pediatric hematology oncology labwork interpretation linda ballard, cpnp, aprn

Pediatric Hematology Oncology

Labwork Interpretation Linda Ballard, CPNP, APRN

Aflac Cancer and Blood Disorders Center

Heme/Onc Lab Interpretation• I’m freaking out- the platelet count is 20

k!!

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Okay, so a low platelet count by itself isn’t always leukemia!

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Components of the CBC

White blood cells (WBC) Red blood cells (RBC) Platelets (PLT)

BONE MARROW PROGENITORS

Bone marrow precursors produce WBC RBC Platelets


White Blood Cells

Normal lifespan is hours to days Primary responsibility…..fight infection Normal range~4-15,000

Race variation Age variation


White Blood Cells

Differential Neutrophils Lymphocytes Monocytes Eosinophils Basophils


White Blood Cells

Neutrophils; also called Segs Most numerous ~31-75% Shortest lifespan Band=immature form

“Left shift”

Myelocytes/Metamyelocytes


White Blood Cells--Neutrophils

Increased by Infections, stress response, inflammatory

disease, childbirth, ischemic necrosis

Decreased by Infection, hypersplenism, SLE, chemotherapy,

radiation therapy Autoimmune process


White Blood Cells-Lymphocytes

Lymphocytes Normal range 35-61% Produced in lymph nodes and thymus Increased by: infection, mononucleosis,

thyrotoxicosis, ulcerative colitis, leukemia Decreased by: steroids, immunosuppressants,

renal failure


White Blood Cells-Monocytes

2nd line of defense after neutrophils Phagocytosis…..think Pac-man Normal range 4-7% Increased by: infection, leukemia, TB,

RMSF, malaria, ulcerative colitis, mono Decreased by: infection, bone marrow

failure/leukemia


White Blood Cells--Eosinophils

Normal range 2-4% Most commonly produced in response to

parasitic infections allergic disorders

Other stimulants: leukemia, Hodgkin, ulcerative colitis, scarlet fever

Decreased production: stress, Cushings


White Blood Cells---Basophils

Normal range 0-1% Increased by: chronic inflammation,

hypersensitivity reactions Decreased by: Steroids, hyperthyroidism


White Blood Cell--ANC

Absolute Neutrophil Count= ANC

ANC=WBC x (neutrophils/segs +bands)

Important predictor of immune function/reserve

Body’s ability to fight bacterial infections


Red Blood Cells

Normal lifespan is 120 days Primary role is to carry hemoglobin 2 primary regulatory factors

Tissue oxygenation Renal production of erythropoietin


Red Blood Cells-Indices

Mean cellular volume(MCV)

Mean cellular hemoglobin(MCH)

Mean cellular hemoglobin concentration(MCHC)

Red cell distribution width(RDW)


Indices--MCV

Average size of the red cell Normal range~75-94 Morphology

Microcytic Normocytic Macrocytic


Microcytic RBC ( Low MCV)

Small size Common causes:

Fe Deficiency Lead poisoning Thalassemia Inflammation


Normocytic RBCs

Normal MCV=normal size Normocytic anemia:

Early aplastic anemia TEC Leukemia/solid tumors IBD/JRA Sickle cell/hemolytic anemias Renal disease


Macrocytic RBC’s (High MCV)

Large size=macrocytic Common causes:

Nutritional Liver disease, cyanotic heart disease Hypothyroidism Down’s Syndrome Bone marrow failure


RBC indices--MCH

Mean cellular hemoglobin (MCH) average weight of Hgb per RBC generally rises and falls with MCV


Red Cell Indices-MCHC

Mean cellular hemoglobin concentration measures the concentration of hemoblobin in

the RBC Hypochromic; pale appearing Normochromic Hyperchromic


Red Cell Distribution Width

RDW Measures the uniformity of cell size Range~11.5-14.5 Increased in

Fe deficiency B12/Folate deficiency Sickle cell

Anisocytosis….variablity in the RBC size


Reticulocyte Count

Immature RBC Measures hematopoesis from the bone

marrow 0.5-1.5% normal range


Reticulocytosis (High retic)

Indicates an overactive bone marrow Hemolytic anemias

Sickle cell, AIHA, Hereditary spherocytosis Acute blood loss


Reticulocytopenia (Low retic)

Indicates lack of RBC production in the bone marrow Infection Bone marrow failure syndromes Folate/Fe deficiency/B12 anemias


Hemoglobin--Hgb

Part of RBC that binds oxygen and delivers to tissues in the body

Normal ranges based on age and gender Physiologic nadir ~2mos. Of age


Hemoglobin--Hgb

Increased with: Congenital heart disease Chronic hypoxia High altitudes Polycythemia vera Dehydration


Hemoglobin-Hgb

3 major reasons for decreased hgb Decreased production of RBC Increased destruction of RBC Blood loss


Hematocrit

Percentage of RBC to whole blood In relation to Hemoglobin

usually 3 times the hemoglobin value

Affected by: Dehydration Stress Vasocclusion


Platelets

Form a plug at the site of injury Lifespan is 8-10 days Normal range is 150-450k 2/3 in circulating blood volume; 1/3 in

spleen


Platelets

Thrombocytopenia Decreased platelet count <150,000 Causes:

Decreased production Abnormal destruction Abnormal pooling


Platelets

Thrombocytosis Increased platelet count>600,000 Causes:

Myeloproliferative disease Acute blood loss Polycythemia vera


Platelets--MPV

MPV=Mean platelet volume Measures uniformity of platelet size

Increased: ITP, leukemia, splenectomy , vasculitis

Decreased: Wiskott Aldrich


Abnormal labs

• Production vs Destruction

• Quality vs Quantity

• Acquired vs Congenital

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Clinical Assessment

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• History– Activity level, appetite– Recent infections, fevers– Pain– Weight loss– Family medical hx


Clinical Assessment

• Physical– Skin color– Bruising, bleeding– Rashes– Lymph nodes– Spleen, liver– Lung sounds

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Other Labs

• Chemistries

• Bone Marrow

• CSF

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Case # 1

• Annie is a 2 year old referred for anemia. • Screening hgb at well check was 9.4. – Clinical sx to review?

• Pt started on oral iron supplement 2 mg/kg/day

• Recheck 2 mths later- CBC: WBC 6.8, Hgb 9.9, Hct 29, MCV 62, plt 224 k.

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Case # 2

• Henry is 3 years old, brought to PCP for 4 days of worsening fever, lethargy, pallor.

• Alert, VSS. • PE: enlarged spleen, scleral icterus,

jaundice• CBC: WBC 9.4, Hgb 7.5, MCV 78, plt 257 k• retic 10.8

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Case # 3

• Lucy is a 10 year old brought to PCP for a “rash” noted on chest, back and abdomen for a few days.

• Other sx include fatigue, c/o leg pains. Low grade fever

• CBC: WBC 35 K, Hgb 11, plt 34 K.

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Summary

It’s not just about the numbers History

Patient Family

Physical findings Full system exam

If the labs don’t match the clinical picture, repeat the lab!

pediatric hematology oncology labwork interpretation linda ballard, cpnp, aprn

Documents

aflac cancer

blood disorders center

blood disorders center

aprn slide

cushings slide

hyperthyroidism slide

renal failure slide

red cell normal range