At a Glance
Why Get Tested?
To determine your general health status; to screen for, diagnose, or monitor any one of a variety of diseases and conditions that affect blood cells, such as anemia, infection, inflammation, bleeding disorder or cancer
When to Get Tested?
As part of a routine medical exam; when you have signs and symptoms that may be related to a condition that affects blood cells; at regular intervals to monitor treatment or when you are receiving treatment known to affect blood cells
A blood sample drawn from a vein in the arm or a fingerstick or heelstick (newborns)
Test Preparation Needed?
The Test Sample
What is being tested?
The complete blood count (CBC) is a test that evaluates the cells that circulate in blood. Blood consists of three types of cells suspended in fluid called plasma: white blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs). They are produced and mature primarily in the bone marrow and, under normal circumstances, are released into the bloodstream as needed.
A CBC is typically performed using an automated instrument that measures various parameters, including counts of the cells that are present in a person's sample of blood. The results of a CBC can provide information about not only the number of cell types but also can give an indication of the physical characteristics of some of the cells. A standard CBC includes the following:
- Evaluation of white blood cells: WBC count; may or may not include a WBC differential
- Evaluation of red blood cells: RBC count, hemoglobin (Hb), hematocrit (Hct) and RBC indices, which includes mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and sometimes red cell distribution width (RDW). The RBC evaluation may or may not include reticulocyte count.
- Evaluation of platelets: platelet count; may or may not include mean platelet volume (MPV) and/or platelet distribution width (PDW)
The three types of cells evaluated by the CBC include:
White Blood Cells
There are five different types of WBCs, also called leukocytes, that the body uses to maintain a healthy state and to fight infections or other causes of injury. They are neutrophils, lymphocytes, basophils, eosinophils, and monocytes. They are present in the blood at relatively stable numbers. These numbers may temporarily shift higher or lower depending on what is going on in the body. For instance, an infection can stimulate the body to produce a higher number of neutrophils to fight off bacterial infection. With allergies, there may be an increased number of eosinophils. An increased number of lymphocytes may be produced with a viral infection. In certain disease states, such as leukemia, abnormal (immature or mature) white cells rapidly multiply, increasing the WBC count.
Red Blood Cells
Red blood cells, also called erythrocytes, are produced in the bone marrow and released into the bloodstream as they mature. They contain hemoglobin, a protein that transports oxygen throughout the body. The typical lifespan of an RBC is 120 days; thus the bone marrow must continually produce new RBCs to replace those that age and disintegrate or are lost through bleeding. A number of conditions can affect the production of new RBCs and/or their lifespan, in addition to those conditions that may result in significant bleeding. The CBC determines the number of RBCs and amount of hemoglobin present, the proportion of blood made up of RBCs (hematocrit), and whether the population of RBCs appears to be normal. RBCs normally are uniform with minimal variations in size and shape; however, significant variations can occur with conditions such as vitamin B12 and folate deficiencies, iron deficiency, and with a variety of other conditions. If there are insufficient normal RBCs present, a person is said to have anemia and may have symptoms such as fatigue and weakness. Much less frequently, there may be too many RBCs in the blood (erythrocytosis or polycythemia). In extreme cases, this can interfere with the flow of blood through the small veins and arteries.
Platelets, also called thrombocytes, are special cell fragments that play an important role in normal blood clotting. A person who does not have enough platelets may be at an increased risk of excessive bleeding and bruising. The CBC measures the number and size of platelets present.
Significant abnormalities in one or more of the blood cell populations can indicate the presence of one or more conditions. Typically other tests are performed to help determine the cause of abnormal results. Often, this requires visual confirmation by examining a blood smear under a microscope. A trained laboratorian can evaluate the appearance and physical characteristics of the blood cells such as size, shape and color, noting any abnormalities that may be present. Any additional information is noted and reported to the doctor. This information gives the health practitioner additional clues as to the cause of abnormal CBC results.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm or from a fingerstick (for children and adults) or heelstick (for infants).
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Chap 3, Pp 305-328, 578-589.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, Chap. 31, Pp 477-478, 545-560, 730, 754-757.
Wintrobe's Clinical Hematology. 12th ed. Greer J, Foerster J, Rodgers G, Paraskevas F, Glader B, Arber D, Means R, eds. Philadelphia, PA: Lippincott Williams & Wilkins: 2009, Pp 170-402, 1512-1516, 1522-1524, 1528-1533.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005). Harrison's Principles of Internal Medicine, 16th Edition, McGraw Hill, Pp 329-336, 340-341, 673-675.
Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006, Pp 409-412, 447-448.
(Updated May 10, 2010) Inoue S, et al. Leukocytosis, Medscape Reference article. Available online at http://emedicine.medscape.com/article/956278-overview through http://emedicine.medscape.com. Accessed May 2012.
(February 1, 2011) National Heart Lung Blood Institute. What is lymphocytopenia? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/lym/ through http://www.nhlbi.nih.gov. Accessed May 2012.
(January 8 2010) Kempert P. White Blood Cell Function, Overview of the Immune System. Medscape Reference article. Available online at http://emedicine.medscape.com/article/960027-overview through http://emedicine.medscape.com. Accessed May 2012.
(January 6, 2010) Naushad H. Leukocyte Count (WBC). Medscape Reference article. Available online at http://emedicine.medscape.com/article/2054452-overview#aw2aab6b2 through http://emedicine.medscape.com. Accessed May 2012.
(Updated December 5, 2011) Nader N. Neutrophilia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/208576-overview through http://emedicine.medscape.com. Accessed May 2012.
(May 24, 2011) Godwin J. Neutropenia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/204821-overview through http://emedicine.medscape.com. Accessed May 2012.
(August 25, 2011) Liss M. Eosinophilia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/199879-overview through http://emedicine.medscape.com. Accessed May 2012.
(March 1, 2011) National Heart, Lung and Blood Institute. What is Polycythemia vera? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/poly/ through http://www.nhlbi.nih.gov. Accessed May 2012.
(May 18 2012) National Heart, Lung and Blood Institute. Anemia. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/ through http://www.nhlbi.nih.gov. Accessed May 2012.
(November 4, 2011) Maakaron J. Anemia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/198475-overview through http://emedicine.medscape.com. Accessed May 2012.
(April 19, 2012) Dugdale D. RBC Count. MedlinePlus Medical Encyclopedia. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003644.htm. Accessed May 2012.
Riley R, et.al. Automated Hematologic Evaluation. Medical College of Virginia, Virginia Commonwealth University. Available online at http://www.pathology.vcu.edu/education/PathLab/pages/hematopath/pbs.html#Anchor-Automated-47857 through http://www.pathology.vcu.edu. Accessed May 2012.
(August 1, 2010) National Heart, Lung and Blood Institute. What are thrombocythemia and thrombocytosis? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/thrm/ through http://www.nhlbi.nih.gov. Accessed May 2012.
(Aug 1, 2010) National Heart, Lung and Blood Institute. What is thrombocytopenia? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/ through http://www.nhlbi.nih.gov. Accessed May 2012.
(July 16, 2010) Mayo Clinic. Diseases and Conditions, Thrombocytosis. Available online at http://www.mayoclinic.com/health/thrombocytosis/DS01088 through http://www.mayoclinic.com. Accessed May 2012.
Sources Used in Previous Reviews
Clinical Hematology: Principles, Procedures, Correlations. Second edition. E. Anne Stiene-Martin, Cheryl A. Lotspeich-Steininger, John A. Koepke. Lippincott Co. 1998.
Clinical Hematology and Fundamentals of Hemostasis. Third edition. Denise M. Harmening.F. A. Davis Co., 1915 Arch Street Philadelphia, PA 19103. 1997.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
Brose, M., Updated (2004 August 03, Updated). CBC. MEDLINEplus Health Information, Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm.
Brose, M, Updated (2003 May 08, Updated). Blood differential. MEDLINEplus Health Information, Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm.
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 290.