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CBC / COMPLETE BLOOD COUNT / HEMOGRAM

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REASON FOR TESTING OF CBC


Routine examination of the individual involves CBC as the most common test being performed .It can be ordered in the healthy individual and also in people with certain signs and symptoms:

  • Lethargy
  • Weakness
  • Fever
  • Infection
  • Bruising

WHAT IS BEING TESTED IN CBC


CBC examination involves certain basic parameters:

  • Haemoglobin ( Hb)
  • Red blood cell count ( RBC count)
  • Packed cell volume ( PCV )
  • Total leucocyte count (TLC)
  • Differential leucocyte count (DLC)
  • Platelet count (PC)
  • RBC indices (MCV , MCH , MCHC )
  • Erythrocyte sedimentation rate ( ESR)

Haemoglobin

Haemoglobin is the major component of the RBC .It is a type of conjugated protein that helps in the transport of the the oxygen hence it represent the amount of oxygen carrying protein in the blood.

Red Blood cell count

It represent the number of red blood cell present in the blood of the patient .It indirectly also measure the oxygen carrying capacity of the unit of blood

Packed cell volume

Aka Haematocrit

It is the ratio of the volume of erythrocytes to that of the whole blood .It is usually expressed as percentage.


Total Leucocyte count

Total leucocyte count is the absolute number of the white blood cells (Leucocyte ) present in the unit amount of blood. Leucocyte are involved in the body defence system.

Differential Leucocyte count

It provide information regarding the different type of white blood cells in the blood and it is represented as the percentage on the total leucocyte count. It is also reported as the Absolute differential leucocyte count. It elaborate on the 5 types of the leucocytes present in blood - Neutrophil, Lymphocyte , Monocyte , Eosinophil , Basophil . Each of these cells have specific functions and their percentage varies with different subsets of physiological and pathological response.


Platelet count

Platelet functions are involved in the blood coagulation pathways of human body hence they are key to maintaining the haemostasis and vascular integrity. At times platelet distribution width (PDW) is also reported which reflect the uniformity in the size of the platelet.


RBC indices

Aka erythrocyte indices

These indices are of major importance in sub classifying Anaemia. These are calculated from the red cell count, haematocrit and Haemoglobin concentration. These include:

MCV- It is the average volume of the Red blood cell.

MCH- It is the content of Hb present in the average red blood cell.

MCHC- It is the average amount of Haemoglobin present in the given volume of haematocrit


ESR

ESR estimation is usually done separately, but at times it can be part of the CBC examination. It is nonspecific test which highlights the underlying process of inflammation in the body . In recent times it being replaced by C - reactive protein (CRP) estimation.


INTERPRETATION OF CBC TEST RESULT


RED BLOOD CELL COUNT

Decreased (known as Anaemia) -

  • Nutritional deficiency of Iron, vitamin B12, folate.
  • Haemolytic anaemia (RBC destruction).
  • Acute and chronic bleeding.
  • Chronic inflammatory disorders.
  • Bone marrow disorders.
  • Chronic renal disorders.

Increased (known as Polycythaemia) -

  • Dehydration
  • Chronic smokers
  • Residence of high altitude
  • Kidney tumour secreting excess erythropoietin (rare)
  • Polycythaemia Vera (rare)

Haemoglobin and Packed cell volume

Usually represented by values of RBC COUNT

RBC INDICES

MCV 
Decreased ( microcytes ) -

  • iron deficiency anemia.
  • Thalassemia

Increased ( microcytes ) -
  • vitamin B12 / folate deficiency
  • Hypothyroidism
  • Liver disease
  • Alcoholic

MCH-
Correlate with the MCV values and usually follow same trend.

MCHC-
Decreased-

  • Iron deficiency anaemia
  • Thalassemia

TOTAL LEUCOCYTE COUNT

Decreased( Leucopenia ) -
  • Autoimmune disorder
  • Bone marrow disorder
  • Immune disorder (HIV)
  • Sepsis (rare )

Increased (leucocytosis ) -
  • Infection ( bacterial , viral )
  • Leukemia
  • Inflammation
  • Trauma , Burn

DIFFERENTIAL LEUCOCYTE COUNT

NEUTROPHIL
Increased ( Neutrophilia ) -
  • Acute bacterial infection
  • Exercise
  • Leukemia
  • Trauma
  • Stress

Decreased ( Neutropenia ) -
  • Dietary deficiency
  • Autoimmune disorder
  • Severe sepsis
  • Chemotherapy
  • Immunodeficiency

LYMPHOCYTE
Increased ( Lymphocytosis ) -
  • Acute viral infection
  • Tuberculosis
  • Stress
  • Chronic inflammatory disorder
  • Lymphocytic leukaemia ( elderly)

Decreased ( Lymphopenia ) -
  • Viral hepatitis
  • SLE
  • Rheumatoid arthritis
  • Typhoid
  • Corticosteroids therapy

MONOCYTE
Increased ( Monocytosis ) -
  • Tuberculosis
  • Fungal infection
  • SLE
  • Scleroderma
  • Vasculitis

Decreased ( Monocytosis ) -
  • not significant

EOSINOPHIL
Increased ( Eosinophilia ) -
  • Parasitic infection
  • Allergy
  • Asthma
  • Drug reaction
  • Celiac disease

Decreased ( Eosinophilia ) -
  • not significant

BASOPHIL
Increased ( Basophilia ) -
  • Rheumatoid arthritis
  • Ulcerative colitis
  • Rare allergic reaction
  • Chronic myeloid leukaemia ( rare )

Decreased ( Basophilia ) -
  • not significant

PLATELETS
Increased ( Thrombocytopenia ) -
  • Myeloproliferative disorder
  • SLE
  • Rheumatoid arthritis
  • Inflammatory bowel disease

Decreased ( Thrombocytopenia ) -
  • Acute Viral infection
  • Dengue
  • Measles
  • Cirrhosis
  • Platelet autoantibody
  • Autoimmune disorder
  • Sepsis

ESR
Increased -
  • Chronic infection
  • Tuberculosis
  • SLE
  • Rheumatoid arthritis
  • Vasculitis
  • Malignancy
  • Multiple myeloma

CBC REFERENCE RANGE


Red blood cell (RBC) count
Men:

4.5-5.5 million RBCs per microliter (mcL)

Women:

4.0-5.0 million RBCs per mcL

Children:

3.8-6.0 million RBCs per mcL

Newborn:

4.1-6.1 million RBCs per mcL


Hematocrit (HCT)
Men:

42%-52%

Women:

36%-48%

Children:

29%-59%

Newborn:

44%-64%


Hemoglobin (Hgb)
Men:

14-17.4 grams per deciliter (g/dL)

Women:

12-16 g/dL

Children:

9.5-20.5 g/dL

Newborn:

14.5-24.5 g/dL


Red blood cell indices
Mean corpuscular :

84-96 femtoliters (fL)

volume (MCV)-Adults:

Mean corpuscular hemoglobin (MCH)-Adults:

28-34 picograms (pg)per cell

Mean corpuscular hemoglobin concentration (MCHC)-Adults:

32-36 grams per deciliter (g/dL)


Red cell distribution width (RDW)
Normal:

11.5%-14.5%


White blood cell (WBC, leukocyte) counts
Men and non pregnant women:

5,000-10,000 WBCs per cubic millimeter (mm3)


White blood cell types (WBC, differential)
Neutrophils:

50%-62%

Band neutrophils:

3%-6%

Lymphocytes:

25%-40%

Monocytes:

3%-7%

Eosinophils:

0%-3%

Basophils:

0%-1%


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