Blood Analysis Flow Charts

flowchart TD %% Start and Initial Checks Start[CBC Analysis] --> InitialCheck{Check HGB-RBC-HCT Pattern} %% Wrong Measurements Path InitialCheck --> WrongPattern{Wrong Patterns} WrongPattern --> |"HGB-RBC-HCT:
Low-Low-High OR...
High-High-Normal"| LabError[Laboratory Error] %% Normal Patterns Path InitialCheck --> NormalPattern{Normal Patterns} NormalPattern --> |"Normal-Normal-Low/Normal/High"| MCVCheck1{Check MCV} MCVCheck1 -->|"MCV < 75"| EarlyMicro[Early Microcytic
Iron Deficiency/Beta Thalassemia] MCVCheck1 -->|"75 ≤ MCV ≤ 100"| NormalCase[Normal CBC] MCVCheck1 -->|"MCV > 100"| EarlyMacro[Early Macrocytic] %% Disease Classification InitialCheck --> DiseasePath{Disease Classification
Based on MCV & RDW} DiseasePath --> RDWHighMCVLow["RDW High + MCV Low"] RDWHighMCVLow --> MentzerHML{Mentzer Index} MentzerHML -->|"> 13"| IDAGroup["Iron Deficiency Anemia"] MentzerHML -->|"< 13"| ThalGroup["Beta Thalassemia"] DiseasePath --> RDWNormMCVLow["RDW Normal + MCV Low"] RDWNormMCVLow --> MentzerNML{Mentzer Index} MentzerNML -->|"> 13"| LateIronGroup["Late Iron Deficiency"] MentzerNML -->|"< 13"| ThalTraitGroup["Thalassemia Trait"] DiseasePath --> RDWHighMCVNorm["RDW High + MCV Normal"] RDWHighMCVNorm --> EarlyDefGroup["Early Deficiencies (Iron, B12/Folate, Sickle Cell)"] DiseasePath --> RDWNormMCVNorm["RDW Normal + MCV Normal"] RDWNormMCVNorm --> NormNormGroup["Chronic Illness, Hemolysis, etc."] DiseasePath --> RDWHighMCVHigh["RDW High + MCV High"] RDWHighMCVHigh --> MacroHighGroup["Macrocytic Conditions"] DiseasePath --> RDWNormMCVHigh["RDW Normal + MCV High"] RDWNormMCVHigh --> MacroNormGroup["Aplastic Anemia, etc."] DiseasePath --> RDWLow["RDW Low"] RDWLow --> LowRDWGroup["Thalassemia, Aplastic Anemia"] %% Additional Anemia Patterns InitialCheck --> AnemiaPattern{"Anemia Patterns"} AnemiaPattern --> LeukemiaSuspicion{"Leukemia Indicators"} LeukemiaSuspicion --> WBCCheck{Check WBC Count} WBCCheck -->|"WBC > 50,000/µL"| HighWBC[High WBC - Suspicious] WBCCheck -->|"WBC < 4,000/µL"| LowWBC[Low WBC - Suspicious] %% Early Microcytosis Path InitialCheck --> MicroPattern{"Early Microcytosis Pattern"} MicroPattern --> CompResponse[Compensatory Response] %% WBC and PLT Combined Critical Cases subgraph Combined["Critical Combinations"] CritStart[Start Combined Analysis] --> LeukemiaCheck{Check Leukemia Indicators} LeukemiaCheck -->|"WBC > 25,000
Anemia/PLT Issues"| AcuteLeukemia[Acute Leukemia] LeukemiaCheck -->|"High WBC
Anemia/PLT Issues"| ChronicLeukemia[Chronic Leukemia] end %% Links between subgraphs WBCValues -->|"Critical Patterns"| CritStart PLTValues -->|"Critical Patterns"| CritStart

flowchart TD Start[WBC Analysis] --> InitialWBC{Check Total WBC Count} %% Severe Leukocytosis Branch InitialWBC -->|"> 50,000/µL"| SevereLeuko[Severe Leukocytosis] SevereLeuko --> BlastCheck{Check Blasts} BlastCheck -->|"Blasts ≥ 20%"| AML["AML Suspect:
- Check bone marrow
- Flow cytometry
- Genetic testing"] BlastCheck -->|"Blasts < 20%"| DiffCount1{Differential Count} DiffCount1 --> |"NE# > 30,000/µL"| CML["CML Suspect:
1. BCR-ABL testing
2. JAK2 mutation
3. Bone marrow biopsy"] DiffCount1 --> |"LY# > 30,000/µL"| CLL["CLL Suspect:
1. Flow cytometry
2. FISH analysis
3. Check CD markers"] %% Moderate Leukocytosis Branch InitialWBC -->|"11,000-50,000/µL"| ModerateLeuko[Moderate Leukocytosis] ModerateLeuko --> DiffCount2{Differential Count} DiffCount2 -->|"NE# > 7,500/µL"| Neutrophilia["Neutrophilia:
- Infection
- Inflammation
- Early CML"] DiffCount2 -->|"LY# > 4,000/µL"| Lymphocytosis["Lymphocytosis:
- Viral infection
- Early CLL
- Lymphoma"] DiffCount2 -->|"MO# > 1,000/µL"| Monocytosis["Monocytosis:
- CMML
- Infection
- Autoimmune"] DiffCount2 -->|"EO# > 1,500/µL"| Eosinophilia["Eosinophilia:
- Allergy
- Parasitic
- HES"] DiffCount2 -->|"BA# > 200/µL"| Basophilia["Basophilia:
- CML
- Allergy
- Inflammation"] %% Leukopenia Branch InitialWBC -->|"< 4,000/µL"| Leukopenia[Leukopenia] Leukopenia --> DiffCount3{Differential Count} DiffCount3 -->|"NE# < 1,500/µL"| Neutropenia["Neutropenia:
- Aplastic anemia
- Drug-induced
- Early AML"] DiffCount3 -->|"LY# < 1,000/µL"| Lymphopenia["Lymphopenia:
- HIV
- Chemotherapy
- ALL"] %% Combined Abnormalities InitialWBC --> CombinedCheck{Check Combined Parameters} CombinedCheck --> |"WBC > 25k + PLT < 100k"| AcuteLeuk["Acute Leukemia Likely:
1. Urgent bone marrow
2. Cytogenetics"] CombinedCheck --> |"WBC > 25k + PLT > 450k"| ChronicLeuk["Chronic MPNs:
1. JAK2 testing
2. BCR-ABL"] %% Blast Patterns InitialWBC --> BlastPattern{Blast Patterns} BlastPattern --> |"Blasts ≥ 20%
Any WBC count"| AcuteLeukemia["Acute Leukemia:
- AML if myeloid
- ALL if lymphoid"] BlastPattern --> |"Blasts 5-19%"| MDS["MDS/Early Leukemia:
1. Bone marrow
2. Cytogenetics"] %% Special Considerations InitialWBC --> SpecialCases{Special Cases} SpecialCases --> |"Pancytopenia"| PanCases["Check For:
1. Aplastic anemia
2. PNH
3. Early leukemia"] SpecialCases --> |"Bicytopenia"| BiCases["Check For:
1. MDS
2. Early leukemia
3. Bone marrow failure"] %% PLT Integration InitialWBC --> PLTCheck{Check PLT Count} PLTCheck -->|"PLT < 50,000/µL"| SevereThromb["Severe Thrombocytopenia:
1. Check bone marrow
2. Rule out DIC"] PLTCheck -->|"PLT > 1,000,000/µL"| ExtremeThromb["Extreme Thrombocytosis:
1. JAK2 testing
2. Check for MPN"] %% MPV Considerations PLTCheck --> MPVCheck{Check MPV} MPVCheck -->|"MPV > 12.0 fL"| HighMPV["High MPV:
- ITP
- Bernard-Soulier
- Pre-AML"] MPVCheck -->|"MPV < 7.0 fL"| LowMPV["Low MPV:
- Aplastic anemia
- WAS
- Pre-ALL"]

flowchart TD Start[CBC Analysis] --> InitialCheck{Check HGB-RBC-HCT Pattern} %% Wrong Measurements InitialCheck --> WrongPattern{Wrong Patterns} WrongPattern --> |"HGB-RBC-HCT:
Low-Low-High OR
Low-Normal-High OR
Low-High-High OR
Normal-Low-High OR
Normal-High-Low OR
High-Low-Low OR
High-Low-High OR
High-Low-Normal OR
High-Normal-Low OR
High-High-Low OR
High-High-Normal"| LabError[Laboratory Error] %% Normal Cases InitialCheck --> NormalPattern{Normal Patterns} NormalPattern --> |"HGB-RBC-HCT:
Normal-Normal-Low OR
Normal-Normal-Normal OR
Normal-Normal-High"| MCVCheck1{Check MCV} MCVCheck1 -->|"MCV < 75"| EarlyMicro[Early Microcytic
Iron Deficiency/Beta Thalassemia] MCVCheck1 -->|"75 ≤ MCV ≤ 100"| NormalCase[Normal CBC] MCVCheck1 -->|"MCV > 100"| EarlyMacro[Early Macrocytic] NormalPattern --> |"HGB-RBC-HCT:
Normal-High-Normal OR
Normal-High-High OR
High-Normal-High OR
High-Normal-Normal"| MCVCheck2{Check MCV} MCVCheck2 -->|"MCV < 80"| RDWCheck{Check RDW} RDWCheck -->|RDW > 14.5| EarlyMicroNormal[Early Microcytic - Monitor] RDWCheck -->|RDW ≤ 14.5| ThalassemiaOrMildIron[Thalassemia or mild iron deficiency] MCVCheck2 -->|"MCV Normal"| NormalCase %% Comprehensive Disease Classification InitialCheck --> DiseasePath{Disease Classification
Based on MCV & RDW} %% RDW High + MCV Low Branch DiseasePath --> RDWHighMCVLow["RDW High + MCV Low"] RDWHighMCVLow --> MentzerHML{Mentzer Index} MentzerHML -->|"> 13"| IDAGroup["Primary: Iron Deficiency Anemia
Secondary Possibilities:
- Chronic Illness
- RBC Fragmentation
- G6PD Deficiency"] MentzerHML -->|"< 13"| ThalGroup["Primary: Beta Thalassemia
Secondary Possibility:
- Hemoglobin H"] %% RDW Normal + MCV Low Branch DiseasePath --> RDWNormMCVLow["RDW Normal + MCV Low"] RDWNormMCVLow --> MentzerNML{Mentzer Index} MentzerNML -->|"> 13"| LateIronGroup["Primary: Late Iron Deficiency
Secondary Possibilities:
- Chronic Illness
- Hereditary Spherocytosis"] MentzerNML -->|"< 13"| ThalTraitGroup["Primary: Thalassemia Trait
Secondary Possibility:
- Chronic Illness"] %% RDW High + MCV Normal Branch DiseasePath --> RDWHighMCVNorm["RDW High + MCV Normal"] RDWHighMCVNorm --> EarlyDefGroup["Possibilities:
- Early Iron Deficiency
- Early B12/Folate Deficiency
- Sickle Cell Anemia"] %% RDW Normal + MCV Normal Branch DiseasePath --> RDWNormMCVNorm["RDW Normal + MCV Normal"] RDWNormMCVNorm --> NormNormGroup["Possibilities:
- Myelodysplasia
- Blood Loss
- Chronic Illness
- Hemolysis
- CLL/CML
- Hemoglobinopathy"] %% RDW High + MCV High Branch DiseasePath --> RDWHighMCVHigh["RDW High + MCV High"] RDWHighMCVHigh --> MacroHighGroup["Possibilities:
- B12/Folate Deficiency
- Autoimmune Hemolytic Anemia
- Cold Agglutinin
- Alcoholism"] %% RDW Normal + MCV High Branch DiseasePath --> RDWNormMCVHigh["RDW Normal + MCV High"] RDWNormMCVHigh --> MacroNormGroup["Possibilities:
- Aplastic Anemia
- Hepatopathy
- Preleukemia
- Myelodysplastic
- Alcoholism"] %% RDW Low Branch DiseasePath --> RDWLow["RDW Low"] RDWLow --> LowRDWGroup["Possibilities:
- Aplastic Anemia
- Thalassemia"] %% Early Microcytosis InitialCheck --> MicroPattern{"Early Microcytosis Pattern
HGB-RBC-HCT:
Low-High-Low OR
Low-High-Normal"} MicroPattern --> CompResponse[Compensatory Response] %% Anemia Patterns InitialCheck --> AnemiaPattern{"Anemia Patterns
HGB-RBC-HCT:
Low-Low-Low OR
Low-Low-Normal OR
Low-Normal-Low OR
Low-Normal-Normal"} %% Leukemia Branch AnemiaPattern --> LeukemiaSuspicion{"Leukemia Indicators"} LeukemiaSuspicion --> WBCCheck{Check WBC Count} WBCCheck -->|"WBC > 50,000/µL"| HighWBC[High WBC - Suspicious] WBCCheck -->|"WBC < 4,000/µL"| LowWBC[Low WBC - Suspicious] HighWBC --> BlastCheck{Check Blast %} BlastCheck -->|"Blasts > 20%"| AML["AML Suspect
1. Check bone marrow
2. Flow cytometry"] BlastCheck -->|"Blasts < 20%
High mature WBC"| CML["CML Suspect
1. Check BCR-ABL
2. Bone marrow biopsy"] LowWBC --> LymphCheck{Check Lymphocytes} LymphCheck -->|"Mature Lymphs > 5,000/µL"| CLL["CLL Suspect
1. Flow cytometry
2. FISH analysis"] LymphCheck -->|"Blasts present"| ALL["ALL Suspect
1. Flow cytometry
2. Genetic testing"] %% Additional Criteria for Leukemia LeukemiaSuspicion --> PLTCheck{Check Platelets} PLTCheck -->|"PLT < 100,000/µL"| LowPLT[Suspicious - Check Bone Marrow] PLTCheck -->|"PLT > 450,000/µL"| HighPLT[Check for MPN]