1. Dr.abdulfattah alshenawi
MBBch,Msc,Mrcs(Ireland)
Cons,general surgery(M.G.H)

2. OBJECTIVES
Be able to interpret (CBC) reports
Recognize common blood disorders
Know when to request hematology
consultation

4.  Screening?
 Diagnosing clinical situations.
 Monitoring disease& effect of treatment
 Prior to major procedure.

5.  57% Plasma
 1% Buffy coat
– WBC
 42% RBCS

6. o All Blood Cells made in bone marrow.
o Bone Marrow is the spongy centers of bones
sometimes seen in cuts of meat
oStem cells are young cells
oThey get “drafted” as RBCs, WBCs or platelets
depending on the body’s needs

9. • May be affected by
Activity
Diet
Stress
Geography
medications
Time of the day

15.  HB% gm%(13-17gm%)
 HCT volume of blood occupied by RBCS(35-45%)
 MCV average volume of individual RBC.(80-100fl)
 RETIC % of immature RBCs in blood(1-2%)
 RDW (10-15%)
 RBCS. COUNT IS ADDITIONAL TO DIAGNOSIS
 RBCSX3=HBX3=HCT (If not -indicates micro or
macrocytosis or hypochromia).
 PBS is additional privilge.
depend on both
total red cell mass
and plasma volume
BM activity
Degree of
anisocytosis

18. 50 100 200 fl
RBC
%
 width" refers to the width of the
volume curve (distribution
width), not the width of the cells.
 Correlate with the degree of
anisocytosis
normal RDW+ mic. Anaemia thalassemia
high RDW + mic.anaemia iron deficiency
high RDW + mac.anaemia vit B12&folate def.
high RDW + norm.anaemia hge

20.  Is the pt. anaemic?
 Low HB = anaemia
 Look to MCV
 Normal =normocytic anaemia?
A. Acute hge= normal Hct
B. explore for the site by HX&PE(shock,revealed
or concealed hge)
C. Haemolysis= high retic.,
( high LDH,low haptoglobin,& indirect
hyperbilirubinaemia,jaundice)
 Acute haemolysis, incompatible blood trans.
 Chronic haemolysis (Hbpathy,enzymopathy,
membranopathy)

21.  Haemoglobinuria is differentiating between IV&EV
haemolysis

22. A B
AB
A
A
DELTA
DELTA
A
A
GAMMA
GAMMA
HBA
A2B2
HBA2
A2D2
HB F
A2 G2
Normal variant of HB

23. HBS
Def.B Subunit
Sickle cell
anaemia
B, thalass
Dec. B chain
A.Thalass
Dec,A chain
Abnormal HB

25. RBCS SHAPE

26.  Low MCV= microcytic anaemia
 What THIS?
1) Normal or low retic=do serum ferritin
 IDA (low ferritin)
 ACD (high ferritin) (low TIBC)
 Thalas (normal ferritin)
 SA (high ferritin) (normal TIBC)
2) High Retic=
 Search for signs of haemolysis

27.  Thalasemia
 I.D.A
 S.A
 A.C.D

28.  THINK OF DESTURBED HB SUBSTRATES.

31.  CHECK RBCs
• thalassemia
• ACD,SA,IDA S.ferritin
Low in IDA
High in
SA,ACD

32.  High MCV= macrocytic anemia
 Think of neutritional deficiency
1) Vit B12
2) Folic acid
 Do what???????

33. PBS
1) non megaloblastic
macroreticulocyte,rounded macrocytes
(alcohol liver dis.) RFT,LFT(GGT)TFT

34. 2)MEGALOPLASTIC
• 85% pernicious anaemia.(+ve AB for IF)
• Macroovalocyte& hypersegm.neutrophil

35. Rule out medic
Check vit
B12&FOLIC
DEC.folate
Norm.B12
CONSIDER folate
def.
Dec.B12
Norm folate
Check MMA
Increase
MMA
Confirm def.
Both
normal
Consider
alcohol.liver,med
hypothyroidism

36. Microcytic
MCV
Normocytic Macrocytic
Iron Deficiency IDA
Thalassemias
Hemoglobinopathies
Sideroblastic Anemia
Hemolysis
Hemorhage
Vit B12
Folic acid
Alcohol liver dis.
drugs

45. Different types
Different life span
Different functions
Different sizes

46.  TLC 4-11000/cmm
 DLC neutrophil(60%)
lymphocyte(30%)
eosinophil(6%)
monocyte(3%)
basophil(1%)

47.  PROLIFERATIVE OR LEUKOPENIA
 PROLIFERATIVE MAY BE REACTIVE OR
NEOPLASTIC
 DIFFERENTIATION BENIGN FROM MALIGNANT
DISORDERS IS OF UTMOST IMPORTANCE.

48.  Leukocytosis increase WBCs.>11000
 Leukopenia decrease WBCs.<4000
 Granulocytosis neutrophilia
 Granulocytopenia neutropenia<2000/cmm
 Agranulocytosis neutropenia<500/cmm

49.  Leukocytosis
 (neoplastic &prolifrative)
 Identify infection,inflammation,&tissue
damage
 More than100000/cmm. seen in leukaemia.
 Stress & steroids are reversible soon

50.  Morphology.
 Granulocytosis.
 Early in acute infection x agranulocytes!!
 Shift to left indicate overwhelming
infections.(bands or stabs)
 Shift to right indicate tissue damage or
necrosis.(segs.)

51. Red flags
person particularly unwell
severity
rate of change of neutrophilia
presence of left shift

52.  Elevated in parasitic infestations& allergy.
 Intestinal parasite,and toxoplasmosis.
 Asthma &hay fever.

53.  Most uncommon.
 Seen in systemic hypersensitivity.
 Thorough allergy history should be
obtained before any surgical procedures.

54.  Late in acute infections
 Chronic infections as TB&SBE.
 Hodgkin,s lymphoma,fungal
 Monocytopenia(aplastic
anaemia,glucocorticoid ,&hairy cell leuk).

55.  Origin& maturation
 Types .
 Acute viral infections
 CMV,INF.MONONUCLEOSIS,MMR
 EARLY H.I.V
 CLL.
 Lymphopenia in HIV& AIDS.(CD4 count
<200)

56.  Decrease production(CT,RT.).
 Neutropenia (aka,granulocytopenia)
 Neutrophil<2000/ul.
 Bone marrow exhaustion(prolonged severe
inf
 Increased destruction(hyperspleenism)
 Antithyroid,antidepressant,NSAID.
 Protect pt.,avoid surgery if possible.

57.  Severe neutropenia(aka.agranulocytosis)
 Neutrophil,< 500/ul.
 Pt.is predisposed to serious,G-ve,G+ve,&
fungal infections.
 Red flags
 person particularly unwell
 lymphadenopathy, hepatosplenomegaly

58.  Leukocytosis signals infections.
 Leukopenia signals BM depression.
 Neutropenic precautions
 Care of invasive maneuvres.
 Avoid crowding& recent vacc.children
 Avoid steroids&antipyretics.
 Avoid raw &uncooked foods.
 Reporting high temp.

59.  Outpt . VS inpt.
 Norms:150-400.000/ml
 TPO is the primary regulatory protein in the
production of platelets

60.  The primary reason for evaluating
thrombocytopenia is to assess the risk of
bleeding and assess the presence of
underlying disorders (TTP, HIT etc.)
 < 20 000 increased risk of bleeding
 20 to 50000 rarely have increase risk of
spontaneous bleeding but increase risk of
bleeding from procedures
 50 to 100000 no increased risk of spontaneous
bleeding and can undergo most procedures

61.  Thrombocytopenia is
defined as a platelet
count less than
150,000
 2.5 percent of the
normal population
will have a platelet
count lower than
this

62.  Pseudothrombocytopenia
 Decreased Production- suggested by:
 other cytopenias
 normal sized/small platelets suggest a reduced bone
marrow response to need
 Increased Destruction- suggested by:
 Microangiopathic blood picture (fragmented
RBCs, high LDH)
 Large platelets on smear
 Associated autoimmune disease

63.  History, FH,MED H,
 PBS
 TTP+lymphocytosis,neutrophilia ( infection)
 Isolated TTP(DIC,ITP,HIT,DITP)
 Giant plat.(hereditary TTP)
 Blasts& nucleated RBCS(BM disorder)
 Schistocytes(HUS,DIC)

64.  Petechiae
 Purpura —
 Ecchymoses
 The most common
cause of
thrombocytopenia
developing for the
first time in an ICU
patient is
sepsis, accounting
for one-half of the
cases
 Bone marrow
suppression from
infection
 Platelet
microaggregation
 Production of toxins
 Consumption of
coagulation factors
(DIC)

65. If blood sample is inadequately
anticoagulated, platelet clumps can be
counted as WBC’s
0.1% of patients have EDTA dependent
agglutinins

66.  Viral infections
 Direct megakaryocyte damage-HIV
 Post CT,RT
 Acquired bone marrow hypoplasia- Fanconi
anemia.
 alcohol toxicity
 B12 or folate deficiency

67.  autoimmune destruction anti-platelet
Abs(ITP,SLE)
 Alloimmune destruction( posttransfusion)
 Destination destruction(hypersplenism)
 Consumption (DIC ,TTP- HUS)
 HELLP in pregnant women
 Medications- heparin, valproic acid
 Infections- EBV, CMV, sepsis

68. y
PS.PENIA TRUE.PENIA Giant plt
Isolated TP
ITP
HIT
DIC
Neutrophil
lymphocyt
Consider
infection
Blast cells
Nucleated
RBCS
1ry BM
DISORDER
schistocyte
TTP/HUS/
DIC
THROMBOCYTOPENIA
Hereditary
thrombocyt
PBSPLT clumbing

69.  AML
 Anaemia
 Leukocytosis
 Thrombocytopenia
 >20% blast in PBS
 >80% blast in BMA
 PUO+splenomegally
 Auer rodes
 ALL
 Anaemia
 Leukocytosis
 Throbocytopenia
 >20% blast in PBS
 >80% blast in BMA
 PUO,LN swelling

70.  CML
 Anaemia
 Leukocytosis+lt.shift
 Lymphocytosis
 Thrombocytopenia
 Basophilia
 splenomegally
 Philadelphia ch.
 CLL
 Anaemia
 Leukocytosis+lt shift
 Lymphocytosis
 Thrombocytosis
 Basophilia
 Splenomegally
 B cell CD19,,CD5 flow
cytometry