Interpreting The CBC
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Interpreting The CBC
Francisco F. Lopez, MDThe 2005 Advanced Medical Underwriting Course
January 14, 2005
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Outline
• Definition• Microcytic anemia• Normocytic anemia• Macrocytic anemia• Algorithm
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Definition
Complete Blood Count is a blood test obtained in the peripheral vein that gives us a numerical value of the white and red cells and platelets, and a picture of what is going on in the bone marrow.
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The CBCMean Corpuscular Volume (MCV):
the average volume of the red cellshematoctirt (L/L) x 1000 / red cell count (x1012/L)normocytic, microcytic, macrocytic
Mean Corpuscular Hemoglobin (MCH):A measure of the hemoglobin concentration per red cellhemoglobin (g/L) / red cell count (x1012/L)
Mean Corpuscular Hemoglobin Concentration (MCHC):The average concentration of hemoglobin per red cellhemoglobin (g/dL) / hematocrit (L/L)
Red Cell Distribution Width (RDW):The range of red cell sizes measured within a sample
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Case # 1
68y/o male with a cc: anemia and SOB. No melena or hematochezia.
PE: unremarkableHgb 10 hct 31 rbc 3.99 MCV 77.6 retic 2.2%Iron 2.8 (low), feritin 4.22 (low) TIBC 84
(high)
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Case # 2
40y/o female cc: SOB x 1 weekShe was brought to the ER of AHMC
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Laboratory test
WBC 12.1 (4.5 – 11 x 109/L)RBC 2.18 (3.8 – 5.3 x 109/L)Hgb 62 (120 – 160 g/ L)Hct 0.175 (0.35 – 0.47)MCV 80.2 (73 – 103 fL)Platelet212 (140-440 x 109/L)
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Laboratory tests
Iron 15.3 umol/L (6.6 – 30.4)TIBC 84 umol/L (44.8 – 80.6)Ferritin 362.9 ng/ml (11 – 306.8)Retic count 3.4% (0.5 – 1.5%)Peripheral smear: anisocytosis and
poikilocytosis, normochromicESR 119 (0.0 – 20 mm/hr)
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Laboratory tests
Urea 40.9 (2.5 6.1)Creatinine 1348 (62 – 106)
Tx: dialysis
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Case # 367 y/o male admitted at AHMC because of
dizziness. He was ruled out for any cardiac or neurologic diseases. No gastrointestinal bleeding. Weight loss of 5 pounds.
PE: normalLabs: Hgb 11.7; LDH 1184;
Reticulocyte count 1.4; stool for occult blood negative
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Vit B12 50 (low)TSH normalFolate normal
Rx: methycobal 500mcg IM
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A p p roa c h to A ne m ia
iro nT IB C
fe rrit in
m ic ro cy ticM C V < 80
iro nT IB C
fe rrit inE S R
n o rm o c y ticM C V 80 -1 00
B 12fo la teT S H
m a cro c y ticM C V > 1 00
M e a n C orp u scu la r V o lu m e
B o n e M a rro w B ip o sy
p e rip h e ra l sm e arre tic u lo cy te c o u nt
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Summary
The CBC gives us a picture of what is going on in the bone marrow
Not all anemia should be treated with ironFurther diagnostic tests should be pursued to
determine the cause of the anemia.
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