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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 countPlatelet count
The Test
 
How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?

How is it used?
The CBC 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, 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 as pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW.



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?
NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean.

The following table explains what increases or decreases in each of the components of the CBC may mean. To download an expanded, printable version of this table, click here.

Test

Name

Increased/Decreased

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

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

% Lymphs

Lymphocyte

% Mono

Monocyte

% Eos

Eosinophil

%Baso

Basophil

Neutrophil

Neutrophil/Band/Seg

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 and thalassemia

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), with Systemic 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



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.






This article was last reviewed on March 2, 2008.
 
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