Blood Results


Normal haematology values

Male Female

Hb (g dl) 13 18 11.5 15.5

PCV (haematocrit) 0.42 0.53 0.36 0.45

RCC (x 1012/l) 4.5 6 3.9 5.1 (about 5 million mm3)

MCV (fl) 80 96 (10-15)

MCH (pg) 27 33 (10-12)

MCHC (g/dl) 32 35

WCC (109/litre) 4 11 (about 7 000 mm3)

Neutrophils (109/litre) 3.5 - 7.5

Eosinophils (109/litre) 0.04 - 0.4

Basophils (109/litre) 0.01 - 0.1

Lymphocytes (109/litre) 1.5 - 4

Monocytes (109/litre) 0.2 - 0.8

Platelets (109/litre) 150 - 400

ESR (mm/hour) <15 <20

Reticulocytes (%) 0.5 2.5



The mass of haemoglobin for a given volume of blood


Causes of low

Anaemia Hypervolaemia Haemorrhage


Causes of high

Dehydration Polycythaemia COPD


Alterations in Hb may be genuine or spurious



Packed cell volume


The percentage of blood volume which is cells, also called haematocrit


Causes of low

Haemorrhage Anaemia


Causes of high

Increased red cell production Polycythaemia Chronic hypoxia Dehydration Adaptation to altitude


Red cell count

The number of erythrocytes in a given volume of whole blood


Causes of low

Haemorrhage Fluid overload


Causes of high

Polycythaemia Dehydration


Mean corpuscular volume of red cells


An evaluation of the average volume of each red cell derived from the ratio of the haematocrit to the total number of red cells


Causes of low

Microcytic anaemias eg. Iron deficiency, thalassaemia, anaemia of chronic disease, sideroblastic anaemia,

Chronic blood loss


Causes of high

Macrocytic anaemias, eg. Vit B12 of folic acid deficiency

In normocytic anaemias the MCV will be normal eg. In liver disease, alcohol abuse and haemolytic

Myxoedema Alcohol or liver disease



Mean corpuscular haemoglobin

The amount of haemoglobin in an average erythrocyte, derived from the ration between the amount of haemoglobin and the number of red cells present


Causes of low

Hypochromic anaemia eg. iron deficiency Thalassaemia

Chronic blood loss Megaloblastic anaemia


Causes of high

B12 or foliate deficiency Myxoedema



Mean corpuscular haemoglobin concentration


An estimation of the concentration of haemoglobin per 100 mls of packed cells, derived from the ratio between the haemoglobin and the haematocrit


Causes of low

Iron deficiency Blood loss Thalassaemia


Causes of high

Spherocytosis Sickle cell disease



The proportion of haemoglobin which is glycosolated



White cell count

Total number of circulating leucocytes


Causes of low (leucopenia)

Viral infections

Bone marrow failure, megaloblastic anaemia, hypersplenism, overwhelming sepsis, autoimmunity, drug induced


Causes of high (leucocytosis)

Infections, trauma, infarcts, chronic inflammatory disease, malignant neoplasms, steroid therapy, leukaemias, renal failure, diabetes mellitus


Differential White cell counts




Causes of Neutrophilia

Response to acute infection Stress, adrenaline and steroids Tissue damage


Causes of neutropenia (agranulocytosis)

Some viral infections


Aplastic anaemia, may be secondary to cytotoxic drugs or starvation

Drug ADRs, type 1 or type 2


Counts less than 1 predispose to infections, less than 0.5 predisposes to life threatening infections




Causes of lymphocytosis

Viral infections Hepatitis Infectious mononucleosis

Infectious hepatitis Measles, mumps TB, EBV

Toxoplasmosis Chronic infections May be associated with enlarged lymph nodes




Causes of monocytosis

Infectious mononucleosis Hodgkin`s disease Recuperative phase of infections

TB and other chronic bacterial infections




Causes of eosinophilia

Allergic reactions Asthma Parasitic infections Some cancers




Causes of basocytosis

Hypothyroidism Ulcerative colitis


Erythrocyte sedimentation rate


The rate of fall of the red cells in a column of blood

A measure of the acute phase response.

C - reactive protein is an acute phase protein, produced in the liver and rises within 6 hours of an acute event, it also rises with pyrexia

The pathological process may be immune, infective, ischaemic, malignant or traumatic

ESR increases with age, higher in females


Causes of low

Polycythaemia vera


Causes of high

Increase in plasma fibrinogen or immunoglobulins

Increased serum proteins cause rouleax formation, therefore increase sedimentation

Severe anaemia

Plasma viscosity is sometimes used instead of ESR



Contain residual ribosomal RNA and mature within 1 - 2 days of release into the circulation


A guide to erythroid activity in the bone marrow


Causes of low

In the presence of anaemia may indicate an inappropriate response by the bone marrow or deficiency of a haematinic


Causes of high

Haemorrhage, haemolysis, response to treatment with a haematinic




A count below 20 (ie. 20 x 109/litre) causes spontaneous bleeding


Causes of low (thrombocytopenia)

Failure of platelet production; eg. Leukaemia, marrow infiltrations, hypoplastic anaemia, chemotherapy, alcohol, viral infections


Increased destruction of platelets; eg. Autoimmune Thrombocytopenic purpura, drug induced, DIC, post - transfusional, neonatal, splenomegaly




Causes of high (thrombocytosis)

Acute or chronic blood loss, Iron deficiency, chronic inflammatory disease, (eg. RA), malignant disease


In some cases bleeding time may be increased


Coagulation studies


Bleeding time

2.5 - 9 minutes


Increased in

Aspirin ingestion Thrombocytopathology Uremia Anticoagulation therapy


Prothrombin time (PT)

Often used with INR in warfarin therapy 11 - 16 seconds

Time taken for blood to clot from the prothrombin stage



Partial thromboplastin time (PTT)

Often used in heparin therapy



International ratio of patients prothrombin time compared to an agreed control


Used to monitor anticoagulation treatments


Therapeutic range depends on the condition eg. DVT range = 2 - 3, Artificial heart valves and repeated thromboembolism = 3 - 4.5


Causes of high

Blood slow to clot Deficiency of prothrombin DIC Vit K deficiency


Causes of low

Blood clots too quickly



D - Dimer test

Measures breakdown products of plasma fibrin clots

Elevated in DIC, DVT, PE, after thrombolytic therapy, surgery or trauma




Liver function tests


Serum bilirubin

Normal range for total bilirubin 2 - 22 umol/L Clinical jaundice > 35

Normal range for Conjugated bilirubin 0 - 10 umol/L

Also check for urinary bilirubin and urobilinogen


Raised bilirubin suggests

Hepatitis Biliary stasis Increased haemolysis


Alkaline phosphatase

An indicator of liver and bone disease, may also come from gut and placenta, normal range 40 - 117 U/L

Levels in children are 2 - 3 times higher than in adults

Levels are raised post fracture

The liver excreted Alk Phos into the bile so if there is obstructive biliary disease the serum levels are raised


Aspartate aminotransferase

Normal adult range 12 - 44 U/L

Found in high concentrations in heart, liver, RBCs, skeletal muscle

Formally known as SGOT

Raised in hepatocellular liver disease such as viral hepatitis, moderately raised in hepatic obstruction


Gamma glutamyl transpeptidase (Gama GT)

Normal range, male = 18 - 70 U/L, female = 12 - 42 U/L


May be raised by liver cell damage, excessive alcohol intake, MI, CVA, diabetes and chronic lung disease



Serum amylase

Normal range 30 - 90 U/L


May be raised in bile duct obstruction, perforated duodenal ulcer, small bowel obstruction, renal failure and ectopic pregnancy


      1200 = acute pancreatitis




Normal range 3.5 - 8.5 mmol/L



Cholesterol and triglycerides are transported through the blood by lipoproteins


50% of cholesterol is synthesised by the liver


Total cholesterol desirable < 6.5 for women and < 6.0 for men. Less the 5.2 desirable in ischaemic heart disease


HDL normally 0.9 - 1.6

LDL 3.35 - 4, abnormal if >5

HDL should be > 0.2 of total cholesterol


Cardiac enzymes

Creatine kinase normal male = 58 - 205, female 20 - 192 U/L

AST normal = 13 - 44 U/L

Lactate dehydrogenase, normal =285 - 577 U/L


Troponins T and I released after 2 4 hours and persist for up to 7 days


Ca++/ Proteins

Calcium and proteins are measured together because calcium is protein bound to some extent in the plasma.


Causes of hypoproteinaemia



Immunology and virology

Viral studies look for the presence of antigen in a sample


Antibody titres assess the levels of antibodies in the plasma



Blood cultures detect and identify the form of bacteria in the blood