Aplastic anemia patients often have blood counts taken to gauge progress. The following are "guidelines" to commonly accepted blood values. The complete blood count is universally accepted whereas the differentials guidelines vary from laboratory to laboratory. Please keep in mind that the complete blood count does just that--count blood. It does not address the "quality" of the patient's blood. The quality of blood is a very important factor for affecting the patient's health.
STANDARD RANGES FOR ADULTS
Complete Blood Count (CBC)
| Male | Female | |
| White Blood Count (WBC) | 4.0-11 | 4.0-11 |
| Red Blood Count (RBC) | 4.7-6.1 | 4.2-5.4 |
| Hemoglobin (Hgb) | 14.0-18.0 | 12.0-16.0 |
| Hematocrit (HCT) | 42%-52% | 37-47% |
| Mean Corpusle Volume (MCV) | 82-101 | 82-101 |
| Platelets (PLT) | 150,000-400,000 | 150,000-400,000 |
There is more to blood than
just how many cells you have. For instance, white blood cells are
counted and grouped as one total on a CBC, although there are different
types of white blood cells with different functions. Neutrophils,
lymphocytes, monocytes, eosinophils, and basophils are all white blood
cells, but each have different functions from one another. For example,
neutrophils are known to fight "bacterial" infections while lymphocytes
are known to fight "viral" infections. Our blood should contain these
different white blood cells to fight off infections properly. The
different white blood cells are measured by percentage. Below is
an example of how white blood cells should be distributed in healthy people.
This guideline is called the "differentials."
| Total White Blood Cells (WBC) | 4-11 |
| Polymorphoneutrophils (Neutrophils) | 42-75% |
| Lymphocytes | 20-51% |
| Monocytes | 1-12% |
| Eosinophils | 0-10% |
| Basophils | 0-1% |
The above reference ranges were taken from a Kaiser lab. These ranges vary from lab to lab, but will show you that you should have the highest concentration of neutrophils followed by lymphocytes. If you have too few neutrophils, you are considered neutropenic (having a low neutrophil count). The range for neutropenia is as follows:
Normal absolute neutrophil counts (ANC) 1,800-7,000.
If a person's ANC drops below 1,000, then he/she is considered "neutropenic."
If a person's ANC drops below 500, then he/she is considered "severely neutropenic."
If a person's ANC drops below 200, then he/she is considered "very severely neutropenic."
The absolute neutrophil count (ANC) can be figured by multiplying the total white blood count with the neutrophil percentage shown on the differential.
Example: 4,000 x .42 = 1,680 (The lab would round it off to an ANC of 1,700)
Many AA patients have very few neutrophils and have mostly lymphocytes. With few neutrophils, an AA patient is susceptable to bacterial infections, and since the lymphocytes are obviously malfunctioning, viral infections can also be a problem.
In contrast to the normal range
of a healthy person's differential, the differentials of my white blood
count (WBC) in the beginning of my diagnosis looked like this:
| White Blood Count Differentials | Mine in 1999 | Normal range |
| Total White Blood Count | 0.500 | 4-11 (4,000-11,000) |
| Neutrophils | 0% | 42-75% |
| Lymphocytes | 99% | 20-51% |
| Monocytes | 0% | 1-12% |
| Eosinophils | 0% | 0-10% |
| Basophils | 0% | 0-1% |
| Plasmazoid | 1% |
As you can see from the above chart, in 1999, I had "0" neutrophils. With zero neutrophils, that was equivalent to an absolute neutrophil count (ANC) of zero. That meant that I had practically "zero" protection from bacterial infections. Hence, my hospital stay was confined to reverse isolation.
Regarding reading the white blood count, it is necessary to know what your absolute neutrophil count (ANC) is, and not just the total white blood count (WBC), to know if your body has any protection from infection. Let me give you an example of this:
Say that your total white blood count is 11, and your neutrophil count is only 5%.
11000 x .05=550
This would show that your absolute neutrophil count (ANC) is only 550. You are now severly neutropenic.
In contrast, say your total white blood count is 2, and your neutrophil count is 65%.
2000 x .65=1,300
This shows you that your absolute neutrophil count (ANC) is 1,300. You are not below the 1,000 mark to be labeled neutropenic.
As you can see, just looking at the WBC without differentials to tell you what your ANC is is very misleading because you can have a WBC of 2 and have more protection than a WBC of 11 depending upon how many neutrophils you have.
Another thing to consider is the "quality" of your cells. Just because you have lots of them doesn't mean they are all functioning properly. So, again, just looking at the complete blood counts are only a "guideline." Keep your eye out for symptoms.
The red cells are also counted in different ways--RBCs, Hgb., Hct, MCV, and RDW.
The total red blood cells (RBC) is based on aperture impedence principle. The blood cells which are non-conductors of electricity are diluted in a buffered electrolyte solution and passed through the orifice of an aperture tube between two electrodes. Interruption of the current by the cells alters the electrical charge and a pulse is produced. The amplitude of each pulse is proportional to the volume of the cell. The RBC is determined from the total number of pulses obtained from a measured volume of blood.
Hemoglobin (Hgb.) is the oxygen carrying pigment of the erythrocytes. It is measured in various ways one of which a drop of blood is added to a reagent that converts the hemoglobin to methemoglobin azide.
Hematocrit (Hct.) is the ratio of red blood cells to plasma. This is determined by centrifuging the blood sample which separates the red cells from the plasma.
Mean Corpuscular Volume (MCV) measures the average size of the red cells. The MCV can help to determine the maturity and health of the red cells. Iron overload, iron deficiency, B12 deficiency, folate deficiency, etc. can influence the MCV.
Red Cell Distribution Width (RDW) indicates the range of sizes of the red cells within the blood sample.
Aside from low white blood and red blood counts, AA patients often have low platelet counts. The platelets are the portion of the blood that aides our bodies in clotting and repairing injuries. The "quality" of our platelets, I believe, are actually more important than the "quantity." Also, it should be taken into consideration that our bodies have other clotting factors that work with our platelets such as factor VIII and protime. It is common to receive platelet transfusions when the platelet level drops below 15,000. However, if you are very stable, it is possible to take platelet transfusions at an even lower level. The article below reveals a study done on AA patients with low platelet levels.
A Restrictive Platelet Transfusion
Policy Allowing Long-Term Support of
Outpatients With Severe
Aplastic Anemia
Markus Sagmeister, Lic
Oec, and Jürg Gmür
From the Department of Internal
Medicine, the Division of Hematology,
University Hospital of
Zürich, Zürich, Switzerland.
The threshold for prophylactic
platelet transfusions in patients with
hypoplastic thrombopenia
generally recommended in the standard literature is
20,000 platelets/µL.
A more restrictive transfusion policy may be indicated
in patients with chronic
severe aplastic anemia (SAA) in need of long-term
platelet support. We evaluated
the feasibility and safety of a policy with
low thresholds for prophylactic
transfusions (5,000 platelets/µL in stable
patients; 6,000 to 10,000
platelets/µL in cases with fever and/or
hemorrhagic signs) combined
with progressive lengthening of transfusion
intervals (up to at least
7 days irrespective of the interim course of
platelet counts). The study
was based on a retrospective analysis of a total
of 18,706 patient days
with platelet counts 10,000/µL in patients with
chronic SAA treated (for
more than 3 months) on an outpatient basis.
Altogether, 1,135 platelet
transfusions were given, 88% at counts 10,000/µL
and 57% at counts 5,000/µL.
The mean transfusion interval was 10 days.
During the period of observation,
three major nonlethal bleeding
complications occurred,
which could be well controlled. We conclude that the
restrictive policy with
low transfusion thresholds and prolonged transfusion
intervals proved feasible
and safe in chronic SAA patients.
One might wonder why I would forego a platelet transfusion at an 8,000 level. There are a few reasons.
1. Too many platelet transfusions can make your body develop antibodies so that in the future, they will not work for me anymore. This is known as being refractory.
2. Platelets only last for about a week if they are compatible with you, so that would mean that I would be constantly going in for platelet transfusions every week.
3. It is very common to get adverse reactions to platelet transfusions. In addition to hives, I passed out during one of my platelet transfusions. (Now that was quite embarrassing if you knew the details of what happened!)
4. I am not symptomatic. I do not have any bleeding problems.
5. I have
now gone over 7 months without a platelet transfusion and since then, my
platelets have continued to remain above 15,000.