: Blood is a Many Splendored Thing A Lecture by Dr. Roma

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In a message dated 10/29/2003 9:34:01 PM Eastern Standard Time,

mickinatlanta@... writes:

> Hey Girls!

>

> I know someone out there is a blood expert. I got my copies of my

> lab reports today from my Dr's office and there are some things I

> don't understand? If anyone can explain I would appreciate.

:

Blood expert, I'm NOT!

However, I think I might qualify as a " B.E.D " . ('Blood Expert

Dilettante!!!--how's that for a great oxymoron-- " expert dilettante " !!) What

follows is The

Dr. Roma, (B.E.D) Lecture on BBB-Blood Background Basics:

OK, Class, let's begin.....

As you might know......

Blood is composed of two basic things:

1) Plasma (the liquid portion of blood ) and

2) Cells. Specifically: three types of blood cells. The blood cells (namely,

white blood cells, red blood cells and platelets)are all produced in the bone

marrow.

The CBC (Complete Blood Count) is a " portrait " of these cells at any given

moment in time.

Part I. WBC (White Blood Cells)

Your WBC count is the number of white cells in a liter of whole blood .

, is your TOTAL WBC count in the normal reference range? Each lab has

a slightly different normal. My lab's normal WBC range is 4---10.5

Then, it is important to know what KIND of different WBC make up our blood,

because they can provide important diagnostic info.

So, after looking at the total number of WBC's

they also look at the 5 different types of WBC's in our blood:

1.Neutrophils

2. Lymphocytes

3. Monocytes

4. Eosinophils

5. Basophils

A DIFFERENTIAL count seen on your report measures the types of WBC's as a

both a _percentage_ of the total WBC count AND an _absolute_ number.

You can tell one from the other on your report by looking at the description

( % or number.)

It's very important to consider BOTH the PERCENTAGE( relative value) and the

ABSOLUTE number of these WBC's to make an accurate diagnosis.

From your email, I gather your low lymphocyte count and your low monocyte

count refer to the % ONLY. But I'm going to assume that your ABSOLUTE VALUE of

Lymphs and Monocytes, on the other hand, are both normal. Is this assumption

correct?

Look at the part of your report that has these values marked ABSOLUTE

monocytes, ABSOLUTE Eos, etc.

BTW, that ABSOLUTE number is obtained by multiplying your total WBC count by

that %. If that ABSOLUTE number is within normal range, it shouldn't be too

worrisome.

In any event, your numbers--while outside the expected or reference range,

are not too wild.

A review of my monthly CBC's shows that I've had similar LOW LYMPH (relative

value--i.e, %) and LOW MONOs (again, the %, NOT THE ABSOLUTE VALUE).

Interestingly, these values seem to bounce around a lot, and even have returned

to

normal within the space of month. Like you, I had LOW LYMPH %--when my ABSOLUTE

#

was within range.

My hemo-onc who worries about every thing else on my report-- was absolutely

unaffected by MY lymph % 9. Because my ABSOLUTE lymph was .8 (normal was .7 -

4.5)

Oh, just as a FYI:

LYMPHOCYTES are the primary immune cell in the body. These cells develop in

the thymus gland, and then travel to the various lymph nodes in our body.

There are two different kinds of lymphocytes.

1) T lymphocytes (aka the famous " T cells " )and

2) B lymphocytes

MONOCYTES are the white blood cells that can destroy old, damaged and dead

cells in the body.

But, bottom line--if your ABSOLUTE VALUES are within the norm and your TOTAL

WBC is in range, I say, don't sweat it.

*************************************************************

.....Now might be the time in the lecture to take a short break--grab a cup

of coffee, and stretch your legs, chat with your neighbor in the row behind

you.................................................................

Ok, are you back? Great. Break over!!!!!!!!!

*************************************************************

Time to talk about your high RDW (i.e., Relative or Red Cell Distributive

Width--RDW).

But, first,a few words about the RBC, Hb, Hct, MCV, MCH,.......

(HEY!! !!!!!!!!!!!!!!!! No yawning during a Dr. Roma lecture!!!!)

All of the above acronyms are descriptions of the red blood cells. Some tell

us the number, another the size, one the amount of hemoglobin carried by the

RBC, etc.

After you get the absolute number of the RBC's you want to know what the

RBC's look like. Most RBC's are quite boring ( a little like Dr. Roma's

lectures???)

Most RBC's are boring because they all look alike, and have the same number

of hemoglobin.....(and " they're all made outta ticky tacky and they look just

the same " ...remember that Pete Seeger song circa 1964??!?!?) Sorry, I digress.

Anyway, the RDW is a relatively new test that measures the SIZE of every red

cell it finds. The test then finds the average, and then compares that

" average RBC " of yours to each and every red blood cell it finds in your blood

sample. The larger the number on the RDW the less uniform all your RBC's are in

SIZE. Since your RDW is higher than normal, this indicates that there are a lot

of

size differences in your red cells.

As red blood cells go, honey, yours are definitely not boring!

BUT, again....NOT TO WORRY! This is a common finding in a lot of disorders,

and very common in Iron Deficiency Anemia. Which you are recovering from.

As a final reassurance, know that in the world of hematology, the first

values to go haywire, are the LAST ones to return to normal.

I hope you've enjoyed this lecture, and have taken good notes!

Be forewarned: They're WILL be a pop quiz in the days to follow! And. yes,

those results WILL weigh heavily on your FINAL GRADE !!!!!

Pedantically yours.

Perpetual Patient & Professor Roma, B.E.D.

Good

>

> news is that my Hemoglobin is up form 9.7 to 11.4....still low but

> almost within normal limits. Also Hematocrit is up from 28.9 to 33.9

> still low too...but up. Now the confusing?

>

> 1. RBC Dist Width Normal is 11.0-14.0%

>

> In August it was 14.6 and in October it is 17.7.

>

> I do not not what this value even means....let alone...why I continue

> to go above the range?

>

> 2. Lymphocyte Normal is 20.0-45.0

>

> In August it was 12.2 and in October it is 8.7

>

> Monocyte Normal is 2.0-10.0

>

> In August it was 2.3 and in October it is 1.4

>

> ***From what I have read on different websites....these are

> components of the WBC count. I don't understand what would make

> these be below normal? My WBC is within normal limits?

>

> Any light anyone can shed about the RBC Dist and Lymphocyte Monocyte

> would be greatly appreciated!

>

> Thanks!

>

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