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      How to Interpret and Pursue an Abnormal Complete Blood Cell Count in Adults

      review-article
      Author(s): , MD a , * , , MD b , , MD a
      Publication date (Electronic):
      Journal: Mayo Clinic Proceedings
      Publisher: Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.
      Keywords: ACD, anemia of chronic disease, ANC, absolute neutrophil count, CBC, complete blood cell count, CML, chronic myeloid leukemia, ET, essential thrombocythemia, FISH, fluorescence in situ hybridization, Hct, hematocrit, HES, hypereosinophilic syndrome, Hgb, hemoglobin, HIV, human immunodeficiency virus, IDA, iron deficiency anemia, ITP, idiopathic thrombocytopenic purpura, LDH, lactate dehydrogenase, LGL, large granular lymphocyte, MCV, mean corpuscular volume, MDS, myelodysplastic syndrome, PA, pernicious anemia, PBS, peripheral blood smear, PT, primary thrombocytosis, PV, polycythemia vera, RBC, red blood cell, RCM, RBC mass, RT, reactive thrombocytosis, TCR, T-cell receptor, TTP/HUS, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, WBC, white blood cell

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          Abstract

          A complete blood cell count (CBC) is one of the most common laboratory tests in medicine. For example, at our institution alone, approximately 1800 CBCs are ordered every day, and 10% to 20% of results are reported as abnormal. Therefore, it is in every clinician's interest to have some understanding of the specific test basics as well as a structured action plan when confronted with abnormal CBC results. In this article, we provide practical diagnostic algorithms that address frequently encountered conditions associated with CBC abnormalities including anemia, thrombocytopenia, leukopenia, polycythemia, thrombocytosis, and leukocytosis. The objective is to help the nonhematologist recognize when a subspecialty consultation is reasonable and when it may be circumvented, thus allowing a cost-effective and intellectually rewarding practice.

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          Most cited references108

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          Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia.

          G Bodey, M. Buckley, Y S Sathe … (1966)
          Article 0 comments Cited 250 times – based on 0 reviews     Review now
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            Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans.

            John Osborne, Timothy Buchman, Kenneth J. Hui … (2001)
            Patients with sepsis have impaired host defenses that contribute to the lethality of the disorder. Recent work implicates lymphocyte apoptosis as a potential factor in the immunosuppression of sepsis. If lymphocyte apoptosis is an important mechanism, specific subsets of lymphocytes may be more vulnerable. A prospective study of lymphocyte cell typing and apoptosis was conducted in spleens from 27 patients with sepsis and 25 patients with trauma. Spleens from 16 critically ill nonseptic (3 prospective and 13 retrospective) patients were also evaluated. Immunohistochemical staining showed a caspase-9-mediated profound progressive loss of B and CD4 T helper cells in sepsis. Interestingly, sepsis did not decrease CD8 T or NK cells. Although there was no overall effect on lymphocytes from critically ill nonseptic patients (considered as a group), certain individual patients did exhibit significant loss of B and CD4 T cells. The loss of B and CD4 T cells in sepsis is especially significant because it occurs during life-threatening infection, a state in which massive lymphocyte clonal expansion should exist. Mitochondria-dependent lymphocyte apoptosis may contribute to the immunosuppression in sepsis by decreasing the number of immune effector cells. Similar loss of lymphocytes may be occurring in critically ill patients with other disorders.
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              Autoimmune hemolytic anemia.

              Bradley C Gehrs, Richard C. Friedberg (2002)
              Red blood cell (RBC) autoantibodies are a relatively uncommon cause of anemia. However, autoimmune hemolytic anemia (AIHA) must be considered in the differential diagnosis of hemolytic anemias, especially if the patient has a concomitant lymphoproliferative disorder, autoimmune disease, or viral or mycoplasmal infection. Classifications of AIHA include warm AIHA, cold agglutinin syndrome, paroxysmal cold hemoglobinuria, mixed-type AIHA, and drug-induced AIHA. Characteristics of the autoantibodies are responsible for the various clinical entities. As a result, diagnosis is based on the clinical presentation and a serologic work-up. For each classification of AIHA, this review discusses the demographics, etiology, clinical presentation, laboratory evaluation, and treatment options. Copyright 2002 Wiley-Liss, Inc.
              Article 0 comments Cited 119 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ayalew Tefferi
                Journal
                Journal ID (nlm-ta): Mayo Clin Proc
                Journal ID (iso-abbrev): Mayo Clin. Proc
                Title: Mayo Clinic Proceedings
                Publisher: Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.
                ISSN (Print): 0025-6196
                ISSN (Electronic): 1942-5546
                Publication date PMC-release: 20 October 2011
                Publication date (Print): July 2005
                Publication date (Electronic): 20 October 2011
                Volume: 80
                Issue: 7
                Pages: 923-936
                Affiliations
                [a ]Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minn
                [b ]Department of Laboratory Medicine and Pathology and Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minn
                Author notes
                [* ]Individual reprints of this article are not available. Address correspondence to Ayalew Tefferi, MD, Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905 tefferi.ayalew@ 123456mayo.edu
                Article
                Publisher ID: S0025-6196(11)61568-1
                DOI: 10.4065/80.7.923
                PMC ID: 7127472
                PubMed ID: 16007898
                SO-VID: d17e63a0-b8e6-4b6c-a9da-89ec300b2c1a
                Copyright © Copyright © 2005 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Article

                Keywords: acd, anemia of chronic disease,anc, absolute neutrophil count,cbc, complete blood cell count,cml, chronic myeloid leukemia,et, essential thrombocythemia,fish, fluorescence in situ hybridization,hct, hematocrit,hes, hypereosinophilic syndrome,hgb, hemoglobin,hiv, human immunodeficiency virus,ida, iron deficiency anemia,itp, idiopathic thrombocytopenic purpura,ldh, lactate dehydrogenase,lgl, large granular lymphocyte,mcv, mean corpuscular volume,mds, myelodysplastic syndrome,pa, pernicious anemia,pbs, peripheral blood smear,pt, primary thrombocytosis,pv, polycythemia vera,rbc, red blood cell,rcm, rbc mass,rt, reactive thrombocytosis,tcr, t-cell receptor,ttp/hus, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome,wbc, white blood cell
                Data availability:
                Keywords: acd, anemia of chronic disease, anc, absolute neutrophil count, cbc, complete blood cell count, cml, chronic myeloid leukemia, et, essential thrombocythemia, fish, fluorescence in situ hybridization, hct, hematocrit, hes, hypereosinophilic syndrome, hgb, hemoglobin, hiv, human immunodeficiency virus, ida, iron deficiency anemia, itp, idiopathic thrombocytopenic purpura, ldh, lactate dehydrogenase, lgl, large granular lymphocyte, mcv, mean corpuscular volume, mds, myelodysplastic syndrome, pa, pernicious anemia, pbs, peripheral blood smear, pt, primary thrombocytosis, pv, polycythemia vera, rbc, red blood cell, rcm, rbc mass, rt, reactive thrombocytosis, tcr, t-cell receptor, ttp/hus, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, wbc, white blood cell

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