The ABC of CBC: Interpretation of Complete Blood Count and Histograms DP Lokwani, Sunit Lokwani
INDEX
A
Abciximab 51
Abetalipoproteinemia 6, 21
ABO incompatibility 22
Acanthocytes 24
Acquired immunodeficiency syndrome 36
Acquired storage pool deficiency 53
Acridine orange 29
Acute coronary syndrome 57
Afibrinogenemia, congenital 53
African sleeping sickness 34
Aggregation defects 53
Agranulocytes 35
Alcoholism 13, 20, 53
Allergic disorders 149
Allergic reactions 36
Allergy 36
Alpha thalassemia, heterozygous 128
Alpha-granule deficiency 54
Amino acids 5
Amyloidosis, systemic 21
Anabolic metabolism 6
Androgens 5
Anemia 10, 13, 17
advanced megaloblastic 88
aplastic 6, 10, 13, 36, 40, 45, 51, 55, 56, 94, 136, 137, 148
autoimmune hemolytic 14, 22
chronic macrocytic 132
diagnosis of 3
dimorphic 13, 100
drugs-induced chronic macrocytic 132
dual deficiency 106
dyserythropoietic 23, 25
early megaloblastic 88
hemolytic 3, 5, 10, 24, 38, 133
hypochromic microcytic 14
hypoplastic 148
hypoproliferative 16
macrocytic 6, 13, 14, 26
megaloblastic 6, 10, 13, 22, 23, 25, 55, 56, 8890, 106, 130, 131, 148
microangiopathic hemolytic 6, 21, 22, 51
microcytic 14
mixed nutritional deficiency 133
nonmegaloblastic macrocytic 13
normocytic 13, 14
pernicious 6, 13, 26, 130
schistocytic hemolytic 21
severe 26
Anisocytosis 20, 79, 141, 145
Antibiotics 53
Antibody-synthesizing lymphocytes 49
Anticonvulsants 13
Anti-inflammatory agents 53
Antimicrobials 13
Antiplatelet antibodies 53
Antitumor agents 13
Aorta, coarctation of 21
Aplasia 12
Auer bodies 41
Auer rod 41
Autoagglutination 14
Autoimmune disease 53
Automated cell counters, advantage of 70
B
Babesiosis 34
Bacterial infection 35, 38, 118
Baso channel 119
Baso cytogram 118, 120122, 143147
method 118
Basophils 1, 44, 117
Bell cells 21
Bernard-Soulier
disease 54, 55
syndrome 52, 53
Beta thalassemia
heterozygous 75
major 106, 126
minor 127
trait 106
Bite cell 23
Bleeding
disorders 3
manifestation 51
peptic ulcer 22
severe 51
Blood
cell 6, 66
dyscrasias 16
films 27, 28
examination 33
loss 5, 6, 12
acute 6, 16, 53
chronic 6
low oxygen level in 12
transfusion 75, 106
Bone marrow 36, 144
aplasia 3
aspirate 141
failure 12, 56
hypoplasia 51
infiltration 51
production defect 16
replacement 25
stimulation 25
studies 16
Brugia
malayi 33
timori 33
Burns 21, 22, 40
injury 38
Burr cells 22
C
Cabot rings 26
Calcium mobilization 53
Cancer, metastatic 38
Capillary blood method 33
Capillary tube method 33
Carboxyhemoglobin 7
Carcinomatosis, disseminated 21
Cardiac patch 21
Cardiac valve, abnormal 21
Cathodal proteins 26
Celiac disease 13
Cell
counts 161
cytogram, cell distribution of 116
size 68
structure density 68
volume 68
Chagas disease 34
Chédiak-Higashi syndrome 41, 53
Chemotherapy 36, 51, 55, 56, 124
Chromatin 37, 38, 44, 46
Chronic disease, anemia of 10, 13, 20, 87, 128
Cirrhosis 10, 53
Clonal overproduction 53
Coagulopathy 153
Cobalt 5
Cold agglutinin 14, 52, 106, 135
disease 75
Collagen
diseases 45
vascular disease 12, 38
Comma-shaped cytogram 96, 127
Complete blood
cell 61
count 13, 31
Composite platelet index 58
Conductivity 68, 115
Connective tissue
diseases 26
disorder 21
Cor pulmonale 12
Corticosteroids 38
COVID-19 49
Crohn's disease 45
Cyanmethemoglobin method 7
Cyclooxygenase deficiency 53
Cyclophosphamide 13
Cytochemistry 144, 145
Cytogram 2, 80, 101, 126, 127, 131, 133, 135, 138, 146, 150
Cytomegalovirus 25, 51
Cytoplasm 37, 38, 4446
Cytotoxic chemotherapy 129, 148
D
Dacryocyte 21
Degmacyte 23
Dehydration 6, 12, 22
Dengue 36, 55, 57, 122
hemorrhagic fever 12
Di Guglielmo disease 13
Diabetes mellitus 26
Diarrhea
bloody 51
severe 12
Disseminated intravascular coagulation 6, 21, 51, 52, 57
Döhle body 40
Dracunculus medinensis 33
Drugs 36, 53
allergy 149
reactions 40
Dysproteinemias 53
E
Echinocytes 22
Eclampsia 38
Electronic impedance 68
Coulter's concept of 64
Elliptocytosis, hereditary 6, 22
Emphysema 6
Endocarditis, subacute bacterial 45
Endocrine disorders, anemia of 6
Enzyme deficiencies 6
Eosinopenia 44
Eosinophil 44, 117
Eosinophilia 44, 119, 149
Epinephrine 53
Epstein-Barr virus 51
Erythroblastosis fetalis 10
Erythroblasts, maturation of 6
Erythrocyte 5
fragmented 56
volume
fraction 11
histogram for 76
Erythroid hyperplasia 16
Erythropoiesis, ineffective 16
Erythropoietin deficiency 6, 12
Ethanol 51
Ethylenediaminetetraacetic acid 52, 61, 150
Exercise 53
F
Fanconi anemia 6
Ferritin 16
Fever 51
Fibrosis 51
pulmonary 6, 12
Filaria 3
Filariasis 33
subcutaneous 33
Fistula 13
Flow cytometry 80, 145
fluorescent dyes augmentation of 67
role of 66, 70
Fluid overload 5
Fluorescence flow cytometry 115
Fluorescent microscopy 29
after centrifugation 29
Folate 5
deficiency 13, 20, 36
anemia 75, 129
nutritional deficiencies of 12
Folic acid 3, 10
Free plasma hemoglobin 163
Fungal infection 25
G
Gametocyte 28, 29
Gastrointestinal tract lesions 6
Gaucher disease 53
Gaussian
curve 159
distribution 73, 159
Giant platelets 52, 162
Giemsa stain 27
Glanzmann thrombasthenia 53
Glomerulonephritis 21
Glucose-6-phosphate dehydrogenase deficiency 6, 21, 23
Glycolysis, defective 6
Golgi apparatus 47
Gram-negative bacterial infection 53
Granular lymphocyte 47
Granulocytes 35
immature 43, 120
Granulomas 6, 51
Gray platelet syndrome 53, 54
Guinea worm 33
Gynecologic disturbances 6
H
Hairy cell leukemia 36, 45
Heart
diseases 6, 12
failure 6
surgery 6
valve prosthesis 55
Heinz bodies 23, 24
HELLP syndrome 59
Hematinic treatment 75
Hematocrit 11, 14, 64
calculation of 2
normal range 11
Hematological scoring system 39
interpretation of 39
Hematology 1, 73
automated cell analyser, basic components of 65
automation 63
general principles of 63
Hematopoiesis, extramedullary 25
Heme synthesis 6
Hemocytometer 62
Hemodilution 5
Hemoglobin 7, 9, 14, 64, 102
concentration 7
distribution width 2, 17
measurement of 2, 8
normal range 7
Hemoglobinopathies 3, 6, 13, 20, 21, 26
Hemolysis 12, 14, 53
Hemolytic
disease 6, 134
disorders 6
uremic syndrome 21, 51
Hemoparasites 27
Hemorrhage 10, 12, 13, 38, 53
Heparin 51
Hepatitis 49, 51
Heterozygote 21
Hexokinase deficiencies 6
High fluorescence reticulocyte 10
High heparin concentration 14
High red blood cell count, causes of 6
High white blood cell counts, causes of 35
High-frequency radio wave 67
Histogram 2, 71, 73, 101, 126, 127, 139, 140
generation, general principles of 71
interpretation of 72
review of 162
Hodgkin's lymphoma 36
Homozygote 21
Howell-Jolly bodies 23
Human immunodeficiency virus infection 36, 51
Hydroxyurea 13
Hyperadrenocorticism 45
Hypereosinophilic syndrome 40, 149
Hyperglycemia 105, 163
Hyperlipidemia 8
Hypersegmentation 40
Hypersensitivity reaction 38
Hypersplenism 22, 52, 53, 55
Hypertension
malignant 21
portal 53
Hyperthyroidism 55
Hypervolemia 6
Hypoadrenalism 13
Hypochromic cell 20, 84
Hypogonadism 13
Hypopituitarism 13
Hypoplasia 12
megakaryocytic 55
Hyposplenia 23
Hypothyroidism 13, 20, 24
anemia of 13
Hypoxia 10, 25
I
Idiopathic thrombocytopenic purpura 55, 152
Immature platelet fraction 2, 56, 57
benefits of 57
Immature reticulocyte fraction 11
Immune
hemolytic anemia 92, 93, 129
thrombocytopenia purpura 52, 57
Impaired red blood cell production 5
Infections 6, 42, 5153
acute 26
chronic 13, 26, 35
congenital 25
malarial 31
mycobacterial 25
parasitic 149
severe 40
Inflammation 38
chronic 6, 45
non-infectious 53
Inflammatory disorders 151
Influenza 36
International Council for Standardization in Hematology 7
Intestinal resection 13
Iron 3, 5, 10
deficiency 85, 86
advanced 84
anemia 6, 20, 22, 23, 53, 75, 106, 125, 128, 151
early 83
severe 21
nutritional deficiencies of 12
serum 16
J
Jaundice, alcoholic 26
K
Ketoacidosis 38
Kidney disease 10, 12
L
Laser
light
application of 66
scatter 67
technology 68, 80
Lead
poisoning 24, 26
toxicity 26
Leishman stain 34
Leishmania 3
Leishmaniasis 33
Leukemia 10, 12, 26, 36, 51
acute
lymphatic 145
lymphoblastic 139
lymphocytic 36, 121, 139
myelogenous 121
myeloid 36, 142, 143
chronic
granulocytic 53, 151
lymphocytic 36, 53, 102, 122, 143
myelogenous 36, 56
myeloid 53
myelocytic 38
promyelocytic 121
Leukemoid reaction, causes of 42
Leukocyte
alkaline phosphatase score 42
maturation, stages of 36
mononuclear 35
Leukocytosis 14, 35, 38, 118
Leukoerythroblastic reaction 21, 22, 25
Leukopenia 35, 119
Levey Jennings chart 156
Light absorption 68
Lipemia 14
Lipoxygenase deficiency 53
Lithium 38
Liver
cirrhosis 21
disease 13, 2022, 25, 26, 129
disorders 53
Low fluorescence reticulocyte 10
Low white cell counts, causes of 36
Lung diseases 6
Lupus erythematosus 12
Lymphatic filariasis 33
Lymphoblast 46
Lymphocyte 46, 47, 117, 163
activation 49
atypical 48
reactive 49
Lymphocytosis 49
Lymphoma 48
spillage 36
Lymphopenia 49
Lymphoproliferative
disorders 51
solid tumors, spillage of 3
M
Macrocytes 99
Macrocytic red cells 20
Macroglobulinemia 26
Malabsorption 24
Malaria 3, 6, 22, 27, 36, 51, 55
antigen detection 31
detection, automation based 31
diagnosis of 27
parasite 27
serology-antibody detection 30
Malignancy 26, 40, 51, 53, 149
metastatic 3
Malignant cells 36
Malnutrition 12
Manganese 5
Mansonella
ozzardi 33
perstans 33
streptocerca 33
Manual reticulocyte count 9
Marrow
aplasia 16
depression, drugs-induced 148
Maturation disorder 16
May-Hegglin
anomaly 51, 55
disease 54
Mean cell hemoglobin concentration 64
Mean corpuscular
hemoglobin 13, 14
concentration 13, 14
volume 13, 15, 76
normal range 13
Mean platelet
component 57
mass 57
volume 2, 52, 55, 57, 64, 113
Measles 36
Mediterranean macrothrombocytopenia, benign 52
Medium fluorescence reticulocyte 10
Megathrombocyte 52
Membrane
filtration 33
lipids 6
skeleton proteins 6
Mentzer index 85
Metamyelocyte 37
Metastasis 51
Methemoglobin 7
Methotrexate 13
Microcytes 99
Microfilaria, appearance of 33
Microhematocrit tube 33
Mismatch transfusion reactions 6
Monoclonal gammopathy 141
Monoclonal proteins 14
Monocytes 117
Monocytopenia 45
Monocytosis 45
Mononuclear cells, positions of 118
Mononucleosis, infectious 45, 146
Multiple angle polarized scatter separation 66
Myeloblast 36
Myelocyte 37
Myelodysplasia 52, 55, 133, 147
Myelodysplastic syndrome 3, 6, 13, 16, 20, 24, 51, 53, 57, 120
Myelofibrosis 36, 104, 133
idiopathic 53
Myeloid metaplasia 38
Myeloma, multiple 12, 26, 48, 141
Myelophthisic anemia 6, 13
Myelophthisis 6
Myeloproliferative disorders 16, 21, 38, 52, 53, 55
Myocardial infarction 38, 50
N
Neonatal sepsis, early diagnosis of 39
Neoplasms 13, 42
Neutropenia, causes of 39
Neutrophil 117, 120
apparent absence of 139
dysplasia 118
granularity
index 43
intensity 43
reactivity intensity 43
volume 43
Neutrophilia 38, 45
Nonmegaloblastic macrocytosis 106
Normal red blood cells values 5
Nuclear chromatin 45
Nuclear density analysis 118
Nucleus 44
Nutritional deficiencies 3, 12
O
Onchocerca volvulus 33
Oral contraceptives 13
Organ failure 16
Ovarian tumor 124
Oxidative stress 6
P
Packed cell volume 11
Pantothenic acid 5
Pappenheimer bodies 24
Parasitemia 3, 27
Paroxysmal nocturnal hemoglobinuria 6
Pelger-Huët anomaly 41
Penicillins 51
Peripheral blood smear 141
examination 18, 27
preparation 18
Peripheral smear 63, 132, 143, 147
examination 58
Perox cytogram 117, 120122, 144, 147
method 117
Peroxidase
activity 118
staining 115, 117
Phenytoin 13
Plasma
cell 47
protein 8
Plasmacytoid lymphocyte 48
Plasmodium
antigens, detection of 30
falciparum 27
malariae 27
ovale 27
vivax 27
appearance of 28
Platelet 50, 124153, 163
adhesion defects 53
agglutination 52, 150
clumps 162
component distribution width 58
count 2, 50, 51, 63
derived histograms 113
destructions 52
disorders of 54
distribution
curves 113
width 56, 113
function defects 53
histogram 107, 113, 162
index 113
lineage 58
parameters 3, 4
production 51
selective marrow suppression of 51
satellitism 52, 162
scattergram 122
volume histogram for 113
Pleomorphic plasma cells 141
Poikilocytosis 20
Polychromasia 25
Polychromatophilia 25
Polycythemia vera 6, 12, 36, 38, 53, 151
Polymerase chain reaction 31
Polymorphonuclear
cells 118
leukocytes 35
Polymorphs 38
Postradiation marrow depression 148
Post-splenectomy 13, 21, 2325
Post-therapy megaloblastic anemia 131
Post-transfusion 22
purpura 51
sample 138
Pregnancy 10, 16, 58
macrocytic anemia of 13
Prematurity, anemia of 6
Primidone 13
Progranulocyte 37
Prolymphocyte 46
Promyelocyte 37
Prosthetic
cardiac valve 21
valve surgery 6
Pseudoleukopenia 36
Pseudo-Pelger-Huët anomaly 41
Pseudothrombocytopenia 52, 150
Psittacosis 36
Pure red cell aplasia 6
Pyrimethamine 13
Pyruvate kinase deficiency 6, 22
Q
Quality control 154, 162
data, analysis of 159
direct 155
external 158
indirect 154
internal 154, 155
methods 158
monitoring 154
purpose of 154
Quantitative buffy coat 29
Quinine 51
R
Radiation 51
therapy 36
Radiofrequency 1, 68, 115
Real-time polymerase chain reaction 31
Red blood cell 2, 5, 62, 124153
anisocytosis 79
count 2
cytogram 75, 80, 83, 84, 91, 92, 94, 98, 104, 125, 129, 136
fragmentation 90, 91
histogram 75, 82, 125, 162
abnormal 77
hyperchromia 80
lineage 58
macrocytosis 78
maturation defect 16
microcytosis 78
morphology 145
clinical importance of 19
nucleated 25, 162
parameters 3, 4
Red cell
agglutination 163
agglutinins 101
count 63
cytogram 88, 100, 130, 132
distribution width 2, 15, 17
double populations of 75
fragmentation 91, 133, 163
Renal disease, end-stage 10
Renal failure 16, 22, 51
acute 38
anemia of 6
Renal insufficiency 51
Renal neoplasia 6
Reticulocyte 9
count 10, 69
automated 9
normal range of 9
hemoglobin 2
measurement 10
production 16
proliferation index 10
Rheumatoid
arthritis 12, 36, 53
disease 45
Riboflavin 5
Rickettsial infections 36
Rouleaux formation 26, 141
Rubella 25
Rule of three 12
S
Sahli acid hematin method 8
Sarcoidosis 45
Schistocytes 21
Sepsis 25, 36, 55, 57, 118
postoperative 140
severe 148
Septicemia 140
Serum immunoglobulin electrophoresis 141
Sickle cell 25
anemia 3, 6, 14, 55, 97, 129
Sickle crisis 129
Sideroblastic anemia 13, 20, 24, 99, 133
Siderotic granules 24
Small lymphocyte 46
Smudge cell 48, 143
Spherocytes 22
Spherocytosis 106
causes of 22
hereditary 6, 14, 22, 23
Spheroschistocytes 21
Spleen
enlargement of 36
hyperfunction 12
Splenectomy 24, 38, 53, 55, 151
Spur cell 24
Steatorrhea 13
Stem cells 6
Stomach cancer 22
Stomatocyte 23
Storage pool disease 53, 55
Stress 35, 45
physical 35
Sulfamethoxazole 13
Sulfasalazine 13
Syphilis, congenital 25
Systemic lupus erythematosus 21, 36, 45, 51, 53
T
Tear drop cells 21
Thalassemia 3, 6, 10, 21, 25, 26
heterozygous 96, 128
major 21, 22
minor 20
trait 128
Thiamine 5
Thrombasthenia 53
Thrombocytes 50
Thrombocythemia
essential 53, 54, 56, 57, 151
primary 53, 54, 151
Thrombocytopenia 3, 5153, 57, 58
absent radii syndrome 51, 55
amegakaryocytic 51
causes of 51, 58
drugs-induced 51
gestational 59
idiopathic 51
infection-related 55
mild 53
severe 51
Thrombocytopenic purpura 152
Thrombocytosis 53
reactive 57
Thrombopoiesis 56
Thrombotic thrombocytopenic purpura 21, 51, 52, 54, 57
Thromboxane
A2 receptor deficiency 53
synthetase deficiency 53
Thyroid hormone 5
Tissue
damage 35
injury 38
Toxic granulation 40, 145
Toxins 51
Transfusion therapy 24
Trauma 6
Trimethoprim 13
Trophozoite 27, 28
Trypanosoma
brucei 34
cruzi 34
Tuberculosis 36, 45
Tubular necrosis, acute 21
Tumors, malignant 6
Typhoid 36
U
Ulcerative colitis 45
Uremia 13, 21, 25, 53
V
Vasculitis 51
Venous blood method 33
Viral infections 35, 45, 48, 53, 122
Vitamin
B12 3, 5, 10, 13, 20, 75, 129
deficiency 6, 130, 131
impaired absorption of 6
B6, nutritional deficiencies of 12
E deficiency 24
Volume conductivity scatter technology 115
von Willebrand disease 51, 53
W
Waldenström's macroglobulinemia 48
Water-dilution hemolysis 22
Westgard rules 156158
White blood cell 2, 31, 35, 107, 124153
count 2, 35, 63
histogram
abnormal 108
types of 111
lineage 58
parameters 3, 4
volume histogram for 107
Wiskott-Aldrich syndrome 51, 53, 55
Wuchereria bancrofti 33
X
X-linked lymphoproliferative disease 49
Y
Y-axis 80
Z
Zidovudine 13
×
Chapter Notes

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The ABC of CBC Interpretation of Complete Blood Count and Histograms
The ABC of CBC Interpretation of Complete Blood Count and Histograms
Second Edition
DP Lokwani MD Former Founder Vice-Chancellor Madhya Pradesh Medical Sciences University Jabalpur, Madhya Pradesh, India Professor and Head Department of Pathology Netaji Subhash Chandra Bose (NSCB) Medical College Jabalpur, Madhya Pradesh, India Former Honorary Dean (Academics) Diplomate National Board Courses Jabalpur Hospital and Research Center Jabalpur, Madhya Pradesh, India Sunit Lokwani MD DM Consultant Hematologist and Medical Oncologist Shalby Group of Hospitals Jabalpur, Madhya Pradesh, India Foreword MB Agarwal
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The ABC of CBC: Interpretation of Complete Blood Count and Histograms
First Edition: 2013
Second Edition: 2022
9789390595983
Printed at
Dedicated to
BabajiMy Spiritual Master
My ParentsMy Blessings
My TeachersMy Strength
My StudentsMy Treasure
My PatientsMy Experience
Foreword
Hematology has advanced by leaps and bounds during the last two decades. Sophisticated laboratory investigations have moved from research to clinical laboratories. This is an era of polymerase chain reaction (PCR), fluorescence in situ hybridization (FISH), flow cytometry, etc. One may feel that trying to read a book dedicated to complete blood count (CBC), may not be worth the time spent. However, we teach our students that in clinical practice, history and examination of the patient are of more importance than various investigations ordered costing thousands of rupees. Similarly, a well-executed “CBC” followed by its proper interpretation has its worth in gold and a shrewd clinician can make tremendous use of this simple and cheap test for diagnosing hematological or even non-hematological disorders.
All of us order CBC as the first and unavoidable test in our clinical practice. A student also talks of CBC as a routine test without giving it any importance. To write a book on such a test is bringing back some respect to the test that it deserves.
DP Lokwani has done a laudable job in writing this book on “CBC” and histograms in the era of sophisticated laboratory techniques. I have been told that he has utilized data collected over thousands of CBCs and histograms to prepare this book and that makes the book even more important. There is no match to the knowledge generated out of the experience and this is what he has done. The book has been written based on material collected over seven long years of his huge practice and hence the information provided is useful not only to students but also to the practicing clinicians and teachers in the field of hematology, pathology, and allied branches.
I had the opportunity of going through the book which also has 30 case illustrations. This makes the discussion even more lively and practical. I have no hesitation in recommending the book to be on the shelf of everyone even remotely connected with CBC.
MB Agarwal MD MNAMS
Head
Department of Hematology
Bombay Hospital Institute of Medical Sciences
Mumbai, Maharashtra, India
Book Review
Despite the enormous advances made in immunophenotyping and cytogenetics and molecular aspects of hematology, the analysis of the composition of peripheral blood and the observation of the peripheral blood smear at the microscope remains fundamental in the diagnosis of hematological disorders, as well as in many other areas of clinical medicine. The complete blood count (CBC), in effect, has evolved during the last decades from a short-list of numerical results to a real-time representation of the functional status of hematopoiesis. New automated instruments have immensely improved the speed and reproducibility of quantitative measurement of the EDTA-anticoagulated blood. Original cellular parameters, in addition to the classical CBC and WBC differential count, have been devised and made available to the laboratory operators, such as RDW, IRF, CHr, Ret-He. Flags for abnormal cells are important to identify samples that need a microscope review, and their sensitivity and specificity are continuously improving with a reduction in the rates of false-positive and false-negative results. Such instruments, including the morphology of cell distribution in histograms and scattergrams, must be interpreted by the trained and skilled human eye and brain so that the full spectrum of diagnostic information present in such a simple analytical report is fully exploited. Thus, the study of the new methods is a necessary complement to practice for those who are approaching the laboratory hematology of the year 2000. Similarly, the knowledge of hematological pathologies and cellular aberrations in the different diseases remains a cornerstone for the interpretation.
The ABC of CBC, wisely conceived, scientifically devised, and skillfully written by DP Lokwani, represents an excellent and authoritative reference tool to answer the need for knowledge in the area of laboratory hematology.
Besides a clear and comprehensive text, the book is full of microscope cell images, diagrams, histograms, and scattergrams. It indicates to the reader the best approach to fully appreciate and exploit all the new information and the advanced diagnostic features of the current automated technologies for CBC. Throughout the pages, it is easy to appreciate the value of the wide spectrum of clinical information present in an instrumental report. In the different chapters, we find technical descriptions of diagnostic methods, often in a historical perspective (for instance, see page 7 and chapter 6), as well as a description of both the basic and the new hematological measurements. These include some valuable time-honored practical information, such as the “rule of 3” (page 12). The pages are also rich in colorful drawings, visually illustrating some otherwise abstract concepts so that the rigorous scientific approach does not impede the Author's lively creativity and artistic talent. the use of images is very important to catch the imagination, the interest, and the concentration of students and readers; a representative and vivid figure will never be forgotten. Updated scientific information also covers very specific areas, with significant practical impacts, such as the possibility of detection of malaria parasites using automated blood cell count (page 31) or the importance of osmotic changes in red cells due to hyperglycemia (page 105). Chapter 6 describes the interwoven roles of automated and manual methods, while chapter 7 gives detailed and original clues for the interpretation of cell distribution in the instrument histograms. Cell distributions in a large number of disorders are also shown and explained, from aplastic anemia to HBH disease, from iron deficiency to myelofibrosis. Chapter 10, in which the author presents 30 well-documented clinical cases selected to represent a wide range of clinical conditions is among the most valuable features of this textbook. Finally, the author does not forget that perfect technical quality of testing represents an unavoidable premise to any diagnostic observation; the last chapter thus reminds the important rules of quality control, that all laboratory operators must know and use with great attention.
“The ABC of CBC” indicates to us how correct and informed use of the automated blood cell count can represent a bridge between the traditional laboratory diagnosis of blood disorders and the latest diagnostic technologies. Discoveries and capabilities have not canceled or replaced the classical methods, but have increased their value. Even in the era of molecular medicine textbooks like this still play a central and unique role in the training of the new generation of blood professionals in laboratory hematology.
Prof. Gina Zini
Director of Blood Bank
Director of UNICATT Cord Blood Bank
Fondazione Policlinico Universitario A. Gemelli IRCCS - Roma
Università Cattolica del Sacro Cuore, Rome
Preface to the Second Edition
The second edition, a step forward from the first edition, has been derived from the marked increase in documented innovations over the last few years and their applicability in diagnostic improvisation.
Increasingly enough, medical practitioners have recognized the use of these improved techniques and equipment. I have kept the essential backbone of the informatics; the story is the same as in the previous edition.
All the old chapters have been overhauled, most of them significantly restructured, updated, and extended. There are many new sections within the updates chapter covering relevant recent advances and applications in clinical practice.
As the test menu in the clinical laboratory is complex and as computer's increasing ability to generate and interpret newer and newer parameters within the same sample of CBC is getting incorporated in the cell counter technology, it becomes a call of the times to update the commonly referred elaborate document ABC of CBC for the better understanding of this very basic and most demanded investigation.
Updates in this ever-evolving subject have been happening by leaps and bounds. It seemed a foolhardy mission for me to cope up with the ever-changing dynamism of the subject of CBC, with the diversity of philosophies and their products of cell counters of various brands, this homogenous take would not have been possible without the help of Dr. Sunit Lokwani, who made this exercise more workable in the available time as well as in the scientific frame.
Apart from many relevant changes and additions made to each chapter, the most liked chapter of this book “Interpretation of Histograms” has been enriched with RBC cytograms and WBC scatterograms in various disease conditions with their interpretation and practical application in diagnostic medicine.
DP Lokwani
Preface to the First Edition
Diagnosis is not the end but the beginning of practice—Martin H Fischer
The complete blood count (CBC) is one of the most frequently ordered and routinely done investigations in the hematology laboratory. It is a Pandora's Box of information, which aids in the diagnosis of a multitude of diseases and disorders in the human body. This simple investigation, aptly labeled as the “meat and potatoes of hematology”, is economical, the time-honoring, minimally invasive, and exorbitantly informative.
This book is a navigation guide for students and practitioners alike related to pathology and clinical subjects, as nearly all body ailments have a direct or indirect influence on the blood picture. Hematology is all about relationships, like the relationships of the bone marrow to the systemic circulation, the plasma environment to the red cell lifespan, and hemoglobin to the red cell, so the book and you, the students and practitioners, are a vital part of this relationship.
With the changing dynamics of technology, the last decade has brought forth a radical change in hematology. The wheels of hematology have moved from predominantly manual practice to highly advanced automation. The Coulter principle and Coulter counter was a landmark in the field of hematology, and the prolific Coulter's revolutionized laboratory procedures changed the face of medicine by turning hematology guesswork into accuracy. What is needed for the novice practitioner is a way to approach interpreting the visual automated data. This skill is neither necessarily practiced at university programs, nor much of the literature is available in the racks of medical libraries dedicated to the subject of CBC in this era of automation.
The book aims to help the student bridge the gap between the classroom and clinical practice; introducing the automation principles in hematology along with interpretation and deciphering of various parameters like red cell distribution width (RDW) and histograms which carry a lot of encrypted diagnostic information because eyes can see only those things which brain knows. Although the data of the automated blood count alone will not guarantee specific diagnosis in every case, yet does every disease have a single pattern of abnormality. Rather these values should be used to narrow the differential diagnosis as much as possible, so that more expensive and time requiring, a confirmatory battery of expensive investigations like vitamin B12, folic acid, serum iron, total iron-binding capacity (TIBC) estimations, or Hb electrophoresis, etc., is done only selectively and invasive procedures like bone marrow aspiration and biopsy can be avoided, by proper evaluation of CBC.
The approach of the book is as simple, straightforward, and user-friendly as possible. I hope that clinical residents and consultants will find the book useful and also the text will travel with you, as you continue your career in the laboratory profession and the information will motivate you arousing your intellectual curiosity.
Attempt is virgin, mistakes are mandatory, corrections and suggestions are solicited.
DP Lokwani
Acknowledgments
A long time back, I had this dream, a vision of presenting a book on Hematology to the members of my fraternity.
And here I am with my pristine venture, 2nd edition of The ABC of CBC.
First and foremost, I thank Babaji (My Spiritual Master), for giving me the ability, skill, and courage to complete this arduous task and fulfill this long-awaited dream.
Most humbly I am indebted and grateful to my mother, Mrs Heerdevi, for her incessant prayers and blessings and to my father, Mr Kishinchand Lokwani, for making me what I am today and instilling in me his virtues.
I am immensely grateful to my siblings, Shobha, Roopa, Vasu, Chandar and Pushpa, for having staunch faith in me and my capabilities.
I acknowledge my gratitude to all my teachers, both formal and informal, who have influenced my professional standing the most with a special mention to Dr PL Tandon and Dr BC Chhaparwal.
It is gratifying to be able to acknowledge at this platform my immeasurable gratitude and admiration for Dr MB Agarwal, who has been my role model and a perpetual source of inspiration.
I will fail in my duty if I don't especially mention the hardwork put in by beloved Shweta to shape the 2nd edition.
My professional growth has been nurtured by my supportive wife, Dr Lakshmi Lokwani, who made it possible for me to spend endless uninterrupted evenings at my desk, and encouraging me all the way.
I am immensely grateful to my beloved friend and my source of inspiration Dr Rajesh B Dhirawani, an eminent maxillofacial surgeon, who has guided the sails of my life towards a prosperous shore.
A very special mention to Dr Pushpraj Singh Baghel, my student, for his untiring efforts and dedication; without his support, this mammoth task would not have been completed in time. He has spent with me endless strenuous hours in the shaping and framing of the book. He has been a cardinal buttress in the foundation of the book. I consider myself extremely fortunate to have such a prized student and also thank my student Dr Apoorva.
I sincerely acknowledge the efforts and elementary research on this subject by Dr Bessman, who systematically addressed the use of histograms and dedicate to him, with deference, humility, and respect.
A special thanks to my workplace, Jabalpur Hospital and Research Center, Jabalpur, Madhya Pradesh, India, and all its consultants and patients and my colleagues at Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, Madhya Pradesh, India, and Mahatma Gandhi Memorial (MGM) Medical College, Indore, Madhya Pradesh, India.
Most importantly, my beloved children, Anita, Manisha, Hitesh, Kavneet, and my dearest granddaughter Kavya, for being my source of energy. I will fail in my duty if I don't especially mention the hard work and skilled efforts put in by my daughter-in-law Dr Shweta Lokwani to shape the 2nd edition.
It will be lapse on my part if I don't appreciate the cooperation and contribution of cell counter research and manufacturing giants Siemens, Mindray, Abbott, Sysmex, and others.
Gratitude towards all the students, practicing doctors, and all readers who have taught me so much about laboratory medicine and inspired me to bring forward this second edition.
Sincere thanks to Prof Gina Zini of Rome for her very sincere review with expert guidance.
I am extremely grateful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving me this opportunity to dissipate my work to the people of my fraternity.
Glossary of Terms Employed in Automation and Hematology