Francesca Li

FBC Interpretation and Function of Blood

Components
1. Discuss the interpretation of a Full Blood Count including the significance of the
different types of cells reported in the full blood count
2. What else is blood composed of and what is the function
N.B. There are a lot of abbreviations and new terms in this document regarding
causes of high or low counts but its too lengthy to explain each one. It will be covered
later in the module, I thought it would be more helpful to make concise interpretation
tables for future reference!

FBC INTERPRETATION

AND

SIGNIFICANCE

A full blood count usually includes the following:

RED CELLS (more important) (less important), WHITE CELLS, PLATELETS
NORMAL VALUES (may differ)
-

Haemoglobin
o Men
o Women
Mean cell volume (MCV)
Reticulocyte count
Red cell count
Haematocrit (HCT)/Packed cell volume (PCV)
o Men
o Women
Red cell distribution width (RDW)
Mean cell haemoglobin (MCH)
Mean cell haemoglobin concentration (MCHC)
White cells (total)
o Neutrophils
o Lymphocytes
o Eosinophils
o Monocytes
o Basophils
Platelets

130-180g/L
115-160g/L
76-96fL
0.5-1.5 %
4.1-5.6 (x109/L)
42-54 %
38-46 %
11.7-15%
27-32 pg
320-360g/L
4-11 (x109/L)
2.5-7.5 (x109/L)
1.3-3.5 (x109/L)
0.04-0.44 (x109/L)
0.2-0.8 (x109/L)
0.1 (x109/L)
150-400 (x109/L)

Red Cell Count

Haemoglobin (Hb)
Reticulocyte count
Red cell count (RCC)
Haematocrit (HCT)/Packed cell
volume (PCV)
Red cell distribution width (RDW)
Mean cell volume (MCV)

The concentration of Hb in the blood

Concentration of immature red blood cells
The concentration of red blood cells in the
blood
Volume percentage of red blood cells in the
blood
Measures the variation of red blood cell
volumes. Used with MCV to determine if
anaemia is due to mixed cause
Mean volume of the red blood cell (classifies

Francesca Li
Mean cell haemoglobin (MCH)
Mean cell haemoglobin
concentration (MCHC)

anaemia)
Mean haemoglobin quantity within the
blood cells
Mean haemoglobin concentration within
the blood cells

Red Cell Count Interpretation

Haemoglobin (Hb)
Reticulocyte count
Red cell count
(RCC)
Haematocrit
(HCT)/Packed cell
volume (PCV)
Red cell
distribution width
(RDW)

Mean cell volume

(MCV)

High
Polycythaemia (primary
or secondary)
Blood loss
Haemolytic anaemia
Polycythaemic
disorders
Thalassaemias
Polycythaemia of any
cause

Normal

Low
Anaemia
Bone marrow
failure
Hypoproliferative
anaemias
Aplasias
Anaemia of any
cause

RDW measures the range of cell size in a sample of blood.

Anisocytosis refers to the difference in range. Useful for
some anaemias.
E.g. Microcytic anaemia with a normal RDW suggests a beta
thalassaemia trait, whereas the same anaemia with a high
RDW points towards iron deficiency.
RDW is usually used by hematologists.
Macrocytic
Normocytic
Microcytic
(anaemia)
Acute blood
(anaemia)
Megaloblastic: low B12 loss
Sideroblastic
and folate
Haemolytic
Iron deficiency
Non-megaloblastic:
anaemia
Thalassaemia
Alcohol, reticulocytosis, Sickle cell
Chronic disease
liver disease,
Chronic disease
pregnancy
Hypothyroidism
Hypothyroidism
Bone marrow
Bone marrow failure
failure

Mean cell
haemoglobin
(MCH)

Hyperchromic
(bright)
Macrocytosis

Normochromi
c

Mean cell
haemoglobin
concentration
(MCHC)

Microcytic anaemias

Macrocytic
anaemias (high
MCH is
cancelled out
by larger cells)

Hypochromic
(pale)
Iron deficiency
Thalassaemia
Sickle cell
Other hereditary
disease

White Cell Count Significance and Interpretation

Neutrophils

High
Bacterial infection
Inflammation
Myeloproliferative disorders

Low
Drugs e.g Post-chemotherapy,
cytotoxic agents
Viral infections

Francesca Li
Drugs (steroids)
Malignancy
Stress (trauma, surgery, burns,
haemorrhage, seisures)

Lymphocytes

Monocytes
Eosinophils

Basophils

Acute viral infection

Chronic infections e.g. TB,
hepatitis, syphilis
Leukaemias and lymphomas
Autoimmune diseases
Leukaemias/ Hodgkins disease
Post-chemo or radiotherapy
Allergy (asthma, atopy)
Parasitic infection
Drug reactions e.g. erythema
multiforme
Skin diseases e.g. phemigus,
eczema, psoriasis, dermatitis
herpetiformis
Myeloproliferative diseases
Viral infections
IgE mediated hypersensitivity
reactions e.g. urticaria and
hypothyroidism
Inflammatory disorders e.g. RA

Severe sepsis
Neutrophil antibodies (SLE,
haemolytic anaemia)
Hypersplenism e.g. Feltys
syndrome
Bone marrow failure decreased
production
Steroid therapy
Marrow infiltration
Post-chemo or radiothearpy
Acute infections
Corticosteroids
Leukaemias
N/A

N/A

Platelet Count Significance and Interpretation

High (Thrombocythemia)
Primary
o Essential thrombocythaemia,
other myeloproliferative
disorders
Secondary
o Bleeding, inflammation,
infection, malignancy, postsplenectomy

Low (Thrombocytopenia)
Decreased production
o Bone marrow failure, aplastic
anaemia, megalobastic
anaemia, myelosuppression
Increased destruction
o Non immune: DIC, TTP,
sequestration in hypersplenism
o Primary immune: ITP
o Secondary immune: SLE, CLL,
viruses, drugs alloimmune

BLOOD COMPONENTS

AND

FUNCTION

Red Blood Cells

Erythrocytes make up 40% of blood volume. Its function is to deliver oxygen to body
tissues via the circulatory system. The cytoplasm of erythrocytes contain
haemoglobin. Haemoglobin contains iron containing oxygen-transport metalloprotein.

Francesca Li
Each haemoglobin molecute consists of 4
polypeptide chains (known as globins) and
in adults are 2 alpha chains and 2 beta
chains and an inorganic haem group.
Each haem group contains an iron (Fe2+)
ion that is held in a heterocyclic ring,
known as porphyrin.
Summary: Each RBC contains
approximately 280 million haemoglobin
molecules. Whereby each haemoglobin
molecule contains 4 chains (2 alpha and 2
beta), each one contains a haem molecule. Each haem molecule surrounds an iron
ion. (1 Hb = 4 chains = 4 haem groups = 4 iron ions)

5 Types of White Blood Cells

White blood cells are also known as leucocytes, are cells of the immune system that
defends the body against invading pathogens.
There are three major groups of WBCs:

Granulocytes (Neutrophils, eosinophils, basophils)

They are phagocytes and their cytoplasm contains granules of enzymes that
help digest invading microbes
Lymphocytes (B lymphocytes and T lymphocytes)
Monocytes (Dendritic cells and macrophages)

Types of white blood cells

Neutrophils

Lymphocytes

Francesca Li

Eosinophils

Monocytes

Basophils

Francesca Li

Platelets
Thrombocytes are important in the function of haemostasis (process of stopping
bleeding), along with coagulation factors.
They undergo adhesion to the damaged endothelium, then change shape and
secrete chemical messengers causing activation and lastly they bind to each other in
aggregation. This process results in the formation of a platelet plug (primary
haemostasis). With the help of the coagulation cascade the cross-linked fibrin
formed at the end contributes to a stable platelet plug (secondary haemostasis).

Plasma
Blood plasma is a substance that holds blood cells in suspension. It is the extracellular
matrix of blood cells. They make up more than half of the total blood volume.
It contains mainly of water (95% by vol), dissolved proteins (e.g. serum albumin,
globulins, fibrinogen and antibodies), glucose, clotting factors, electrolytes, hormones
and carbon dioxide.
Albumin prevents fluid from leaking out of the blood vessels and into the tissues.
Plasma acts as a reservoir for protein reserve. It has a role of intravascular osmotic
effect to keep electrolytes balanced. It can also replenish insufficient water or absorb
excess water from tissues.
Other functions include the prevention of blood vessels from collapsing and
maintaining blood pressure and circulation as they fill the vessels. It also helps
regulate the body temperature by carrying heat generated from area and
redistributing it to more peripheral tissues.

Francesca Li

References:
1. FBC interpretation - http://www.patient.co.uk/doctor/full-blood-count (accessed
31st March 2015)
2. OSCE Stop Interpretation of the Full Blood Count
3. FBC normal reference ranges and interpretation Oxford Handbook of Clinical
Medicine 9th edition
4. Components of blood http://www.merckmanuals.com/home/blood_disorders/biology_of_blood/compon
ents_of_blood.html (accessed 1st April 2015)
5. White cells - Medical Sciences (2009), Naish, pg. 635-645
6. White cells - Essential Haematology, 5th Edition (2006), A.V. Hoffbrand pg. 94109