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CBC

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Complete Blood Count

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Y axis take off is caused by:

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-clotting specimen -clumping plts

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CBC Components

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WBC: K/uL RBS: M/uL HgB: g/dL HCT: % MCV: fL(1x10x-15) MCH: pg (1x10x-12) MCHC: g/dL or % RDW: % PLT: K/uL Diff count : %

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WBC ranges

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4.8 - 10.8 x 10x3 uL of whole blood (4,800 - 10,800 uL of whole blood) *High (leukocytosis) = bacterial infection *Low (leukopenia) = viral infection

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RBC ranges

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males = 5.4 +/- 0.7 x 10x6 uL of whole blood (4.7 - 6.1 million uL of whole blood) females = 4.8 +/- 0.6 uL of whole blood (4.2 -5.4 million uL of whole blood)

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Low RBC is characterisitc of:

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anemia

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Hemoglobin (HgB)

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-measures the oxygen-carrying capacity of the RBC -When the _____ is below normal, the pt is anemic -males: 16+/- 2 g/dL -females: 14 +/- 2 g/dL

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Hematocrit (HCT)

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-The % of RBCs in a volume of whole blood -aka: packed cell volume -A low ______ also signifies anemia -males: 46 +/- 5% -females: 42 +/- 5%

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The H&H in Hematology

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The rules of three (under normal conditions) -RBC x 3 = HgB -HgB x 3 = HCT

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If the HgB is 12, what is the expected HCT?

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HgB x 3 = HCT 12 X 3 = 36%

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If the HCT is 45, what is the expected HgB?

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HgB x 3 = HCT HCT/3 = HgB 45/3 = 15g/dL

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Exceptions to the "Rules of 3"

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-Severe dehydration --HgB is typically higher than what they actually are -Acute Blood Loss --The H/H reads lower than expected -IDA --The RBC usually higher than expected for the HgB

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MCV: Mean Corpuscular Volume

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-Measures of the size/volume of RBCs *Most stable of all the CBC parameters* -Males: 87 +/- 7 fL -Females: 90 +/- 9 fL -Low ___: Mircocytic RBCs -High ___: Macrocytic RBCs -Normal ____: Suggests normocytic RBCs

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Microcytic RBCs

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MCV <80fL

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Macrocytic RBCs

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MCV >100fL

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Normal RBCs

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MCV 80-100fL

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MCH: Mean Corpuscular Hemoglobin

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-Indicates the actual weight (in pg) of the hemoglobin in the RBCs -Normal range: 27 - 31 pg

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MCHC: Mean Corpuscular Hemoglobin Concentration

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-Expresses the ratio of the weight of HgB to the volume of the RBC -Determines the "chromasia" of the RBC -Low ___: hypochromic RBC -normal ___: Normochromic RBC -High ____: --True cases are very rare --commonly indicates an error in the HgB or RBC readings _____ cannot >= 40%

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MCHC Normal value

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35 +/- 2 g/dL if 40 g/dL or higher, the blood specimen is most likely lipemic.

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Calculations of RBC Indices

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MCV = HCT/RBC x 10 MCH = HgB/RBC x 10 MCHC = HgB/HCT x 100

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RDW: Relative Distribution Width

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Normal Range: 11 - 13% -Indicates the variation of RBC size -HIGH ____: *Increased variation in RBC size, which is called anisocytosis *Population shows both big and small RBCs

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Three Parameters that go Together

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*High RDW *"Broad Based" RBC histogram *Anisocytosis

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PLT:Platelet (Thrombocyte)

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Normal: 130,000 - 400,000 /uL Low ____: thrombocytopenia High ____: thrombocytosis

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Critical Value, Med Alert Values, Panic values

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Defined as a value at such variance with normal as to represent a pathophysiological state to the patient which is or could potentially life-threatening unless immediate action is taken

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What is used for a "Delta Check?"

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MCV

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Examples of Critical Values:

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Hematology: -HgB: 50,000/ uL -Plt: <30,000/ uL

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Types of Leukocytes in Normal Peripheral Blood

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Segs: 50-70% Bands: 0-5% Lymph: 20-40% Mono: 1-8% Eos: 0-5% Baso: 0-1%

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Relative and Absolute Values

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The differential denotes the relative percetn of each type of white blood cells

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Absolute Value Calculations

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(% on diff)(total WBC count) PT: 10,000 WBC/ uL Diff:60segs;5bands;30lymphs;5monos (.30)(10,000)=3,000 lymphs/uL WBC (absolute count)

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Lymphocytosis

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Causes: Viral Infections;Mononucleosis;Whooping Cough

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Neutrophilia

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Causes: Bacterial Infections; Appendicitis(Increased Bands)

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Neutropenia

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-Decrease in neutrophils -This often occurs when there is a corresponding increase in lymphs

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Monocytosis

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Tuberculosis Lupus Subacute bacterial endocarditis

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Eosinosphila

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Allergies Parasitic Infections

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Basophilia

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Chronic Myelogenous leukemia

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Absolute Count Examples

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Slide 39 in Lecture 2

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S.I. Units

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Conventional: WBC- 8.5 x 10x3 /uL RBC - 4.76 x 10x6 /uL HgB- 14.2 g/dL HCT- 43% Plt- 348 x 10x3 /uL S.I.: WBC- 8.5 x 10x9/L RBC- 4.76 x 10x12/L HgB-142g/L HCT- .43 L Plt- 348 x 10x9/L

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Conversion factors

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1,000 uL = 1mL 1,000 mL = 1 L 1 L = 10x6 uL

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What is a control?

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A material with a predetermined assay value that has the same matrix as the patient sample

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What is a primary Standard?

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Reference material used to calibrate an instrument -Has a fixed known composition and is capable of being prepared in essentially pure form

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What is a secondary standard?

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Reference material in which the analyte concentration has been ascertained reference to a primary standard

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What is a calibrator?

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Preserved human cell suspension whose hematology parameters have been determined by multiple reference laboratories

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Quality Control

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-Monitors the characteristics of the testing system(instrument)

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Quality Assurance

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Much broader than QC -Looks at the overall process from chart to chart

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Internal QC

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Done daily Run assayed known control samples with patient testing May include commercial controls as well as "patient" controls

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External QC

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Proficiency Testing: Involves running unknown samples and sending in results for comparsion with other labs Not done daily

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What is accuracy?

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The exactness of a mearsurement in comparsion with the true value

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What is precision?

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Measures the reproducibility of an analyzer

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What is a Delta Check?

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Comparing the result from the current analysis of a sample with the results from the previous sample for the same analyte for the same patient

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CV: Coefficient of Variation

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SD/MEAN x 100% -The smaller the ___, the more precise the analytical method -A ____ of >5% is unacceptable.

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What is sensitivity?

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Proportion of patients with the disease who have a positive test result -Screening test- -Used to rule out a disease

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What is specificity?

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Proportion of the patients without the disease who have a negative test results -Confirmation test- -Used to confirm the presence of a disease

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For our controls in hematology, the control result must fall into a acceptable range, which is typically the mean +/- ___ SD

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2

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Levey-Jennings Control Charts

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95% of values should fall between +/- 2SD 99% of values should fall between +/- 3SD

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Shifts on LJ Chart

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Sudden change of values from one level to another Causes: Erroneous reagents, controls, etc.

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Trend on LJ Charts

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Drift of values in one direction over six or more consecutive values Causes: Deterioration of reagents, light sources, etc

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Westgard Rules

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If any of these rules are broken, your instrument is "out of control" and your results are inaccurate and can't be reported

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1 2s

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Considered a "warning." The run must be rejected if another Westgard rule is broken in addition to this rule. *1 control exceeds 2SD from the mean

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1 3s

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1 control result exceeds 3 SD from the mean

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2 2s

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2 controls exceed 2SD on the same day of testing

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4 1s

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4 results exceed 1 SD in the same direction -Control values are beyond 1 SD for 4 consecutive days

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R 4s

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4 SD difference between controls in the same run *Most common reason: Picking up wrong control ; running it

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10x violation

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10 consecutive values fall on the same side of the mean

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1 3s or R 4s

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*Indicate random error *Sample not mixed well, technical error, etc

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2 2s, 4 1s, or 10x

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*Indicates systemic error *Deteriorating reagents, instruments needs cleaning, etc.

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Limitations of Bulls Moving Average

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*Not sensitive to random errors *Very sensitive to patient population; a number of oncology patients culd affect the calculation in the absence of instrument malfunction *This method does not directly monitor the WBC and platelet counts

Hematology Lecture 2: LMU – Flashcards

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