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(1)Complete Blood Count

Also known as: CBC; Hemogram; CBC with differential Formal name: Complete Blood Count Related tests: Blood smear; Hemoglobin; Hematocrit; Red blood cell (RBC) count; White blood cell (WBC) count; White blood cell differential count; Platelet count

How is it used?
The complete blood count or CBC test is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following:

White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant. White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person's white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils.

Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions. Hemoglobin measures the amount of oxygen-carrying protein in the blood. Hematocrit measures the percentage of red blood cells in a given volume of whole blood. The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow.

Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 deficiency. When the MCV is decreased, your RBCs are smaller than normal (microcytic) as is seen in iron deficiency anemia or thalassemias.

Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. Macrocytic RBCs are large so tend to have a higher MCH, while microcytic red cells would have a lower value. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a red cell. Decreased MCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anemia and in thalassemia. Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is abnormally concentrated inside the red cells, such as in burn patients and hereditary spherocytosis, a relatively rare congenital disorder.

Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. In some anemias, such aspernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape poikilocytosis) causes an increase in the RDW. ^ Back to top

When is it ordered?
The CBC is a very common test. Many patients will have baseline CBC tests to help determine their general health status. If they are healthy and they have cell populations that are within normal limits, then they may not require another CBC until their health status changes or until their doctor feels that it is necessary. If a patient is having symptoms such as fatigue or weakness or has an infection, inflammation, bruising, or bleeding, then the doctor may order a CBC to help diagnose the cause. Significant increases in WBCs may help confirm that an infection is present and suggest the need for further testing to identify its cause. Decreases in the number of RBCs (anemia) can be further evaluated by changes in size or shape of the RBCs to help determine if the cause might be decreased production, increased loss, or increased destruction of RBCs. A platelet count that is low or extremely high may confirm the cause of excessive bleeding or clotting and can also be associated with diseases of the bone marrow such as leukemia. Many conditions will result in increases or decreases in the cell populations. Some of these conditions may require treatment, while others will resolve on their own. Some diseases, such as cancer (and chemotherapy treatment), can affect bone marrow production of cells, increasing the production of one cell at the expense of others or decreasing overall cell production. Some medications can decrease WBC counts while some vitamin and mineral deficiencies can cause anemia. The CBC test may be ordered by the doctor on a regular basis to monitor these conditions and drug treatments.

What does the test result mean?

The following table explains what increases or decreases in each of the components of the CBC may mean.

Expand TableComponents
TEST

of the CBC
INCREASED/DECREASED

NAME

WBC

White Blood Cell

May be increased with infections, inflammation, cancer, leukemia; decreased with some medications (such as methotrexate), some autoimmune conditions, some severe infections, bone marrow failure, and congenital marrow aplasia (marrow doesn't develop normally)

% Neutrophil

Neutrophil/Band/Seg/Gran

This is a dynamic population that varies somewhat from day to day depending on what is going on in the body. Significant increases in particular types are associated with different temporary/acute and/or chronic conditions. An example of this is the increased number of

Lymphs

Lymphocyte

lymphocytes seen with lymphocytic leukemia. For more information, see Blood Smear and WBC.

% Mono

Monocyte

% Eos

Eosinophil

% Baso

Basophil

Neutrophil

Neutrophil/Ban/Seg/Gran

Lymphs

Lymphocyte

Mono

Monocyte

Eos

Eosinophil

Baso

Basophil

RBC

Red Blood Cell

Decreased with anemia; increased when too many made and with fluid loss due to diarrhea, dehydration, burns

Hgb

Hemoglobin

Mirrors RBC results

Hct

Hematocrit

Mirrors RBC results

MCV

Mean Corpuscular Volume

Increased with B12 and Folate deficiency; decreased with iron deficiency andthalassemia

TEST

NAME

INCREASED/DECREASED

MCH

Mean Corpuscular Hemoglobin

Mirrors MCV results

MCHC

Mean Corpuscular Hemoglobin Concentration

May be decreased when MCV is decreased; increases limited to amount of Hgb that will fit inside a RBC

RDW

RBC Distribution Width

Increased RDW indicates mixed population of RBCs; immature RBCs tend to be larger

Platelet

Platelet

Decreased or increased with conditions that affect platelet production; decreased when greater numbers used, as with bleeding; decreased with some inherited disorders (such as Wiskott-Aldrich, Bernard-Soulier), withSystemic lupus erythematosus, pernicious anemia, hypersplenism (spleen takes too many out of circulation), leukemia, and chemotherapy

MPV

Mean Platelet Volume

Vary with platelet production; younger platelets are larger than older ones

^ Back to top

Is there anything else I should know?


While no specific pre-testing restrictions are necessary, it is best to avoid a fatty meal prior to having your blood drawn. Normal CBC values for babies and children may be different from adults and need to be considered when interpreting data.

(2)Full blood count (FBC)


The full blood count (FBC), sometimes referred to as a full blood examination or complete blood count, is one of the most commonly performed blood tests, as it can tell us so much about the status of our health. It is important for diagnosing conditions in which the number of blood cells is abnormally high or abnormally low, or the cells themselves are abnormal. A full blood count measures the status of a number of different features of the blood, including:

the amount of haemoglobin in the blood; the number of red blood cells (red cell count); the percentage of blood cells as a proportion of the total blood volume (haematocrit or packed cell volume); the volume of red blood cells (mean cell volume); the average amount of haemoglobin in the red blood cells (known as mean cell haemoglobin); the number of white blood cells (white cell count); the percentages of the different types of white blood cells (leucocyte differential count); and the number of platelets.

The following provides an explanation of the various components that are measured, and helps to demystify some of the jargon you may hear in relation to this blood test.

Haemoglobin (Hb)
Haemoglobin is an iron-containing compound found in the red blood cells, which transports oxygen around the body. Measuring the concentration of haemoglobin in the blood can help diagnose anaemia, a condition caused by a deficiency of haemoglobin. Anaemia can arise due to:

inadequate production of red blood cells in the bone marrow; inadequate iron intake; inadequate folate or vitamin B12 intake; microscopic bleeding or other blood loss; blood cell destruction; a chronic illness; or a defect in the haemoglobin molecule itself.

This measurement may also detect abnormally high concentrations of haemoglobin. This may occur in people with chronic lung disease, as an adaptation to high altitudes, or because of an abnormal increase in red cell production by the bone marrow (polycythaemia vera).

The normal haemoglobin level for adult males is 130-170 g/L, and 120-150 g/L for adult females.

Red cell count (RCC)


Red cell count is an estimation of the number of red blood cells per litre of blood. Abnormally low numbers of red blood cells may indicate anaemia as a result of blood loss, bone marrow failure, malnutrition such as iron deficiency, over-hydration, or mechanical damage to red blood cells. Abnormally high numbers of red blood cells may indicate congenital heart disease, some lung diseases, dehydration, kidney disease or polycythaemia vera.

The normal red cell count for adult males is 4.5-5.5 x 1012/L, and 3.8-4.8 x 1012/L for adult females.

Packed cell volume (PCV) or haematocrit (Hct)


Haematocrit is a measure of the percentage of red blood cells to the total blood volume. A low haematocrit may indicate anaemia, blood loss, bone marrow failure, leukaemia, multiple myeloma, nutritional deficiency, over-hydration or rheumatoid arthritis. A high haematocrit may indicate dehydration (for example, due to burns or diarrhoea), eclampsia (a serious condition that can occur during pregnancy) or polycythaemia vera.

The normal haematocrit range for adult males is 40-50 per cent, and 36-46 per cent for adult females.

Mean cell volume or mean corpuscular volume (MCV)


Mean cell volume is an estimate of the volume of red blood cells. It is useful for determining the type of anaemia a person might have.

A low MCV may indicate iron deficiency, chronic disease, pregnancy, a haemoglobin disorder such as thalassaemia, anaemia due to blood cell destruction or bone marrow disorders. A high MCV may indicate anaemia due to nutritional deficiencies, bone marrow abnormalities, liver disease, alcoholism, chronic lung disease, or therapy with certain medications.

The normal MCV range for adults is 83-101 fL.

Mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC)
These measures, also known as mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration, are further guides to the investigation of anaemia. The MCH is the haemoglobin content of the average red cell. The MCHC is the average haemoglobin concentration in a given volume of packed red cells. The MCH may be low in types of anaemia where the red blood cells are abnormally small, or high in other types of anaemia where the red blood cells are enlarged (for example, as a result of folic acid or vitamin B12 deficiency). The MCHC is low in iron deficiency, blood loss, pregnancy and anaemias caused by chronic disease.

The normal MCH range for adults is 27-32 pg, and the normal MCHC range is 315-345 g/L.

White cell (leucocyte) count


White cell count estimates the total number of white blood cells per litre of blood. An abnormal high or low white cell count can indicate many possible medical conditions and a leucocyte differential count, which provides numbers of the different types of white cells, is usually needed to help make any diagnosis. Abnormally low numbers of white blood cells may indicate liver or spleen disorders, bone marrow disorders, or exposure to radiation or toxic substances. A number of viral infections can cause a temporary reduction in the white cell count. Abnormally high levels of white blood cells may indicate infection, tissue damage, leukaemia, or inflammatory diseases.

The normal white cell count for adults is 4.0-10.0 x 109/L.

Leucocyte (white cell) differential count


Leucocyte differential count provides an estimate of the numbers of the 5 main types of white blood cells. These are: neutrophils; monocytes; lymphocytes; eosinophils; and basophils. Each of the 5 types has a specific role in the body. Neutrophils and monocytes protect the body against bacteria and eat up small particles of foreign matter. Lymphocytes are involved in the immune process, producing antibodies against foreign organisms, protecting against viruses and fighting cancer. Eosinophils kill parasites and are involved in allergic responses. High numbers of eosinophils may be associated with worm infections or exposure to substances that cause allergic reactions. Basophils also take part in allergic responses and increased basophil production may be associated with bone marrow disorders or viral infection. The normal ranges for the number of the different types of white cells in adults are:

Neutrophils: 2.0-7.0 x 109/L Eosinophils: 0.02-0.5 x 109/L Basophils: 0.05-0.1 x 109/L Monocytes: 0.2-1.0 x 109/L Lymphocytes: 1.0-3.0 x 109/L

Platelet count
Platelet count is an estimation of the number of platelets per litre of blood. Abnormally low numbers of platelets is known as thrombocytopenia, while an abnormally high level of platelets is known as thrombocytosis. Platelet counts are often used to monitor medications that can have toxic effects on bone marrow, or conditions such as thrombocytopenia. They may also be used to help diagnose problems associated with abnormal bleeding or bruising.

The normal platelet count for adults is 150-400 x 109/L.

A note on differing laboratory values


The ranges for what is considered normal given here are typical figures. However, different laboratories may use slightly different ranges, depending on how they perform the measurements. Ask your doctor if you are unsure about your results.

(3)

What It Is

The complete blood count (CBC) is a common blood test that evaluates the three major types of cells in the blood: red blood cells, white blood cells, and platelets.

Why It's Done


A CBC may be ordered as part of a routine checkup, or if your child is feeling more tired than usual, seems to have an infection, or has unexplained bruising or bleeding.

Red blood cells: The CBC's measurements of red blood cell (RBC) count, hemoglobin (the oxygen-carrying protein in RBCs), and mean (red) cell volume (MCV) provides information about the RBCs, which carry oxygen from the lungs to the rest of the body. These measurements are usually done to test for anemia, a common condition that occurs when the body has insufficient red blood cells.

White blood cells: The white blood cell (WBC) count measures the number of WBCs (also called leukocytes) in the blood. The WBC differential test measures the relative numbers of the different kinds of WBCs in the blood. WBCs, which help the body fight infection, are bigger than red blood cells and there are far fewer of them in the bloodstream. An abnormal WBC count may indicate an infection, inflammation, or other stress in the body. For example, a bacterial infection can cause the WBC count to increase, or decrease, dramatically.

Platelets: The smallest blood cells, platelets play an important role in blood clotting and the prevention of bleeding. When a blood vessel is damaged or cut, platelets clump together and plug the hole until the blood clots. If the platelet count is too low, a person can be in danger of bleeding in any part of the body.

The CBC can also test for loss of blood, abnormalities in the production or destruction of blood cells, acute and chronic infections, allergies, and problems with blood clotting.

Preparation
No special preparations are needed. Having your child wear a short-sleeve shirt on the day of the test can make things easier for the technician who will be drawing blood.

The Procedure
Not much blood is drawn in a CBC. A health professional will usually draw the blood from a vein. For an infant, the blood may be obtained by puncturing the heel with a small needle (lancet). If the blood is being drawn from a vein, the skin surface is cleaned with antiseptic, and an elastic band (tourniquet) is placed around the upper arm to apply pressure and cause the veins to swell with blood. A needle is inserted into a vein (usually in the arm inside of the elbow or on the back of the hand) and blood is withdrawn and collected in a vial or syringe.

After the procedure, the elastic band is removed. Once the blood has been collected, the needle is removed and the area is covered with cotton or a bandage to stop the bleeding. Collecting blood for this test will only take a few minutes.

What to Expect
Either method (heel sticking or vein withdrawal) of collecting a sample of blood is only temporarily uncomfortable and can feel like a quick pinprick. Afterward, there may be some mild bruising, which should go away in a few days.

Getting the Results


The blood sample will be processed by a machine. Parts of the CBC results can be available in minutes in an emergency, but more commonly the full test results come after a few hours or the next day.

If a CBC test points to anemia, infection, or other concerns, your child's doctor may repeat the test just to be sure. If the second set of test results come back the same, your doctor will likely order further lab tests for your child to determine what's causing the problem and how to treat it.

Risks
The CBC test is considered a safe procedure. However, as with many medical tests, there are some problems that can occur with having blood drawn, such as:

fainting or feeling lightheaded hematoma (blood accumulating under the skin causing a lump or a bruise) pain associated with multiple punctures to locate a vein

Helping Your Child


Having a blood test is relatively painless. Still, many kids are afraid of needles. Explaining the test in terms your child can understand might help ease some of the fear.

Allow your child to ask the technician any questions he or she might have. Tell your child to try to relax and stay still during the procedure, as tensing muscles and moving can make it harder and more painful to draw blood. It also may help if your child looks away when the needle is being inserted into the skin.

If You Have Questions


If you have questions about the CBC test, contact your doctor.

Reviewed by: Steven Dowshen, MD Date reviewed: February 2011

Complete Blood Count (CBC)


A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells ,white blood cells , and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. A CBC also helps him or her diagnose conditions, such as anemia, infection, and many other disorders. A CBC test usually includes:

White blood cell (WBC, leukocyte) count. White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly. The number of white blood cells is sometimes used to find an infection or to see how the body is dealing withcancer treatment. White blood cell types (WBC differential). The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immature neutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxic reaction to medicines or chemicals, and many conditions, such as leukemia. Red blood cell (RBC) count. Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tiny blood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen. Hematocrit (HCT, packed cell volume, PCV). This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present. Hemoglobin (Hgb). The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body. Red blood cell indices. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. These numbers help in the diagnosis of different types of anemia. Red cell distribution width (RDW) can also be measured which shows if the cells are all the same or different sizes or shapes. Platelet (thrombocyte) count. Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis). Mean platelet volume (MPV). Mean platelet volume measures the average amount (volume) of platelets. Mean platelet volume is used along with platelet count to diagnose some diseases. If the platelet count is normal, the mean platelet volume can still be too high or too low. Your doctor may order a blood smear test to be done at the same time as a CBC but it is not part of the regular CBC test. In this test, a drop of blood is spread (smeared) on a slide and stained with a special dye. The slide is looked at under a microscope. The number, size, and shape of red blood cells, white blood cells, and platelets are recorded. Blood cells with different shapes or sizes can help diagnose many blood diseases, such as leukemia, malaria, or sickle cell disease.