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Hematology Lecture 1

CBC interpretation

Reticulocyte

- An early, immature form of a red blood cell. Over time, the reticulocyte develops to become a mature, oxygen-carrying red
blood cell.

Reticulocytosis

- Increase in the number of circulating reticulocytes above 1% of the total number of RBCs
- Occurs during active blood regeneration (stimulation of red bone marrow)
- Seen in certain anemias, especially congenital hemolytic anemia.

Microcytes

- Microcytes are unusually small red blood cells associated with certain anemias.

Microcytosis

- Condition in which RBCs are unusually small as measured by their mean corpuscular volume. It is also known as
"microcythemia". When associated with anemia, it is known as microcytic anemia.

Anisocytosis 

- Medical term meaning that a patient's red blood cells are of unequal size.
- Commonly found in anemia and other blood conditions.
- Can be seen in various types of anemia and vitamin deficiencies.

Red Blood Cell Indices: MCV, MCHC, MCH

What is measured as RBC data?


- Total RBC count
- Hemoglobin (Hgb)
- Hematocrit (Hct)
- Mean corpuscular volume (MCV)

- Hyperproliferative Reticulocytes (> 2%) bone marrow working harder and some anemia going on
- Hypoproliferative Reticulocytes (< 2%) bone marrow not working enough could be due to cancers?

Hemoglobin:
- Hemoglobin concentration reflects the number of RBCs in the blood
- Hgb constitutes over 90% of RBCs
- Decrease in Hgb concentration = ANEMIA
- Increase in Hgb concentration =
POLYCYTHEMIA
o Absolute: RBCs high all the time
(high altitude)
o Relative

Hematocrit:
- Measure of the % of the total blood volume that
is made up by RBCs
- HEMOGLOBIN x 3 = HEMATOCRIT

Mean Corpuscular Volume (MCV):


- Average size or volume of the RBCs
- Will tell you if pt is micro, macro, or normocytic

- Important in classifying anemias:


o Normal MCV = normocytic anemia
o Increased MCV = macrocytic anemia
 Megaloblastic anemia, alcohol excess, cirrhosis, hypothyroidism, reticulocytotic, marrow infiltration,
myelodysplastic syndrome
o Decreased MCV = microcytic anemia
 Iron deficiency anemia, thalassemia, sideroblastic anemia, lead poisoning)

Mean Corpuscular Hemoglobin (MCH)


- Indicates the weight of Hb in the average RBC
o Increased = macrocytic anemia
o Decreased = blood loss, little iron in the body, microcytic anemia

Mean Cell Hemoglobin Concentration (MCHC)


- Indicates the concentration of Hb in the average RBC or the ratio of Hb weight to the volume
o Increased = hereditary, autoimmune hemolytic anemia, sickle cell anemia
o Decreased = blood loss, little iron, hypochromic anemia

Feedback:
- Positive feedback: anemia  bone marrow produce RBCs
- Negative feedback: High RBCs  tell liver to stop producing erythropoietin  stop producing RBCs

Leukocytosis
- WBCs above normal range
- Frequently a sign of inflammatory response and most commonly, infection
o Other causes: parasitic invasion, bone tumors, leukemia, FUO, strenuous exercise, epilepsy, emotional stress,
pregnancy/labor, anesthesia, and epinephrine administration

- Left shift – neutrophilia (bacterial infections)


- Right shift – lymphocytosis (viral infections)

Types of Leukocytosis
Neutrophilia
- Higher than normal number of neutrophils
o May occur without an increase in total granulocyte pool (TBGP)
o Or from a true increase in the total granulocyte pool size = TRUE neutrophilia
- Normal value = 55-60% of total WBCs
- Causes:
o M.C.= primary WBC that responds to BACTERIAL infections
 Especially pyogenic infections
o Increase in ACUTE inflammation, after heart attack, other infarct, or burns

Eosinophilia
- High number of eosinophils
- Can indicates a parasitic infection, allergic reaction, or cancer
- Normal value = 1-3%
- Usually less than 7% of circulating leukocytes

Basophilia
- High number of basophils
- Associated with pruritus due to histamine release
- Normal value = 0-1%
- Generally linked to allergic/hypersensitivity disorders or chronic inflammatory conditions like eczema, or hay fever

Lymphocytosis
- Increase in number of lymphocytes in the blood
- Normal value = 20-40%
- Three main types
o Natural killer cells
o T-Cells
o B-Cells
- Seen in: TB, lymphoma, leukemia, infectious mononucleosis (EBV), mumps, etc.
Pancytopenia
- Deficiency of all three cellular components of the blood (red cells, white cells, and platelets).

Monocytosis
- Increase in monocytes, normal range is 5-10%
- Monocytes present antigens to T lymphocytes for immune response
- Monocytes turn into macrophages when they get to the tissues
o Alveolar macrophages – Lungs
o Histiocytes – Connective tissue
o Kupffer cells – Liver
o Osteoclastic – Bone
- Monocytosis is seen in TB, Fungal infection, Listeriosis, Leukemia

Poikilocytosis 

- Poikilocytes are abnormally shaped red blood cells.


- Poikilocytosis is increased number on abnormally shaped red
blood cells in the blood.
- Teardrop cell

Types of Poikilocytes

- As name indicates these poikilocytes or RBCs are termed as teardrop due to their resemblance with tear drops.
- Target cell: Poikilocytes or RBCs having shape like bull's eye are termed as target cells
- Spherocyte: Poikilocytes or RBCs have shape like sphere or having spherical shape are termed as spherocytes.
- Sickle cell: Poikilocytes or RBCs having look like crescent are termed as sickle cells
- Schistocyte: Poikilocytes or RBCs having no proper shape are termed as schistocytes.
- Acanthocyte: Poikilocytes or RBCs arranged in an irregular pattern are termed as acanthocytes
- Stomatocyte: Cup shaped Poikilocytes or RBCs.
- Bite cell: Due to removal of one or more semicircular portions from the cell margin

Target cell

- Abnormal RBC which appears as a dark ring


surrounding a dark central spot, typical of certain
kinds of anemia.
- Common causes of Target cells are Thalassemia,
Hemoglobin S, Hemoglobin C and Post splenectomy
etc.

Leukopenia

- Decrease in the number of WBCs found in the blood,


which places individuals at increased risk of infection.
- Causes of Leukopenia: Aplastic anemia,
Myelodysplastic syndrome, myelofibrosis.

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