Hematocrit – an overview | ScienceDirect Topics

External Blood Loss

PCV in a dog does not fully reflect the severity of acute blood loss anemia for 1 to 3 days, until fluid volume of the vascular space is replaced and the remaining RBCs and PPs are diluted by fluid replacement (thirst, redistribution of body fluids, or fluid treatment). Splenic contraction in the first few hours releases stored, concentrated RBCs into the circulation and may initially mask the severity of anemia. Release of reticulocytes should be noticeable by 3 days after hemorrhage, and peak aggregate reticulocytosis occurs 4 to 5 days after hemorrhage (see Figure 3-1). Improvement in the PCV occurs rapidly over the first 2 weeks until PCV reaches the low-normal reference interval. Thereafter, hypoxia is too mild to stimulate strong erythropoietin production, so the PCV increases slowly and may take a month to return to the original value.

Note

After a single episode of blood loss, improvement in the PCV occurs rapidly over the first 2 weeks. The PCV increases slowly thereafter and may take a month to return to the original PCV.

In adult animals, chronic hemorrhage over several weeks causes iron deficiency (see Figure 3-12) and a negative protein balance impairing erythropoiesis. Thus blood loss anemia initially (e.g., in the first 1 to 2 days) has no reticulocytosis in the blood (i.e., pre-regenerative), becomes most regenerative, and then over time becomes poorly regenerative or nonregenerative because of iron deficiency. Puppies and kittens are born with small iron reserves and with maximum erythropoiesis to match growth rate; iron depletion occurs more rapidly with blood loss (e.g., hookworms or coccidia). Even normal kittens just before weaning often have subclinical iron deficiency while drinking milk (an iron-poor diet).

A low or low-normal PP level in regenerative anemia is frequently associated with external blood loss and is a useful diagnostic feature. PP is lost with external blood loss. In hemolytic anemia and internal blood loss, PP concentration tends to be normal to slightly increased, because no protein is lost from the body. The PP reference interval may be too wide for the PP concentration to seem abnormal, but values may be in the lower end of the reference interval. PPs are replaced by the liver and lymphoid tissues more quickly than the bone marrow can replace RBCs, so hypoproteinemia less consistently reflects the presence or severity of external hemorrhage than does PCV.

Feline PCV response to blood loss somewhat parallels the canine response for the first 2 weeks. Feline aggregate reticulocyte response reaches a peak about 4 days after hemorrhage (see Figure 3-1). The maximum number of feline aggregate reticulocytes is much lower than the maximum number of canine reticulocytes in strong regenerative responses. Similarly, less polychromasia is needed on a feline blood smear to indicate strong regeneration than on a canine smear. Punctate reticulocytes peak about 1 week after hemorrhage and may remain elevated for 3 weeks or more. Punctate reticulocytes may remain increased after the PCV has returned to the reference interval. Therefore, a punctate reticulocytosis probably reflects accelerated erythropoiesis sometime within the previous 2 weeks.

Feline aggregate and punctate reticulocyte numbers can help determine when an anemia began. Moderately to markedly increased numbers of aggregate reticulocytes with few punctate reticulocytes indicates recent anemia (e.g., 2 to 4 days). Increased punctate reticulocytes without increased aggregate reticulocytes indicate anemia of 1 to 3 weeks’ duration or anemia too mild to stimulate an aggregate reticulocyte response.

Age-related changes in puppies and kittens must be considered. The PCV in healthy 2- to 6-week-old puppies is approximately 28%, and the PP normally may be less than 6 g/dl. Puppies have approximately 3% to 7% reticulocytes at 2 months of age or younger, with the highest percentage (7%) occurring at 0 to 2 weeks of age. Conversely, adult dogs normally have less than 1.5% reticulocytes. Using adult reference intervals, one would incorrectly conclude that a puppy has anemia, reticulocytosis, and hypoproteinemia, which indicate external blood loss. Therefore age-related reference intervals should be used.²⁸

Note

Healthy puppies at 2 to 6 weeks old have a PCV of 28, PP less than 6 g/dl, and 3% to 7% reticulocytes. Age-based reference values should be used.

Young animals are less able to respond to blood loss than are adults. Puppies and kittens already have high rates of bone marrow erythropoietic activity because of the need to expand blood volume as they grow. When bone marrow erythropoiesis is already at a high rate, one cannot expect as great an increase with blood loss as occurs in adults.

Low Blood Counts – Managing Side Effects

Includes: Low red blood cell
count, Low white blood cell count,
Low platelet count,
Infection-prevention guidelines for immunosuppressed patients.

Other words you may hear:

• Myelosuppression – a decrease in the production of blood cells,
  which may lead to low blood count.
• Pancytopenia – a lowering of all three types of blood cells; red
  blood cells, platelets, and white blood cells, which may lead to low red blood cell
  count, low blood platelet count, and/or low white blood cell count.
• Anemia – a decrease in the number of red blood cells (RBC), which
  may lead to low red blood count.
• Thrombocytopenia – a decrease in the number of platelets (PLT),
  which may lead to low blood platelet count.
• Leukopenia – a decrease in the total number of white blood cells
  (WBC), which may lead to low white blood cell count.
• Neutropenia – a decrease in the number of neutrophils, one type
  of white blood cell, which may lead to low white blood cell count.
• Granulocytopenia – a decrease in the number of granulocytes, the
  group of white blood cells that include neutrophils, basophils and eosinophils,
  which may lead to low white blood cell count.

What Are Low Blood Counts?

Many of the chemotherapy drugs temporarily stop cells from dividing, especially
the cells that divide quickly. Blood cells; red blood cells, white blood cells
and platelets are made by the bone marrow. These blood cells divide quickly.
Chemotherapy may lead to low blood counts, causing the possibility of a variety
of symptoms. The symptoms depend on the type of low blood cell count.

Low Red Blood Cell Count

(Anemia, low hemoglobin, low hematocrit)

Red blood cells carry oxygen and nutrients throughout the body. A complete
blood count (CBC) is a blood test used to check your blood count. The RBC,
hemoglobin, and hematocrit are tests to see if you have low red blood count.

Normal Adult Values Male Female RBC 4. 5 – 6.0 M/ul 4.2 – 5.4 M/ul Hemoglobin (HgB) 14 – 18 g/dL 12 – 16 g/dL Hematocrit (Hct) 40 – 52% 37 – 47%

Note: Normal values will vary from laboratory to laboratory.

When you have low red blood cell count you may feel:

• Fatigued
• Weak
• Short of breath
• Increase in your heart rate
• Dizzy or lightheaded when you change positions quickly

If you suffer from low red blood cell count, you may experience:

• Headaches
• Chest Pain
• Pale skin

Things you can do to help manage your low red blood count:

• Rest between activities.
• Plan ahead and save your energy for the most important activities.
• Avoid or stop activities that make you short of breath or make your heart beat faster.
• Ask others for help.
• Eat a diet with adequate protein and vitamins.
• Drink plenty of non-caffeinated and non-alcoholic fluids.

When to call your doctor or health care provider about low blood counts:

• Severe weakness.
• You feel dizzy or lightheaded.
• Your heart is beating faster.
• You feel short of breath or are having difficulty breathing.
• Call immediately if you are having chest pain.

Your doctor or health care provider may prescribe or suggest to treat your low
red blood count:

• Epoetin alfa (PROCRIT^®).
• Darbepoetin (Aranesp^®).
• Iron supplement.
• Multivitamin.
• A diet high in protein.
• A red blood cell transfusion.

Low White Blood Cell Count

(low WBC)

Leukopenia – A decrease in the total number of white blood cells,
which may lead to low white blood cell count.
Neutropenia – A decrease in the number of neutrophils, which may
lead to low white blood count.
Granulocytopenia – Some people use this term in place of
Neutropenia.

White blood cells fight infection. The white blood count (WBC) is part of
a complete blood count (CBC) that is used to check your blood counts. There
are several types of white blood cells. A differential test will show more
detail about your white blood cell count:

Note:  Normal values will vary from laboratory to laboratory.

When you have a low white blood cell count there is an increased risk of infection. 
The level of risk depends on several factors:

• How low your white blood count falls
• How long your white blood count is low
• Which type of low white blood cell count you have
• Other medications you may be taking such as steroids or immunosuppressive agents
  (cyclosporin).

One measure of risk is the absolute neutrophil count (ANC). The ANC is calculated
by multiplying the total white blood count by the percent of neutrophils
(also called segmented neutrophils, segs, polymorphoneucleated cells or PMNs, polys)

Total white blood count x % neutrophils* = ANC

* Neutrophils may be reported as segs & bands (a band is slightly less mature
form of a seg). In this case add the % of segs to the % of bands then multiply
by the total number of white blood cells.

(% segs + % bands) x Total white blood count = ANC

Things you can do to reduce your risk of infection when you have low white blood
count:

• Frequent hand washing of both you and those coming in contact with you.
• Avoid contact with anyone who is sick. If someone in the home is sick limit
  contact and consult your doctor or nurse.
• Do not have dental work done while your white blood cell count is low.

When your white blood cell count is low you may NOT have the usual signs and
symptoms when developing an infection such as:

• Redness
• Swelling
• Pus formation (at the site of an injury or incision)
• Cough
• Sputum
• Nasal drainage (from a sinus or respiratory infection)

Therefore, it is extremely important to be alert to any change in how you feel and
report and discuss what you are feeling with your doctor or nurse.

When to call your doctor or health care provider about low blood count:

Call immediately if you have:

• A temperature greater than or equal to 100. 5°F. (Check with your health care
  provider, you may be instructed to call for temperature greater than or equal to
  100°F)
• Chills (rigors) or shakes
• Sudden onset of a new unexplained pain.

Call within 24 hours if you experience the following:

• Sore throat
• Sores in your mouth
• A white coating in your mouth, especially your tongue
• Signs of a bladder infection
  • Burning with urination
  • Blood in your urine
  • Needing to urinate more frequently than normal
  • Having to urinate in a hurry and possibly not making it to the bathroom in time.

Your doctor or health care provider may prescribe or suggest to treat low white
blood cell count:

• The following medications may be given after each cycle of chemotherapy to prevent
  your white blood cells from falling too low and/or for too long.
  • Filgrastim (Neupogen^®)
  • Pegfilgrastim (Neulasta^®)
  • Sargramostim (Leukine^®)
• The following are antimicrobial medications that may be prescribed to prevent specific
  infections that are common when the immune system is suppressed by chemotherapy
  and/or other medications.
  • Sulfamethoxazole – trimethoprim
  • Acyclovir
  • Fluconazole
  • Itraconazole
• Other antibiotics or antimicrobials are used to treat specific infections as needed.

Low Blood Platelet Count

(Thrombocytopenia, low PLT)

Platelets help blood to clot. They are found in the blood flowing through
the blood vessels. Platelets also line the inside of the blood vessel.
When low blood platelet count is present, this layer thins and tiny
drops of blood can leak through the spaces made when this layer thins, causing red
dots on the skin called petechiae (pa-TEE-kee-eye).

Note: Normal values will vary from laboratory to laboratory.

When low blood platelet count present a person is at an increased
risk of bleeding.

When you suffer from low blood platelet count you may notice:

• Increased bruising
• Petechiae (red dots on your skin described above)
• Bleeding from nose, gums, rectum

Call your doctor immediately if you have sudden, severe unexplained
pain.

Things you may do to decrease your risk of bleeding if you have low blood platelet
count:

• Do not take medications that interfere with the platelets being able to form a clot.
  • Aspirin
  • Ibuprofen (Advil^®, Motrin^®)
  • Naproxen (Aleeve^®)
• If you are not sure about taking any medication, check with your doctor, nurse or
  pharmacist.
• Do not use rectal suppositories or take your temperature rectally.
• Use caution or avoid flossing your teeth.
• Use a very soft bristle toothbrush or oral swabs as recommended by your doctor or
  health care provider.
• If your gums bleed, rinse with cold water. If bleeding does not stop call
  your doctor or health care provider.
• Avoid activities that increase your risk of bleeding when you have low blood platelet
  count:
  • Contact sports
  • Amusement park rides that involve fast or quick motion.
  • Strenuous exercise.
  • Avoid or limit the use of sharp objects such as knives, razors.
  • Hold pressure on any cut or scrape for at least 5 minutes.

When to call your doctor or health care provider about low blood count:

• Bleeding that will not stop after 5 minutes of pressure.
• Bleeding that occurs spontaneously (by itself), without injury.
• New or unexplained pain
• Fall or experience trauma or injury
• Feel dizzy or lightheaded
• Have difficulty seeing or double vision

Your doctor or health care provider may prescribe or suggest for low blood platelet
counts:

• Oprelvekin (Neumega^®)
• A platelet transfusion

Common Sense Infection-Prevention

For Immunosuppressed Patients and Post-Transplant Patients:

These precautions are intended for people with absolute neutrophil count
(ANC) less than 500 or for people with prolonged neutropenia. Consult your
physician to discuss precautions specific to your low blood count.

The basic holistic tenets of good hygiene, a well-balanced nutritious diet, stress
avoidance, sufficient sleep and moderate exercise are more important than ever for
a person with low white blood cell count and a recovering immune system.
Any activity or practice that enhances the body’s basic immune structure or does
not stress it will help to prevent endogenous (from within yourself) and exogenous
(from outside yourself) infections.

Food selection and preparation

• Do not eat raw or undercooked eggs, or foods that may contain raw egg (some
  hollandaise sauce, Caesar or other salad dressings and mayonnaise.)
• Do not eat raw or undercooked poultry, meat, or seafood or unpasteurized dairy products.
  (Well-cooked means no pink in the middle or with the internal temperature higher
  than 165F.)
• Produce should be thoroughly washed before being eaten. (See Travel section
  if leaving the U.S.A)
• Take care to avoid cross contamination of food. For example, uncooked meats
  should not come into contact with other foods. Hands, cutting boards, counters,
  and knives and other utensils should be washed thoroughly after contact with uncooked
  foods.
• Do not share food, eating or drinking utensils with others if you have low white
  blood cell count. A dishwasher is not necessary as long as soap, friction,
  a hot rinse and a clean towel are used for utensils. Avoid using “communal”
  dips with vegetables, crackers etc. where others re-dip items that have been in their
  mouths or do not wash their hands.

Immunizations:Influenza vaccine is recommended annually before
the influenza season.

• Pneumococcal vaccine is recommended for all patients.
• All adults who have not had chickenpox should discuss the value of Varicella vaccine
  with their physician.
• Babies and children in the household should receive inactivated (injection form)
  of polio vaccine rather than the oral (live virus) vaccine. Consult the child’s
  pediatrician.

Prophylaxis (prevention):

• Depending on the level of immunosuppression some patients should receive medication
  to prevent PCP (Pneumocystis carinii) pneumonia.
• If a person with low blood count is exposed to another person with an infectious
  disease (sexual contact or intimate contact) consult the physician as soon
  as possible for possible preventative medication. Some of the diseases
  of concern are pulmonary tuberculosis, sexually transmitted diseases (e.g. gonorrhea,
  syphilis, chlamydia), or hepatitis A, B, or C.
• Many patients also receive medications such as a acyclovir or ganciclovir for prevention
  of certain viral infections. Some patients receive medications to prevent
  fungal infections. These preventative programs vary depending on the type
  of transplant received as well as other factors.

Infants, babies and children:

• Contact with human feces (diaper changing) can potentially expose people to a variety
  of infections. It is preferable that another family member be the principal
  diaper changer when you suffer from low blood count. But if it becomes necessary,
  wash hands thoroughly after changing diapers, and avoid caring for babies with diarrhea.
  Wear gloves if at all possible.
• Avoid contact (kissing, hugging) children who have been exposed to childhood diseases
  or “who do not feel well.” This is especially applicable for children exposed
  to chickenpox and have not been vaccinated, or had the disease. If the immunosuppressed
  person has not had chickenpox, discuss the possibility of vaccination with your
  physician.
• Most of the time however, hugging and kissing your family members and close friends
  is fine!

Pets:

• Wash hands after handling pets (especially before eating) if you have low white
  blood count. Avoid contact with pets’ feces, especially if the animal has diarrhea.
  Seek veterinary care for animals with diarrheal illness and a fecal sample from
  such animals should be examined for Cryptosporidium, Salmonella, and Campylobacter.
• Those who elect to acquire a cat should adopt or purchase one that is over one year
  of age. People who are severely immunosuppressed are at an unusually high
  risk of developing a disease caused by Bartonella species (cat-scratch fever).
  Unfortunately routine testing of a cat for the organism is not beneficial and declawing
  is not generally advised. To avoid infection with Toxoplasma gondii that may
  be found in cat feces, have the litter box changed daily, preferably by a nonimmunosuppressed,
  nonpregnant person; alternatively the person should wash their hands thoroughly
  after changing the litter box. People need not be advised to part with their
  cats or have them tested for toxoplasmosis (encephalitis).
• Avoid contact with reptiles such as snakes, lizards, and turtles because of the
  risk of salmonellosis.
• Avoid cleaning fish tanks because of possible exposure to Mycobacterium marinum.
• Birds, especially if imported from other countries, should receive a clean bill
  of health from a veterinarian.
• Special care should be taken in a farm, barnyard, or other outdoor environment.
  Persons with low blood counts should avoid situations where hay or other fodder
  is being “pitched.” Inhalation of environmental fungal spores, particularly
  from moist, dark areas (e.g. compost piles) should be avoided at all costs especially
  if the white blood count is low or if extra immunosuppressive medication is being
  administered.

Gardening/Farming:

• Routine flower and vegetable gardening is permissible using some precautions for
  your low white blood count. Strictly avoid an environment where mulch, hay,
  topsoil, etc. is being “pitched” or spread. Inhalation of environmental spores,
  particularly from moist, dark areas (e.g. compost piles) should be completely avoided.
  (Aspergillus spores that are abundant in these areas and if they are inhaled can
  cause serious disease in the immunosuppressed person.)
• Gloves should be worn for contact with dirt and soil and good hand washing after
  the gloves are removed is essential. If walking through areas where soil,
  dust and fungal spores may be found in the air cannot be avoided, wearing a mask
  is preferred.

Camping/Fishing/Swimming:

• Immunosuppressed people should not drink water directly from lakes or rivers.
  If necessary boil water for 1 full minute to avoid Cryptosporidium and other waterborne
  organisms. Use of a submicron personal-use water filter may reduce the risk.
  Be advised that swimming can cause accidental ingestion of water and may increase
  the possibility of acquiring Cryptosporidium, even in public swimming pools.
  Avoid situations that would permit the inhalation of environmental spores, particularly
  from moist, dark areas (e.g. compost piles, rotting leaves etc.). Again these
  are areas where Aspergillus spores are abundant and if they are inhaled can cause
  serious disease in the Immunosuppressed person.
• Hot tubs, saunas, and other communal baths are generally not recommended.
  Bacteria and other microorganisms thrive in warm water. However, if the immunosuppressed
  person is aware that the tub is adequately disinfected regularly as recommended
  then there is no contraindication their use.
• Spelunking or cave exploration should not be done during periods of low white blood
  cell count because of the risks associated with bat guano exposure.

Travel:

• The risk of food and waterborne infections among immunosuppressed persons is magnified
  during travel to developing countries. Those who elect to travel should avoid
  foods and beverages that may be contaminated, particular raw fruits and vegetables,
  raw or undercooked seafood or meat, tap water, ice made with tap water, unpasteurized
  milk and dairy products, and items sold by street vendors. Foods and beverages
  that are generally safe for those with low white blood cell count include steaming-hot
  foods, fruits that are peeled by the traveler, bottled (especially carbonated) beverages,
  hot coffee and tea, beer, wine, and water brought to a rolling boil for 1 minute.
  Treatment of water with iodine or chlorine may not be as effective as boiling but
  can be used when boiling is not practical.
• Prophylactic (preventive) antimicrobial agents are not generally recommended for
  travelers, but your doctor may advise carrying certain medications with you.
  The effectiveness of these agents depends upon local antimicrobial-resistance patterns,
  which are seldom known. Check with your physician for decisions based upon
  your low blood counts and the region and duration of travel.
• Check with your doctor or health care provider well before the planned travel date
  is advised.

Housekeeping:

• Regular dusting, sweeping, windows, floor washing, bathrooms are okay to clean if
  you feel well. However, avoid cleaning or dusting areas where a lot of sediment
  can be aerosolized. Use common sense and avoid cleaning areas that have been
  untouched for years (Aspergillus lives in dust, especially in old building).
  Wear gloves for washing heavily soiled areas and commodes.

Construction/Renovation:

• In general, it is wise to avoid construction/renovation areas if you have
  low white blood count because of the possibility of aerosolized yeast or mold in
  the dust. If it is unavoidable an immunosuppressed person can reduce
  the risk by wearing a particulate respirator (mask – NIOSH approved N95 respirator)
  and fitting it tightly to his face.

Public Places (Restaurants, Shopping, Sporting Events, Church):

• On the whole, it is fine to go to public places. Avoid, if possible tightly
  crowded places during the height of the cold/flu season. Generally a mask
  will not offer much protection from viruses, so it is better to avoid close contact
  with people coughing and sneezing. Hand washing is always advisable, especially
  after frequent handshaking.

Masks:

• There are a few occasions when a mask (NIOSH approved N95 particulate respirator)
  is appropriate, such as if a person suffering from low white blood cell count must
  go into a construction/renovation area, or when exposed to heavy “puffs” of dust
  or debris. Additionally if required to have close contact with another (children,
  adults, etc.) who is ill with a respiratory infection (common cold, flu, childhood
  illness) a mask will reduce the risk of acquiring the infection.

These guidelines for persons with low white blood count are based on the
following:

USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons
Infected with Human Immunodeficiency Virus: A Summary. MMWR, Vol 44,
No. RR-8-1995.

Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website about low blood count and other medical conditions is
meant to be helpful and educational, but is not a substitute for medical advice.

UF Health, University of Florida Health

Definition

Hematocrit is a blood test that measures how much of a person’s blood is made up of red blood cells. This measurement depends on the number of and size of the red blood cells.

Alternative Names

HCT

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

No special preparation is necessary for this test.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away.

Why the Test is Performed

The hematocrit is almost always done as part of a complete blood count (CBC).

Your health care provider may recommend this test if you have signs of or are at risk for anemia. These include having:

• Grumpiness or tiredness
• Headaches
• Problems concentrating
• Poor nutrition
• Heavy menstrual periods
• Blood in your stools, or vomit (if you throw up)
• Treatment for cancer
• Leukemia or other problems in the bone marrow
• Chronic medical problems, such as kidney disease or certain types of arthritis

Normal Results

Normal results vary, but in general they are:

• Male: 40.7% to 50.3%
• Female: 36.1% to 44.3%

For babies, normal results are:

• Newborn: 45% to 61%
• Infant: 32% to 42%

The examples above are common measurements for results of these tests. Normal value ranges vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your provider about the meaning of your specific test results.

What Abnormal Results Mean

Low hematocrit may be due to:

• Anemia
• Bleeding
• Destruction of red blood cells
• Leukemia
• Malnutrition
• Too little iron, folate, vitamin B12, and vitamin B6 in the diet
• Too much water in the body

High hematocrit may be due to:

• Congenital heart disease
• Failure of the right side of the heart
• Too little water in the body (dehydration)
• Low levels of oxygen in the blood
• Scarring or thickening of the lungs
• Bone marrow disease that causes abnormal increase in red blood cells

Risks

There is little risk involved with having your blood taken.Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood buildup under the skin)
• Infection (a slight risk any time the skin is broken)

Images

References

Chernecky CC, Berger BJ. H. Hematocrit (Hct) – blood. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:620-621.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Blood disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 124.

Means RT. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 149.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 30.

Complete Blood Count (CBC) | HealthLink BC

Test Overview

A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders.

A CBC test usually includes:

• White blood cell (WBC, leukocyte) count. White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly. The number of white blood cells is sometimes used to find an infection or to see how the body is dealing with cancer treatment.
• White blood cell types (WBC differential). The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immature neutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxic reaction to medicines or chemicals, and many conditions, such as leukemia.
• Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.
• Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood’s volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present.
• Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red colour. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood’s ability to carry oxygen throughout the body.
• Red blood cell indices. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. These numbers help in the diagnosis of different types of anemia. Red cell distribution width (RDW) can also be measured which shows if the cells are all the same or different sizes or shapes.
• Platelet (thrombocyte) count. Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis).
• Mean platelet volume (MPV). Mean platelet volume measures the average amount (volume) of platelets. Mean platelet volume is used along with platelet count to diagnose some diseases. If the platelet count is normal, the mean platelet volume can still be too high or too low.

Your doctor may order a blood smear test to be done at the same time as a CBC but it is not part of the regular CBC test. In this test, a drop of blood is spread (smeared) on a slide and stained with a special dye. The slide is looked at under a microscope. The number, size, and shape of red blood cells, white blood cells, and platelets are recorded. Blood cells with different shapes or sizes can help diagnose many blood diseases, such as leukemia, malaria, or sickle cell disease.

Why It Is Done

A complete blood count may be done to:

• Find the cause of symptoms such as fatigue, weakness, fever, bruising, or weight loss.
• Check for anemia.
• See how much blood has been lost if there is bleeding.
• Diagnose polycythemia.
• Check for an infection.
• Diagnose diseases of the blood, such as leukemia.
• Check how the body is dealing with some types of drug or radiation treatment.
• Check how abnormal bleeding is affecting the blood cells and counts.
• Screen for high and low values before a surgery.
• See if there are too many or too few of certain types of cells. This may help find other conditions, such as too many eosinophils may mean an allergy or asthma is present.

A complete blood count may be done as part of a regular physical examination. A blood count can give valuable information about the general state of your health.

How To Prepare

You do not need to do anything before having this test.

How It Is Done

Your health professional drawing blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure to the site and then a bandage.

If this blood test is done on a baby, a heel stick will be done instead of a blood draw from a vein.

How It Feels

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little chance of a problem from having a blood sample taken from a vein.

• You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
• In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.

Results

A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders.

Normal

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Normal values for the complete blood count (CBC) tests depend on age, sex, how high above sea level you live, and the type of blood sample. Your doctor may use all the CBC values to check for a condition. For example, the red blood cell (RBC) count, hemoglobin (Hgb), and hematocrit (HCT) are the most important values needed to tell whether a person has anemia, but the red blood cell indices and the blood smear also help with the diagnosis and may show a possible cause for the anemia.

To see if the white blood cell (WBC, leukocyte) count is good and how the cells look on the smear, your doctor will look at both the number (WBC count) and the WBC differential. To see whether there are too many or too few of a certain type of cell, your doctor will look at the total count and the percentage of that particular cell. There are normal values for the total number of each type of white cell.

Pregnancy can change these blood values. Your doctor will talk with you about normal values during each trimester of your pregnancy.

In general, a normal hemoglobin level is about one-third the value of the hematocrit.

High values

Red blood cell (RBC)

• Conditions that cause high RBC values include smoking, exposure to carbon monoxide, long-term lung disease, kidney disease, some cancers, certain forms of heart disease, alcohol use disorder, liver disease, a rare disorder of the bone marrow (polycythemia vera), or a rare disorder of hemoglobin that binds oxygen tightly.
• Conditions that affect the body’s water content can also cause high RBC values. These conditions include dehydration, diarrhea or vomiting, excessive sweating, and the use of diuretics. The lack of fluid in the body makes the RBC volume look high; this is sometimes called spurious polycythemia.

White blood cell (WBC, leukocyte)

• Conditions that cause high WBC values include infection, inflammation, damage to body tissues (such as a heart attack), severe physical or emotional stress (such as a fever, injury, or surgery), kidney failure, lupus, tuberculosis (TB), rheumatoid arthritis, malnutrition, leukemia, and diseases such as cancer.
• The use of corticosteroids, underactive adrenal glands, thyroid gland problems, certain medicines, or removal of the spleen can also cause high WBC values.

Platelets

• High platelet values may be seen with bleeding, iron deficiency, some diseases like cancer, or problems with the bone marrow.

Low values

Red blood cell (RBC)

• Anemia lowers RBC values. Anemia can be caused by heavy menstrual bleeding, stomach ulcers, colon cancer, inflammatory bowel disease, some tumours, Addison’s disease, thalassemia, lead poisoning, sickle cell disease, or reactions to some chemicals and medicines. A low RBC value may also be seen if the spleen has been taken out.
• A lack of folic acid or vitamin B12 can also cause anemia, such as pernicious anemia, which is a problem with absorbing vitamin B12.
• The RBC indices value and a blood smear may help find the cause of anemia.

White blood cell (WBC, leukocyte)

Platelets

• Low platelet values can occur in pregnancy or immune thrombocytopenic purpura (ITP) and other conditions that affect how platelets are made or that destroy platelets.
• A large spleen can lower the platelet count.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• If the elastic band was on your arm a long time while the blood sample was taken.
• Taking medicines that can cause low platelet levels. Some examples of the many medicines that cause low platelet levels include steroids, some antibiotics, thiazide diuretics, chemotherapy medicines, quinidine, and meprobamate.
• A very high white blood cell count or high levels of a type of fat (triglycerides). These can cause falsely high hemoglobin values.
• Having an enlarged spleen, which may cause a low platelet count (thrombocytopenia) or a low white blood cell count. An enlarged spleen may be caused by certain types of cancer.
• Pregnancy, which normally causes a low RBC value and less often a high WBC value.

References

Citations

1. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

Current as of:
December 9, 2019

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine

Current as of: December 9, 2019

Author: Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine

Thalassemia: Complications and Treatment | CDC

If I have thalassemia, how does it affect my body?

Hear Robert Mannino discuss how iron overload affects the body and why it is important to stay on track with thalassemia treatments.

Since your body has fewer red blood cells when you have thalassemia, you may have symptoms of a low blood count, or anemia. When you have anemia, you might feel tired or weak. You might also experience:

• Dizziness
• Shortness of breath
• A fast heart beat
• Headache
• Leg cramps
• Difficulty concentrating
• Pale skin

Your body will try very hard to make more red blood cells. The main place where blood cells are made is the bone marrow, the dark spongy part in the middle of bones. Because your bone marrow may be working harder than normal, it might grow bigger. This causes your bones to expand, and may stretch your bones and make them thinner and more easily broken.

Another place where blood is made is an organ called the spleen. It sits on the left side of your abdomen, just under your lower ribs. The spleen has many other jobs. Two of the major ones are filtering the blood and monitoring the blood for certain infections. When it finds these infections, it can start the process of fighting them. When you have thalassemia, the spleen can get very big as it tries to make blood cells. Because it is working so hard on this job, it can’t work as hard to filter blood or monitor for and fight infections. Because of this, people with thalassemia are said to be “immunocompromised,” which means that some of the body’s defenses against infection aren’t working. When you are immunocompromised, it is easier for you to get infections and you sometimes need extra protection, like flu shots and other vaccines.

How is thalassemia treated?

Hear Robert’s tips on how to successfully transition to adult care for thalassemia.

The type of treatment a person receives depends on how severe the thalassemia is. The more severe the thalassemia, the less hemoglobin the body has, and the more severe the anemia may be.

One way to treat anemia is to provide the body with more red blood cells to carry oxygen. This can be done through a blood transfusion, a safe, common procedure in which you receive blood through a small plastic tube inserted into one of your blood vessels. Some people with thalassemia – usually with thalassemia major – need regular blood transfusions because their body makes such low amounts of hemoglobin. People with thalassemia intermedia (not as severe as major, but not as mild as trait) may need blood transfusions sometimes, such as when they have an infection or an illness. People with thalassemia minor or trait usually do not need blood transfusions because they either do not have anemia or have only a mild anemia.

Many times people with thalassemia are prescribed a supplemental B vitamin, known as folic acid, to help treat anemia. Folic acid can help red blood cells develop. Treatment with folic acid is usually done in addition to other therapies.

How do blood transfusions affect my body?

People who receive a lot of blood transfusions are at risk for iron overload. Red blood cells contain a lot of iron, and over time, the iron from all of the transfusions can build up in the body. When it builds up, the iron collects in places like the heart, liver, and brain, and can make it hard for these organs to work properly. To prevent iron overload, people with thalassemia may need chelation therapy, which is when doctors give a medicine – either a pill or a shot under the skin – to remove excess iron before it builds up in the organs.

Every time a person gets a blood transfusion, their risk for a problem called “alloimmunization” goes up. Alloimmunization happens when a person’s body reacts to blood from a transfusion because it is seen as harmful by their immune system, and tries to destroy it. Persons with alloimmunization can still receive blood transfusions, but the blood they receive has to be checked and compared to their own blood to make sure that it won’t be destroyed by their immune system. This takes time and can mean that persons with alloimmunization have to wait longer for blood, or may have a harder time finding blood that won’t be destroyed by their body.

Another concern for people who receive a lot of blood transfusions is the safety of the blood they receive. Some infections, like hepatitis, can be carried in blood. In the United States, the blood supply is screened and monitored for safety, and the risk of getting an infection from a blood transfusion is very low. Nevertheless, there is still a very small risk of getting an infection through a blood transfusion. Learn more about complications of transfusions in thalassemia.

Read more here about how CDC has been working with partners to better understand these health problems.

How is Pernicious Anemia Diagnosed?

Your doctor will diagnose pernicious anemia based on your medical and family histories, a physical exam, and test results.

Your doctor will want to find out whether the condition is due to a lack of intrinsic factor or another cause. He or she also will want to find out the severity of the condition, so it can be properly treated.

Specialists Involved

Primary care doctors—such as family doctors, internists, and pediatricians (doctors who treat children)—often diagnose and treat pernicious anemia. Other kinds of doctors also may be involved, including:

• A neurologist (nervous system specialist)
• A cardiologist (heart specialist)
• A hematologist (blood disease specialist)
• A gastroenterologist (digestive tract specialist)

Medical and Family Histories

Your doctor may ask about your signs and symptoms. He or she also may ask:

• Whether you’ve had any stomach or intestinal surgeries
• Whether you have any digestive disorders, such as celiac disease or Crohn’s disease
• About your diet and any medicines you take
• Whether you have a family history of anemia or pernicious anemia
• Whether you have a family history of autoimmune disorders (such as Addison’s disease, type 1 diabetes, Graves’ disease, or vitiligo). Research suggests a link may exist between these autoimmune disorders and pernicious anemia that’s caused by an autoimmune response.

Physical Exam

During the physical exam, your doctor may check for pale or yellowish skin and an enlarged liver. He or she may listen to your heart for rapid or irregular heartbeats or a heart murmur.

Your doctor also may check for signs of nerve damage. He or she may want to see how well your muscles, eyes, senses, and reflexes work. Your doctor may ask questions or do tests to check your mental status, coordination, and ability to walk.

Diagnostic Tests and Procedures

Blood tests and procedures can help diagnose pernicious anemia and find out what’s causing it.

Complete Blood Count

Often, the first test used to diagnose many types of anemia is a complete blood count (CBC). This test measures many parts of your blood. For this test, a small amount of blood is drawn from a vein (usually in your arm) using a needle.

A CBC checks your hemoglobin (HEE-muh-glow-bin) and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.

The normal range of these levels may be lower in certain racial and ethnic populations. Your doctor can explain your test results to you.

The CBC also checks the number of red blood cells, white blood cells, and platelets (PLATE-lets) in your blood. Abnormal results may be a sign of anemia, another blood disorder, an infection, or another condition.

Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. MCV can be a clue as to what’s causing your anemia. In pernicious anemia, the red blood cells tend to be larger than normal.

Other Blood Tests

If the CBC results confirm that you have anemia, you may need other blood tests to find out what type of anemia you have.

A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have pernicious anemia have low reticulocyte counts.

Serum folate, iron, and iron-binding capacity tests also can help show whether you have pernicious anemia or another type of anemia.

Another common test, called the Combined Binding Luminescence Test, sometimes gives false results. Scientists are working to develop a more reliable test.

Your doctor may recommend other blood tests to check:

• Your vitamin B12 level. A low level of vitamin B12 in the blood indicates pernicious anemia. However, a falsely normal or high value of vitamin B12 in the blood may occur if antibodies interfere with the test.
• Your homocysteine and methylmalonic acid (MMA) levels. High levels of these substances in your body are a sign of pernicious anemia.
• For intrinsic factor antibodies and parietal cell antibodies. These antibodies also are a sign of pernicious anemia.

Bone Marrow Tests

Bone marrow tests can show whether your bone marrow is healthy and making enough red blood cells. The two bone marrow tests are aspiration (as-pi-RA-shun) and biopsy.

For aspiration, your doctor removes a small amount of fluid bone marrow through a needle. For a biopsy, your doctor removes a small amount of bone marrow tissue through a larger needle. The samples are then examined under a microscope.

In pernicious anemia, the bone marrow cells that turn into blood cells are larger than normal.

Source: National Heart, Lung, and Blood Institute, National Institutes of Health.

Evaluation of Anemia in Children

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90,000 low, below normal, decreased hematocrit

Sometimes, in order to make a correct diagnosis, it is necessary to carry out special laboratory tests to determine the ratio of red blood cells to total blood volume. The percentage hct value can indicate how much of the plasma volume falls on a particular formed element of the blood flow. For a better understanding of what this means lowered hematocrit, you will need to reveal the definition of the term itself.

Concept of hematocrit

Hematocrit (Ht) is an indicator that reveals the number of formed components such as erythrocytes, platelets and leukocytes, in percentage terms in the blood stream.As a rule, it is the numerical value of red blood cells in relation to the total volume of plasma fluid that is calculated by detecting hct in a blood test. Because red blood cells make up 99% of the total number of all blood cells.

The hematocrit number is obtained using special devices:

1. Hematocrit is a pair of shortened, calibrated glass capillaries on a support. The determination process takes place by filling glass capillaries with the patient’s blood and an anticoagulant.And subsequent centrifugation of the composition until a stable erythrocyte column is obtained. The result obtained during the study is indicated as a fractional indicator, where the volume of shaped particles acts as the numerator, and the volume of plasma acts as the denominator.
2. Conductometer, which is a meter of the electrical conductive properties of blood, which is determined by the electrical resistance of erythrocytes.
3. Nomogram, which is a scale marked with the corresponding hematocrit values ​​and hemoglobin saturation readings.The hematocrit number is calculated in this way according to the established concentration of hemoglobin.

By detecting hematocrit, the ability of red blood cells to transport oxygen to organs, tissues and systems of the body is detected. The information obtained as a result of blood diagnostics allows the healthcare professional to determine the state of health of the patient. And also recognize the causes of low hematocrit.

Why the hematocrit decreases

A decrease in hematocrit occurs when there is a lack of red blood cells in the plasma.Iron deficiency anemia usually leads to such deviations. But not always, only due to a lack of iron, the hematocrit is lowered.

Such consequences can lead to:

• blood loss;
• pregnancy;
• increase in the amount of blood;
• blood thinning;
• rapid death of erythrocytes;
• delayed production of red blood cells;
• starvation or malnutrition;
• various diseases.

If studies reveal a low hematocrit, this is an important reason for additional examination. You will need to establish a reliable hematocrit of the cause. Since the source of the problem can be both a harmless error in nutrition, and the development of a serious ailment that can be cured only in the early stages.

Symptoms of low hematocrit

It must be borne in mind that an insufficient number of red blood cells, which form the basis of blood, always affects the well-being and general condition of the human body.

Before a low blood hematocrit is detected, a person may feel a general malaise.

This is due to the fact that the lack of red blood cells leads to oxygen starvation. Since it is the red blood cells that are entrusted with the important mission of supplying nutrients and oxygen to every cell of the body. And in addition, the return of waste carbon dioxide back to the lungs for excretion.

Signs of a low hematocrit number:

• Feeling tired.
• Feeling of lack of air.
• Pallor of the skin.
• Hair loss.
• Rapid heartbeat.
• Headaches.

When laboratory tests show a hematocrit below normal, there is no need to panic. First, it is necessary to eliminate a common factor that often reduces the hematocrit number – this is malnutrition and, as a result, a lack of iron and other important nutrients. If everything is in order with nutrition and in the near future there was no blood loss or pregnancy in women, then it makes sense to have a complete examination to detect a specific cause of hematocrit.

Norm of hematocrit number

It is especially important to monitor the hematocrit of a child, due to the fact that his body is just being formed. And the development of the whole organism depends on the state of the blood. A baby may be born with a deviation from the normal hematocrit number – this means that in the womb or during childbirth he suffered from hypoxia. And, as you know, oxygen starvation, especially in infants, can lead to irreversible consequences.

Children have a hematocrit value:

• newborn 34–64%;

90,015 up to a year 34–43%;

90,015 from one to five years 33-40%;

90,015 from six to twelve years 34–43%;

90,015 from twelve to seventeen years 35-45% for boys and 34-44% for girls.

An insignificant difference in the hematocrit value in adolescence in boys and girls is due to the onset of the menstrual cycle in the female body.

Only a qualified specialist can correctly interpret the test results.Children need to be tested more often than adults.

Due to the fact that the child does not always correctly name the symptoms, it is better not to trust the child’s assumptions, but to ascertain his state of health with the help of tests. As for adults, it will not be superfluous to periodically monitor, through laboratory tests, their well-being.

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General blood test of the child: hemoglobin, hematocrit, reticulocytes

most of us are not told anything at all.In this article, we want to talk about such indicators as: hemoglobin, hematocrit and reculocytes, which relate to one of the three formed elements – erythrocytes. We will start with them, and then we will go in order.

Erythrocytes in the general blood test of a child

In the article “General blood test of a child – basic concepts” it was said that red blood cells are one of the formed elements, but, in fact, they are the main cells. Their number is the largest in comparison with others, but conducting a general analysis implies determining their exact number in one liter.For this, a clearly measured, but very small, volume of blood is taken, placed in a special vessel and the number of these cells is counted under a microscope. After that, in proportion, the result is converted to an indicator per liter. The last number always has 12 zeros, and the result of the analysis is the number in front of them.

An increased level of erythrocytes, like hemoglobin, which will be discussed below, is possible in very rare diseases of the entire hematopoietic system. Most often, he says that this tissue thickens in the body, which is a consequence of a lack of fluid, and this happens with diarrhea, with vomiting, excessive sweating, etc.

A reduced level is an unambiguous sign of anemia, which is the result of:

• violation of the “reproduction” of erythrocytes or their destruction for any reason;
• blood loss.

Hemoglobin in the general blood test of a child

Hemoglobin itself, also referred to as Hb, is a protein, but special. Its peculiarity lies in the easy ability to connect and part with any gases. Oxygen is a gas and it is hemoglobin that combines with it in the lungs, then delivers it to the tissues of the body, gives it up there, combines with carbon dioxide, delivers it to the lungs, and again everything is repeated anew.By the way, it is in hemoglobin that the component that gives the red tint is contained. It is called gem.

The hemoglobin content in the results of a child’s general blood test is measured in grams per liter (g / l), i.e. expresses the total number of grams in one liter.

For children, unlike adults, the hemoglobin content is the same for both girls and boys. But right there it is worth noting that a newborn’s hemoglobin and erythrocyte count will always be elevated.This is normal and after birth begins the breakdown of the “excess” of erythrocytes, which lasts approximately 2-3 weeks.

Average hemoglobin content in an erythrocyte, color index

When calculating an indicator of hemoglobin content in an erythrocyte, the norm of which is considered to be a level of 30 – 35 pg ² , the amount of hemoglobin in one liter is simply taken and divided by the number of erythrocytes in the same liter …

In approximately the same way, but according to a more complex formula, taking into account the indicator of the norm, the color indicator is calculated.The norm for him is one, i.e. the number of erythrocytes and hemoglobin should be exactly equal to the accepted level as the norm.

Hematocrit in the general analysis of the child’s blood

The hematocrit index (also referred to as Ht) is one of the most informative and very important in the general analysis of the child’s blood. It reflects the ratio of the volumes of plasma and shaped elements. You can read more about the first and second concepts in the article “General blood count of a child – the main points.”Such a definition may seem too complicated and it is better to explain it using an example that is clear to everyone.

Let’s imagine a jar (let it be a liter) with the most common compote made from any berry. In our example, it will mean a liter of blood. So the liquid in our jar is plasma, and the berries floating in it are shaped elements. Compote can be different in its density and it depends on the number of berries floating in it. The more of them, the thicker the compote and this density, only in relation to our topic of conversation, reflects the hematocrit indicator.By its growth, thickening is determined, and by its decrease, conclusions are drawn about liquefaction.

Reticulocytes in the general blood test of a child

Reculocytes are the same erythrocytes (they are also referred to in the article “General blood test of a child – highlights”), but only young. Their presence does not indicate an illness – they are always there. Their appearance is a constant process, but the number of reticulocytes is determined by the body’s need for new erythrocytes. The number of reticulocytes is measured in ppm, expressing a thousandth of a specific total.

Attention !!!

Before comparing the results of your child’s general blood test with the average for red blood cells and shown in the table below, we want to note that an increase in the level of hematocrit, hemoglobin and red blood cells occurs with thickening of the blood, and this is a consequence of the loss of fluid in the body. In other words, if there is vomiting, diarrhea, general overheating of the body, excessive sweating, etc., leading to the withdrawal of fluid, then thickening and, consequently, an increase in indicators will occur.

You can read about the reliability of materials related to the child’s health by clicking on the link provided.

You can find more materials on child health in the section of the same name of our parents’ club by clicking on the link given, as well as in its subsection “Guide for parents”.

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08/27/2020

Complete blood count in a pregnant woman

So, what distinguishes the normal blood of a non-pregnant woman from the blood of a pregnant woman?

First of all, this is the amount of plasma.⠀

The volume of circulating blood during pregnancy is gradually increasing, as the mother works for herself and for the future baby. During pregnancy, a physiological decrease in some parameters occurs: the total number of erythrocytes and, accordingly, hemoglobin decreases. Now ATTENTION! for the diagnosis of anemia in pregnant women, these indicators are not enough. With a reduced amount of hemoglobin (below 110) and erythrocytes (below 3.5), it is recommended not to immediately diagnose ANEMIA, but to look at a few more parameters: ⠀

✔️ Form of erythrocytes.⠀

A mature, iron-rich erythrocyte is a biconvex disc that appears as a bright circle on a blood test. And if he is a pale ring, smaller in size, then you will see in the analysis – “hypochromia” and “anisocytosis” – the sure signs of anemia. ⠀

How to be sure? ➡️ ⠀

✔️ Determination of blood ferritin. ⠀

It is this analysis that shows the presence of iron in the granaries of the body. Only he will answer the question: is it just a slight dilution of the blood of a pregnant woman, or is it still a painful condition that requires therapy.Moreover, just the level of ferritin is an indicator of the effectiveness of the treatment. Not hemoglobin in a general blood test (!), But ferritin in an additional one. ⠀

Second Feature:

✔️ total number of leukocytes – leukocytosis (on average up to 11×10 in the 9th grade)

the higher the gestational age, the greater the number of leukocytes. The body reacts in this way to the fact that in the body “someone else, not quite your own”

by the way, it is for this reason that the number of leukocytes is increased in the vaginal smear, and not with inflammation!

✔️increased ESR – erythrocyte sedimentation rate.

The force that causes red blood cells to stick to each other, to settle, is a change in the composition of the blood. This happens with infections, inflammatory diseases, injuries.

during all these conditions, the amount of free protein in the blood increases and it settles on the surface of the erythrocyte, which becomes heavier and quickly adheres to its “brother”.

During pregnancy, the amount of proteins in the blood increases and, under their weight, erythrocytes settle faster and in large quantities.

Therefore, if there is a doubt about the ESR figures, and there is a suspicion of an inflammatory process, it is necessary to pass one more test – PROCALCITONIN. it is the only non-specific marker of inflammation in pregnant women.

You can individually consult, undergo diagnostics, analyze analyzes from our obstetricians-gynecologists by appointment by phone +7 3452 593957 or online

Diagnostic Center MEDLIFE-BIO

Complete blood count – a set of tests aimed at determining the number of various blood cells (erythrocytes, leukocytes, platelets), their characteristics and ratio.A complete blood count is the most commonly prescribed type of laboratory research. This test is used both for a general assessment of health status during routine examinations, before surgical interventions, as well as for diagnostics, determining a possible cause, and evaluating the effectiveness of treatment of anemias (anemia), infections and inflammatory processes, blood clotting disorders, leukemias (leukemias), allergies …

The following symptoms may cause a visit to a doctor and prescribing a complete blood count:
– weakness, fatigue, shortness of breath with light or moderate exertion, palpitations, headache, tinnitus, sleep disturbances, appetite, sexual desire – signs of anemia;
– pain in the affected organ, redness and swelling of the skin, fever, chills, headache, joint aches, decreased appetite – signs of infectious and inflammatory processes;
– blockage of blood vessels and, conversely, increased bleeding – signs of a violation of blood coagulation;
– anemia, increased bleeding, and infectious complications – can occur with leukemia;
– suffocation attacks, runny nose, eye inflammation, redness and swelling of the skin, indigestion are signs of allergies.

Given the high value of a complete blood count for the diagnosis of a wide range of diseases, its results must meet the high reliability requirements of . It should be noted that blood tests performed by “manual” methods have large errors and often cause justified criticism from both doctors and patients. It is from the point of view of the reliability of the results obtained that automated hematological analyzers have a number of advantages over “manual” research.
The main ones are:
– analysis of a large number of cells: more than 10 thousand, compared with 100-200 cells with a visual method of counting,
– standardization of each stage of analysis,
– minimization of the “human factor”.

Most of the hematological analyzers functioning in the laboratories of Ukraine determine up to 18 parameters of the general blood test, and are not capable of performing a complete analysis of the leukocyte formula. In the diagnostic center “Global-Diagnostic”, a general blood test is performed using a complex analytical system Sysmex XS-1000i (Japan) , which determines 24 parameters of a general blood test, and allows you to obtain a number of additional cell characteristics that cannot be assessed by visual analysis blood smear.The Sysmex XS-1000i analyzer not only performs a detailed blood test with differentiation of leukocytes into 5 subtypes, but also plots the distribution of leukocytes, erythrocytes and platelets by size. The analysis of these graphs provides additional diagnostically valuable information.
A unique feature of this analyzer is the ability to detect immature leukocytes, blasts, atypical and pathological lymphocytes. The presence of even 1% of such cells in a sample can be a sign of serious pathology, while when only 100 cells are analyzed in a smear, they can be “skipped”.
However, the role of the laboratory assistant in performing this study is also very important. The analyzer “issues” a special message about any deviations from the norm, as well as finds requiring additional research, and these samples are then analyzed “visually” by a qualified specialist to confirm and clarify pathological findings.
For analysis, both venous and capillary blood can be used.

Clinical and diagnostic value of indicators of the general blood test
Hematocrit (HCT) – the percentage of blood cells (formed elements) to its liquid part; is used in a comprehensive assessment of anemias and conditions in which the number of formed elements, on the contrary, increases (erythrocytosis, leukemia), helps to decide on the need for blood transfusion and to evaluate the results of this procedure.
Hemoglobin (HGB) is the main component of red blood cells, with the help of which they transport oxygen from the lungs to tissues and organs, and carbon dioxide from tissues and organs to the lungs. The concentration of hemoglobin in the blood is an important indicator for assessing the severity of anemia or erythrocytosis and for monitoring the effectiveness of therapy for these conditions.
Red blood cells (RBC) – cells containing hemoglobin and transporting oxygen and carbon dioxide in human blood. Determination of the number of red blood cells is necessary for the diagnosis of anemia or erythrocytosis and differentiation between different types of anemia.
Erythrocyte indices: provide information on the size of red blood cells and their hemoglobin content.
• average erythrocyte volume (MCV) – characterizes the size of these cells; it is necessary to determine the cause of anemia. So, for example, with a deficiency of vitamin B12, the size of erythrocytes increases, with a deficiency of iron, it decreases.
• mean erythrocyte hemoglobin (MCH) and mean erythrocyte hemoglobin concentration (MCHC) are complementary and are used instead of the obsolete and less informative color indicator.These indices help determine the cause of the anemia. So, for example, with a deficiency of vitamin B12 in enlarged erythrocytes, the content and concentration of hemoglobin are increased, and with a deficiency of iron, they are reduced.
• the width of distribution of erythrocytes by volume (RDW) – an indicator that determines the degree of difference in size of the patient’s erythrocytes. It is important in the early diagnosis of anemia, since it often changes earlier than the size of red blood cells. Allows you to evaluate the effectiveness of the treatment of anemia.
Leukocytes (WBC) – a group of cells whose main task is to detect foreign agents (bacteria, viruses) in the body and destroy them.Determination of the number of leukocytes is necessary for the diagnosis of infections, damage to body tissues, malignant tumors, bone marrow diseases.
Leukocyte formula – relative (%) and absolute number of leukocytes of different types: neutrophils, lymphocytes, monocytes, eosinophils, basophils. If counting the total number of leukocytes allows you to find out the total number of these cells, then the leukocyte formula is the number of cells of each type separately. This information is of great importance for the diagnosis of diseases, since each type of white blood cell performs a specific function.
Neutrophils – the most numerous of the leukocytes – are the first to fight against pathogens of bacterial and fungal infections and are the first to appear at the site of tissue damage (organ infarctions, burns, injuries, operations). An increase in the number of neutrophils is one of the main laboratory signs of any suppurative process. A decrease in the number of neutrophils may indicate primary damage to the bone marrow or its depletion, and is an unfavorable prognostic sign, as it increases the risk of infection.
With many severe infections, septic and purulent processes, malignant tumors, diseases of the bone marrow, the leukocyte formula changes due to an increase in the percentage of young forms of neutrophils: stab, metamyelocytes, myelocytes and promyelocytes. Such a change in the leukocyte formula is called a shift to the left. The Sysmex XS-1000i analyzer automatically detects and counts even the smallest (less than 0.5%) amount of these immature forms of neutrophils.
Eosinophils – protects the body from parasites, and also actively participate in allergic reactions. Therefore, the presence of parasites in the body or such allergic diseases as rhinitis, conjunctivitis, asthma, eczema are accompanied by an increase in the number of eosinophils in the blood.
Basophils – normally participate in the regulation of the permeability of the vascular wall, and in pathology – in the development of immediate allergic reactions, inflammatory processes.Therefore, if you are allergic to food or drugs, the number of these cells in the blood may increase. Also, an increase in the number of basophils may indicate bone marrow disease.
Lymphocytes are the main cells of the immune system, their main function is to recognize molecules (antigens) that are dangerous to the body and respond specifically to them. As a result of an adequate response to antigenic stimulation, an increase in the number of lymphocytes occurs; with an inadequate response, the number of lymphocytes may decrease.Lymphocytes are actively involved in the development of immunodeficiency states, infectious, allergic, oncological diseases, rejection of transplanted organs, as well as autoimmune processes. With these processes, the number of lymphocytes in the blood can change significantly.
Monocytes – cells involved in the body’s defense reactions. They are removed from the body by absorption (phagocytosis) of dying cells and bacteria. An increase in the number of monocytes in the blood can be a consequence of bone marrow diseases or antigenic irritation.
Platelets are cells that play an important role in blood clotting. If a person has a low platelet count, they are at increased risk of bleeding and bruising.
Platelet count (PLT) – often determines the likelihood of thrombosis or bleeding. The reasons for the change in the number of platelets can be bone marrow diseases, malignant tumors, infections, inflammatory diseases.
Thrombocritis (PCT ) is the proportion of whole blood volume occupied by platelets.
Platelet indices
Average platelet volume (MPV) and the percentage of large platelets (P-LCR) characterize the size of these cells, indicate their activity and rate of formation in the bone marrow.
Platelet Volume Distribution Width (PDW) is a measure of the extent to which a patient’s platelets differ in size, which can help determine the cause of a change in the number of these cells.

Erythrocyte sedimentation rate (ESR)
This technique measures the rate of erythrocyte sedimentation to the bottom of the capillary under the action of gravity.Bonding of erythrocytes leads to the formation of clusters (aggregates) of these cells, the weight of which is much higher than a single erythrocyte, and which therefore settle faster.
The ESR value depends on two main components. First? the presence and level of proteins-globulins in plasma, the amount of which increases during inflammatory processes due to infection, as well as in case of damage to body tissues (heart attack, burns, etc.). These proteins are fixed on the surface of red blood cells and stimulate their adhesion to each other.The second component is blood viscosity, which, first of all, depends on the number of erythrocytes themselves (a smaller number of erythrocytes is higher than ESR, and vice versa).
Unfortunately, very often the results of ESR determination by the traditional method for our country (Panchenkova) do not correspond to the clinical picture. This is not surprising, since this method is not subject to quality control and cannot be standardized!
First of all, it is not possible to standardize the procedure for obtaining capillary blood.Anyone who has donated blood from a finger for analysis at least a couple of times will agree that in order to obtain a sufficient amount of blood, the laboratory technician has to excessively compress the narrow puncture site. As a result of this, firstly, part of the erythrocytes can be destroyed, and secondly, a tissue fluid rich in globulin proteins enters the blood sample. Meanwhile, it is these two components that determine the ESR value.
In addition, a number of nonspecific factors affect the ESR value: the quality of the capillary, the correct dilution of blood with sodium citrate before the study, the quality of sodium citrate.
It should be noted that in developed countries for the “manual” determination of ESR, they use the Westergren method, which is recommended by the World Health Organization. The differences between the Westergren and Panchenkov methods are in the structure of the capillary. All methodological documents of the International Committee for Standardization in Hematology (ICSH) and the World Health Society strictly regulate that the inner diameter of the capillary must be at least 2.55 mm, but the inner diameter of the Panchenkov capillary is only 1 mm.If large accumulations of red blood cells are formed, then with such a narrow lumen, they can block their own sedimentation. As a result, the erythrocyte sedimentation rate is artificially reduced.
International standards also state that the length of the graduated working surface of the capillary for determining the ESR must be at least 200 mm. The Panchenkov capillary has a working surface length of 100 mm, which sharply limits the level of maximum ESR values.
However, the Westergren method is not ideal , and also has a number of disadvantages that make it difficult to use it effectively, namely:
1.Duration of obtaining results: 60 minutes, while the rest of the indicators of the general blood test can be obtained in 60 seconds.
2. Despite the standardization, the variability of the ESR determination results remains at a high level – the difference can reach more than 15%.
3. When a laboratory technician is working with dozens of samples at the same time, it is very difficult. Difficulty working with a series of samples. It takes about 30 seconds to load each sample into the ESR rack.If it is necessary to load 10 samples for ESR analysis, then from the setting of the first capillary to the last one takes on average 5 minutes, therefore, if we evaluate the last capillary in 60 minutes, then the first one in 65 minutes after setting. Moreover, if we take into account that the ESR between 60 and 66 minutes can change by 10 mm, then the results in the first capillary will be falsely overestimated.
4. Difficulty of standardizing the temperature regime for performing ESR measurements. According to ICSH recommendations, ESR analysis should be carried out at a constant temperature with fluctuations of no more than 1 ° C.This requirement is due to the fact that a change in temperature by one degree Celsius leads to a change in ESR by 3%.
5. The classical Westergren method is practically not amenable to automation.
6. One of the main limitations of the Westergren method is the impossibility of including this method in the quality control system, which makes the results obtained using this method approximate and unreliable.

The presence of the above limitations of the classical method for determining ESR according to Westergren forced the research laboratories of leading manufacturers in the field of laboratory equipment to look for new methods for its determination that would satisfy all the methodological and clinical needs of modern laboratories.Developments in this area have resulted in fully automated analytical systems for measuring ESR of the Roller type by Alifax (Italy). The unique method for determining ESR, implemented in this device, allowed to solve all the problems inherent in the classical Westergren method, while the correlation with the reference method is 95–99%.
According to the methodology of the Westergren reference method, the result of erythrocyte sedimentation is assessed once 60 minutes after setting, i.e.That is, he assesses not the sedimentation rate, but the amount of erythrocyte sedimentation in 1 hour. The principle of operation of the Roller analyzer is based on measuring the kinetics of erythrocyte aggregation, which is achieved by multiple evaluation (1000 measurements) of the optical density of the sample under study in a special capillary for 20 seconds. This means that these analyzers really measure the speed of the process. In addition, the analyzers offered by Alifax evaluate the most specific phase of the erythrocyte sedimentation process, namely the aggregation phase.
The introduction of automatic ESR analyzers into practice made it possible to eliminate the limitations associated with the classical Westergren method, namely:
1. The duration of one ESR study is 20 seconds, which allows you to receive a complete complete blood count within 1 minute, including the results of counting blood cells, differentiation of the formula and ESR.
2. The Roller analyzer uses whole blood with EDTA as a biological material for studying ESR, which makes it possible to determine ESR and perform automatic hematological analysis from one tube.This eliminates the need to collect blood separately with sodium citrate, and this greatly simplifies the blood collection process, reduces costs (there is no need to use special vacuum tubes with sodium citrate) and eliminates an additional source of errors associated with blood dilution and the quality of sodium citrate (in the case of if special tubes are not used).
3. Alifax analyzers are not sensitive to the influence of such sample properties as high / low hematocrit MCV, as well as to fluctuations in ambient temperature.
One of the main advantages of ESR analyzers offered by Alifax is the ability to include ESR studies in the quality control system. Special three-level control materials have been developed that allow quality control of ESR determination on the analyzer and Roller in accordance with all standards.
To date, a sufficient amount of material has been accumulated in order to draw a conclusion about the good diagnostic efficiency of using the ESR results obtained using the Roller analyzer.Some publications indicate a greater sensitivity of the ESR measurement result, in comparison with the classical Westergren method, for assessing active inflammation in cancer patients, as well as in patients with autoimmune diseases and infections.

ESR clinical application range: old and new possibilities.
A well-known fact is the dependence of ESR values ​​on age, sex, race (Table 8).

Table 8. ESR reference values ​​for different clinical groups.

The use of new standardized methods for determining ESR will expand the range of clinical application of the results of this test.The above reference values ​​developed for the Westergren method are applicable to the interpretation of ESR results obtained with the Roller analyzer.
The use of ESR for screening in the general population of people without clinical symptoms of the disease is currently not recommended. At the same time, this test can be useful in conjunction with the results of physical examination and history taking to identify pathological conditions in patients with clinical manifestations.It was demonstrated that in 68% of cases, the obtained high ESR values ​​confirmed the doctor’s clinical hypothesis, previously formed on the basis of anamnestic data and examination data. According to the recommendations of some authors, the ESR indicator can be used as the so-called “pain index” in the group of hospitalized patients. For example, the percentage of detection of new diseases among patients with an ESR level of up to 20 mm / h was 7%, and with an ESR level of more than 50 mm / h, this indicator increased to 66%.
Particular attention should be paid to the interpretation of ESR values ​​above 100 mm / h. Due to the limitations of the Panchenkov method, domestic clinicians are not familiar with the rules for interpreting an ESR level of more than 80 mm / h. Based on numerous clinical studies, it has been shown that the specificity of the test for pathological conditions increases in proportion to the increase in ESR values, and at levels above 100 mm / h, the number of false-positive results is reduced to zero. The most common causes of such high ESR values ​​are tuberculosis, metastatic tumors and paraproteinemia.The direction of further diagnostic search depends on other clinical data. For example, if a patient over 50 years of age without clinical signs of inflammation has an ESR level of more than 100 mm / h, then the next diagnostic step is to perform electrophoresis of serum proteins in order to detect the monoclonal component. In addition, ESR can be an additional criterion for the differential diagnosis between multiple myeloma (ESR> 50 mm / h) and benign monoclonal gammopathy (ESR
Over the past 20 years, a lot of publications have appeared, indicating the possibility of effective use of the ESR indicator for the diagnosis and monitoring of therapy for various pathological conditions.For example, one study demonstrated that detection of ESR> 40 mm / h and C-reactive protein> 60 mg / L in women with suspected pelvic inflammatory disease confirmed the diagnosis in 70%. Moreover, the degree of ESR growth correlated with the severity of the pathological process. Another study showed that an ESR level of more than 37 mm / h in patients with prostate cancer indicates a high risk of disease progression and death. The effectiveness of the use of ESR analysis in the diagnosis and assessment of the prognosis of coronary and cerebrovascular complications of atherosclerosis was studied.It was found that ESR values ​​above 22 mm / h in the group of patients aged 45-65 years are associated with a high risk of developing cardiovascular complications of atherosclerosis. In patients with ischemic stroke, a normal ESR level indicated a rapid recovery of neurological deficit, and ESR values ​​of more than 28 mm / h were associated with a poor prognosis.

What is the analysis used for

• preventive examination
• acute and chronic inflammatory processes,
• infectious diseases
• oncological diseases
• autoimmune diseases (diagnosis, prognosis).

Reasons for increased ESR

• Infectious diseases (more often of bacterial etiology).
• Inflammatory diseases.
• Diseases of the connective tissue (rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, vasculitis).
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis).
• Oncological diseases (myeloma, lymphogranulomatosis, cancer of various localizations).
• Myocardial infarction.
• Anemia.
• Burns, injuries.
• Amyloidosis
• Pregnancy

Reasons for a decrease in ESR

• Diseases accompanied by a change in the shape of erythrocytes, such as sickle cell anemia or hereditary spherocytosis
• Polycythemia and conditions that lead to it, such as, for example, chronic heart failure or lung disease.
• Hypofibrinogenemia.
• Dehydration.

Critical values ​​of indicators of a general blood test
A strong deviation of some laboratory parameters from the reference values ​​in one direction or another can lead to serious consequences for the patient, including life threatening.