Basic Examination

of Blood

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 Complete Blood Count (CBC)
 “Hematologi Rutin”
 Provides important information about the kinds
and numbers of RBC, WBC and platelet.
 Part of routine physical examination

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 Help :
 Evaluate symptoms (weakness, fatigue, bruising,
fever, or weight loss)
 Diagnose conditions (anemia, infection)
 Diagnose diseases of the blood (leukemia)
 Monitor the response to some types of drug or
radiation treatment

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1. Hemoglobin
2. Hematocrit
1. Blood cell counting:
 WBC count/WBC differential
 RBC count/RBC indices (MCV, MCH, MCHC)/RDW
 Platelet count
3. Blood film examination*
4. ESR*

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 Main component of RBC
 Conjugated protein
 Serves as a vehicle for the transportation of O2
and CO2.
 Gives blood cell it’s red color
 Hemoglobin test measures the amount of
hemoglobin in blood.
 Decrease  anemia

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 Hemiglobincyanide (HiCN) method
 Principle:
 Blood is diluted in a solution of K3Fe(CN)6 and KCN.

K3Fe(CN)6
 Hemoglobin hemiglobin

 Hemiglobin KCN HiCN

 The absorbance of the solution is measured in a
spectrophotometer at 540 nm and compared with
that of a standard HiCN solution.

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1. Errors inherent in the sample
2. Errors inherent in the method
3. Errors inherent in the equipment
4. Operator’s errors

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1. Hemiglobin (Methemoglobin/Hi)
2. Sulfhemoglobin
3. Carboxyhemoglobin (HbCO)

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 Ratio of a volume of RBCs to that of the whole
blood.
 Expressed as a:
 percentage (conventional)
 Decimal fraction (SI units) L/L
 Ex : Ht 38% means that 38% of the blood’s volume
is composed of RBCs.

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Measurement :
 Direct  centrifugation
(micromethod & macromethod)
 Indirect  automated instrument 
MCV X RBC count

Sources of error:
- Centrifugation
- Sample
- other

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Expressed as concentration – cells per unit
volume of blood (mm3/μL)

1. Erythrocytes counts
2. Erythrocytes indices
3. Leucocytes counts
4. Leucocyte differential counts
5. Platelets counts
6. Reticulocytes counts*

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 Manually :
 Hemocytometer
 Calculate from other CBC results (RBC
indices)
 Semiautomatically
 Automatically (hematologic analyzer)

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 Is expressed as concentration – cells per unit
volume of blood (mm3).
 No distinction is made among the six normal cell
types (PMN, band neutrophils, lymphocytes,
monocytes, eosinophils, basophils).
 Increase WBC count  leucocytosis
 Decrease WBC count  leucopenia

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 6 major kinds of WBC
 Immature neutrophil (band neutrophil) 
include to the test.
 Each type of cell plays a different role in
protecting the body.
 Number of each type  give important
information about the immune system.
 Expressed as a percentage of each type

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 Increase/decrease number of
each type  help to identify :
 infection (neutrophilia,
lymphocytosis)
 Allergic or toxic reaction to
certain medication
(eosinophilia)
 Malignancy (leukemia)

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 Is expressed as concentration –
cells per unit volume of blood
(mm3).
 Decrease  anemia
 Increase  polycythaemia

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There are 3 RBC indices :
1. MCV (Mean Corpuscular Volume)
2. MCH (Mean Corpuscular Hemoglobin)
3. MCHC (Mean Corpuscular Hemoglobin
Concentration).

Their values are determined from other

measurements noted during CBC

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 Calculation for determining the size, content, and
Hb concentration of RBC
 Useful for morphologic characterization of
anemia
 Maybe calculated from:
 Red cell count
 Hemoglobin concentration
 Hematocrit
 3 indices: MCV, MCH, MCHC

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 Shows the size of RBCs.
 Calculated from the Ht and RBC count

Ht X 1000
 MCV = -----------------------------------
RBC (in million per μL)

 Expressed in femtoliter (fL) or cubic micrometers

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 Average volume of RBC  Normocyte
size
 Counted from hct and
Microcyte
RBC count
Macrocyte
Ht (%)
MCV = -------------------- fL
RBC count (L)

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 Is the content (weight) of Hb of the average RBCs.
 Calculated from the Hb concentration and RBC
count.
 Expressed in picograms (μμg)

Hb (g/L)
 MCH = ---------------------------------- pg
RBC (in million per μL)

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 Is the average concentration of Hb in a given
volume of packed red cells.
 Calculated from Hb concentration and the
hematocrit.
 Expressed in g/dL

Hb (g/dL)
 MCHC = ----------------- g/dL
Ht

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 Deviation of the RBC indices from the reference value
(normal value)  useful in characterizing
morphologic type of anemia

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Hgb
Ht
RBC Count

-Decrease  microcyter
MCV
MCV -Normal  normocyter
-Increase  macrocyter

-Decrease  hypochrom
MCH/C -Normal  normochrom

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 Is expressed as concentration – cells per unit volume of
blood (mm3).
 Decrease  thrombocytopenia
 Increase  thrombocytosis

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 To evaluate the
numbers, size, and
shape of RBC, WBC
and platelet in a
stained smear of
peripheral blood.

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 Red Cell Distribution width
 Reports whether all the red cells are about the same
width, size, and shape.
 This helps further classify the types of anemia.

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 Measures the settling of erythrocytes in
diluted human plasma over a specified time period (1 hour)
 Measuring the distance from the bottom of the surface
meniscus to the top of erythrocyte sedimentation in a
vertical column containing diluted whole blood.
 Not very specific/diagnostic test  still use in many
institutions as a screening test for inflammation

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 RBC size & shape
 Plasma fibrinogen & globulin levels
 Mechanical
 Technical

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Increase : Decrease :
1. Rouleaux formation 1. Microcytes
2. Fibrinogen (elevated) 2. Sickle cells
3. Immunoglobulin 3. Spherocytes
(excess)

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 Manual :
 Westergren Method
 Wintrobe & Landsberg Method
 Automatic

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Adult men 0-15 mm/h
Adult women 0-20 mm/h

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1. Rheumatoid arthritis 8. Malignant neoplasms
2. Multiple Myeloma 9. Paraproteinemias
3. Cryoglobulinemia 10. Macroglobulinemia
4. Temporal arteritis 11. Hyperfibrinogenemia
5. Inflammatory diseases 12. Chronic infections
6. Pregnancy 13. Collagen disease
7. Anemia 14. Polymyalgia
rheumatica

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 Normal value can vary from lab to lab
 Normal value for CBC tests vary, depending on age,
sex, elevation above sea level, and type of sample.

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 70 year old female.
 Symptoms of dyspnea on exertion, easy fatigability,
and lassitude for past 2 to 3 months.
 Denied hemoptysis, GI or vaginal bleeding.
 Claimed diet was good, but appetite varied.

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 Other than pallor, no significant physical findings
were noted.
 Occult blood was negative.

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 RBC3.71 X 10 [12] / L
 HGB 5.9 g/dL
 HCT 20.9 %
 MCV 56.2 fL
 MCH 15.9 pg
 MCHC 28.3 g/dL
 RDW 20.2

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 N 82 %
 L 13
 M 1
 E 4
 B 0

 PLT 383 X 10 [9] / L

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Morphologic alterations
Results of the blood smear exam were :
RBC morphology :
- 2 + hypochromasia
- 3 + microcytosis
- 2 + anisocytosis
- 2 + elliptocytes and target cells
- occ teardrops and fragments
WBC morphology : within normal limits (only
lymphocyte shown here)
PLT morphology : within normal limits 54
What further laboratory studies, if any, are indicated ?

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Further laboratory studies
Iron studies were performed, and result were :
- serum ferritin < 10 ng/mL (RI 12-86)
- Serum iron 24 ug/dL (RI 65-175)
- TIBC 729 ug/dL (RI 250-410)
- Saturation 3% (RI 20-55)

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 What is the most likely diagnosis ?

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 Iron Deficiency Anemia

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 Diagnostic procedures included upper GI
endoscopy, colonoscopy, and small bowel biopsy.
All were negative.
 The patient received packed RBC transfusions and
was started on Iron therapy.
 She refused any further laboratory testing or other
procedures, and was discharged at her own
request. She was lost to follow up.
 The etiology of her iron deficiency anemia could
not be determined, but it was most likely
nutritional.

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