Showing posts with label cbc. Show all posts
Showing posts with label cbc. Show all posts

Wednesday, August 11, 2010

Abnormally shaped RBCs Spiculated

Abnormally shaped RBCs

Spiculated –
Acanthocytes (abetalipoproteinemia, post – splenectomy, fulminating liver disease); Burr cells (stomach cancer, GI bleeding, uremia); Bite cells (hemolysis due to drugs); RBC fragmentation (cytotoxic chemotherapy, autoimmune hemolytic anemia, deficiency anemias, acute leukemia, inherited structural abnormality of RBC membrane protein spectrin).

Abnormally shaped RBCs Elongated

Abnormally shaped RBCs
Elongated –
Elliptocytes (hereditary, microcytic anemia); ovalocytes (megaloblastic anemia); teardrop cells (spent polycythemia. myelofibrosis. Thalassemia); Sickle cells (sickle cell disorders); HbC crystalloids (HbC trait or disease). Acute alcoholism); Target cells (HbC disease or trait, HbD, HbE, HbS, thalassemia, iron deficiency anemia, liver disease, post – splenectomy).

Abnormally shaped RBCs Round

Abnormally shaped RBCs

Round – Macrocytes (increased erythropoiesis); round macrocytes (liver disease, hypothyroidism, alcoholism); macro – ovalocytes (megaloblastic anemia, cancer chemotherapy, myelodysplastic syndromes); microcytes (hypochromic anemias), spherocytes (hereditary spherocytosis, recent blood transfusion); stomatocytes (hereditary stomatocytosis, acute alcoholism); target cells (HBC disease or trait, HbD, HbE, HbS, thalassemia, iron deficiency anemia, liver disease, post splenectomy).

Peripheral Blood Smear (PS)

Peripheral Blood Smear(PS) - RBCs


Peripheral smear is done for typing anemia, to confirm red blood cells (RBC) indices or indicate leukemia or other conditions,

RBC inclusions

Basophilic or polychromatophilic macrocytes ( < 15 in healthy persons, increased in erythropoiesis due to hemorrhage or hemolysis); microcytes with stippling (thalassemia, lead poisoning); Cabot's rings (severe hemolytic anemias, pernicious anemia [ PA]); Howell – Jolly bodies(megaloblastic anemia, thalassemia, hyposplenism, splenectomy); Pappenheimer bodies (Sideroblastic anemia, thalassemia, lead poisoning, pyridoxine unresponsive or responsive anemias); Heinz bodies (congenital G – 6 PD deficiency, drug induced hemolytic anemias); Plasmodium trophozoites(malaria); reticulocyte.

Thrombocytopenia (Decreased Platelet Count )

Thrombocytopenia in

Bone marrow depression, hypersplenism, viral infections (especially in dengue fever), drug hypersensitivity, antiplatelet antibodies (lgG and lgM), increased platelet consumption in thrombotic thrombocytopenia (TTP), disseminated intravascular coagulation (DIC) and septicemia.

Thrombocytosis (Increased Platelet Count )

Thrombocytosis in

After administration of epinephrine due to splenic contraction or after splenectomy, trauma (e.g. surgery, injury, childbirth) and stress.

Platelet Count (PC)

 Platelet Count (PC)


Normal Range

1,50,000 – 3, 50,000/

Causes of eosinophilia (> 250/ diurnal variation with highest levels in morning)

Causes of eosinophilia (> 250/ diurnal variation with highest levels in morning)

Allergic diseases (bronchial asthma, hay fever, urticaria, allergic rhinitis);

Parasitic infestations, mycoses, scarlet lever, erythema multiforme systemic lupus erythematous, rheumatoid arthritis, skin diseases (e.g.pemphigus).

Causes of monocytosis ( > 10% of differential absolute count > 500/

Causes of monocytosis ( > 10% of differential absolute count  > 500/

Monocytic leukemia, other myeloproliferative disorders, lymphomas, lipid storage diseases, post splenectomy, protozoal and some rickettsial infections, SBE, tuberculosis, brucellosis sarcoidosis, rheumatoid arthritis, systemic lupus erythematosus(SLE).

Causes of basopenia

Causes of basopenia

Hyperthyroidism, pregnancy, irradiation, chemotherapy, glucocorticoid administration, acute phase of infection.

Basophilia (50/cumm or > 1%)

Basophilia (50/cumm or > 1%)

May be first sign of blast crisis or accelerated phase of chronic myelocytic leukemia (CML).

Persistent basophilia may indicate unsuspected myeloproliferative disease.


Chronic myelogenous leukemia, basophilic leukemia, polycythemia, myeloid metaplasia, Hodgkin's disease, chronic sinusitis and hemolytic anemia.

Causes of lymphocytopenia (Decreased Lymphocytes) (< 1500 in adults, < 3000 in children)

Causes of lymphocytopenia (< 1500 in adults, < 3000 in children)

Increased destruction (chemotherapy or radiation treatment, corticosteroids), 
increased loss via Gl tract (thoracic duct drainage obstruction to intestinal lymphatic duct drainage), 
congestive heart failure, 
decreased production (aplastic anemia, malignancy, AlDS).

Causes of lymphocytosis (Increased Lymphocytes) (> 4000/cumm in adults, > 7200/cumm adolescents, > 9000/cumm in children and infants)

Causes of lymphocytosis (> 4000/cumm in adults, > 7200/cumm adolescents, > 9000/cumm in children and infants)

Infection (Pertusis, infectious, lymphocytosis, infectious hepatitis, cytomegalovirus (CMV) infections, mumps, rubella, varicella, toxoplasmosis, chronic tuberculosis), 

Others like 


Addison's disease, 

neutropenia with relative lymphocytosis, 

lymphatic leukemia, 

Crohn's disease, 

ulcerative colitis and 

infancy (normal count 40- 60 %) called relative lymphocytosis.

Causes of Neutropenia (Decreased Neutrophil) (Absolute count < 8000/

Causes of Neutropenia (Absolute count < 8000/

·        Infections: bacterial (e.g. overwhelming infection, septicemia, typhoid, paratyphoid) viral infections (infectious mononucleosis, hepatitis, influenza, measles, rubella), rickettsia, others (malaria, kala- azar).

·        Infants (normal count 40%).

·        Hodgkin's disease, chronic sinusitis, hemolytic anemia and lonizing radiation

·        Drugs & chemical (antibiotics, analgesics, antithyroids, arsenicals and ionizing radiation

·        Hematopoietic diseases (aleukemic leukemia, aplastic anemia) and splenic sequestration.

·        Autoimmune and isoimmune neotropenias.

·        Immune defects like infertile genetic agranulocytosis.

Causes of Neutrophilia (Increased Neutrophil) (Absolute count > 8000/

Causes of Neutrophilia (Absolute count > 8000/  

·        Acute infections:

·        Localized (e.g. Pneumonia, meningitis, tonsillitis).

·        Generalized (e.g. acute rheumatic fever, septicemia, cholera).

·        Inflammation (e.g. vasculitis).

·        Intoxications: metabolic (e.g. acidosis, uremia, acute gout); Poisonings (e.g. mercury, epinephrine, black widow spider bite).

·        Acute hemorrhage or hemolysis of red blood cells.

·        Tissue necrosis (e.g. acute myocardial infarction [AMI], burns, gangrene).

·        Physiological (e.g. exercise, Stress, obstetric labor, menstrution).

Tuesday, August 10, 2010

Differential leukocyte Count (DLC)

Differential leukocyte Count (DLC)
                                               Normal Range
    54-62 %
    20- 40 %
     1-4 %
     3-7 %
     < 1 %

 Support diagnosis of various infections and inflammation; 
diagnosis of myeloproliferative disorders;
neutrophil and band counts may be useful in acute appendicitis and 
neonatal sepsis with moderate sensitivity and specificity

TLC Decreased

Leukopenia in
Some bacterial infections (e.g. typhoid), 
viral or protozoal infection, 
bone marrow depression and 
starvation and 
physiological at night. 

TLC Increased

Leukocytosis in

Any acute/ chronic pyogenic or pyogenic (fever producing) infection, 
physiological in newborns, 
after exercise, 
in evenings, 
epinephrine injection, 
administration of steroids. 

Total leukocyte Count (TLC) Normal Range

Total leukocyte Count (TLC)

Normal Range (leucocytes/cumm)
       New born
        1-23 months
4000 – 10,500
9100 – 34,000
6000 – 14,000

Mean Corpuscular Hemoglobin Concentration (MCHC)

Mean Corpuscular Hemoglobin Concentration (MCHC)

      MCHC is calculated as Hb divided by Hct.
      Normal Range
      32-38 %

For laboratory quality control, chiefly because changes occur very late in the course of iron deficiency when anemia is severe and for instrument calibration.

Increased in
Hereditary spherocytosis (MCHC is > 36 gm/dL), infants and newborns, other causes due to automated cell counters are hemolysis, cold agglutinins, lipemia, rouleaux or RBC agglutinates.

Decreased in
Hypochromic anemia (Low MCHC may not occur in iron deficiency anemia when measured with automated instruments), marked leukocytosis (automated cell counter).