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interpretation-of-CBC WBCLYPHMCVHGB.pptx
- 1. CBC interpretation (WBC) Shumoos Abed PGY-4
- 8. A&E (10/9/2018) Referred from rehabilitation clinic to the emergency as a case of sever anemia (6.1 gm/dl) for blood transfusion
- 9. (10/9/2018)
- 10. Medical Registerar (10/9/2018) OGD & colonoscopy showed no cause of GI bleeding
- 13. PANCYTOPENIA
- 14. Definitions PANCYTOPENIA:- Decreases in all peripheral blood lineages BiCYTOPENIA:- Decreases in two peripheral blood lineages LEUKOPENIA:- Decrease in WBCs count (<4400 cells/microL in most clinical laboratories)
- 15. How to approach HISTORY EXAMINATION LAB TEST Hematology Referral INITIAL FURTHER CBC CMP Peripheral smear Retics Count Coagulation profile Blood grouping Case based e.g Bone marrow Imaging Endosco pies Less Urgent No referral Emergency
- 16. Neutropenia Mild ANC 1000 and <1500 cells/microL Moderate ANC 500 and <1000 cells/microL Severe ANC <500 cells/microL Agranulocytosis ANC <200 cells/microL Chronic neutropenia Neutropenia for >3 months Constitutional neutropenia Longstanding neutropenia, typically since childhood Granulocytopenia Reduced number of neutrophils, eosinophils, and basophils Isolated neutropenia Neutropenia without associated anemia and/or thrombocytopenia
- 17. Absolute neutrophil count The absolute neutrophil count (ANC) is the number of neutrophils plus bands, but does not include metamyelocytes and less mature forms. ANC = WBC (cells/microL) x percent (PMNs + bands) 歎 100
- 18. Mechanisms of PANCYTOPENIA 1. Bone marrow infiltration/replacement 2. Bone marrow aplasia 3. Blood cell destruction or sequestration
- 20. When to repeat CBC? If mild and patient is well Repeat in 1-2 weeks, and if persistently low after 6 weeks, then needs further investigation and to refer him to hematology If moderate or severe If unwell of febrile, urgent referral If patient is well, repeat CBC after 2 weeks (safety netting) QUESTION ANSWER
- 21. HISTORY Time course and clinical severity Symptoms associated with pancytopenia Recurrent, severe, or unusual infections Fatigue, dyspnea, chest pain, hemodynamic instability, or claudication due to anemia Bleeding or easy bruising Fever, night sweats, and/or weight loss Nausea, vomiting, and jaundice that may be associated with liver disease Previous treatments Other medical conditions Problematic medications Personal and occupational exposures
- 22. Rashes that may be related to drug reactions, rheumatologic disorders, infections, and malignancies Oral lesions; as examples, thrush suggests immune compromise; oral ulcers may be seen in diseases such as systemic lupus erythematosus Lymphadenopathy and/or splenomegaly Jaundice and stigmata of liver disease EXAMINATION
- 24. Not usually clinically significant Lymphocytopenia Normal range 1.0-4.0 X 109 /L It represents 20-40%
- 26. 19-year-old male, not known to have any chronic illnesess presented to the clinic with generalized weakness, backache, and significant weight loss for the past 2 years. He was taking B12 and folic acid plus Iron as supplementations for 2 months prior to presentation. On examination Mild pallor, massive splenomegaly to the level of the umbilicus, and mild hepatomegaly
- 28. Leukocytosis refers to elevated WBC (leukocyte) count. Neutrophilia is the most common type of leukocytosis, but leukocytosis may also be due to increased monocytes, eosinophils, basophils, and/or lymphocytes Granulocytosis is often used interchangeably with neutrophilia, but granulocytosis is a broader term that can also reflect increased eosinophils or basophils. Left shift is an ill-defined term that refers to an increase in the percentage of band forms, generally accompanied by metamyelocytes and myelocytes. Leukemoid reaction refers to WBC >50,000/microL from causes other than leukemia, with the majority being mature neutrophils, often accompanied by increased numbers of bands, metamyelocytes, and/or myelocytes LEUKOCYTOSIS
- 29. Approach to the patient with neutrophilia HISTORY EXAMINATION LAB TEST Special Testing CBC Peripheral Smear Active or prior infection or inflammation Hematologic malignancies Surgical or functional asplenia Cigarette smoking Vigorous exercise Extreme physical or emotional distress Conditions that may be associated with neutrophilia (eg, pregnancy, eclampsia, post-partum, thyroid storm, hypercortisolism) Family history Bone marrow aspirate and biopsy Flow cytometry Molecular/genetic testing
- 30. How to differentiate between Leukemoid reaction and CML ? The LAPscore is raised in Leukemoid reaction whereas decreased in CML Presence of left shift in CML Prominence of Myelocytes in CML May be Eosinphilia and/or Basophilia in CML QUESTION ANSWER
- 31. MECHANISMS Increased production of neutrophils Autonomous (ie, due to malignant disorders such as myeloproliferative neoplasms) Reactive (ie, in response to infectious or inflammatory processes)
- 33. How to follow a patient with an isolated neutrophilia ? If patient is well 1-2 months, then 3 monthly for 12 months. Stop monitoring if normal QUESTION ANSWER
- 34. Lymphocytosis Normal range 1.0-4.0 X 109 /L It represents 20-40%
- 35. EOSINOPHILIA Referral tot hematologist if eosinophilia (moderate, marked) is persistently high for more than 6 months
- 36. BASOPHILIA Normal range 0.0 - 0.2 X 109 /L Because it is vey rarely be significantly raised, a repeat CBC 1-2 weeks may help