ࡱ> y x?bjbjEE A`''g7WWWWWkkk84Tk3.~+++++-------0S3-W-WW++-***W+W+-*-**"-n-+u k#:--.03.B-, 4S' 4n- 4Wn-Tl*p$+--)~3. 4 :  Complete Blood Count (Cbc) Interpretation Worksheet Instructions: A. Interpret each CBC. 1. Examine the RBC, Hgb, and Hct values, considering the red cell indices, Retic count, and bilirubin level. 2. Examine the Platelet count. 3. Examine the WBC and differential. 4. Calculate the ANC when necessary. B. Identify a possible pathophysiologic cause for any abnormalities; classify anemias. C. List Clinical Manifestations you would expect to find. D. Summarize a probable treatment plan. Please review the worksheet suggestions which follow the 15 CBC profiles 1. RBC 4.5 mill/mm3 Hgb 9 g/dl Hct 30% MCV 67 fl MCH 20 pg MCHC 30% Retic 1.0% Total Bili. 1.0 mg/dl Platelets 250,000/mm3 WBC 5,000/mm3 Basos < 1% Polys 62% Lymphs 29% Monos 3% Bands 2% Eos 3% ANC /mm3 A. INTERPRETATION: Anemia, microcytic-hypochromic, normal WBC, normal Platelets . B. PATHOPHYSIOLOGY Pregnancy, Low iron intake, chronic bleeding, esp GI . C. CLINICAL MANIFESTATIONS Fatigue, Lightheadedness, DOE, Pallor, pica, tachycardia . D. TREATMENT Treat underlying condition, Iron supplement, severe give Epo . 2. RBC 4.0mill/mm3 Hgb 15 g/dl Hct 45% MCV 113 fl MCH 38 pg MCHC 33% Retic 2.5% Total Bili. 0.9 mg/dl Platelets 340,000/mm3 WBC 8,000/mm3 Basos 0.5% Polys 70.5% Lymphs 23% Monos 3% Bands 0% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 4. RBC 2.25 mill/mm3 Hgb 7 g/dl Hct 20% MCV 91 fl MCH 31 pg MCHC 34% Retic 3.0% Total Bili. 4.2 mg/dl Platelets 280,000/mm3 WBC 8,000/mm3 Basos 0.5% Polys 63% Lymphs 30% Monos 2.5% Bands 1% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 5. RBC 4.5 mill/mm3 Hgb 14 g/dl Hct 34% MCV 91 fl MCH 31 pg MCHC 34% Retic 0.6% Total Bili. 0.2 mg/dl Platelets 250,000/mm3 WBC 18,000/mm3 Basos < 1% Polys 61% Lymphs 23% Monos 3% Bands 10% Eos 2% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 6. RBC 4.5 mill/mm3 Hgb 14 g/dl Hct 41% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.5 mg/dl Platelets 300,000/mm3 WBC 18,000/mm3 Basos < 1% Polys 80% Lymphs 12% Monos 3% Bands 1% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 7. RBC 4.5 mill/mm3 Hgb 14 g/dl Hct 41% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.3 mg/dl Platelets 350,000/mm3 WBC 20,000/mm3 Basos < 1% Polys 31% Lymphs 23% Monos 2% Bands 10% Eos 33% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 8. RBC 5.1 mill/mm3 Hgb 15 g/dl Hct 40% MCV 91fl MCH 31 pg MCHC 34% Retic 1.2% Total Bili. 1.1 mg/dl Platelets 350,000/mm3 WBC 3,000/mm3 Basos 0.75% Polys 11% Lymphs 72.25% Monos 3% Bands 10% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 9. RBC 4.5 mill/mm3 Hgb 14 g/dl Hct 41% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.8 mg/dl Platelets 40,000/mm3 WBC 10,000/mm3 Basos 0.25% Polys 60.75% Lymphs 33% Monos 3% Bands 0% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 10. RBC 2.1 mill/mm3 Hgb 7.5 g/dl Hct 20% MCV 91fl MCH 31 pg MCHC 34% Retic 1.9% Total Bili. 0.6 mg/dl Platelets 5,000/mm3 WBC 800/mm3 Basos < 1% Polys 10% Lymphs 83% Monos 3% Bands 0% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 11. RBC 7.1 mill/mm3 Hgb 20 g/dl Hct 58% MCV 82 fl MCH 28 pg MCHC 34% Retic 4.0% Total Bili. 1.0 mg/dl Platelets 450,000/mm3 WBC 10,000/mm3 Basos 0.33% Polys 71% Lymphs 23% Monos 3% Bands 0% Eos 2.67% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 12. RBC 4.5 mill/mm3 Hgb 12 g/dl Hct 38% MCV 62 fl MCH 27 pg MCHC 32% Retic 3.0% Total Bili. 0.4 mg/dl Platelets 290,000/mm3 WBC 8,500/mm3 Basos 0.4% Polys 80% Lymphs 13% Monos 3% Bands 0.6% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 13. RBC 5.5 mill/mm3 Hgb 15 g/dl Hct 47% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.8 mg/dl Platelets 240,000/mm3 WBC 8,500/mm3 Basos 1% Polys 67% Lymphs 24% Monos 5% Bands 0% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 14. RBC 5.5 mill/mm3 Hgb 15 g/dl Hct 47% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.8 mg/dl Platelets 240,000/mm3 WBC 300/mm3 Differential not available ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . 15. RBC 5.5 mill/mm3 Hgb 15 g/dl Hct 47% MCV 91fl MCH 31 pg MCHC 34% Retic 1.0% Total Bili. 0.8 mg/dl Platelets 240,000/mm3 WBC 1,500/mm3 Basos 0.2% Polys 0% Lymphs 94.8% Monos 2% Bands 0% Eos 3% ANC /mm3 A. INTERPRETATION: . B. PATHOPHYSIOLOGY . C. CLINICAL MANIFESTATIONS . D. TREATMENT . I have intentionally not included an answer key with this worksheet because I have found that the crossword puzzle phenomenon is alive and well when students attempt the worksheets and end up looking at the answer key prematurely rather than working through each problem. I would like each of you to complete the worksheet as a worksheet open book/open notes. Do not be frustrated if you do not know the answers off the top of your head as you begin the worksheet I do not expect you to at first. But after you have completed the worksheet, most students discover that they have developed a routine for approaching serum CBC analysis that facilitates the recall that you desire and that you need in order to be successful on the patho exams and in the clinical setting. If you find that you have questions, problems, or insecurities regarding the CBC analysis worksheet, please feel free to communicate with me after class, during office hours, by appointment, via e-mail, via phone, or any other way you can think of!! WORKSHEET SUGGESTIONS: 1. First identify the abnormal values ( you need to memorize these). Most students will place arrows, up or down next to the identified abnormal values. Some students like to highlight the abnormals or circle them. 2. Then your attention needs to focus on the abnormal values you have identified. I suggest you consider them individually (i.e Platelet count) or in associated groups (i.e. RBC, Hgb, & Hct). If there are multiple abnormals, dont try to consider all at once frankly that is usually too complex even for experts, so as a beginner you need to take one piece at a time too. (in the future as an experienced CBC analyzer, you may be able to recognize that certain CBC profiles are typical for i.e. a person with a particular disease, but that is way beyond what I am expecting you to recognize now). 3. INTERPRETATION what I am looking for is a word or words to classify the abnormal/s. For example if you observe a decreased WBC value, the term Leukopenia is the interpretation. If the RBC, Hgb, & Hct are elevated, then you have Polycythemia as your interpretation, etc. 4. PATHOPHYSIOLOGY in this section I want you to speculate what could cause the abnormal value/s. For example if you observe decreased RBC, Hct, & Hgb values, you need to consider the red cell indices which allows you to narrow down the possible types of anemia. If you discover a macrocytic, normochromic anemia, you could list the possible causes for this i.e. folate or Vit B12 deficiency. Certainly, if you have numerous abnormals, you may have quite a list of possible causes for the various abnormalities. It is exciting to observe relationships, where i.e. poor nutrition could cause several if not all of the observed problems. Dont expect everything to correlate, but enjoy it when you discover it! 5. CLINICAL MANIFESTATIONS simply list all of the possible clinical manifestations that a person with the identified CBC abnormality might display. i.e. a person with an increased WBC value may demonstrate signs and symptoms of infection/inflammation, i.e. fever, erythema, edema etc. Certainly, if you have numerous abnormals, you may have quite a list of possible clinical manifestations for the various abnormalities. It is exciting to observe relationships, where i.e. weaknes and fatigue could result from several if not all of the observed problems. Dont expect everything to correlate, but enjoy it when you discover it! 6. 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