CBC

The complete blood count (CBC) is often used as a broad screening test to determine an individual's general health status. It can be used to:

Screen for a wide range of conditions and diseases Help diagnose various conditions, such as anemia, infection, inflammation, bleeding disorder or leukemia, to name just a few Monitor the condition and/or effectiveness of treatment after a diagnosis is established Monitor treatment that is known to affect blood cells, such as chemotherapy or radiation therapy

A CBC is a panel of tests that evaluates the three types of cells that circulate in the blood and includes the following:

Evaluation of white blood cells, the cells that are part of the body's defense system against infections and cancer and also play a role in allergies and inflammation:

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White blood cell (WBC) count is a count of the total number of white blood cells in a person's sample of blood. White blood cell differential may or may not be included as part of the panel of tests. It identifies and counts the number of the various types of white blood cells present. The five types include neutrophils, lymphocytes,monocytes, eosinophils, and basophils.

Evaluation of red blood cells, the cells that transport oxygen throughout the body:

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Red blood cell (RBC) count is a count of the actual number of red blood cells in a person's sample of blood. Hemoglobin measures the amount of the oxygen-carrying protein in the blood. Hematocrit measures the percentage of a person's blood that consists of red blood cells. Red blood cell indices are calculations that provide information on the physical characteristics of the RBCs:

Mean corpuscular volume (MCV) is a measurement of the average size of RBCs. Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell.

Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average percentage of hemoglobin inside a red cell.

Red cell distribution width (RDW), which may be included in a CBC, is a calculation of the variation in the size of RBCs.

The CBC may also include reticulocyte count, which is a measurement of the absolute count or percentage of young red blood cells in blood.

Evaluation of platelets, cell fragments that are vital for normal blood clotting:

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The platelet count is the number of platelets in a person's sample of blood. Mean platelet volume (MPV) may be reported with a CBC. It is a calculation of the average size of platelets.

Platelet distribution width (PDW) may also be reported with a CBC. It is a measurement of the variation of platelet size.

When is it ordered?
The CBC is a very common test. Many people have a CBC performed when they have a routine health examination. If a person is healthy and has results that are within normal limits, then he or she may not require another CBC until their health status changes or until their doctor feels that it is necessary. A CBC may be ordered when a person has any number of signs and symptoms that may be related to disorders that affect blood cells. When an individual has fatigue or weakness or has an infection, inflammation, bruising, or bleeding, a doctor may order a CBC to help diagnose the cause and/or determine its severity. When a person has been diagnosed with a disease known to affect blood cells, a CBC will often be ordered on a regular basis to monitor their condition. Likewise, if someone is receiving treatment for a blood-related disorder, then a CBC may be performed frequently to determine if the treatment is effective. Some therapies, such as chemotherapy, can affect bone marrow production of cells. Some medications can decreaseWBC counts overall. A CBC may be ordered on a regular basis to monitor these drug treatments.

What does the test result mean?

A doctor typically evaluates and interprets results from the components of the CBC together. Depending on the purpose of the test, a number of additional or follow-up tests may be ordered for further investigation. The following tables briefly and generally explain what the result for each component of the CBC may mean.

WBC evaluation RBC evaluation Platelet evaluation

Components of the CBC WBC Evaluation

TEST FULL NAME EXAMPLES OF CAUSES OF A LOW COUNT EXAMPLES OF CAUSES OF A HIGH COUNT

WBC

White Blood Cell Count

Known as leukopenia

Known as leukocytosis

TEST

FULL NAME

EXAMPLES OF CAUSES OF A LOW COUNT

EXAMPLES OF CAUSES OF A HIGH COUNT

Bone marrow disorders or damage Autoimmune conditions Severe infections (sepsis) Lymphoma or other cancer that spread to the bone marrow

Infection, most commonly bacterialor viral Inflammation Leukemia, myeloproliferative disorders Allergies, asthma Tissue death (trauma, burns, heart attack) Intense exercise or severe stress

Diseases of immune system (e.g.,HIV)

Diff White Blood Cell Differential (Not always performed; may be done as part of or in follow up to CBC)

Neu, PMN, polys

Absolute neutrophil count, % neutrophils

Known as neutropenia

Known as neutrophilia

Severe, overwhelming infection (sepsis)

Acute bacterial infections Inflammation Tissue death (necrosis) caused by trauma, heart attack, burns

Autoimmune disorders Reaction to drugs, chemotherapy

Physiological (stress, rigorous exercise)

Immunodeficiency

Myelodysplasia Bone marrow damage (e.g., chemotherapy, radiation therapy)

Certain leukemias (e.g., chronic myeloid leukemia)

Cancer that spreads to the bone marrow

Lymph

Absolute lymphocytecount, % lymphocytes

Known as lymphocytopenia

Known as lymphocytosis

Autoimmune disorders

Acute viral infections (e.g., chicken

TEST

FULL NAME

EXAMPLES OF CAUSES OF A LOW COUNT

EXAMPLES OF CAUSES OF A HIGH COUNT

(e.g., lupus,rheumatoid arthritis)

pox, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes, rubella)

Infections (e.g., HIV, viral hepatitis, typhoid fever, influenza)

Certain bacterial infections (e.g.,pertussis (whooping cough),tuberculosis (TB))

Bone marrow damage (e.g., chemotherapy, radiation therapy)

Toxoplasmosis Chronic inflammatory disorder (e.g., ulcerative colitis) Lymphocytic leukemia, lymphoma Stress (acute)

Corticosteroids

Mono

Absolute monocyte count, % monocytes

Usually, one low count is not medically significant. Repeated low counts can indicate:

Chronic infections (e.g., tuberculosis, fungal infection) Infection within the heart (bacterial endocarditis)

Bone marrow damage or failure

Collagen vascular diseases (e.g., lupus, scleroderma, rheumatoid arthritis, vasculitis)

Hairy cell leukemia

Monocytic or myelomonocytic leukemia (acute or chronic)

Eos

Absolute eosinophilcount, % eosinophils

Numbers are normally low in the blood. One or an occasional low number is usually not medically significant

Asthma, allergies such as hay fever Drug reactions Parasitic infections Inflammatory disorders (celiac disease, inflammatory bowel disease)

Some cancers, leukemias or lymphomas

Baso

Absolute basophil count, % basophils

As with eosinophils, numbers are normally low in the blood;

Rare allergic reactions (hives, food

TEST

FULL NAME

EXAMPLES OF CAUSES OF A LOW COUNT

EXAMPLES OF CAUSES OF A HIGH COUNT

usually not medically significant

allergy)

Inflammation (rheumatoid arthritis, ulcerative colitis)

Some leukemias

Expand TableRBC Evaluation

TEST

FULL NAME

EXAMPLES OF CAUSES OF LOW RESULT

EXAMPLES OF CAUSES OF HIGH RESULT

RBC

Red Blood Cell Count

Known as anemia

Known as polycythemia

Acute or chronic bleeding RBC destruction (e.g., hemolytic anemia, etc.) Nutritional deficiency (e.g., iron deficiency, vitamin B12 or folate deficiency)

Dehydration Lung (pulmonary) disease Kidney or other tumor that produces excess erythropoietin

Smoking Genetic causes (altered oxygen sensing, abnormality in hemoglobin oxygen release)

Bone marrow disorders or damage

Chronic inflammatory disease Kidney failure

Polycythemia veraa rare disease

Hb

Hemoglobin

Usually mirrors RBC results, provides added information

Usually mirrors RBC results

Hct

Hematocrit

Usually mirrors RBC results

Usually mirrors RBC results; most common cause is dehydration

RBC indices MCV Mean Corpuscular Volume Indicates RBCs are smaller than normal (microcytic); caused by iron deficiency anemia or thalassemias, for example. MCH Mean Mirrors MCV results; small red cells Indicates RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 or folate deficiency Mirrors MCV results; macrocytic RBCs

TEST

FULL NAME

EXAMPLES OF CAUSES OF LOW RESULT

EXAMPLES OF CAUSES OF HIGH RESULT

Corpuscular Hemoglobin MCHC Mean Corpuscular Hemoglobin Concentration

would have a lower value.

are large so tend to have a higher MCH.

May be low when MCV is low; decreased MCHC values (hypochromia) are seen in conditions such as iron deficiency anemia and thalassemia.

Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is more concentrated inside the red cells, such as autoimmune hemolytic anemia, in burn patients, and hereditary spherocytosis, a rare congenital disorder.

RDW (Not always reported)

RBC Distribution Low value indicates uniformity in size Width of RBCs

Indicates mixed population of small and large RBCs; immature RBCs tend to be larger. For example, in iron deficiency anemia or pernicious anemia, there is high variation (anisocytosis) in RBC size (along with variation in shape poikilocytosis), causing an increase in the RDW.

Reticulocyte Count (Not always done)

Reticulocytes (absolute count or %)

In the setting of anemia, a low reticulocyte count indicates a condition is affecting the production of red blood cells, such as bone marrow disorder or damage, or a nutritional deficiency (iron, B12 or folate)

In the setting of anemia, a high reticulocyte count generally indicates peripheral cause, such as bleeding or hemolysis, or response to treatment (e.g., iron supplementation for iron deficiency anemia)

Expand TablePlatelet Evaluation

TEST

FULL NAME

EXAMPLES OF CAUSES OF LOW RESULT

EXAMPLES OF CAUSES OF HIGH RESULT

Plt

Platelet Count

Known as thrombocytopenia:

Know as thrombocytosis:

Viral infection (mononucleosis, measles, hepatitis) Rocky mountain spotted fever

Cancer (lung, gastrointestinal,breast, ovarian, lymphoma)

Platelet autoantibody Drugs (acetaminophen, quinidine,

Rheumatoid arthritis, inflammatory bowel disease, lupus

Iron deficiency anemia

TEST

FULL NAME

EXAMPLES OF CAUSES OF LOW RESULT

EXAMPLES OF CAUSES OF HIGH RESULT

sulfa drugs)

Hemolytic anemia Myeloproliferative disorder (e.g., essential thrombocythemia)

Cirrhosis Autoimmune disorders Sepsis Leukemia, lymphoma Myelodysplasia Chemo or radiation therapy

MPV (Not always reported)

Mean Platelet Volume

Indicates average size of platelets is small; older platelets are generally smaller than younger ones and a low MPV may mean that a condition is affecting the production of platelets by the bone marrow.

Indicates a high number of larger, younger platelets in the blood; this may be due to the bone marrow producing and releasing platelets rapidly into circulation.

PDW(Not always reported)

Platelet Distribution Width

Indicates uniformity in size of platelets

Indicates increased variation in the size of the platelets, which may mean that a condition is present that is affecting platelets

Albumin Alkaline phosphatase (Adults: 25-60) Adults > 61 yo: Ammonia Bilirubin, direct Bilirubin, total

3.2 - 5 g/dl 33 - 131 IU/L 51 - 153 IU/L 20 - 70 mcg/dl 0 - 0.3 mg/dl 0.1 - 1.2 mg/dl

Blood Gases

Arterial pH pCO2 pO2 HCO3 O2 Sat % BUN 7.35 - 7.45 35 - 45 70 - 100 19 - 25 90 - 95 7 - 20 mg/dl

Venous 7.32 - 7.42 38 - 52 28 - 48 19 - 25 40 - 70

Complete blood count (CBC) Adults

Male Hemoglobin (g/dl) Hematocrit (%) RBC's ( x 106 /ml) RDW (RBC distribution width) MCV MCH MCHC % 13.5 - 16.5 41 - 50 4.5 - 5.5 < 14.5 80 - 100 26 - 34 31 - 37

Female 12.0 - 15.0 36 - 44 4.0 - 4.9

Platelet count

100,000 to 450,000
Creatine kinase (CK) isoenzymes

CK-BB CK-MB (cardiac) CK-MM Creatine phosphokinase (CPK) Creatinine (mg/dl)

0% 0 - 3.9% 96 - 100% 8 - 150 IU/L 0.5 - 1.4

Electrolytes

Calcium Calcium, ionized Chloride Magnesium Phosphate Potassium Sodium

8.8 - 10.3 mg/dL 2.24 - 2.46 meq/L 95 - 107 mEq/L 1.6 - 2.4 mEq/L 2.5 - 4.5 mg/dL 3.5 - 5.2 mEq/L 135 - 147 mEq/L
Other

Ferritin (ng/ml)

13 - 300

Folate (ng/dl) Glucose, fasting (mg/dl) Glucose (2 hours postprandial) (mg/dl)

3.6 - 20 60 - 110 Up to 140 <6% of total Hb AACE Guidelines (2011) Hemoglobin A1c, % (as a screening test) 5.4 - Normal ------------------------5.5-6.4 - High risk/prediabetes; requires screening by glucose criteria ------------------------6.5 -Diabetes, confirmed by repeating the test on a different day ================= In general, therapy should target a A1C level of 6.5% or less for most nonpregnant adults. 65 - 150 0.7 - 2.1 56 - 194 IU/L

Hemoglobin A1c

Iron (mcg/dl) Lactic acid (meq/L) LDH (lactic dehydrogenase)

Lipoproteins and triglycerides

Cholesterol, total HDL cholesterol LDL cholesterol

< 200 mg/dl 35 mg/dL. Negative risk factor: 65 - 180 mg/dl 60 mg/dL

Triglycerides

45 - 155 mg/dl (< 160)

Osmolality SGOT (AST) SGPT (ALT)

289 - 308 mOsm/kg < 35 IU/L (20-48) <35 IU/L

Thyroid Function tests

Thyroid Function Testing Thyroid Function Test Total T4 (TT4) Free T4 (FT4) Free T4 Index (FT4I) Total T3 (TT3) Resin T3 Uptake (RT3U) TRH TSH Measurement Normal Range

bound and free T4 free T4 estimate of free T4 FT4I = TT4 x RT3U bound and free T3 binding capacity of TBG TRH TSH

4.5 -11.5 mg/dL 0.8 -2.8 ng/dL 1.0 -4.3 U

75 -200 ng/dL 25 -35%

5 -25 mIu/mL 0.5 - 4.70 IU/mL American Association of Clinical Endocrinologists guidelines

changed their normal range for TSH to 0.3 - 3.04 mIU/L. Thyroglobulin Radioactive Iodine Uptake (RAIU) Thyroglobulin 5-25 ng/mL

Distribution of 5 hr 5 to 15% radiolabeled iodine in 24 hr 15 to 35% the thyroid

Notes: Free T4 - much more useful then total T4 (e.g. interested in unbound or active form). Total T4 not commonly measured. Greatly affected by TBG. Free T4 index: indirect measure of free T4. Corrects for high/low values of TBG. Total T3: not as useful as free T3, however, may be useful in locating problems with TBG, or if looking for problems with peripheral conversion of T4 to T3. Resin T3 Uptake: if low, then TBG binding capacity is high. Opposite if high. TSH: best measure to determine thyroid function. Thyroglobulin: nonspecific test that is elevated when the thyroid gland is inflamed or enlarged. Free T3 Total iron binding capacity (TIBC) Transferrin Uric acid (male) (female) 2.3-4.2 pg/ml 250 - 420 mcg/dl > 200 mg/dl 2.0 - 8.0 mg/dl 2.0 - 7.5 mg/dl

WBC + differential

WBC (cells/ml) Segmented neutrophils Band forms Basophils Eosinophils lymphocytes Monocytes

4,500 - 10,000 54 - 62% 3 - 5% (above 8% indicates left shift) 0 - 1 (0 - 0.75%) 0 - 3 (1 - 3%) 24 - 44 (25 - 33%) 3 - 6 (3 - 7%)
Absolute Neutrophil Count (ANC) - Oncology

Equations: (1) Segs and bands reported as a percentage: WBC * ((segs / 100) + (bands / 100)) (2) Segs and bands reported in total numbers: WBC * (segs + bands) Neutrophils (aka polymorphonuclear cells, PMNs, granulocytes, segmented neutrophils, or segs) fight against infection and represent a subset of the white blood count. Neutropenia by definition is an ANC below 1800/mm3 (some sources use a lower value). Absolute neutrophil count (ANC) of 1000-1800: Most patients will be given chemotherapy in this range. Risk of infection is considered low. Mild neutropenia - Absolute neutrophil count (ANC) of 500-1000: Carries with it a moderate risk of infection.

Absolute neutrophil count (ANC) of less than 500: Severe neutropenia - high risk of infection. Remember that a reduced WBC is known as leukopenia. The WBC consists of the following (differential): Lymphocytes: 20-40% Neutrophils: 50-60% Basophils: 0.5-2% Eosinophils: 1-4% Monocytes: 2-9% (average: 4%). ANC = Total WBC x (% "Segs" + % "Bands") Equivalent to: WBC x ((Segs/100) + (Bands/100)) The ANC refers to the total number of neutrophil granulocytes present in the blood. Normal value: 1500 cells/mm3. Mild neutropenia: 1000 - <1500/mm3. Moderate neutropenia: 500 - <1000/mm3. Severe neutropenia: < 500/mm3.

HGB

Adult males: 14-18 gm/dl Adult women: 12-16 gm/dl

Hemoglobin is the protein molecule in red blood cells that carries oxygenfrom the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.

Low Hemoglobin level It is referred to as anemia. There are many reasons for anemia. Some of the more common causes are:

loss of blood (traumatic injury, surgery, bleeding colon cancer orstomach ulcer),

nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hemoglobin (sickle cell anemia).

High Hemoglobin level It can be seen in people living at high altitudes and in people who smokes. Dehydration produces a falsely high hemoglobin which disappears when proper fluid balance is restored. Some other infrequent causes are:

advanced lung disease (for example,emphysema), certain tumors, a disorder of the bone marrow known aspolycythemia rubra vera, and abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.

Clotting Time The time required for blood to form a clot, tested by collecting 4 mL of blood in a glass tube and examining it for clot formation. The first appearance of a clot is noted and timed. The normal coagulation time in glass tubes is 5 to 15 minutes. This simple test has been used to diagnose hemophilia, but it does not detect mild coagulation disorders. Its chief application is in monitoring anticoagulant therapy. In order for blood to clot, the enzyme thrombin must be generated from the plasma precursor prothrombin. Thrombin then converts soluble fibrinogen into insoluble fibrin. Generation of thrombin involves the sequential activation of a number of other plasma clotting factor, this process is also being assisted by Ca++ and by factors released by platelets and damaged tissues . The time taken for blood to clot mainly reflects the time required for the generation of thrombin in this manner. If the plasma concentration of prothrombin or of some of the other factors is low (or if the factor is absent, or functionally inactive), clotting time will be prolonged. Lee-White method

A method of determining the length of time required for a clot to form in a test tube of venous blood. It is not specific for any coagulation disorder but is often used to monitor coagulation during heparin therapy. Because normal values and precise methodology vary, instructions are provided by most laboratories. It is also called a clot retraction, clotting time test or coagulation time. It is used to evaluate the presence of a bleeding disorder. Clot retraction is "the shrinking of the clot that forms when blood is allowed to stand, due to the fibrin network formed in the clot." Retraction time/clotting time is a generalized result that will be prolonged when there is a decreased platelet count or abnormal platelet function. The time it takes for a clot to form, separate from clear serum in a glass tube and for the edges to retract from the sides of the glass tube is noted. Bleeding Time This test measures the time taken for blood vessel constriction and platelet plug formation to occur. No clot is allowed to form, so that the arrest of bleeding depends exclusively on blood vessel constriction and platelet action. Bleeding time is used most often to detect qualitative defects of platelets. The test helps identify people who have defects in their platelet function. This is the ability of blood to clot following a wound or trauma. Normally, platelets interact with the walls of blood vessels to cause a blood clot. There are many factors in the clotting mechanism, and they are initiated by platelets. The bleeding time test is usually used on patients who have a history of prolonged bleeding after cuts, or who have a family history of bleeding disorders. Also, the bleeding time test is sometimes performed as a preoperative test to determine a patient's likely bleeding response during and after surgery. However, in patients with no history of bleeding problems, or who are not taking anti-inflammatory drugs, the bleeding time test is not usually necessary.

Serum Potassium (K) This test shows the level of potassium in the blood. Potassium plays an important role in muscle contractions and cell function. Both high and low levels of potassium can cause problems with the rhythm of the heart so it is important to monitor the level of potassium after surgery. Patients who are taking diuretics regularly may require regular blood tests to monitor potassium levels, as some diuretics cause the kidneys to excrete too much potassium.

Normal Values: 3.5-5 mEq/L / 3.5-5 mmol/L Serum Sodium (Na) This portion of the test shows the amount of sodium present in the blood. The kidneys work to excrete any excess sodium that is ingested in food and beverages. Sodium levels fluctuate with dehydration or over-hydration, the food

and beverages consumed, diarrhea, endocrine disorders, water retention (various causes), trauma and bleeding. Normal Values: 135-145 mEq/L / 3.5-5 mmol/L