Cont- Leukocyte count PDF

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Cont- Leukocyte count Hematology must to know...

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ABSOLUTE VALUES WBC count x Relative value of specific WBC (%) N.V. WBC = 5,000-10,000/cu.mm PMN: (57-65%) 5000 x 57 = 2850/cu.mm 100 = 2.85 x109/L N.V.:

10000 x 8 100

= 800/cu.mm = 0.8 x109/L

10000 x 5 100

= 500/cu.mm = 0.5 x109/L

10000 x 1 100

= 100/cu.mm = 0.1 x109/L

100 – 500/cu.mm 0.1 – 0.5 x109/L

Basophils: (0-1%) 5000 x 0 = 0/cu.mm 100 = 0x x109/L N.V.:

= 3500/cu.mm = 3.5 x109/L

200 – 800/cu.mm 0.2 – 0.8 x109/L

Eosinophils: (2-5%) 5000 x 2 = 100/cu.mm 100 = 0.1 x109/L N.V.:

10000 x 35 100

1,250 – 3,500/cu.mm 1.25 – 3.5 x109/L

Monocytes: (4-8%) 5000 x 4 = 200/cu.mm 100 = 0.2 x109/L N.V.:

= 6500/cu.mm = 6.5 x109/L

2,850 – 6,500/cu.mm 2.85 – 6.5 x109/L

Lymphocytes: (25-35%) 5000 x 25 = 1250/cu.mm 100 = 1.25 x109/L N.V.:

10000 x 65 100

0 – 100/cu.mm 0 – 0.1 x109/L

RELATIVE VS ABSOLUTE VALUES Example: Patients A,B,C with same differential count but different WBC counts. Differential counts WBC counts PMN 70% A. 2,000/cu.mm LYMPH 24% MONO 3% B. 10,000/cu.mm EOSINO 2% BASO 1% C. 20,000/cu.mm 100% Patient A:

2000 x 70 100

= 1400/cu.mm or 1.4 x109/L below normal

Patient B:

10000 x 70 100

= 7000/cu.mm or 7 x109/L above normal

Patient C:

20000 x 70 100

= 14000/cu.mm or 14 x109/L above normal

Example: A patient with diff. count: Lymph – 70% WBC count – 3000/cu.mm 3000 x 70 = 2100/cu.mm or 2.1 x109/L 100 normal

Different Approaches to the Differential Quantitation of Leukocyte Cells I. Schilling Count - A systematic method of counting granulocytic cells in groups according to their sequential development stage - In actual cell classification, the younger forms are placed on the left and the more mature forms on the right Myeloblast & Myelocyte Promyelocyte 0% 0% 



Metamyelocyte 0-1%

Stabs

PMN

2-5%

57-65%

Shift to the Left – increase in the younger cells e.g. PMN – 50% Stabs – 15% Shift to the Right – increase in the older cells e.g. PMN – 73% Stabs – 1%

II. Schilling Hemogram (modified) - The classification in the Schilling count when included with the differential count constitutes the Schilling Hemogram. WBC – 5000-10000 Myelobast & Promyelocyte – 0% Metamyelocyte – 0% Stabs – 2-5% PMN – 57-65% Eosinophil –2-5% Basophil – 0-1% Lymphocyte – 25-35% Monocyte – 4-8% 2 Types of Shifts: 1. Regenerative Shift – increase in the total WBC count 2. Degenerative Shift – decrease in the total WBC count

1.Regenerative Shift to the Left - Characterized with a high WBC count and an increase in the younger cells

e.g. WBC count – 25,000/cu.mm Seen in: acute infections PMN – 50% acute sepsis Stabs – 15% 2. Degenerative Shift to the Left - Low WBC count and an increase in the younger cells e.g. WBC count – 3,000/cu.mm Seen in: TB PMN – 45% Typhoid fever Stabs – 20% 3. Regenerative Shift to the Right - Increase WBC count and an increase in mature cells e.g. WBC count – 20,000/cu.mm PMN – 75% Stabs – 0% III. Arneth Count - A qualitative and quantitative classification based on the number of nuclear lobes possessed by the neutrophils. There are 5 class. CLASS I II III IV V

NUCLEAR LOBES Nucleus unsegmented 2 Nuclear lobes 3 Nuclear lobes 4 Nuclear lobes 5 Nuclear lobes

Shift to the Left – Shift to the Right – ARNETH INDEX FORMULA: Class I + II + ½ III = 5 + 35 + 20.5 = 60.5% (Normal Arneth Index) a.Arneth Index is 85% Interpretation: Shift to the Left e.g. 10 : 40 : 41 : 8 : 1 = 10 + 40 + 20.5 = 70.5 (Shift to the Left) b.Arneth Index is 40%....??

VALUES 5% 35% 41% 17% 2% 100%...