Haematology profile

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Haematology is the study of blood and blood disorders. The NHS suggests a haematology profile may to detect signs of infection or inflammation and bleeding or clotting disorders. This profile includes 13 readings including white blood cells, red blood cells and a platelet count and can help diagnose anaemia, infection, haemophilia, blood-clotting disorders, and leukaemia.

About

Blood is composed of a variety of living cells that circulate through the heart, arteries and veins carrying nourishment, hormones, vitamins, antibodies, heat and oxygen to the body’s tissues. Blood contains three main components — red blood cells, white blood cells, and platelets — suspended in a fluid, called plasma. Red blood cells contain haemoglobin, a protein that carries oxygen to all the tissues of the body. Among other functions, white blood cells are responsible for protecting the body from invasion by foreign substances such as bacteria, fungi and viruses. White blood cells also control the immune process. Platelets help the blood clotting process by plugging holes in broken blood vessels.


The FBC is used as a broad screening test to check for such disorders as anaemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following:
  • White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant.
  • White blood cell differential: looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person’s white blood cells into each type: neutrophils (also known as PMNs), lymphocytes, monocytes, eosinophils, and basophils.
  • Red blood cell (RBC) count: is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.
  • Haemoglobin measures the amount of oxygen-carrying protein in the blood.
  • Haematocrit measures the amount of space red blood cells take up in the blood. It is reported as a percentage (0 to 100) or a proportion (0 to 1).
  • The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to bleeding or bone marrow disorders.
  • Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced.
  • Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal (macrocytic), for example in anaemia caused by or folic acid deficiency. When the MCV is decreased, your RBCs are smaller than normal (microcytic), which may indicate iron deficiency anaemia, inflammation or occasionally thalassaemias.
  • Mean corpuscular haemoglobin (MCH) is a calculation of the amount of oxygen-carrying haemoglobin inside your RBCs. Since macrocytic RBCs are larger than either normal or microcytic RBCs, they would also tend to have higher MCH values.
  • Mean corpuscular haemoglobin concentration (MCHC) is a calculation of the concentration of haemoglobin inside the RBCs. Decreased MCHC values (hypochromia) are seen in conditions where the haemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anaemia, long-standing inflammation or thalassaemia. Increased MCHC values (hyperchromia) are seen in conditions where the haemoglobin is abnormally concentrated inside the red cells, such as in hereditary or autoimmune spherocytosis.
  • Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. In some anaemias, such as iron deficiency or pernicious anaemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW.
  • Erythrocyte sedimentation rate (ESR or sed rate) is a test that indirectly measures the degree of inflammation present in the body. Inflammation is part of the body’s immune response. It can be acute, developing rapidly after trauma, injury or infection, for example, or can occur over an extended time (chronic) with conditions such as autoimmune diseases or cancer. The ESR is not diagnostic; it is a non-specific test that may be elevated in a number of these different conditions. It provides general information about the presence or absence of an inflammatory condition.

Preparation

No test preparation is needed.

Indications

The haematology profile is a very common set of test a used to screen for, help diagnose, and to monitor a variety of conditions.


If you are having symptoms, such as fatigue or weakness, or have an infection, inflammation, bruising, or bleeding, then the doctor may order FBC to help diagnose the cause. Significant increases in WBCs may help confirm that an infection is present and suggest the need for further testing to identify its cause. Decreases in the number of RBCs (anaemia) can be further evaluated by observing changes in size or shape of the RBCs to help determine if the cause might be decreased production, increased loss, or increased destruction of RBCs.


Many conditions will result in increases or decreases in cell populations. Some of these conditions may require treatment, while others will resolve on their own. Some diseases, such as cancer (and chemotherapy treatment), can affect bone marrow production of cells, increasing the production of one cell at the expense of others or decreasing overall cell production. Some medications can decrease WBC counts, and some vitamin and mineral deficiencies can cause anaemia. The FBC test may be requested by the doctor on a regular basis to monitor these conditions and drug treatments.


An ESR may be ordered when a condition or disease is suspected of causing inflammation somewhere in the body. There are numerous inflammatory conditions that may be detected using this test. For example, it may be ordered when arthritis is suspected of causing inflammation and pain in the joints or when digestive symptoms are suspected to be caused by inflammatory bowel disease.

Interpretation

FBC


Most FBCs come back with cell numbers in the normal range. About 5% of people that are tested will have a minor blood count abnormality. If there are symptoms associated with this abnormality, they can usually be treated quite easily. Sometimes, however, a full blood count can present abnormal results that are indicative of more serious diseases. In this case, your doctor will refer you to a blood specialist for further tests. Abnormal numbers of a specific type of blood cell can be indicative of specific problems.


The information provided here must be used as a guide only. If you have an abnormal blood count, your doctor will determine what treatment is necessary.


Platelets


These are the cell responsible for the clotting of the blood to stop wounds bleeding. The platelets stick together at the site of an open wound to form a temporary barrier from the external area.

Normal The normal platelet count is 150–400 billion platelets per litre of blood (or 150-400 x 109/L). As you can imagine, this would make cells very small!

Low A low blood platelet count can be due to a condition called thrombocytopenia. Some drugs can cause a low platelet count. If this is the case, platelet levels will return to normal after stopping the drug. Symptoms can include excessive bleeding or bruising.

High A high platelet count can be due to a condition called thrombocytosis. This condition can predispose a patient to thrombosis in certain situations. People diagnosed with this should be very wary of situations that require them to remain in the same position for a long time as the blood can get “stuck”. If you work in an office environment, make sure you get up at least once an hour: stretch your legs, take a walk to the kitchen and make yourself a cup of tea! Plane rides are another risk for people with thrombocytosis. There is special blood circulation clothing that can be purchased for these situations.


Red blood cells (erythrocytes)


The major function of the red blood cell is to transport oxygen to all parts of the body. Red blood cells are made continuously in the bone marrow and are released into the bloodstream to replace the old circulating blood cells.

Normal As haemoglobin is a chemical in a cell rather than a cell itself, it is measured by weight. The normal haemoglobin content of red blood cells is 115–150 grams per litre. This equates to approximately 27–34 picograms per red blood cell in one litre of blood. A picogram is one-trillionth of a gram, or 1 x 10-12 grams! The normal volume of red blood cells in one litre of blood is 77-98 femtolitres. A femtolitre is even smaller than a picolitre (1 x 10-15 litres).

Low Low haemoglobin content is the most common abnormality found in routine FBCs. This is a condition known as anaemia. Anaemia can be present with or without an iron deficiency. Your doctor will likely assess your diet and history of drug use in order to determine the appropriate treatment.

High Polycythaemia is associated with an abnormally high haemoglobin concentration in the blood and is an indication that red blood cell numbers are also too high. This could be due to respiratory or circulatory disorders or, in some cases, to a tumour. Sometimes a high red blood cell count is due to dehydration.


White blood cells (leukocytes)


White blood cells function as part of the body’s immune system. They help to protect the body from infection and disease. There are several different types of white blood cell:

  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils

Normal The combined white cell count is normally 4–10 billion cells per litre of blood.

Low A low neutrophil count can be associated with infection. This condition is named neutropenia. Low white blood cells can also be indicative of a bone marrow disorder.

High The primary diagnosis for a high white blood cell count is leucocytosis. It is possible that a person with leucocytosis may have lymphoma or leukaemia. Therefore, your doctor will need to assess your history and take further blood tests. If the count returns high again, they will refer you to a specialist. Raised eosinophil counts are most commonly the result of allergies or asthma. If your blood cell counts are abnormal, it is important that you have frequent check-ups to make sure serious problems do not develop.


ESR


Since ESR is a non-specific marker of inflammation and is affected by other factors, the results must be used along with other clinical findings, the individual’s health history, and results from other laboratory tests. If the ESR and clinical findings match, the health practitioner may be able to confirm or rule out a suspected diagnosis.


A single elevated ESR, without any symptoms of a specific disease, will usually not give enough information to make a medical decision. Furthermore, a normal result does not rule out inflammation or disease.


Moderately elevated ESR occurs with inflammation but also with anaemia, infection, pregnancy, and aging.


A very high ESR usually has an obvious cause, such as a severe infection, marked by an increase in globulins, polymyalgia rheumatica or temporal arteritis. A health practitioner will typically use other follow-up tests, such as blood cultures, depending on the person’s symptoms. People with multiple myeloma or Waldenstrom’s macroglobulinemia (tumours that make large amounts of immunoglobulins) typically have very high ESRs even if they don’t have inflammation.

Disclaimer

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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