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Value of CBC
Screening test for diagnosis of many diseases.
Indicator of body’s ability to fight disease.
Monitor the effects of drugs and radiation therapy.
Follow up the patient’s progress in certain diseases (e.g. anaemia & infection …etc)
Blood Leucocytes:
Total & Differential Count
Absolute & Relative Count
Normal Leucocytic count.
Children ,Adult
Corrected Leucocytic count .
Total & Differential Count
Total Leucocytic count .
Factors affecting ( physio. & patholo.) .
Normal values ( Adult & Pediatrics) .
Differential Leucocytic count .
Manual Vs Automated .count .
Factors affecting Diff. count .
Spreading .
Storage .
Absolute & Relative count .
Abs. count = TLC X Relative count .
Corrected Leucocytic Count
Example :
Total Nucleated Cells (TNC) = 30,000 / cmm
Normoblasts = 150/ 100 WBC
No of cell counted =250 N0 of WBCs = 100
TNC = 30,000 Correcter WB Cs : ?
So Corrected WBCs = 30,000 X 100/ 250 = 12,000
Corrected WBCs =
TNC X 100 /100+Normoblast per/ 100 WBC
Normal Mature Leukocytes
Cellular Differentiation Balance
Cell size (variable)
Cytoplasm :
Color
Granules : granules number
Size Color & Location
Nucleus :
N/C ratio
Nuclear shape (Round, oval ,segmented .etc…)
Location to the cell wall
Nuclear condensation
Nucleolei :
Size Shape Numbers
Perinucleolar condensation
Myelocytic Maturation Series:
Myeloblast
Promyelocyte
Myelocyte
Metamyelocyte
Band Neutrophil
Segmented Neutrophil
**Hematopoiesis: Blood Cell Formation
كل العداوة قد ترجى مودتها إلا عدواة من عاداك عن حسد
Differential WBCs :
• Usually performed by visual examination of stained blood films which are prepared on slides by the spread or wedge technique
Normal differential WBCs :
• Neutrophils : 40-70 % (2000 - 7000/cmm)
• Lymphocytes: 20-40 % (1000 - 3000/cmm)
• Monocytes : 2-10% ( 200 - 1000/cmm)
• Eosinophils : 1-6 % (20-500/cmm)
• Basophils : 0 -1 % ( 20 - 100 /cmm)
Neutrophils )
• Size of the cell: 14 - 20 mm
• Shape of the cell: oval or round
• Colour of cytoplasm: pink
• Granularity: a few azurophilic and neutrophilic, different in number granulation
• Nucleus' shape: obulated (normally less than 5 lobes
• Type of chromatin: condensed
• Nuclear/cytoplasmic ratio: low or very low
• Nucleoli: not visible
• Occurrence:
blood: 40 - 75 %
marrow: 5 - 20 % * Magnification: x 1000
Eosinophils : )
• Size of the cell: 15 - 25 mm
• Shape of the cell: oval or round
• Colour of cytoplasm: pale, covered by granules
• Granularity: abundant eosinophilic (orange-red)
• Nucleus' shape: lobulated, semicircular
• Type of chromatin: condensed
• Nuclear/cytoplasmic ratio: low or very low
• Nucleoli: not visible
• Occurrence:
blood: 2 - 4 %
marrow: < 2 %
BASOPHILS )
• Size of the cell: 12 - 18 mm
• Shape of the cell: round or oval
• Colour of cytoplasm: light-pink, mostly covered by granules and nucleus
• Granularity: very dark, basophilic, granules of various size. The amount varies
• Nucleus' shape: oval shaped in not mature forms; lobular shaped in mature forms
• Type of chromatin: condensed, pale
• Nuclear/cytoplasmic ratio: low or very low
• Nucleoli: not visible
MONOCYTES ()
• Size of the cell: 15 - 25 mm
• Shape of the cell: round, oval or irregular
• Colour of cytoplasm: grey-blue
• Granularity: absent or a few, azurophilic, very fine granules
• Nucleus' shape: usually irregular
• Type of chromatin: coarse chromatin, clumped
• Nuclear/cytoplasmic ratio: moderate or low
• Nucleoli: not visible
• Occurrence:
blood: 4 - 8 %
marrow: < 2 %
Lymphocyte ()
Provide a specific immune response to
infectious diseases.
There are 2 types: -
• Tcell
• Bcell *They produce antibodies
LARGE GRANULAR LYMPHOCYTES )
• Size of the cell: 15 - 25 mm
• Shape of the cell: irregular
• Colour of cytoplasm: blue
• Granularity: a few, thick azurophilic granules
• Nucleus' shape: oval, irregular
• Type of chromatin: fine, homogenous
• Nuclear/cytoplasmic ratio: moderate or low
• Nucleoli: not visible *Occurrence blood: < 10 %
Reactive Lymphocyte: ()
Differential WBCs
• Usually performed by visual examination of stained blood films which are prepared on slides by the spread or wedge technique
Normal differential WBCs :
Neutrophils : 40-70 % (2000 - 7000/cmm)
Lymphocytes: 20-40 % (1000 - 3000/cmm)
Monocytes : 2-10% ( 200 - 1000/cmm)
Eosinophils : 1-6 % (20-500/cmm)
Basophils : 0 -1 % ( 20 - 100 /cmm)
Neutrophilia ()
A. Physiological
• At birth
• Physical exercise.
• Emotion
• Pregnancy.
• Following partum
B. Pathological
1. Infective.
• Pyrogenic: staphylococci, streptococci, pneumococci, and gonococci.
• Non pyrogenic: rheumatic fever, scarlet fever, diphtheria and poliomyelitis.
• Septicemia.
2.Haemorrhage.
intraserous, trauma: surgical, fracture, crush and burns
3.Malignant disease.
carcinoma and sarcoma
4.Cardiac disorders.
infarction
5. Drugs and chemical poisoning.
phenacetin and adrenaline
6. Metabolic disturbances.
renal failure, diabetic coma , gout , eclampsia.
7. Myeloid leukemia.
CML and PRV
8. Collagen disease.
PAN, rheumatoidarthritis, acute exacerbation of SLE
9. Miscellaneous
Serum sickness accompanying intravascular haemolysis.
Neutropenia
1. Infection.
Bacterial: typhoid and paratyphoid.
Viral: influenza, rubella measles and herpes.
Protozoal: malaria and kala azar
2. Acute leukemia
3. Drug induced neutropenia
4. Aplastic anemia
5. Hypersplenism
6. Idiopathic neutropenia
7. Bone marrow infiltration
• Secondary carcinoma.
• Malignant lymphoma.
• Myelosclerosis.
• Multiple myeloma.
8. Megaloblastic anemia
9. DLE
10. Iron deficiency anemia
11. Malignant disease
12. Post irradiation.
Lymphocytosis ()
1. Infection:
• Influenza.
• Brucellosis.
• Secondary syphilis.
• Typhoid.
• TB.
2. Exanthema: initial stage of the following
• Rubella
• Chiken pox.
• Mumps.
3. Lymphocytic leukemia.
4. NHL.
5. Infectious mononucleosis.
6. Toxoplasmosis.
7. Infective hepatitis.
8. Miscellaneous:
• Myasthenia gravis.
• Hypothyroidism
• Thyrotoxicosis.
• Multiple myelomatosis
Monocytosis ()
1.Bacterial infection:
• Tuberculosis
• Brucellosis
• Subacute bacterial
• Endocarditic
2.Protozoal and ricketsial diseases:
• Malaria.
• Typhus.
• Kala azar
• Trypanosoma
3.Infectious mononucleosis:
4.HD.
5. NHL.
6. Monocytic lekemia.
7. Chronic idiopathic neutropenia.
8. Rheumatic arthritis, collagenic disease.
9. Chronic ulcerative colitis.
10. Carcinoma.
Basophilia ()
1- Myeloproliferative disorders, particularly CML.
2- PRV.
3- Iron deficiency anemia.
4. Reactive immunologic conditions (e.g. IgE-mediatea hypersensitivity).
5. Chronic inflammatory disorders (e.g. rheumatoid arthritis, ulcerative colitis).
6. Viral infections.
7.Following radiation
Qualitative WBCs Disorders
Neutrophilia – shift to right(
Hypersegmented Neutrophils -98% à very specific to megaloplastic anemia
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