Question

The Theory Behind Complete Blood Count!

Dr.Jagdish Prasad Mehrotra · Accepted Answer

Complete blood count (CBC):

CBC provides information of the circulating blood & Screen for a wide range of conditions and diseases

Help diagnose various conditions, such as anaemia, infection, inflammation, bleeding disorder or leukaemia
Monitor the condition and/or effectiveness of treatment after a diagnosis has been established
Monitor treatment that is known to affect blood cells, such as chemotherapy or radiation therapy
Human body is made up of cells and water. Many of the cells group together and form the skin, muscle, bones and organs like Heart, Lungs & Kidney.

Some very special and important cells move throughout the body by circulating in the blood which provides Oxygen to all these stationary cells in the body. These help them to fight against the infection, stop bleeding after an injury.

EVALUATION: Three types of cells circulate in our body.

WHITE BLOOD CELLS
REDBLOOD CELLS.
PLATLETS.
A. WHITE BLOOD CELLS (WBC):

These cells represent the defence system of body i.e. fight infection and cancer. It also plays role in allergies and inflammation.

Types of WBC:

NEUTROPHIL: Neutrophils are cells that protect the body from bacterial infections. They move toward bacteria and then swallow them up so the bacteria cannot harm the body.
LYMPHOCYTE: Lymphocytes are cells that protect the body against viruses, bacteria, and fungi. One type of lymphocyte (B-cell) produces antibodies that attack and destroy the bacteria and viruses. Another type of lymphocyte (T-cell) can directly attack viruses and bacteria and can stimulate the B-cells to produce antibodies
MONOCYTES: Monocytes are cells that consume dead or damaged cells. They are the clean-up crew .
EOSINOPHIL: Eosinophils are cells that kill parasites and contribute to allergic reactions.
BASOPHIL: Basophils are cells that release histamines during allergic reactions.
OTHERS: Promyelocytes, Metamyelocytes, Blasts, etc. are not normally appear in the blood. In the presence of any of these cells indicates a need for follow-up .
EVALUATION OF WBC:

Low count of WBC is called Leukopenia. The causes of low count are -

Dietary deficiency.
Autoimmune condition.
Sever infection
Lymphoma or other cancer that spread in bone marrow
Bone marrow disorders or damage
Disease of immune system
High count of WBC called Leucocytosis. The causes of high count are-

Infection most commonly bacterial or viral
Inflammation
Leukaemia
Allergy
Tissue death
Intense exercise or sever stress.

B. RED BLOOD CELLS (RBC)

These cells transport oxygen from the lungs to the rest of body. These oval shaped cells contain haemoglobin, the protein that binds oxygen while it is carried to all stationary cells in the body i.e., cells in the skin, muscle, bone and organ. The chemical process converts the nutrients found in food into energy requires oxygen. All stationary cells require energy to function; thus, they need oxygen and dependent on the RBCs to transport it.

Haemoglobin: It is an iron rich protein.

It carries oxygen.
It makes the blood red.
Normal range in Male: 13.5 to 17.5 grams per decilitre
Normal range in Female: 12.0 to 15.5 gram per decilitre
Low Haemoglobin: This can occur due to

Body produces fewer RBC s than usual
Body destroys RBC s faster than they can produce
Blood loss.
Following conditions produce fewer RBC s -

Aplastic anaemia
Cancer
Drugs like Anti-retroviral used in HIV infection, Chemotherapy of cancer
Chronic kidney disease
Cirrhosis of liver
Hodgkin s lymphoma
Hypothyroidism
Iron deficiency anaemia
Leukaemia
10. lead poisoning
11.Multiple myeloma
12. Myelodysplastic syndrome
13.Non-Hodgkin s lymphoma
14. Vitamin deficiency anaemia
Following conditions destroy RBC s faster
Splenomegaly
Haemolysis
Porphyria
Sickle cell anaemia
Thalassemia
Vasculitis (Blood vessels inflammation)
Other cause of low Haemoglobin count

Bleeding from a wound, digestive tract, ulcers, cancer, Haemorrhoids and menorrhagia (heavy menstrual bleeding)

High Haemoglobin count: It occurs when your body requires increased oxygen -carrying capacity

Smoking
High altitude
Poor heart and lung function ( low blood oxygen levels increase RBC s production)
Bone marrow produces too many RBC s
Consumption of drugs or Hormones e.g. Erythropoietin (EPO) stimulates RBC s production; injection used for athletic performance
Other cause of high hemoglobin in which the body requires an increased oxygen-carrying capacity.

Congenital heart disease in adults
COPD (chronic obstructive pulmonary disease)
Dehydration
Emphysema
Heart failure
Kidney cancer
Liver cancer
Polycythemia vera

HAEMATOCRIT / Packed cell volume (PCV): It is the measurement by centrifugation of blood. It reflects the ratio of the volume of red blood cells to the total volume of blood or Space occupied by the RBCs.

Normal range in Male: 40 .7% to 50.3%

Normal range in Female: 36.1% to 44.3%

Cause of Low PCV/ Haematocrit or anaemia

Bleeding (Ulcers, Trauma, Colon Cancer, Internal bleeding)
Destruction of RBCs (Sickle Cell Anaemia, Splenomegaly)
Decreased Production of RBCs (Bone marrow suppression, Cancer, Drugs)
Nutritional Problems (Low Iron, B12, Folate and Malnutrition)
Overhydration (Polydypsia, Intravenous overhydration)
Cause of High PCV/ Haematocrit or anaemia

Dehydration (Heat exhaustion, No available source of fluids)
Low availability of Oxygen (Smoking, High altitude , Pulmonary fibrosis)
Genetic (Congenital Heart disease)
Erythrocytosis (Overproduction of RBCs by bone marrow or Polycythemia vera)

MEAN CORPUSCLE VOLUME (MCV): It reflects the average size of RBCs.
Low MCV reflect small sized RBCs

High MCV reflect Large sized RBCs

MEAN CORPUSCULAR HAEMOGLOBIN (MCH): It reflects the average concentration of haemoglobin in a single red blood cell.
Low MCH reflect low haemoglobin concentration

High MCV reflect high haemoglobin concentration

MEAN CORPUSCULAR HAEMOGLOBIN CONCENTRATION (MCHC): It reflects the ratio of MCH AND MCV
Low MCHC shows the Thalassemia (Inherited Blood Disorder) microcytic hypochromic anaemia i.e. RBCs are smaller than usual and have decreased level of haemoglobin. It can be caused by

Lack of iron
Poor absorption of iron due to disease like CELIAC DISEASE, CHRON S DISEASE AND GASTRIC BYPASS SURGERY
CHRONIC LOW-GRADE BLOOD LOSS LIKE IN PEPTIC ULCER OR LONG MENSTURAL CYCLE.
HAEMOLYSIS OR PREMATURE DESTRUCTION OF RBCs OVER TIME
CANCER CAUSING INTERNAL BLOOD LOSS.
HOOKWORM INFECTIONS
LEAD POISOINING.
High MCHC reflects more concentrated haemoglobin in red blood cells. It can occur in conditions where red blood cells are fragile or destroyed leading to haemoglobin being present outside te red blood cells. it can be caused by

Autoimmune haemolytic anaemia. In which body develops an antibody that attack your red blood cells. It can be idiopathic autoimmune haemolytic anaemia / Lupus lymphoma/ penicillin reaction.
Hereditary spherocytosis. It is a genetic disease in which mutation affects the red blood cell membrane and make it more fragile and prone to destruction.
Severe burns often have haemolytic anaemia.

1. RED CELL DISTRIBUTION WIDTH (RDW): It reflects the degree of variation in size of the RBCs. Normal red blood cells maintain a standard size of 6-8 micrometres. If cells are larger RDW values will have higher numbers. This test is indicated if one has following problem.

Anaemia
Iron and vitamin deficiency
Family history of blood disorder such as sickle cell anaemia
Significant blood loss
Disease that affects the red blood cells
Chronic illness such as HIV / AIDS.
RDW test diagnose

Types of anaemia
Thalassemia
Diabetes mellitus
Heart disease
Liver disease
Cancer
Normal Range of RDW: 10.2% - 14.5% (39.0 46.0)

Low RDW: Body is not producing enough RBC It indicate

Macrocytic Anaemia: Red blood cells are larger than average. Indicate deficiency of folate or vitamin B12.
Microcytic Anaemia: Red Blood Cells are smaller than average. It indicates deficiency of Iron. It also suggests Thalassemia.
High RDW:

The possible cause can be asses by comparison with MCV

High RDW and MCV: Haemolytic anaemia, Megaloblastic anaemia, Lack of vitamin B12. Indicate chronic Liver Disease
High RDW and low MCV: Iron deficiency anaemia or Microcytic anaemia, Thalassemia intermedia.
High RDW and Normal MCV: Beginning stages of Vitamin B12 or Folate Deficiency, Beginning stage of Iron deficiency Anaemia. Indicate Chronic Liver Disease.

2. Platelets: Platelet is vital for the normal clotting.

EVALUATION OF Platelet:

Low count of Platelet is called Thrombocytopenia. The causes of low count are

Viral infection including Dengue.
Platelet autoantibody
Drugs
Cirrhosis
Autoimmune disease
Sepsis
Leukaemia
Myelodysplasia (production of blood cells disturbs)
High count of Platelet is called Thrombocytosis. The causes of high count are-

Cancer
Rheumatoid arthritis
Iron deficiency anaemia
Myeloproliferative disorder (Disease of bone marrow and blood)
Mean Platelet Width (MPV): It is calculation of average size of Platelets. Platelets are produced in the Bone marrow and released into the blood stream. Larger Platelets are usually young and more recently released from the bone marrow. smaller platelets are more likely to have been in circulation for few days. Low Platelet count and high MPV level suggests that that the bone marrow is rapidly producing platelets this is because older platelets are being destroyed so the bone marrow compensate.

High MPV may be associated (Depends on other CBC result):

Cancer

Several types of cancer e.g. Lung, ovarian, endometrial, colon, kidney, stomach, pancreatic, and breast cancer

Warning signs of cancer are:

Skin changes
Breast changes
Thickening skin or lump on or under your skin
Hoarseness or cough that doesn t go away
Changes in bowel habit
Trouble swallowing
Weight gain or loss for no reason
Abdominal pain
Unexplained night sweats
Unusual bleeding or discharge in urine or stool
Feeling weak or tired
Hyperthyroidism
Heart disease
Diabetes
Vitamin D deficiency
High blood pressure
Stroke
Atrial fibrillation
Low MPV may be associated (Depends on other CBC result):

Inflammatory bowel disease, Crohn s disease or ulcerative colitis
Cytotoxic medication
Aplastic anaemia.
Platelet Distribution Width (PDW): It reflects how uniform platelets ars in size.

Reference range of platelet distribution width is: 10%-18%
Low value of PDW:

A low value indicates uniformity in size of platelets. This may also be an indication that there is a disorder present which is affecting the bone marrow and how it is able to produce platelets. Viral infections will typically produce this result, such as measles, hepatitis, or mononucleosis. Certain drugs and cancers can also cause this result.

High value of PDW:

A high value indicates increased variation in the size of the platelets, which may mean that a condition is present that is affecting platelets. There are numerous younger platelets and numerous older platelets in the same sample. This may be an indication that some sort of disorder has affected the bone marrow or the platelets and further testing may be required. Certain cancers, anaemia, and inflammatory conditions typically cause this result, as will some infectious diseases or the use of birth control pills.

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