DATE : 22.01.

2010
VENUE : JAB PATOLOGI HBM
TIME : 8.30 PAGI
 FBP - A special test
- Not a routine test
- Helps in making diagnosis
- Patient management
- Needs experience
- Requires practice
 Why FBP - Provides differential count
- Identify abnormal cell morp & pop
- Red blood cells, Wbc & Plt
- Detect presence of foreign cells
( Parasite & malignant, inclusion)
- Quality Control
( Rule out lab error : FBC = FBP )
 Basic Steps
Ensure the slide and the FBC results are
from the same patient
Check name, slide number, date
Identify:
Patients age
Gender Different
reference range
Diagnosis, given history and other details
Thin Ideal Thick
 Types and details of blood count print-out
depends on types of analyser used
Parameters of the blood count can be set
by the operator, depend on requirement
Almost all has accompanied histogram,
graphical displays representing the cells
analysed
These can be used as guideline when
reading both FBC and FBP
 Important indices Other indices are less
WBC count and essential but can be
differential used as guide to reach
Hb diagnosis
HCT (PCV) RBC count
MCV
MCH
Platelet
MCHC
RDW

Reference range can be used to program the

analyser to flag or highlight any abnormal
results
 People differ considerably in WBC count
Some maintain constant level, others fluctuate
frequently
Level also affected by daily activity, physiological
changes, disease

Total count all cell types, some older

analyser counted NRBCs as WBC
 Automated analyser uses flow cytometry to
recognise different cell population
Differential count 3, 5 or 7 parts
3 part:- granulocytes (large cell), lymphocytes
(small cell), monocytes (middle cell)
5 parts:- neutrophils, lymphocytes, monocytes,
eosinophils, basophils
7 parts:- as 5 parts plus large immature cells
(blast, myelocytes) and atyp lymphocytes (incl
small blasts)
 Values
are given in percentage
and absolute count
raised or reduced levels are based
on absolute count (not percentage)
 Error in differential:
Presence of abnormal/immature cells
Old sample (storage changes)

It is advisable to perform own differential

count to compare with that of analyser
 Red cell and other cells can be counted
using impedance or light-scattering
method

From red cell count, some other indices of

red cells can be derived MCV, MCH
 Among important indices
RBC count, Hb, Hct (or PCV)
MCV, MCH, MCHC
RDW
Form basis of classifying anaemias
In various combinations have been used to
distinguish between thalassaemias and iron
deficiency
 Red cell count
Usually reflects Hb level and marrow
erythropoietic activity
Low level e.g:
Iron deficiency anaemia
Anaemia due to blood loss
Dilutional anaemia

Normal or high e.g:

Polycythemia
Thal trait (alpha)
 MCV (mean cell volume)

Reflects red cell size as well as shape

Cells with reduced Hb conc will have their MCV
underestimated (using automated analyser)

Cells with rigid membranes and cells with high Hb

conc such as spherocytes, will have MCV
overestimated
 MCHC (Mean corpuscular haemoglobin
concentration)

Derived from Hb and RBC count

Reflects content of Hb per red cell
Level raised and reduced almost always hand in
hand with that of MCV
 Normal ranges
Different studies have diff ref ranges
Each lab should establish their own ref range
based on their own population
MCV
76 96 fl
MCH
27 32 pg
 Macrocytosis raised MCV and MCH
Megaloblastic anaemia (B12/folate def
Liver disease
Alcohol intoxication
Myelodysplasia
Reticulocytosis
Red cell agglutination can also give
raised MCV
 Microcytosis reduced MCV and MCH
Iron deficiency
Thalassaemia
Lead poisoning
Some cases of anaemia of chronic disease
 MCHC (Mean corpuscular haemoglobin
concentration)

Derived from Hb and PCV, or HB, MCV and RBC

count
Useful indicator of hypochromia in iron deficiency
 MCHC
Normal range: 30 36 g/l
Reduced in iron deficiency
Normal in thalassaemia trait
can be used to differentiate
between cases of iron def
and thal trait
 RDW red cell distribution width

Allow presence of more than one population of red

cells be appreciated

May indicate presence of significant number of

microcytes or macrocytes

Can be used to help to distinguish between iron

def and thal trait, and between megaloblastic
anaemia and other causes of macrocytosis
 RDW
Normal range: 7.4 13.4 %
Raised RDW e.g.:
Iron deficiency
Thalassaemia
Megaloblastic anaemia
Post transfusion
Presence of fragmented cells (DIVC)
 Counted using same technique as counting
red cells
- need to separate from red cells and from debris

Giant platelets may be counted as red cells;

fragmented red cells and debris may be
counted as platelet
 MPV (mean platelet volume)
Reflects size of platelets
Elevated in presence of enlarged or giant platelets

PDW
Measures platelet anisocytosis
Also reflects plateletcrits indicative of volume of
circulating platelets
Raised in thrombocytosis due to ET, normal in
reactive thrombocytosis
 Latest analysers can also perform
reticulocyte count using dyes and
fluorochromes, and measures by
flocytometry
Correlate well with manual retic count
Normal range: varies bw analysers/
methods (av 0.5 2.5%)
 FBP is a special test to help reach a
diagnosis and/or help in patient
management
Knowing the various components (indices)
of a full blood count is important in
interpretation of FBP and reaching the
diagnosis
 In some cases, the indices alone can give
ideas what is the most likely diagnosis

Practice makes
perfect!