliters of blood by inserting
a
needle to a vein through skin. 
= The blood is collected in a vial which will then be analyzed in the
laboratory
THESE ARE THE COMPONNTS OF BLOOD MEASURED IN A
COMPLETE BLOOD COUNT :
Hemoglobin (HgB)
Hematrocit (HCT, packed cell volume, PCV)
Red blood cell (RBC) count
White blood cell (WBC) count
White blood cell types (WBC differential)
Platelet (thromobocyte) count
Red blood cell indices
Red cell distribution width (RDW)
Hemoglobin (HgB)
The red color of the blood is attributed to hemoglobin.
how much hemoglobin is present in the blood and reflects the capacity of the
blood to carry oxygen.

Normal:
Men: 14-18 g/dL
Women: 12-16 g/dL
Pregnant women: 1st trimester: 11.4-15.0 g/dL
2nd trimester: 10.0-14.3 g/dL
3rd trimester: 10.2-14.4 g/dL
Postpartum: 10.4-18.0 g/dL
Children: 9.5-15.5 g/dL
Newborn: 14-24 g/dL
Anemia from the Greek (an-aîmia) meaning "without blood”
Difinition :
Condition in which characterized Hb concentration decrease below
the normal value/ absolute reduction of total number of circulating
Red Blood cells ( RBC).
Usually is followed by a :decrease in hematocrit value or erythrocyte
count.
ETIOLOGI OF ANEMIA
1. BLOOD LOSS
- ACUTELY ----- HEMORRHAGE
- CHRONICALLY ---- LOW-VOLUME LOSS
2.EXCESSIVE BLOOD CELL DESTRUCTION /HEMOLYSIS
a. Hereditary abnormalities : erythrocyte membrane, enzyme defect,
hemoglobinopathy
b. Acquired abnormalities : immunologic defect, obstetric infection,
chemistry, physic, mechanic abnormality
3.DEFICIENT RED BLOOD CELL PRODUCTION
(ineffective hematopoiesis).
a. Nutritional anemia : protein, folic acid, Fe, vit B12 deff
b. Bone marrow failure : aplastic anemia, anemia in malignancy

ANEMIA IS THE MOST COMMON DISORDER OF THE BLOOD.

DIAGNOSIS ANEMIA
LABORATORY EVALUATION :
Laboratory evaluation essential to definitive diagnosis and treatment
Complete Blood Count :
RBC number : Hb, Ht, RBC count,
RBC indices : MCV , MCHC, MCH
Platelet count
WBC count , WBC diff
Blood film morfology :
cell size hemoglobinization,
anisocytosis,
poikilocytosis ,
polychromasia
Reticulocyte count
Marrow examination
Marrow aspirate ( E/G RATIO, CELL MORF, IRON STAIN )
Marrow biopsy ( cellularity, morphology )
MORPHOLOGICAL APPROACH TO ANEMIA
ANEMIA IS CLASSIFIED BY THE SIZE OF RED BLOOD CELLS
The size is reflected in the mean corpuscular volume(MCV).
N : 80 – 100 fL

MICROCYTIC If the cells are smaller than normal (under 80 fl),.

NORMOCYTIC if they are normal size (80-100 fl).
MACROCYTIC if they are larger than normal (over 100 fl).

This scheme quickly exposes some of the most common causes of

anemia; for example :
microcytic anemia is often the result of iron deficiency.
In clinical workup, the MCV will be one of the first pieces of
information available.
MICROCYTIC ANEMIA
Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency,
Etiologies:
1.HEME SYNTHESIS DEFECT
Iron deficiency anemia
Anemia of chronic disease (more commonly presenting as normocytic anemia)
2.GLOBIN SYNTHESIS DEFECT
alpha-, and beta-thalassemia
HbE syndrome
HbC syndrome
and various other unstable hemoglobin diseases
3.SIDEROBLASTIC DEFECT
Hereditary sideroblastic anemia
Acquired sideroblastic anemia, including lead toxicity
MACROCYTIC ANEMIA
1.Megaloblastic anemia
The cause of megaloblastic anemia primarily a failure of DNA synthesis with
preserved RNA synthesis, which result in restricted cell division of the progenitor
cells. The two most common causes of megaloblastic anemia are deficiencies of vitamin
B-12 or folate.
The megaloblastic anemias often present with neutrophil hyper segmentation (6-10
lobes).
Specific features of vitamin B12 deficiency :
1.peripheral neuropathy and subacute combined degeneration of the cord with
resulting balance difficulties from posterior column spinal cord pathology.
2.smooth, red tongue and glossitis.

2.Non-megaloblastic MACROCYTIC ANEMIA.

The non-megaloblastic macrocytic anemias have different etiologies (i.e. there is
unimpaired DNA globin synthesis,) which occur, for example in alcoholism.
NORMOCYTIC ANEMIA
Normocytic anaemia occurs when the overall hemoglobin levels decreased, but the
red blood cell size (MCV) remains normal.
Causes :
Acute blood loss
Anemia of chronic disease
Aplastic anemia (bone marrow failure)
Hemolytic anemia

DIMORPHIC ANEMIA
Two causes of anemia act simultaneously, e.g., macrocytic hypochromic :
- hookworm infestation leading to deficiency of both iron and vitamin B12 or folic acid
- following a blood transfusion
Evidence for multiple causes appears with an elevated RBC distribution width (RDW),
which suggests a wider-than-normal range of red cell sizes.
Hematrocit (HCT, packed cell volume, PCV)
This refers to the volume of RBC with respect to the volume of the whole blood.
Together with Hemoglobin values, Hematrocit values could show the presence of
anemia and polycythemia.
Normal:
• Men: 42%-52%
• Women: 37%-47%
• Pregnant women: 1st trimester: 35%-46%
• 2nd trimester: 30%-42%
• 3rd trimester: 34%-44%
• Postpartum: 30%-44%
• Children: 32%-44%
• Newborns: 44%-64%
Red blood cell (RBC) count
The RBC count refers to the number of red blood cells in a given volume of
blood.
The red blood cells are transporters of oxygen from the lungs to the different parts
of the body; while it also returns carbon dioxide from the body parts to the lungs to
be expelled.

Normal:
• Men: 4.7-6.1 million RBCs per mcL
• Women: 4.2-5.4 million RBCs per mcL
• Children: 4.0-5.5 million RBCs per mcL
• Newborn: 4.8-7.1 million RBCs per mcL
High RBC:
This may be due to lack of fluid in the body:
Dehydration, vomiting,
Excessive use of diuretics
Chronic lung, kidney, liver and heart diseases
Smoking and alcohol

Low RBC:
The main cause of low levels of RBC is anemia.
White blood cell (WBC) count
If there is an increase in WBC count, this
could be indicative of an infection especially
bacterial infection
Normal: 4,300 – 10,800 cells/cmm
HIGH WBC / LEUKOCYTOSIS
1.Etiologi :
a. Physiologist : Leukocytes count increase without increasing leukocytes product in bone
marrow
For example : Increase physic activity , menstrual period, anesthesia procedure
b. Patologies : Leukocyte count increase with increasing product leukocyte in bone marrow .
For example : pyogenic infection, intoxication acute hemorrhagic, acute
hemolytic, tissue necrosis, leukemia
2.Acoording increase of cell number
a. Slight leukocytosis : 10.400 – 15000 / uL
b. Mild leukocytosis : 15.000 – 20.000 / uL
c .Severe leukocytosis ; > 20.000/uL
3.According to type of cell :
a.Neutrophilia : -shift to the left
-shift to the right
b.Eosinophilia
c.Basophilia
d.Monocytosis
e.Lymfocytosis
LEUKEMOID REACTION:
- Severe leukocitocyte and in blood smear find blast, promyelocyte, myelocyte, rods
> 6 . This condition like chronic leukemia . Often find in child but this not
malignancy, its reaction causes severe infected, tissue damage or hemorrhage/
hemolytic.
LEUKEMOID REACTION CHRONIC LEUKEMIA
- CLEAR CAUSE - UNCLEAR CAUSE
- USSUALY : NOT FIND SPLENOMEGALI, - FIND :
SPLENOMEGALI,
-TROMBOCYTOPENIA , BASOFILIA,EOSYNOPHILIA -BASOFILIA,
EOSYNOPHILIA
- NAP/LAP SCORE INCREASE - NAP/LAP SCORE LOW
- BONE MARROW HYPERPLASTIC WITHOUT DEPRESED - BONE MARROW
HYPERPLASTIC WITH DEPRESED
ACTIVITY ANOTHER CELLS LINED ACTIVITY ANOTHER
CELLS LINED
LOW WBC/LEUKOPENIA - WBC COUNT
DECREASE

CAUSES
WBC is reduced when there are viral infections, aplastic anemia, AIDS,
malaria, lupus or Cushing’s syndrome. Reactions to medication,
chemotherapy, alcoholism and a large spleen also lower the WBC.
LEUKOFENIA
According type of cells :
Neutrofenia
Lymphofenia
Eusinophenia/Aneosinofilia

Neutrofenia
Neutrofil < 2500 /uL
severe neutrofenia : neutrofil < 500 /uL
Causes :
- Production decrease (Drug , radiation, viral infected ,Congenital ,Cyclic neutrofenia ---
every 21 days)
- Ineffective production : Mielodysplasia , megaloblastic anemia
- Increase destruction :severe infected, AIDS, spleeny sequestration
-Increase margination
EUSYNOPHENIA
-Acute stress ; Adreno corticoid & ephinefrin secretion
-Acute inflammation : Eos migration to place where inflammation occur.
-Cushing Syndrome
- Cortison administration

LYMFOPHENIA
Adult : < 1500/uL
Child : < 3000/uL
Causes
- Decrease production : AIDS, Limfoma Hodkins
- Increase destruction : drug, radiation, AIDS
- Loss of lymphocytes : Collagen vascular diseases, Loss of lymph, Increase
central venous pressure.
White blood cell types (WBC differential)
There are different types of WBC and they are distinguished according to their
shapes and sizes. Basophils, eosinophils, neutrophils, lymphocytes and
monocytes are the cells in a differential count. The counts of each of these
reflect the status of the immune system and can aid in determining the
existence of diseases, toxic or allergic reactions and infections.

• Normal:
• Basophils: 0 % – 1%
• Eosinophils: 1 – 3 %
• Band neutrophils: 2 – 6%
• Neutrophils (or segs): 50 – 70% relative value (3000-7000 absolute value)
• Lymphocytes: 25 – 40% relative value (1700-3400 absolute value)
• Monocytes: 2 – 8% relative value (200-600 absolute value)
Platelet (thrombocyte) count
Platelets are the smallest cells of the blood and serve an
important role in blood clotting.
Platelet count in a complete blood count refers to the number of
platelets in a given volume of blood.
Normal:
Children: 150,000-450,000 platelets per mm3
Adults: 150,000-400,000 platelets per mm3
High platelet:
This is usually a result of bleeding, bone marrow issues, iron deficiency
and diseases such as cancer.
Low platelet:
Large spleen, pregnancy and idiopathic thrombocytopenic purpura may
lead to low platelet count.
THROMBOCYTOSIS
Thrombocytosis is the presence of high platelet counts in the blood ( >
450.000/mm3)
Counts over 750,000 (and especially over a million) are considered serious
enough to warrant investigation and intervention.

Diagnosis
The patient's symptoms suggest the presence of thrombocytosis.
Blood tests confirm the diagnosis.
Thrombocytosis is classified as one of two types.
Secondary thrombocytosis can be traced to another cause, such as inflammation, severe
bleeding, iron deficiency, or some cancers.
Primary thrombocytosis (or essential thrombocythemia) is a single disease entity, with
unique clinical characteristics.
The highest platelet counts usually produce the most severe symptoms. Younger patients
(especially women) may not have symptoms, even though their platelet counts are very high.
Complications
Complications of thrombocytosis include stroke, heart attack, and formation of blood clots
in the arms and legs.
Should be notified whenever bleeding is unexplained or prolonged or the patient
develops:
chest or leg pain
confusion
numbness
weakness
THROMBOCYTOPENIA
Definition
Thrombocytopenia is defined as a platelet count less than 150,000/mm3
CAUSES
1. PLATELET UNDERPRODUCTION --- megakaryocytes
2. PLATELET SEQUESTRATION --- Hypersplenism
3. INCREASED PLATELET DESTRUCTION --- megakaryocytes
1.PLATELET UNDERPRODUCTION
The hallmark of platelet underproduction is decreased marrow megakaryocytes.
Common causes
1.infections (including HIV);
2.drugs (frequently chemotherapy or ethanol, but other medications in rare
instances);
3.radiotherapy; vitamin deficiency (folate or vitamin B12);
4.marrow infiltration by tumor, storage disease, or marrow failure syndromes (such
as myelodysplastic syndrome, acute or chronic leukemias).
2.PLATELET SEQUESTRATION
Hypersplenism from a variety of causes including liver disease or malignancy may
result in platelet sequestration . Mild to moderate thrombocytopenia is caused by
platelet sequestration when there is an associated mild reduction in neutrophil count
and hemoglobin and with minimal impairment of hematopoiesis on bone marrow
examination.
If physical examination fails to detect splenomegaly evaluation with
ultrasonography or radionuclide imaging is recommended to document
splenomegaly.
3.INCREASED PLATELET DESTRUCTION
The hallmark is increased marrow megakaryocytes (or, when available, high
reticulated platelet count).
Platelet destruction results from a variety of immune conditions including the
following:
Immune thrombocytopenic purpura
Thrombotic microangiopathies
Post-transfusion purpura (PTP)
Heparin-induced thrombocytopenia (HIT)
Disseminated intravascular coagulation (DIC).
IMMUNE THROMBOCYTOPENIC PURPURA (ITP)
The incidence of ITP 100 cases per 1 million person-years, with half the cases
occurring in the pediatric age group.
Adult onset is more likely to be chronic and insidious.
Adult onset ITP is more common in females than males (with a female to male
ratio of 1.7:1) while childhood onset has equal gender distribution.
ITP is subdivided into chronic or acute, with the latter being of 6 months or less
in duration.
PATHOPHYSIOLOGY:
The pathophysiology of primary ITP involves the formation of antiplatelet
antibodies, frequently directed at platelet glycoproteins IIb/IIIA, IIb/IX, Ia/IIa, V,
or multiple platelet antigens
DIAGNOSIS IMMUNE THROMBOCYTOPENIC PURPURA (ITP)

1. CBC shoul be unremarkable except for thrombocytopenia or easy-to-account-

for anemia.
2.The peripheral smear must confirm thrombocytopenia, and large, immature
platelets
3.A bone marrow biopsy or aspirate is required only in patients older than 60
years; in the presence of atypical features (which include fatigue, fever, joint
pain, macrocytosis, and neutropenia); or before performing splenectomy in the
patient whose diagnosis is not secure.
4..Testing for antiplatelet antibodies is generally not recommended. Antiplatelet
antibodies have a sensitivity of 49% to 66%, a specificity of 78% to 92%, and a
positive predictive value of 80% to 83%. A negative test result does not rule out the
diagnosis.
Red cell distribution width (RDW)
This measures the red blood cell shape and size variability. The
higher the variation, the higher the RDW is.
Normal: 11.5%-14.6%
THE END