N 340 Women's Health & Illness in The Expanding Family & N345 Clinical Practicum

A complete blood count (CBC) test measures the following:

• The number of red blood cells (RBCs)
• The number of white blood cells (WBCs)
• The total amount of hemoglobin in the blood
• The fraction of the blood composed of red blood cells (hematocrit)
• The mean corpuscular volume (MCV) -- the size of the red blood cells

CBC also includes information about the red blood cells that is calculated from the other measurements:

• MCH (mean corpuscular hemoglobin)
• MCHC (mean corpuscular hemoglobin concentration)
• Reticulocyte count: measures immature RBC red blood cells (RBCs). A reticulocyte count provides information about the rate at which the bone marrow is producing red cells. nl: 0.5-2.5%.

The platelet count is also usually included in the CBC.

Normal Values    From MedLine Plus: http://www.nlm.nih.gov/medlineplus/ency/article/003648.htm

• RBC (varies with altitude):
• Male: 4.7 to 6.1 million cells/mcL
• Female: 4.2 to 5.4 million cells/mcL

• RDW 11-15% (Red cell distribution width so variation in size of RBCs
• WBC: 4,500 to 10,000 cells/mcL

• Hematocrit (varies with altitude):
• Male: 40.7 to 50.3 %
• Female: 36.1 to 44.3 %
• Hemoglobin (varies with altitude):
• Male: 13.8 to 17.2 gm/dL
• Female: 12.1 to 15.1 gm/dL
• MCV: 80 to 95 femtoliter
• MCH (mean corpuscular hemoglobin): 27 to 31 pg/cell = Hgb/RBC count
• MCHC (mean corpuscular hemoglobin concentration): 32 to 36 gm/dL = Hgb/Hct
• Platelets: 150,000 to 400,000 per microliter

Types of Anemias: based on cell size (MCV) and amount of Hgb (MCH).

• MCV less than lower limit of normal: microcytic anemia
• MCV within normal range: normocytic anemia
• MCV greater than upper limit of normal: macrocytic anemia
• MCH less than lower limit of normal: hypochromic anemia
• MCH within normal range: normochromic anemia
• MCH greater than upper limit of normal: hyperchromic anemia

This test is used to diagnose the cause of anemia. The following are the types of anemia and their causes:

• Normocytic/normochromic (NC/NC) anemia is caused by sudden blood loss, prosthetic heart valves, sepsis, tumor, long-term disease or aplastic anemia, pregnancy
• Microcytic/hypochromic anemia is caused by iron deficiency, lead poisoning, or thalassemia (don’t treat this one with Fe!).
• Microcytic/normochromic anemia results from a deficiency of the hormone erythropoietin from kidney failure.
• Macrocytic/normochromic anemia results from chemotherapy, folate deficiency, or vitamin B-12 deficiency. (Cells are larger, but more hgb so nl color)

Iron deficiency anemia: nl levels:

• Iron: 60-170 mcg/dL
• TIBC: 240-450 mcg/dL
• Transferrin saturation (the protein that carries Fe in the blood: 20-50%

Fe deficiency anemia: Decreased: ferritin, hemoglobin, MCV Increased: TIBC, transferrin, RDW

Thrombocytopenia: < platelets. Cam be: Pregnancy! (mild), idiopathic (ITP: bodes develops antibodies gains platelets) , ASA or heparin use, hemorrhage, congenital (i.e. rubella), bone marrow suppression, cancer, chemotherapy, HIV, aplastic anemia, autoimmune diseases (i.e. lupus, rheumatoid arthritis), blood poisoning (bacteremia), trapped blood cells in spleen (enlarged spleen)

Hemochromatosis is a disorder that interferes with the body's ability to break down iron, and results in too much iron being absorbed from the gastrointestinal tract. It occurs when too much iron builds up in the body, particularly the liver. The result is liver swelling. Can be genetic such as thalassemia. Source: https://www.google.com/health/ref/Hemochromatosis

Symptoms: Abdominal pain, Fatigue, Generalized darkening of skin color (often referred to as bronzing), Joint pain, Lack of energy, Loss of body hair, Loss of sexual desire, Weight loss, Weakness

Signs: liver and spleen swelling, and skin color changes.

Blood tests may help make the diagnosis. Serum ferritin (high), Serum iron (high), Percentage of transferrin saturation (high)

WBCs: (4,500-10,000) From: Medline Plus: http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm

Leucoytosis: > WBCs and Leukopenia: < in WBC.

At birth: a newborn has a high white blood cell count, ranging from 9,000 to 30,000 leukocytes. This number falls to adult levels within two weeks.

In Pregnancy: leukocytosis occurs, primarily due to an increase in neutrophils with a slight increase in lymphocytes.

• Neutrophils: 40% to 60% Increase with: Acute infection, Eclampsia , Gout, Myelocytic leukemia , Rheumatoid arthritis , Rheumatic fever , Acute stress, Thyroiditis , Trauma Decrease with:Aplastic anemia , Chemotherapy, Influenza, Widespread bacterial infection. Radiation therapy or exposure
• Lymphocytes: 20% to 40% Increase with: Chronic bacterial infection, Infectious hepatitis, Infectious mononucleosis , Lymphocytic leukemia , Multiple myeloma , Viral infection (such as infectious mononucleosis, mumps, measles), Recovery from a bacterial infection. Decrease with: Chemotherapy, HIV infection, Leukemia, Radiation therapy or exposure, sepsis
• Monocytes: 2% to 8% Increase with: Chronic inflammatory disease, Parasitic infection, Tuberculosis , Viral infection (i.e. infectious mononucleosis, mumps, measles)
• Eosinophils: 1% to 4%: Increase with: Allergic reaction, Cancer, Parasitic infection, Hodgkin's disease
• Basophils: 0.5% to 1%: Decrease with: Acute allergic reaction
• Band (young neutrophil): 0% to 3% May increase with: secondary to inflammatory processes, tissue damage or necrosis, neoplasia, intoxication, metabolic abnormalities, hemorrhage, hemolysis or drugs. Increased band count is not specific for infection.