the red blood cells white blood cells and Now with automated counters the CBC is the average volume of red blood cells Providers use it cytic or macrocytic each with its own differ But other ID: 939445
Download Pdf The PPT/PDF document "Three neglected numbers in the CBCThe RD..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Three neglected numbers in the CBC:The RDW, MPV, and NRBC countCLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 the red blood cells, white blood cells, and Now, with automated counters, the CBC is the aver-age volume of red blood cells. Providers use it cytic, or macrocytic, each with its own differ- But other values in the CBC may be over- The red blood cell distribution width The mean platelet volume The nucleated red blood cell In addition to describing their diagnostic utility, we also discuss emerging evidence of cance in he- ABSTRACT The complete blood cell count (CBC) is one of the most frequently ordered laboratory tests, but some values included in the test may be overlooked. This brief re-of the CBC: the red blood cell distribution width (RDW), the mean platelet volume (MPV), and the nucleated red blood cell (NRBC) count. These results have unique can be incorporated into clinical practice. By understand-ing all components of the CBC, providers can learn more about the patients condition. The RDW can help differentiate the cause of anemia: eg, a high RDW suggests iron-de ciency anemia, while a nor-mal RDW suggests thalassemia. Studies also suggest that a high RDW may be associated with an increased rate of several cardiac diseases.The MPV can be used in the evaluation of thrombocy-topenia. Furthermore, emerging evidence suggests that vascular disorders.An elevated NRBC count may predict poor
outcomes in a number of critical care settings. It can also indicate a serious underlying hematologic disorder. JORI E. MAY, MD Department of Medicine, University of Alabama, MARISA B. MARQUES, MD Department of Pathology, University of Alabama, Birmingham VISHNU V.B. REDDY, MD Department of Pathology,University of Alabama, Birmingham RADHIKA GANGARAJU, MD Department of Medicine, University of Alabama, Birmingham CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 INTERPRETING THE CBC RED BLOOD CELL DISTRIBUTION WIDTHis not derived from the width of the red blood The RDW can be calculated either as a cient of variation, with a reference range of 11% to 16% depending on the laboratory, or, less often, as a standard deviation, with a The RDW can differentiate is often found in nutritional de- ciencies of iron, vitamin B ciency anemia while a nor- In iron deciency, the RDW often rises before the mean The RDW can also be high after recent Because a range of disorders can elevate the RDW, reviewing the peripheral blood cally looking for abnormal red blood cells contributing to the is less diagnostically use-ful. It indicates the red blood cells are of uni- ciency anemia for months to years are RDW, as their red cells of normal size have all is not consistently associated with any hematologic disorder.RDW may have prognostic value The RDW measures in size, Figure 1. ciency shortly after initiation of i
ron supplemen- CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 MAY AND COLLEAGUESRDW. This correlation is particularly prominent )such as ejection fraction, New York Heart As- In a retrospective analysis of 4,111 pa- It is hypothesized that high RDW may ect poor cell membrane integrity from al- Currently, using the RDW to assess prog-study. MEAN PLATELET VOLUME The MPV, ie, the average size of platelets, is count; the product of the MPV and platelet nd the cause of thrombocytopeniaproduction increases and new, larger platelets In contrast, the MPV is low in patients any platelets produced remain small. This dis-nomegaly, as larger platelets are more easily The MPV can also be used to differenti-Soulier syndrome) or a low MPV (eg, Wis-MPV may have prognostic value In a large meta-analysis of patients with than in those with a low MPV. In a study of 213 patients with non-ST-segment elevation myocardial infarction, the cant coronary artery disease was 4.18 times higher in patients with a high MPV In anemia, a high RDW suggests iron ciency, RDW suggests Figure 2. Giant platelets (thin arrows), nor- brosis and extensive CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 INTERPRETING THE CBCand a high troponin level than in patients The authors suggested that a high MPV may help cant t from invasive studies (ie, coronary angiography). This correlation has also been observed in 3 t
imes higher. The MPV has also been found to be higher Conversely, in patients with cancer, a patients with esophageal cancer, those who A low MPV has also been associated with lism in patients with cancer. In a prospective high MPV than in those with low MPV, at But the MPV is far from a perfect clinical cant laboratory variation, an abnormal rmed with evalua-tion of a peripheral blood smear. Furthermore, prognosis in patients without cancer, whereas the opposite is true in patients with cancer. NUCLEATED RED BLOOD CELL COUNTNRBCs are immature red blood cell precur- rst differentiates into a proerythroblast; subsequently, the chromatin erythroblast, also known as a nucleated red Healthy newborns have circulating weeks of birth. However, NRBCs can return Brisk hemolysis or rapid blood loss can cause NRBCs to be released into the blood as eryth- Damage or stress to the bone marrow also eral blood, as is often the case in hematologic kemia (62%), and myelodysplastic syndromes NRBCs also appeared at higher fre- The mechanism by which NRBCs are expelled from the bone marrow is unclear, ammatory cytokines (interleukin 6 Because they are associated with hemato- nding of NRBCs should The NRBC count and prognosis In a study of 421 adult intensive care pa- is far from CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 MAY AND COLLEAGUES Further, the higher the In adults with acute respiratory distress ndi
ng of any NRBCs in the peripheral blood was an independent risk Daily screening in patients in surgical in- In another study, the risk of death within Leukoerythroblastosiswhite blood cells (eg, myelocytes, metamyelo- Leukoerythroblastosis is classically seen in sis, tumor, or other space-occupying processes, In addition, leukoerythroblastosis appears As the marrow ne- At our institution, we have seen 18 pa-with heightened awareness of the disorder. We have found that leukoerythroblastosis is These examples and many others show OLD TESTS CAN STILL BE USEFULtion related to each blood cell. These days, The RDW, MPV, and NRBC count will not nitive or awless diagnostic or prognostic information, but when under-stood and used correctly, they provide readily available, cost-effective, and useful data that making. By understanding the CBC more fully, 1. Lima CS, Reis AR, Grotto HZ, Saad ST, Costa FFcell distribution width and a red cell discriminant function incor- ciency from 2. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA 3. Felker GM, Allen LA, Pocock SJ, et al; CHARM Investigators 4. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M; for the Cholesterol and Recurrent Events (CARE) Trial Investigators117(2):163 168. doi:10.1161/CIRCULATIONAHA.107.727545 5. Goldstein MR, Mascitelli L, Pezzetta FGoldstein MR, Mascitelli L, Pezzetta F2009; 169(16):1539 1540. doi:10.1001/archinternmed.2009.275 6. Sansanaydhu N, Numtha
vaj P, Muntham D, et al. Prognostic effect 7. Taskesen T, Sekhon H, Wroblewski I, et al cant coronary artery disease in patients with non-ST-elevation acute coronary syndromes. Am J 8. Dai Z, Gao J, Li S, et al 9. Papanas N, Symeonidis G, Maltezos E, et al 10. Shen W, Cui MM, Wang X, Wang RT nding should prompt of a peripheral CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 NUMBER 3 MARCH 2019 INTERPRETING THE CBCis associated with poor prognosis in esophageal cancer. Cancer 11. Riedl J, Kaider A Reitter EM, et alwith cancer. Results from the Vienna Cancer and Thrombosis Study (CATS). Thromb Haemost 2014; 111(4):670 678. 12. Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP 13. Danise P, Maconi M, Barrella F, et al 14. Stachon A, Bolulul O, Holland-Letz T, Krieg M 15. Kuert S, Holland-Letz T, Friese J, Stachon A 16. Stachon A, Holland-Letz T, Krieg M 17. Menk M, Giebelhäuser L, Vorderwülbecke G, et altory distress syndrome (ARDS): an observational study. Ann Intensive 18. Stachon A, Kempf R, Holland-Letz T, Friese J, Becker A, Krieg M 19. Purtle SW, Horkan CM, Moromizato T, Gibbons FK, Christopher KBoutcomes: a cohort study. Crit Care 2017; 21(1):154. 20. May J, Sullivan JC, LaVie D, LaVie K, Marques MB 21. Gangaraju R, Reddy VV, Marques MB 22. Tsitsikas DA, Gallinella G, Patel S, Seligman H, Greaves P, Amos RJ: Jori E. May, MD, Department of Medicine, University of Ala-bama, 1720 2nd Avenue South, NP 2565, Birmingham, AL 35