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Copy of The Nurse's Guide to the Complete Blood Count (CBC)

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Barbara Rhine

on 24 March 2014

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Transcript of Copy of The Nurse's Guide to the Complete Blood Count (CBC)

The Nurse's Guide to the Complete Blood Count (CBC)
Context
Before looking at any lab value, consider the clinical context. Knowing the patient's age, history, and current status give you many clues.
Red Blood Cells
(RBC)

Red blood cells transport oxygen and carry out vital processes in the body
Thrombocytes
(platelets)

Platelets main function is to help the blood clot. Too many platelets can make the blood prone to clotting. Too few any you can have problems controlling bleeding
White Blood Cells (WBC)
WBC's are the heart of the immune system and are vital in fighting infection and in autoimmune processes
Neutrophils
Neutrophils may go up with bacterial infections, stress reactions, inflammation, trauma, and certain medications
High platelets
Platelets will increase with a stress on the body as an ACUTE PHASE REACTANT. They can go up early in infection or after a traumatic injury. They can also dangerously increase after a process like Kawasaki disease that cause massive inflammation
Low Platelets
Low platelets can be caused by consumption (e.g. massive bleeding or sepsis), sequestration (e.g. they are trapped in a large spleen), destruction (e.g. idiopathic thrombocytopenia purpura), or poor production (leukemia)
Consider a 3-month old with a high fever... or a 12-yo with leukemia... or a 5-yo who just had a seizure
Look for
IMMATURE
neutrophils to tip you off that the body is working hard to fight something off. Those are
BANDS, metamyelocytes, or even younger forms.
MATURE WBC's can increase from things like seizures, trauma, or medications by DEMARGINATION. This occurs when neutrophils that are stored along the outer part of the blood vessel are moved into the circulation
Neutrophils 'eat' bacteria. They are phagocytes
Lymphocytes
T-cells are specialized wbc's that are critical in fighting viruses, fungal infections, and are involved in allergic/autoimmune conditions
T cells
B cells
B cells make antibodies. High levels can also be a sign of leukemia
Lymphocytes go up in viral infections, fungal infections and in processes like leukemia
Worry about immunodeficiencies like HIV, viral suppression, and susceptibility to uncommon infections if lymphocytes are low
Monocytes
Monocytes can be seen in the recovery phase of common infections. They can increase with many viral infections, pertussis, leukemia, or TB
Eosinophils
These cells go up in allergic conditions like asthma, eczema, and milk protein allergy. They also go up in parasitic infections.
Basophils
These specialized cells are raised in allergic reactions, chicken pox, lead poisoning, and leukemia
Too many RBC's leads to thick blood that can sludge and predispose to clots, strokes, and extra work for the heart
Too few RBC's leads to decrease oxygen carrying. The heart has to work harder to pump enough blood to supply organs like the brain
Nucleated RBC's or reticulocytes are immature RBC's. This is like the immature WBC's that we call BANDS. These cells go up in high production states.
Some people feel that bands are less accurate than other immatures, like metamyelocytes. This is because bands need to be counted manually and are more prone to human error
Low Neutrophils can be a sign of a variety of less common infections like typhoid fever, brucellosis, viral infections, malaria and conditions like leukemia
Beware PANCYTOPENIA (low rbc, wbc, and platelets. It may represent leukemia
Eosinophils also go up in the early phase of acute insults like shock, surgery, major infections, and trauma as well as medications like steroids and epinephrine
Monos are another phagocytic cell
Review Cases
Sarah is a 3mo who has a fever to 40'C. She looks unwell and is very irritable. Her CBC shows:

wbc 27,000 (normal 5,000-15,000)
Hgb 13.2 (normal)
platelets 500 (slightly high)
Differential 60% neutrophils, 15% bands, 5% metamyelocytes, and 20% lymphocytes

Given the CBC, do you think she has a bacterial or viral infection? Why?
Most likely, Sarah has a bacterial infection. She has an increased wbc, with a increase in neutrophils and immatures (bands and metamyelocytes). Her clinical picture (context) helps you as well.
Will is a 4yo with deep bruising, petechia (burst capillaries) and purpura (palpable bruises). You need to figure out if this is leukemia, child abuse, or idiopathic thrombocytopenia purpura (ITP)? What might you look for for each of these conditions? Take a second and write down what you think might happen in the wbc, Hb, and platelet counts.
low wbc, low Hb, low plt
sl. increased or normal wbc (stress), slight low or normal Hb (anemia fr. poor nutrition), and slightly high or normal platelets (stress response) might be seen in child abuse.
Normal wbc, normal Hb and very low patelets might be seen in this common childhood condition.
low wbc, low Hb, low plt
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