Reference Cards

Hematology Lab Differentials

(index)
Increased WBC (leukocytosis, 10,000/ul): Infections, Tissue Necrosis, crush injuries,
AMI, Inflammation Disorders, leukemia, cancer, surgery, stress, DKA, Meds
(Epinephrine, corticosteroids, ...), eclampsia, uremia, Collagen Vascular Disorders
Decreased WBC (leukopenia, <4000/ul): Overwhelming infection/sepsis, Viral
Infections, HIV - AIDS, Immunosuppression, Bone Marrow suppression - infiltration disease, Anemias (Aplastic, Pernicious,...), Meds (chemotherapy, antibiotics, ...)
Increased Neutrophils (segmented, segs, polys, PMNs - >65-70%; bands - >15%): Acute Infection (bacterial sepsis > viral, parasitic, mycotic, spirochete),
Inflammatory Disorder (RA, Vasculitis, Rheumatic fever, thryroiditis), Physiologic
(Stress - physical or mental, pregnant, newborn, exercise), Tissue
Destruction/Necrosis (MI, burns, gangrene, trauma, cancer), Hematologic (leukemia,
Hodgkin's, myeloproliferative disorders, acute hemorrhage, splenectomy, hemolysis),
Meds (Epinephrine, Corticosteroids), DKA, uremia, eclampsia
Decreased Neutrophils (neutropenia, <50%): Overwhelming Bacterial Infection,
sepsis, Viral Infection, (hepatitis, influenza, infectious mononucleosis, measles,
chicken pox...), Typhoid, Paratyphoid, Rickettsial disease, Hematologic (Aplastic
Anemia, Megaloblastic Anemia, iron deficiency anemia, myelofibrosis, bone marrow
infiltration, acute lymphoblastic leukemia, splenomegaly [hypersplenism, congestion,
Gauchers, lymphoma]), Meds (Chloramphenicol, chemotherapy, Chlorpromazine,
Rifampin, antibiotics), liver pathology, ?immunosuppression, Autoimmune disorder
Increased Lymphocytes (> 40-50 %): Viral Infection (infectious mononucleosis,
hepatitis, influenza, measles, mumps, CMV, herpes, ...), Bacterial Infection, (chronic,
TB, 2 Syphilis, Typhoid, Toxoplasmosis), Hematologic (Iymphocytic leukemia,
multiple myeloma, Hodgkin's Disease), Inflammatory Disorders (Ulcerative Colitis,
ITP), Endocrine (Adrenal hypotunction, Thyroid hyperfunction), Leukemias (hairy
cell, acute lymphatic...)
Decreased Lymphocytes (< 15-20 %): Cushing Disease/Syndrome, Corticosteroid
intake, chemotherapy, radiation therapy, Epinephrine, Immunosuppression/deficiency
(AIDS, meds), SLE, cancer, renal failure, alcoholism
Increased Monocytes (> 8%): Infections (infectious mononucleosis, TB, SBE, malaria,
viruses, parasites, rickettsial), Monocytic leukemia, Hodgkins Disease, inflammation,
cancer
Increased Eosinophils (> 4%): Allergic Disorders (hay fever, asthma, drug reactions,
serum sickness), Parasitic Diseases (Schistosomiasis, Strongyloidiasis, Trichinosis,
Echinococcosis, Cysticerosis...), Fungal Infections, Cancer (colon, ovarian, testes,
lung, Hodgkin's, lymphoma, CML), Skin Pathology (Eczema, Psoriasis, Urticaria,
Dermatitis), Collagen Vascular Disorders (SLE, Polyarteritis Nodosa, Vasculitis),

Ulcerative Colitis, Crohn's, Hypereosinophilic syndromes (Leofflers Syndrome,

chronic eosinophilic pneumonia...)
Increased Basophils (> 1-2%): Leukemia (Basophilic, Granulocytic, Monocytic),
Hodgkin's Disease, myeloproliferative disorders, chronic allergic reactions, Sarcoid,
Infections (Syphilis, TB, rickettsial, SBE), inflammation
Increased Platelets (thrombocytosis, > 400 x 10^3/mm^3 or 400 x 10^9/l): Cancer,
splenectomy, acute infection, chronic granulocytic or myelogenous leukemia, chronic
inflammation (RA, CUC...), acute hemorrhage, myeloproliferative disorders,
polycythemia vera
Decreased Platelets (thrombocytopenia, < 100-150 x 10^3/mm^3 or 100-150 10^9/l):
Sepsis, DIC, S/P multiple blood transfusions with significant hemorrhage,
Immunologic (ITP, post transfusion, HIV - AIDS, Infectious Mononucleosis, SLE,
Collagen Vascular Diseases, Sarcoid, Meds [Lasix, Quinine, Quinidine, Sulfonamides,
Thiazides, Gold Salts]), Cancer - ?bone marrow infiltration - suppression (CA, acute
leukemia, lymphoma, CLL, post chemo, post RT, multiple myeloma), hypersplenism,
HUS, TTP, Meds (chemo, Heparin, ASA, Penicillin), Hematologic (Aplastic Anemia,
Pernicious Anemia, Hemolytic Anemia, myelofibrosis), liver disease, heart failure,
heart valve (consumption), significant hemangiomas, Genetic (Bernard Soulier,
Wiskott Aldrich, Gauchers, Fanconi, May Hegglin, Felty's), alcohol
Increased Hgb/Hct (>16-18 g/dL or > 46-52%): Polythycemia Vera (Primary or
Secondary - Altitude), CHF, COPD, Hemoconcentration (dehydration, burns, diarrhea,
increased insensible H20 losses), transfusions, congenital heart disease, Erythropoietin
secreting tumors (renal cell, ovarian, hepatoma ...)
Decreased Hgb/Hct (< 11-13.5 g/dL or < 33-39.5%): Hemorrhage (acute [post op,
ectopic pregnancy, AAA, trauma...], chronic, GI [UGI: PUD, gastritis, varices via
portal hypertension, Mallory Weiss tears, esophagitis, CA-tumors, polyps, lymphoma,
aortoenteric fistula, Meckel's diverticulum; - LGI: angiodysplasia, CA-polyps,
diverticula, colitis-proctitis-IBD, bacterial enterocolitis, hemorrhoids -fissuresfistulas, mesenteric ischemia...], GU), Anemias (Hemoglobinopathies [Sickle Cell,
Thalassemia, S, C], Nutritional Deficiencies [Iron, Folate, Vitamin B12], Pernicious Vitamin B12 Intrinsic Factor problems, Aplastic), Bone Marrow Failure -Infiltration Suppression, Hemolysis (transfusion reaction, artificial heart valve, Hereditary
Spherocytosis, Elliptocytosis, Ovalocytosis, Glycolytic Enzyme Deficiencies [G6PD
deficiency], PNH, microangiopathic [DIC, TTP, HUS], splenomegaly, antibody
production [allo, auto- warm/ cold), cancer, leukemia, lymphoma, Meds (chemo,
antibiotics, sulfonamides...), pregnant, cirrhosis, liver disease, renal failure, fluid
overload, chronic disease (SBE, SLE, RA, TB, Crohns... ), excess phlebotomy (ICU),
hypothyroidism, hypoadrenalism, CHF
Increased MCV ( mean corpuscular volume, macrocytic anemia, MCV > 100 fL):
folate deficiency, Vitamin B12 (cobalamin) def., intrinsic factor def. (gastrectomy),
pernicious anemia, ileal resection or bypass, intestinal stasis, malabsorption (Crohn's,

tropical sprue, blind loop syndrome...), hypothyroidism, alcoholism, liver disease,

Meds (Methotrexate, AZT, chemo-DNA synthesis inhibitors), reticulocytosis (mild),
pregnant (mild), myelodysplastic syndrome
Decreased MCV (microcytic, < 80 fL): iron deficiency*, sideroblastic anemia*
(ETOH, lsoniazid, cancers), hemoglobinopathies (Thalassemia*), lead, chronic
disease; *also MCHC
Increased Reticulocyte Count (retics - immature nonnucleated RBCs, >1.5%, parallels
bone marrow activity): hemolytic anemia, acute post hemorrhage (3-4 days), anemia
Rx (iron, transfusion, folate, Vitamin B12), pregnant
Decreased Reticulocyte Count (< 0.5%): inadequate bone marrow production (aplastic
anemia, sepsis, chemotherapy/RT..), bone marrow failure, renal failure, chronic
disease, hypothyroidism
Peripheral Blood Smear Review: Spherocytes - Hereditary Spherocytosis, hemolytic
anemias (autoimmune), ETOH; Target Cells - Hemoglobinopathies, Thalassemia, post
splenectomy:Tear Drop Cells - myeloproliferative disorders, Thalassemias,
megaloblastic anemia; Schistocytes (fragmented) - microangiopathic hemolytic
anemias (immune, DIC, TTP, HUS, hemangiomas, eclampsia...), prosthetic heart
valves; Howell Jolly Bodies - post splenectomy, hemolytic anemias, megaloblastic
anemia; Heinz Bodies - hemolytic anemia, hemoglobinopathies, oxidation, G6PD
deficiency, post splenectomy; Stippling - lead poisoning, hemolysis,
Thalassemia; Hypochromatic Microcytic - iron deficiency anemia, sideroblastic
anemia, Thalassemia, anemia of chronic disease
Increased Prothrombin Time (PT, > 13-14 seconds): Coumadin (Warfarin), Vitamin K
Deficiency, DIC, Factor Deficiency (VII, X, V, II - Prothrombin, I - Fibrinogen),
Hepatocellular- Biliary Disease (carcinoma, biliary obstruction, cholestasis, cirrhosis/
alcoholism, hepatitis), excessive heparinization, dysfibrinogenemia, ASA, beta lactam
antibiotics
Increased Partial Thromboplastin Time (PTT, > 35-40 seconds): Heparin, DIC, Factor
Deficiency (VIII - Hemophilia A, IX - Hemophilia B/Christmas Disease, XII, XI, X,
V, II, I -Hypofibrinogenemia), von Willebrand's Disease, Hepatic-Biliary Disease
(cirrhosis, biliary obstruction...), Vitamin K deficiency, circulating anticoagulants
(lupus anticoagulant)
Increased Bleeding Time (> 9-10 minutes): platelet dysfunction, ASA, DIC,
thrombocytopenia, von Willebrand's disease, uremia, NSAIDs, Ticlopidine, severe
liver disease, myeloproliferative diseases (leukemia...), Bernard-Soulier, Glanzmann's,
alcohol intoxication
Increased Thrombin Time (> 18 seconds): Heparin, DIC, thrombolytics (tPA,
streptokinase, urokinase), fibrinolysis, severe liver disease, multiple myeloma,

afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia, uremia

Increased Fibrinogen (>400 mg/dl, >4.0 g/l): acute MI, pregnancy, acute infection or
inflammation(acute phase reactant), oral contraceptives
Decreased Fibrinogen (< 200 mg/dl, < 2.0 g/l): DIC, significant liver disease,
fibrinolysis, afibrinogenemia, hypofibrinogenemia, eclampsia, end stage cancer
+D Dimers (from plasmin action on crosslinked fibrin): DIC, PE, tPA, DVT, pregnant,
CA
+FSPs, FDPs (sensitive to fibrinogenolysis and fibrinolysis, > 10 ug/ml): DIC,
thrombolytics, PE, thrombosis (venous), cancer, S/P cardiopulmonary bypass surgery,
late obstetrical problems, significant liver disease
Increased Erythrocyte Sedimentation Rate, ESR (> 15-20 mm/hr): Infections,
Inflammation (acute and chronic), cancer, collagen vascular disease (SLE, RA...),
Ulcerative Colitis, Crohns, glomerulonephritis, thyroid abnormalities, multiple
myeloma, lymphoma, tissue necrosis, acute MI, SBE (Note - This test is very sensitive
with low specificity.)
DIC Differential (Disseminated Intravascular Coagulation): Infections (gram negative
> gram positive sepsis, bacterial, viral, fungal, rickettsial [Rocky Mountain Spotted
Fever], protozoal), Obstetric Complications (retained dead fetus, amniotic fluid
embolism, placental abruption, eclampsia, septic abortion), Cancer (adenocarcinoma,
acute leukemia - promyelocytic,...), Surgical (trauma, fat emboli, burns, prostate),
Shock, DKA, tissue necrosis, pancreatitis, heat stroke, severe liver disease, transfusion
reaction, head injury
Hypercoaguable State: Antithrombin III def., Protein C or S def., lupus anticoagulant,
anticardiolipin Ab, Factor V Leiden, oral contraceptives, pregnancy, obesity,
immobility, myeloproliferative diseases, cancer, major post-op, CHF, age, H/0-MI,
CVA, PE, smoker, COPD
(index)