COMPLETE BLOOD COUNT

Dr: Mona Wagdy Ayad

Assist Prof of clinical pathology

CIINICAL PATHOLOGY DEPARTMENT

Complete blood picture

Hb
R.B.Cs count
Haematocrit
Indices
W.B.Cs count
Platelets count
Differential WBC count .
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Sampling

Whole blood collected on tube containing

K2EDTA as anticoagulant.
Good gentle mixing in a form of 8
movement.
CBC can be done manual or automated.

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Haemoglobin conc.
Hb conc. may be estimated by several method:
1. Cyan-met Hb method: based on Drabkins
potassium-ferricyanide solution. Read
absorbance on 450 nm.
2.

Automated techniques

The reference values of Hb:

Hb :
men
15 2 g/dl
women 13.5 1.5 g/dl

CIINICAL PATHOLOGY DEPARTMENT

The total red blood cell count:

A manual red cell count is so time
consuming and has poor precision.
The reference method for the RBCs is an
automated method.
The reference values of RBCS;
RBCs :
men
5.0 0.5 million/cmm
women 4.3 0.5 million/cmm

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Peripheral blood cells :

Red blood cells:
The RBCs are circular and
fairly uniform in size .
Normally there is slight
variation in size and
shape.

The RBCs biconcave shape

produce a central pallor

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Packed cell volume (PCV) :

PCV or Hct can be measured by:

1. Micro-Haematocrit
2. Automated techniques

PCV value:
men

45 5 %

women

41 5 %

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Red cell indices:

Calculation of mean cell volume (MCV):

MCV =

PCV
x10
RBCs in millions

normal range: 92 9 fl

Calculation of mean cell Hb MCH):

MCH =

Hbx10
RBCs in millions

normal range: 29.5 2.5 pg

Calculation of mean cell Hb conc (MCHC):

MCHC =

Hb in gramsx100
PCV

normal range: 33 1.5 g/dl

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Classification of anaemias

Hypochromic microcytic anaemia

1.
Thalassaemia trait
2.
Iron defeciency
3.
Sideroblastic anaemia
4.
Anaemia of chronic illness

Macrocytic anaemia
Megaloblastic
Non megaloblastic: liver disease, drugs, myxoedema

1.
2.

Normochromic normocytic anaemia : haemolytic anaemia,

haemorrhage

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White blood cell count :

WBCs may be counted by ;

1.

Manual method which is time consuming.

Automated methods.

2.

Normal range :
4,000 10,000 / cmm

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White blood cells

WBCs are divided into:
1.
2.

Granulocytes
Mononuclear cells (lymphocytes & monocytes)

Granulocytes are divided into:

1.
2.
3.

Neutrophils
Eosinophils
Basophils
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Differential WBCs :
Usually performed by visual examination of
stained blood films which are prepared on slides
by the spread or wedge technique.
Normal differential WBCs :
Neutrophils :
40-70 % (2000 7000/cmm)
Lymphocytes :
20-40 % (1000 3000/cmm)
Monocytes :
2 -10 % ( 200 1000/cmm)
Eosinophils :
1 -6 % ( 20 500/cmm )
Basophils
:
0 -1 % ( 20 100 /cmm)

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Neutrophils:
Have 2-5 lobes. Cytoplasm is very
pale blue& contains granules.
Causes of neutrophilia: neutrophils> 7000/cc
1.
2.
3.
4.

Bacterial infections.
Inflammatory disorders as collagen
disease.
Drugs as corticosteroids.
Tissue necrosis as trauma, burns.

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Causes of neutopenia; neutopenia<2000/cc

1.
2.

3.

Idiosyncratic drug reaction.

Autoimmune /other immune
disorders.
Neoplasms replacing bone marrow.

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Eosinophils
Granules stain orange &usually pack
the cytoplasm.
The nucleus is most often bilobed
Causes of eosinophilia; eosinophils >500/cc
1.

2.
3.
4.
5.

Parasitic infections (specially tissue

parasites)
Allergic and hypersensitivity reactions.
Drug allergy.
Cutaneous disorders .
Hypereosinophilic syndrome.
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Basophils
Cytoplasm is packed with large
purple granules which obscure
the lobulated nucleus
Causes of basophilia; basoph.>100/cc

1.
2.
3.
4.
5.

Allergic or hypersensitivity reactions.

Inflammatory disorders (collagen dis.)
Myeloproliferative disorders esp. CML
Basophilic leukemia.
Myxoedema.
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lymphocytes:
Small round cell with a high N/C ratio.
Cytoplasm is basophilic.

Causes of lymphocytosis; lymphocytes>3000/cc

1.
2.
3.

Infectious mononucleosis (EBV) and related syndromes

as CMV, toxoplasmosis, human herpes virus 6.
Other viral infections as viral hepatitis, rubella, mumps.
Malignant causes as: ALL, CLL, lymphoma.
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causes of lymphocytopenia; lymphocytes < 1000/cc

1.

2.
3.

Congenital immunodeficiency
disorders.
Nutritional deficiency.
Autoimmune disorders as rheumatoid
arthritis & SLE

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Monocytes:
Largest WBCs in PB.
Irregular lobulated nucleus& greyblue cytoplasm which may be vaculated.
Causes of monocytosis; monocytes>1000/cc
1.
2.
3.
4.

Chronic infections as TB
Hodgkin's dis.
Collagenic disorders.
Leukemia with monocytic component.

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Platelets

Normal platelet count: 150-400.000/cmm.

Platelet count an be done :
1.
2.
3.

Manual method using ammonium oxalate

Automated cell counters
From blood film

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Bone marrow examination :

Purpose:
BM exam. Allows assessment of the cellularity,
maturation, and composition of the hematopoietic
elements in the BM, as well as evaluation of iron
stores.

Principle :
the cortical bone is penetrated and a sample of the
BM is aspirated.
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Thank you

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