Health Medical

Complete blood count (hemogram) is an easy, practical, and reliable test to diagnose many diseases such as infection, leukemia (blood cancer), and anemia. The content of blood cells and their properties like size, color, distribution are examined. Since the veins are on the brink of the surface, some blood is drawn from these vessels and tested utilizing automatic counting with special devices. Hemogram testing, which contains many parameters like red blood corpuscle count, white blood corpuscle count, platelet count, maybe a vital test and is usually utilized in today’s medicine.

Table of Contents

1. What is a complete blood count (CBC)?

2. What are the components of CBC?

3. What diseases can CBC detect?

4. Why is the complete blood count done?

5. How is a CBC done?

6. How to read CBC results?

7. CBC for children

8. Normal values of complete blood count

What is a complete blood count (CBC)?

Hemogram is that the process of counting the various cells within the content of a blood sample drawn from the vein by special devices. The hemogram test is named CBC, Complete Blood Count. Blood required for hemogram testing is drawn from the veins, because veins are on the brink of the surface, which makes blood drawing easier. Blood samples are usually taken from the vessels from the arms in adults, from the rear of the hands within the children and from the heels within the newborn.

What are the components of CBC?

The hemogram test measures the values of many blood cells such as HGB (hemoglobin), WBC (white blood cell count), PLT (platelets), HTC (hematocrit), MCH, RBC, RDW, lymphocyte, monocyte. Some of these parameters are obtained by direct measurements, while others are obtained directly using the measurement leads to various formulas.

What is WBC?

It is the counting process of white blood cells (leukocytes). These cells are responsible for the body’s struggle against infections. There are different types of white blood cells such as lymphocytes, neutrophils, basophils, eosinophils, monocytes. The hemogram shows the individual values and the ratios of all of these cells.

What is HBG?

HGB is the abbreviation of hemoglobin. Hemoglobin is a structure in red blood cells (erythrocytes) that can bind to oxygen and carbon dioxide and gives red color to erythrocytes. It is involved in transporting oxygen to the tissues of the red blood cells. Its level is directly proportional to the level of red blood cells. Therefore, it gives valuable information about anemia.

What is PLT?

PLT is the abbreviation of platelet (blood flakes). The role of platelets in the body is to stop bleeding. Platelet value is important in cases of bleeding or clotting disorder.

What is MCH?

MCH (Mean Corpuscular Hemoglobin) is a test indicating the average value of erythrocyte hemoglobin. Hemoglobin gives the red color to erythrocytes. In hemoglobin deficiency, red blood cells may be faded. This is measured by the MCH value. In some types of anemia, erythrocyte pallor is important in terms of differential diagnosis.

What is RBC?

RBC (Red Blood Cell) is the direct measurement of the number of red blood cells in blood.

What diseases can CBC detect?

• Differential diagnosis of anemia: iron deficiency anemia, megaloblastic anemia, macrocytic anemia, aplastic anemia

• Bleeding and coagulation disorders: Idiopathic thrombocytopenic purpura, thrombocytopenia, thrombocytosis

• Infectious diseases: systemic and local (regional) infections

• Leukemia

• Lymphoma

• Polycythemia vera

• Lymphadenopathy (growth in lymph nodes)

• Splenomegaly (spleen growth)

• Types of Thalassemia

• Allergy

• Monitoring of liver diseases such as hepatitis

Why is the complete blood count done?

• To investigate if there is a tendency of bleeding by looking at the level of platelet before invasive procedures such as biopsy, surgery,

• As a complement to the medical history of the patient and his/her physical examination. It is a simple, fast and reliable test in the differential diagnosis of most diseases.

• To monitor the changes in the blood cell values of the patients receiving chemotherapy,

• To monitor the severity of bleeding after a traffic accident, surgery or gastric bleeding,

• For an assessment after transplantation of blood or blood components,

• To diagnose patients with problems such as fatigue, pallor, fatigue, bleeding tendency, hemorrhagic bleeding, bone pain, swelling of lymph nodes, frequent infectious disease.

What are the benefits of CBC?

In most diseases that occur in the body, at least one value that can usually be measured in the hemogram test increases or decreases. The changes that are expected to occur in the blood cells in these diseases are known by the doctor and help in the diagnosis of the disease. In some diseases, the values that can be measured in the hemogram test don’t change, which helps to diagnose or to eliminate the diseases in the differential diagnosis.

How is a CBC done?

• A blood vessel that does not have any other fluid in it is selected because it may affect the results.

• The area where the blood sample is to be taken is cleaned with disinfectant.

• The tourniquet is connected to the top of the blood vessel. It is not connected very tightly and is not attached for a long time.

• A certain amount of blood is taken.

• Blood samples are placed in tubes containing EDTA without waiting.

• EDTA is a substance that prevents blood clotting. However, to prevent clot formation in the tube, the blood is gently mixed for 6-7 times as soon as the blood is taken into the tube. It should definitely not be agitated.

•  Blood sample is sent to the laboratory. Measurement is made utilizing special devices.

How is the CBC reported?

The blood sample is examined on the device. As a result of this examination, a report is prepared. The paper contains the reference range values of the blood cells and the patient’s result values. Different marks or colors are used if the result values are high or low relative to the reference range.

A report does not give a diagnosis or pre-diagnosis of the disease. The results paper is used by the physician to make a diagnosis by evaluating the patient’s complaints and physical examinations, and all the other measurements.

How to read CBC results?

•           Low HGB (hemoglobin) value: It is observed in such situations as anemia, blood loss, pregnancy-related changes, leukemia, lymphoma, blood destruction (hemolysis).

•           High HGB (hemoglobin) value: Polycythemia vera, smoking, living in high places, excessive fluid loss (due to vomiting, diarrhea, burns)

•           High WBC (white blood cells) value: Types of leukemia, infections

The number of lymphocytes increases in virus-induced infections, the number of neutrophils increases in bacterial infections, and the number of eosinophils increases in parasitic infections and allergy.

•           High PLT (platelets) value: Myeloproliterative diseases, in the early stages of infections, in some cancers, iron deficiency anemia, after the removal of the spleen, in the postoperative period

•           Low PLT (platelets) value: Idiopathic thrombocytopenic purpura, disseminated intravascular coagulation (depletion of platelets after excessive use), diseases involving the spleen

Also, some drugs and bone marrow cancer can change the above parameters.

What affects CBC results?

•           Very tight connection of the tourniquet when taking blood

•           Shaking the tube after the blood is put into the tube

•           Placing blood into the wrong tube

•           Taking inadequate amount of samples

•           Overfilling the tube

•           Waiting too long before the blood sample is examined

•           Poor biochemical values of the patient (hyperglycemia, hyperlipidemia)

•           Any fluid leaked from the blood taken from the vein

•           Any malfunction in the device

If the results are not consistent with the patient’s problems and physical examination, the test is repeated. Peripheral smear is performed where blood samples are examined microscopically and hemogram test is confirmed.

CBC for children

Hemogram test is a test used frequently in diseases such as infection, anemia, bleeding disorders in children. It is also used in the diagnosis and follow-up of cancers such as leukemia, which is very common in childhood. Also, if the child does not have any problems, a hemogram test can be performed for child development follow-up.

The most important difference in children compared to adults is that the reference range is different from the normal values of the parameters evaluated on the hemogram. So the results are assessed according to the age of children.

Normal values of complete blood count

What are the normal ranges of the CBC test?

The reference range, normal values are specified in each hemogram test. The high or low measurement result is evaluated according to the reference values of the laboratory in which the test is performed. At the same time, age, and gender are taken into account when evaluating reference ranges.

•           Hgb: 11.5-18 g/dl

•           Plt:150.000-400.000

•           Wbc: 4.000- 10.000

•           Neutrophils: 1.800-7.700

•           Number of lymphocytes: 1.000-4.800

•           Number of eosinophils: 0-400

What does abnormal CBC results mean?

If the hemogram test results are above or below the normal range (reference range), the results are considered abnormal. If an external factor that affects the results of the test cannot be identified, these results may indicate a problem. However, this does not mean that there is always a serious problem. At this point, the doctor’s evaluation is the healthiest.

 

Platelets are cells produced by the bone marrow that stop the bleeding by initiating clotting in the blood when blood vessels are damaged. Their amounts in the blood can be reduced or increased depending on different factors. When the number of thrombocytes (Platelets, T) is higher or lower than they should be, a number of problems and complications may occur. For example, its high level may cause a heart attack and cerebral palsy. Blood platelet count is usually measured by whole blood count (Hemogram) tests. According to the test results, doctors can initiate the treatment process.

What are platelets (PLT)?

Platelets (PLT or T) are small blood cells produced by the bone marrow like red and white blood cells that prevent bleeding by allowing blood clotting. These colorless blood cells stop bleeding by clumping if blood vessels are injured. They are produced by cells called megakaryocytes in the bone marrow. The smallest of our blood cells are platelets. They look like a small plate under a microscope.

If one of the blood vessels are damaged, the platelets receive the signal. After having received the signal, platelets run to the site of injury, and initiate clotting. First, they are interconnected where the damaged blood vessel is located.

They then spread to the surface of the blood vessel and stop the bleeding. They come to the wounded area, adhere to it, and grow like a spider. During the clustering process, they send signals to others to increase aggregation.

What is platelet count?

The number of platelets in the blood can be determined by the platelet count. PLT is performed as a neighborhood of an entire blood count test (CBC). First, a sufficient amount of blood is transferred to the tubes, and erythrocytes in the blood are hemolyzed. The remaining platelets are then counted by optical counters. Blood count must be done on an empty stomach. Some situations, such as clustering, can cause test results to fail.

What is the normal platelet count?

The value of platelets in healthy people, is between 150-450 thousands per microliter. Their presence of more than 450 thousand in the blood is called thrombocytosis. It is called thrombocytopenia under 150 thousand. When the platelet count falls below 10-20 thousand, there's a risk of spontaneous bleeding. If the blood vessel is damaged, its number is less than 50 thousand, which can lead to extremely serious bleeding.

Low platelet count (Thrombocytopenia)     

Causes of thrombocytopenia

Low platelet count is a condition in which the total number of platelets in the blood is low. It may be mild or moderate. If untreated, it can have fatal consequences. It usually develops due to leukemia or the use of certain drugs. It can happen to everyone.

• Bone marrow problems

Bone marrow is a spongy tissue in the bone, and produces blood components. The most important cause of thrombocytopenia is the insufficient production of bone marrow. Excess anemia, vitamin B12 deficiency, iron and folate deficiency, cirrhosis, leukemia, heavy alcohol consumption, chemotherapy, exposure to chemicals and radiation, HIV, chickenpox, viral infections and myelodysplasia may lead to insufficient production of platelets by the bone marrow.

• Platelet destruction

Regular use of certain drugs such as anti-seizure and diuretic drugs, etc. may lead to platelet destruction. Spleen enlargement, pregnancy, a bacterial infection in the blood, hemolytic uremic syndrome, autoimmune disorders such as rheumatoid arthritis and thrombotic thrombocytopenic purpura are the most important causes of platelet destruction.

Hemolytic uremic syndrome: It is a rare disease that causes the destruction of red blood cells, loss of function in the kidneys, and a decrease in the amount of platelets. It resembles to E. coli infection that enters the body after consumption of raw or undercooked meat.

• Spleen enlargement

The spleen is an important organ that separates unwanted substances from the blood. Spleen enlargement means that plenty of platelets is housed in the spleen. In this case, the number of circulating blood is indirectly reduced.

• Thrombocytopenic purpura

It is a disease accompanied by blood destruction and decreased blood platelets, together with fever, renal failure, and some neurological effects. Drowsiness, coma, partial paralysis may be observed. If the disease is not treated in time, it is highly likely to cause death.

Symptoms of low platelets

• Red, purple, brown bruises called purpura,

• Bleeding gums,

• Nose bleeding,

• Bleeding in the rectum,

• Blood in urine (a sign of internal bleeding)

• Blood in the stool (a sign of internal bleeding)

• Severe menstruation,

• Bleeding in long-standing, non-healing wounds,

• Small, red, purple rashes called Petechiae,

• Bloody or very dark mucus (a sign of internal bleeding)

Mild cases, such as pregnancy, do not cause serious symptoms. However, serious cases may require urgent medical attention.

Is thrombocytopenia dangerous?

When the platelet count falls below 10,000 per microliters, it can cause dangerous internal bleeding. In cases of severe thrombocytopenia, however rarely, cerebral hemorrhage may occur. If your platelet count is low, you should see a doctor immediately when you experience headaches or any neurological problems.

How to raise platelets naturally?

Thrombocytes can be elevated by limiting alcohol consumption, discontinuing the use of drugs such as aspirin and ibuprofen, and avoiding contact sports and activities that can cause high bleeding or bruising.

 

Treatment of low platelets

Treatment may vary depending on the underlying cause of low platelets. First, the disease that leads to a low level of platelets should be treated. In the case of a light level, your doctor will monitor your condition and continue treatment. Medical treatment may be mandatory in the severe case of low platelets.

 

Medical treatment of thrombocytopenia

The method of treatment may vary depending on the cause of thrombocytopenia. Depending on the situation, one or more of the following treatments may be recommended:

• Replacement of drugs leading to thrombocytopenia

• Prescribing drugs such as steroids, corticosteroids, globulin, and so on.

• Surgical removal of the spleen

• Blood or platelet transfusion (red blood cells are transferred to the lost blood)

• Prescription of immunosuppressive drugs

• Plasma exchange (this method is used in the treatment of thrombocytopenic purpura)

Foods to increase platelets

Citrus fruits rich in vitamin C, spinach, Indian Gooseberry, beets, papaya, Aloe Vera gel, pumpkin, raspberries, lean protein sources rich in B12, foods rich in vitamin A is among the platelet raising foods.

High platelets count (Thrombocytosis)

Causes of thrombocytosis

Thrombocytosis is a condition, which the body produces too much platelet. Infection-induced ones are called secondary thrombocytosis. The absence of any cause behind thrombocytosis is called primary thrombocythemia. This is usually caused by blood or bone marrow disease.

What diseases cause thrombocytosis?

• Secondary thrombocytosis

It is related to an underlying problem. Autoimmune disorders such as cancer, iron deficiency, hemolytic anemia, some infections, acute bleeding and blood loss, surgical traumas, rheumatoid arthritis and so on., or inflammatory disorders such as removal of the spleen, inflammatory bowel disease, etc. may lead to secondary thrombocytosis.

 

• Primary thrombocythemia

It is usually caused by mutations in some genes. Platelets produced by the bone marrow are usually abnormal. It can cause more serious blood clotting and bleeding complications. According to the MPN Research Foundation, most patients with primary thrombocythemia have a JAK2 gene mutation. It is more common in women over the age of 50, but may also affect young people.

Symptoms of high platelets

• Headache

• Dizziness or loss of balance

• Chest Pain

• Fainting

• Temporary vision changes

• Numbness or tingling of hands and feet

• Redness, throbbing and burning sensation in the hands and feet (erythromelalgia)

Symptoms depend on where clots occur:

Sometimes patients do not have any symptoms. The first sign of your disease may be a blood clot formation (thrombus). These clots can develop anywhere in your body, but primary thrombocythemia usually occurs in the brain, hands, and feet. Rarely, if the blood count is too high (more than 1 million per microliter of blood), primary thrombocythemia may cause bleeding as follows:

• Nosebleeds

• Bruising

• Bleeding in your mouth or gums

• Bloody stool

If blood clots occur in the arteries supplying the brain, the blood flow to a part of the brain is temporarily interrupted. This may also cause a transient ischemic attack or stroke. The symptoms of transient ischemic attack or paralysis develop suddenly and are:

• Weakness or numbness on one side of your body, usually your face, arm or leg

• Difficulty in speaking or understanding (aphasia)

• Blurred, double or low vision

 

Is high platelets dangerous?

Patients with primary thrombocythemia may experience transient erythema attacks and paralysis due to high platelets. At the same time, these patients are at risk of having a heart attack. People who experience heart attacks, strokes, or severe bleeding should seek medical attention immediately.

Diagnosis of high platelets

Your doctor may check the size of your spleen or look for signs of infection. With the full blood count test, he/she can detect whether the platelet amount in your blood is higher than normal. He/she can also take tissue samples from your bone marrow for further testing.

Treatment of high platelets

Treatment of high primary or secondary platelets may vary.

 Secondary thrombocytosis treatment

Treatment depends on the cause of thrombocytosis. In the event of blood loss due to surgery or injury, a large amount of coagulation dissolves on its own. The problem is resolved by the treatment of the disease in the case of a chronic discomfort or inflammatory disease-induced thrombocytosis.

If the spleen is removed, you may have to live with a high platelet amount for the rest of your life. However, no additional treatment is needed in this case.

Primary thrombocytosis treatment

Treatment is determined depending on your risk of developing blood clots. Your doctor may prefer only to monitor your condition if there are no symptoms or risks. However, patients over 60 years of age who smoke, have diabetes or any cardiovascular disease, and who have a history of bleeding or blood clotting must be treated.

In this case, low-dose aspirin is usually prescribed. Your doctor may also prescribe certain medications that reduce clotting and slow down thrombsite production. He/she can also prefer to remove excess platelets from your blood by a procedure called platelet perineosis.

If you have recently been diagnosed with primary thrombocythemia, you should first quit smoking. Also, if you have a problem with cholesterol, diabetes or blood pressure, you should exercise regularly and follow a diet of fruits, vegetables, whole grains, and lean protein sources.

Foods that lower platelets

Omega-3 fatty acids, garlic, cumin, cloves, turmeric are among the most important foods that reduce the number of platelets in the blood

Platelet donation

Platelet donation can be performed by anyone in the 18-60 age range. The donation takes approximately 1.5 hours, and has no side effects. The platelet donor must weigh at least 50 kg. The number of platelets should be over 150 thousand. All requirements that are asked for a typical blood donation also apply to platelet donation.

The patient should be in good health, and the vascular structure should be appropriate for donation. While the blood groups of the platelet donor and recipient should be the same as a first priority, people who have a different blood group than the recipient may also donate. The platelet donor should discontinue the use of aspirin and aspirin derivatives at least 48 hours before the procedure. Platelet apheresis can be performed at least 4 weeks after whole blood donation. The patient can donate whole blood at least 48 hours after the apheresis procedure. Sets used during platelet donation are disposable.