Labs Research

7/28/2019 Labs Research

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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 asanemia,infection,inflammation,bleeding disorderorleukemia, 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 inallergiesand inflammation:

o White blood cell (WBC) countis a count of the total number of white blood cells in a person's sample of

blood.

o White blood cell differentialmay 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

includeneutrophils,lymphocytes,monocytes,eosinophils, andbasophils.

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

o Red blood cell (RBC) countis a count of the actual number of red blood cells in a person's sample of

blood.

o Hemoglobinmeasures the amount of the oxygen-carrying protein in the blood.

o Hematocritmeasures the percentage of a person's blood that consists of red blood cells.

o 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.
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o The CBC may also includereticulocyte 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:

o Theplatelet countis the number of platelets in a person's sample of blood.

o Mean platelet volume (MPV) may be reported with a CBC. It is a calculation of the average size of

platelets.

o 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 ofsignsandsymptomsthat may be related to disorders that

affect blood cells. When an individual has fatigue or weakness or has aninfection,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 affectbone marrowproduction of cells. Some medications can

decreaseWBC countsoverall. 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 CBCWBC 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
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TEST FULL NAME



Bone marrow disordersor

damage

Autoimmune conditions Severe infections (sepsis)

Lymphomaor other

cancer that spread to

thebone marrow

Diseases of immune

system (e.g.,HIV)

Infection, most

commonlybacterialorviral

Inflammation Leukemia,myeloproliferative

disorders

Allergies,asthma

Tissue death (trauma, burns,heart

attack)

Intense exercise or severe stress

DiffWhite Blood Cell Differential

(Not always performed; may

be done as part of or in follow

up to CBC)

Neu,

PMN,

polys

Absoluteneutrophilcount, %

neutrophils

Known as neutropenia

Severe, overwhelming

infection (sepsis)

Autoimmune disorders

Reaction to drugs,

chemotherapy

Immunodeficiency

Myelodysplasia

Bone marrow damage

(e.g., chemotherapy,

radiation therapy)

Cancer that spreads to

the bone marrow

Known as neutrophilia

Acutebacterial infections

Inflammation

Tissue death (necrosis) caused by

trauma, heart attack, burns

Physiological (stress, rigorous

exercise)

Certain leukemias (e.g., chronic

myeloid leukemia)

Lymph Absolutelymphocytecount, %

lymphocytes

Known as lymphocytopenia


Known as lymphocytosis

Acute viral infections (e.g.,chicken
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TEST FULL NAME



(e.g.,lupus,rheumatoid

arthritis)

Infections (e.g., HIV,viralhepatitis, typhoid

fever,influenza)

Bone marrow damage

(e.g., chemotherapy,

radiation therapy)

Corticosteroids

pox,cytomegalovirus

(CMV),Epstein-Barr virus

(EBV),herpes,rubella) Certain bacterial infections

(e.g.,pertussis (whooping

cough),tuberculosis (TB))

Toxoplasmosis

Chronicinflammatory disorder (e.g.,

ulcerative colitis)

Lymphocytic leukemia, lymphoma

Stress (acute)

Mono Absolutemonocytecount, %

monocytes

Usually, one low count is not

medically significant.

Repeated low counts can

indicate:

Bone marrow damage or

failure

Hairy cell leukemia

Chronic infections (e.g.,

tuberculosis,fungal infection)

Infection within the heart (bacterial

endocarditis)

Collagen vascular diseases (e.g.,

lupus,scleroderma, rheumatoid

arthritis,vasculitis)

Monocytic or myelomonocytic

leukemia (acute or chronic)

Eos Absoluteeosinophilcount, %

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

Parasiticinfections

Inflammatory disorders (celiac

disease,inflammatory bowel

disease)

Some cancers, leukemias or

lymphomas

Baso Absolutebasophilcount, %

basophils

As with eosinophils, numbers

are normally low in the blood;

Rare allergic reactions (hives, food
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TEST FULL NAME



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 asanemia

Acute or chronic bleeding

RBC destruction (e.g.,hemolytic

anemia, etc.)

Nutritional deficiency (e.g., iron

deficiency, vitamin B12 or folate

deficiency)

Bone marrow disorders or

damage

Chronic inflammatory disease

Kidney failure

Known aspolycythemia

Dehydration

Lung (pulmonary) disease

Kidney or other tumor that

produces excess erythropoietin

Smoking

Genetic causes (altered oxygen

sensing, abnormality in hemoglobin

oxygen release)

Polycythemia vera

a 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 byiron

deficiency anemiaorthalassemias, for

example.

Indicates RBCs are larger than normal

(macrocytic), for example inanemia

caused by vitamin B12 or folate

deficiency

MCH Mean Mirrors MCV results; small red cells Mirrors MCV results; macrocytic RBCs
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Corpuscular

Hemoglobin

would have a lower value. are large so tend to have a higher MCH.

MCHC MeanCorpuscular

Hemoglobin

Concentration

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

Width

Low value indicates uniformity in size

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

orhemolysis, or response to treatment

(e.g., iron supplementation for iron

deficiency anemia)

Expand TablePlatelet Evaluation


Plt Platelet

Count

Known as thrombocytopenia:

Viral infection

(mononucleosis,measles, hepatitis)

Rocky mountain spotted fever

Platelet autoantibody

Drugs (acetaminophen, quinidine,

Know as thrombocytosis:

Cancer (lung,

gastrointestinal,breast,ovarian,

lymphoma)

Rheumatoid arthritis, inflammatory

bowel disease, lupus

Iron deficiency anemia
http://labtestsonline.org/understanding/analytes/reticulocyte/http://labtestsonline.org/understanding/analytes/reticulocyte/http://labtestsonline.org/understanding/analytes/reticulocyte/http://labtestsonline.org/glossary/hemolysis/http://labtestsonline.org/glossary/hemolysis/http://labtestsonline.org/glossary/hemolysis/http://labtestsonline.org/http://labtestsonline.org/understanding/analytes/platelethttp://labtestsonline.org/understanding/analytes/platelethttp://labtestsonline.org/understanding/analytes/mono/tab/samplehttp://labtestsonline.org/understanding/analytes/mono/tab/samplehttp://labtestsonline.org/understanding/analytes/mono/tab/samplehttp://labtestsonline.org/understanding/analytes/measles/tab/samplehttp://labtestsonline.org/understanding/analytes/measles/tab/samplehttp://labtestsonline.org/understanding/analytes/measles/tab/samplehttp://labtestsonline.org/understanding/conditions/breast/http://labtestsonline.org/understanding/conditions/breast/http://labtestsonline.org/understanding/conditions/breast/http://labtestsonline.org/understanding/conditions/ovarian/http://labtestsonline.org/understanding/conditions/ovarian/http://labtestsonline.org/understanding/conditions/ovarian/http://labtestsonline.org/understanding/conditions/ovarian/http://labtestsonline.org/understanding/conditions/breast/http://labtestsonline.org/understanding/analytes/measles/tab/samplehttp://labtestsonline.org/understanding/analytes/mono/tab/samplehttp://labtestsonline.org/understanding/analytes/platelethttp://labtestsonline.org/http://labtestsonline.org/glossary/hemolysis/http://labtestsonline.org/understanding/analytes/reticulocyte/http://labtestsonline.org/understanding/analytes/reticulocyte/


7/17


sulfa drugs)

Cirrhosis


Sepsis

Leukemia, lymphoma

Myelodysplasia

Chemo or radiation therapy

Hemolytic anemia

Myeloproliferative disorder (e.g.,

essential thrombocythemia)

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 3.2 - 5 g/dl

Alkaline phosphatase

(Adults: 25-60)33 - 131 IU/L

Adults > 61 yo: 51 - 153 IU/L

Ammonia 20 - 70 mcg/dl

Bilirubin, direct 0 - 0.3 mg/dl

Bilirubin, total 0.1 - 1.2 mg/dl
http://labtestsonline.org/understanding/conditions/cirrhosis/http://labtestsonline.org/understanding/conditions/cirrhosis/http://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/analytes/platelet/tab/faqhttp://labtestsonline.org/understanding/conditions/cirrhosis/


8/17

Blood Gases

Arterial Venous

pH 7.35 - 7.45 7.32 - 7.42

pCO2 35 - 45 38 - 52

pO2 70 - 100 28 - 48

HCO3 19 - 25 19 - 25

O2Sat % 90 - 95 40 - 70

BUN 7 - 20 mg/dl

Comp lete blood count (CBC) Adults

Male Female

Hemoglobin (g/dl) 13.5 - 16.5 12.0 - 15.0

Hematocrit (%) 41 - 50 36 - 44

RBC's ( x 10 /ml) 4.5 - 5.5 4.0 - 4.9

RDW (RBC distribution

width)< 14.5

MCV 80 - 100

MCH 26 - 34

MCHC % 31 - 37


9/17

Platelet count 100,000 to 450,000

Creatine kinase (CK) isoenzym es

CK-BB 0%

CK-MB (cardiac) 0 - 3.9%

CK-MM 96 - 100%

Creatine phosphokinase

(CPK)8 - 150 IU/L

Creatinine (mg/dl) 0.5 - 1.4

Electrolytes

Calcium 8.8 - 10.3 mg/dL

Calcium, ionized 2.24 - 2.46 meq/L

Chloride 95 - 107 mEq/L

Magnesium 1.6 - 2.4 mEq/L

Phosphate 2.5 - 4.5 mg/dL

Potassium 3.5 - 5.2 mEq/L

Sodium 135 - 147 mEq/L

Other

Ferritin (ng/ml) 13 - 300


10/17

Folate (ng/dl) 3.6 - 20

Glucose, fasting (mg/dl) 60 - 110

Glucose (2 hourspostprandial) (mg/dl)

Up to 140

Hemoglobin A1c


11/17

Triglycerides 45 - 155 mg/dl (< 160)

Osmolality 289 - 308 mOsm/kg

SGOT (AST) < 35 IU/L (20-48)

SGPT (ALT)


12/17

changed their normal range for TSH

to

0.3 - 3.04 mIU/L.

Thyroglobulin Thyroglobulin 5-25 ng/mL

Radioactive

Iodine Uptake

(RAIU)

Distribution of

radiolabeled iodine in

the thyroid

5 hr 5 to 15%

24 hr 15 to 35%

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 2.3-4.2 pg/ml

Total iron binding capacity

(TIBC)250 - 420 mcg/dl

Transferrin > 200 mg/dl

Uric acid (male) 2.0 - 8.0 mg/dl

(female) 2.0 - 7.5 mg/dl


13/17

WBC + different ial

WBC (cells/ml) 4,500 - 10,000

Segmented neutrophils 54 - 62%

Band forms 3 - 5% (above 8% indicates left shift)

Basophils 0 - 1 (0 - 0.75%)

Eosinophils 0 - 3 (1 - 3%)

lymphocytes 24 - 44 (25 - 33%)

Monocytes 3 - 6 (3 - 7%)

Abso lute Neutrophi l Count (ANC) - Oncolog y

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.


14/17

Absolute neutrophil count (ANC) of less than 500:

Severeneutropenia - 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 -


15/17

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 alsobeing 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
http://www.medicinenet.com/script/main/art.asp?articlekey=1966http://www.medicinenet.com/script/main/art.asp?articlekey=3494http://www.medicinenet.com/script/main/art.asp?articlekey=2502http://www.medicinenet.com/script/main/art.asp?articlekey=7778http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=11299http://www.medicinenet.com/script/main/art.asp?articlekey=339http://www.medicinenet.com/script/main/art.asp?articlekey=88081http://www.medicinenet.com/script/main/art.asp?articlekey=104731http://www.medicinenet.com/script/main/art.asp?articlekey=6837http://www.medicinenet.com/script/main/art.asp?articlekey=6837http://www.medicinenet.com/script/main/art.asp?articlekey=104731http://www.medicinenet.com/script/main/art.asp?articlekey=88081http://www.medicinenet.com/script/main/art.asp?articlekey=339http://www.medicinenet.com/script/main/art.asp?articlekey=11299http://www.medicinenet.com/script/main/art.asp?articlekey=10419http://www.medicinenet.com/script/main/art.asp?articlekey=7778http://www.medicinenet.com/script/main/art.asp?articlekey=2502http://www.medicinenet.com/script/main/art.asp?articlekey=3494http://www.medicinenet.com/script/main/art.asp?articlekey=1966


16/17

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 isallowed 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 mostoften 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


17/17

and beverages consumed, diarrhea, endocrine disorders, water retention

(various causes), trauma and bleeding.

Normal Values: 135-145 mEq/L / 3.5-5 mmol/L

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