Interpretation of Haemogram

WHAT IS HAEMOGRAM?

• CBC or hemogram is a complete blood count --

quantitative analysis of white blood cells
(leukocytes), red blood cells (erythrocytes), and
platelets.
 Haemogram/ Histogram
 Offer a visual representation of what was counted
at the aperture.

 Verify that a count has a typical pattern

 Alert you to possible interfering particles

 Histogram/ Haemogram

http://www.drew-scientific.com/
Major principles

1. Electrical impedance
2. Light scattering
Volume

Conductivity

Scatter

Simultaneous
Measurements
 COMPONENTS OF
HAEMOGRAM
 Haemogram
 Histogram
 Scattergram
 Parameters generated from
Automated Blood Analyzers
• Hb • Lymphocytes
• RCC • Monocytes
• MCV • Eosinophils
• MCH • Basophils
• MCHC • PLT
• RDW • MPV
• WBC
• Neutrophils
 Red cell Absolute Indices
 Red cell count
 Hemoglobin
 Hematocrit
 MCV
 MCH
 MCHC
 RDW
 Retic count
 Red Blood Cell Count
 The red blood cell count on the routine CBC is
the concentration of red cells, expressed in
millions / µL of whole blood.

 RBC count is
measured directly.
RBC count
Techniques
1. Electrical impedance
2. Light scattering

Applications
1. Evaluate anaemic status
2. Evaluate polycythemic status
 An accurate RBC requires that thershold be set so
that all red cells, but a minimum of other cells are
included in count.

 The RBC with a volume of 80-100fl are detected

from 40-250fl.
Hemoglobin conentration (Hb)
Techniques
1. Cyanmethemoglobin method

Application
Evaluate anaemic status
 Mean Cell Volume (MCV)
 The mean cell volume indicates the volume of
the "average" red cell in a sample.
 It is expressed in femtoliters (fl; 10-15 liters).

 MCV: HCT(%) ÷ RBC(x10E12/l)

 Automated hematology analyzers provide a more
accurate, direct measure of MCV.
Mean Cell Volume (MCV)
 Increased MCV
(macrocytosis) :
› Artifact
› Regenerative anemia
› Folate or vitamin B12
deficiency
 Decreased MCV
(microcytosis)
› Artifact
› Iron deficiency
 Mean Cell Hemoglobin
 MHC is the mean cell hemoglobin.
 This represents the absolute amount of
hemoglobin in the average red cell in a sample.
 Its units are picograms (pg) per cell.
 MCH: Hb(g/dl) ÷ RBC(x10E12/l)
 Mean Cell Hemoglobin
Concentration (MCHC)
 MCHC is the mean cell hemoglobin
concentration, expressed in g/dL.

 MCHC: Hb(g/dl) ÷ HCT(%)

 The normal value for MCHC is about 33%.
 Red Cell Distribution Width
(RDW)
 The RDW is an index of the variation in cell
volume within the red cell population.
 It is a parameter provided by automated
hematology analyzers.
 It is the electronic equivalent of anisocytosis that
is judged by smear examination.
 Presence of increased numbers of smaller cells
(e.g. in iron deficiency anemia) will increase the
RDW.
Diagnostic values of MCV and RDW

 MCV(L)+RDW(N) : ACD, thal trait

 MCV(L)+RDW(H) : IDA, thal Maj:
 MCV(N)+RDW(N) : ACD, thal trait, HS,
MDS
 MCV(N)+RDW(H) : NA, hemoglobinopathies
 MCV(H)+RDW(N) : AA, MDS
 MCV(H)+RDW(H) : MA, Immune HA
 NORMAL RANGES
 Hb (male=13.7-16.3 , female=11.1-14.5)
 HCT ( male=41.9-48.7 , female=35.4-42.0)
 RBC (male=4.5-6.5, female=3.9-5.5)
 MCV 76.0-96.0 FL
 MCH 26-32 PG
 MCHC 32-36 %
 RDW 14.0
 Agglutination of red cells may be present if:

 MCHC: >40 g/dl

 MCH: > 40pg
 MCV: >150fl
 Reticulocytes
 Reticulocytes are young, anucleate erythrocytes.
 Released from bone marrow into the blood in
increased numbers as a response to anemia
caused by hemolysis (destruction) or loss
(hemorrhage).
Reticulocyte count
Techniques
1.Fluorescence detection of red cells
stained with RNA specific
fluorochroms ( Auramine O, Ethidium
bromide, Oxazine 750, Thiazole
orange)
2. Direct count via volume, light
scattering and opacity of cells
 Reticulocyte count
Types after fluorescence detection
1. Low Fluorescence Ratio (LFR): Most
mature
2. Middle Fluorescence Ratio (MFR): mid
mature
3. High Fluorescence Ratio (HFR): Most
immature
Reticulocyte count

Application (NR 0.5-2.5%)

Evaluation of BM efficiency
 Nucleated Red Blood Cells (NRBC)

 Counted as WBC by automated analyser.

 The obtained nucleated count must be corrected
for the number of nRBC in the circulation.
 White Blood Cell Count (WBC)
 The white cell count (WBC) is the total number
of leukocytes in a volume of blood, expressed as
thousands/µl.

 WBC can be done by manual methods or by

automated cell counters.
 WBC differential count

Techniques
1. By volume
2. By volume + conductivity + light
scattering
3. By light scattering + cytochemistry
4. By light scattering + RF impedance
Types
3-part, 5-part, 6-part, 7-part
Three-part diff histogram
Five-part diff histogram
 Application in leukemia study
 Different machines : Different
displays
 Based on WBC scattergram
 Coulter MAXM

Normal Lymphoma
M5 CML ALL CLL
 Normal ranges for WBC
 WBC 4.0-10.0 *10E9/L
 Neutrophils 40-75 %
 Lymphocytes 20-45
 Monocytes 2-10%
 Eosinophils 1-6%
 Basophils 0-1%
 ABSOLUTE COUNTS
• HOW TO CALCULATE ABSOLUTE COUNT?
• Working formula:
• Abs Count= TLC * DLC
• 100
• neutrophils > 8000
• Lymphocytes > 5000
• Monocytes > 1000
• Eosinophils----- mild (500-1500)
• moderate(1500-5000)
• marked ( > 5000)
• Basophils > 20
 Platelet count
 Normal value: 150-400 X 10E9/L.
 Mean Platelet Volume (MPV):
 Measured by automated analyser similary to MCV.
 Normal value: 8-12
 Increased MPV
› Platelet clumps
› Active thrombopoiesis
› Abnormal platelet production
 HISTOGRAM

• Histogram is a graphical representation of

different population of cell types as haematology
analyzers count and size thousands of cells to
produce a HISTOGRAM
• ADVANTAGES:

• It complement the data obtained by the analyzer

as well as from microscopic examination of a
blood smear.

• It detects pathological changes in the analyte

before the blood smear could be seen.
 Cont.

• A histogram is displayed by plotting the number

of cells on Y-axis and cell size on the X axis.
• It starts from the baseline as ascending slope,
reaches the highest point called the peak, then it
sharply falls to the baseline as the descending
slope.
• It should always starts and ends at the baseline.
 HISTOGRAM

peak

Descending
Ascending slope
slope
 THE BASE LINE:WHAT
DOESNOT STARTS FROM
IF RBC HISTOGRAM

•LARGEPLTS
•MICROERYTHROCYT
ES
•AGGREGATION OF
THROMBOCYTES
 •Normoblast
•Erythroblast/
•RBC Agglutination
IF RBC HISTOGRAM
DOESNOT ENDS AT
BASELINE: WHAT
DOES IT MEANS?
 MEANS?
WHAT DOES IT
MULTIPLE PEAKS:
HISTOGRAM SHOWS
WHEN RBC

•Posttransfusion, if
own and transfused
RBCS are of different
size

•Treated iron
deficiency or
megaloblastic anemia.
Platelet histogram
 DOESNOT ENDS AT
PLT CURVE

•Coagulation of blood

•EDTA induced
platelets agglutination

•Giant platelets
 HISTOGRAM
NO PLT
WHEN THERE IS

•Thrombocytopenia with
giant platelet
•Thrombocytopenia with red
cell fragmentations.
 NO PLT

•Marked
thrombocytopenia.
 HISTOGRAM
NORMAL WBC

•Trimodal WBC histogram ie. lymphocytes

three bell shaped curves that
overlap with each other.
Mixed cells neutrophils
•Should start and ends at
baseline.
 NRBCS •
clumps.•Platelet
•
WBC HISTOGRAM DOESNOT START FROM
BASE LINE:
 END AT BASELINE
WBC HISTOGRAM DOESNOT

•Immature myeloid
precursors i.e.
Promyelocyte,
myelocyte,
metamyelocyte.
THANKS