A complete blood count, also known as a complete blood cell count, full blood count, or full
blood exam, is a blood panel requested by a doctor or other medical professional that
gives information about the cells in a patient's blood.
A scientist or lab technician performs the requested testing and provides the requesting
medical professional with the results of the CBC.
Blood counts of various types have been used for clinical purposes since the 19th century.
Automated equipment to carry out complete blood counts was developed in the 1950s and
1960s.
The cells that circulate in the bloodstream are generally divided into three types: white
blood cells, red blood cells, and platelets.
Abnormally high or low counts may indicate the presence of many forms of disease, and
hence blood counts are amongst the most commonly performed blood tests in medicine, as they
can provide an overview of a patient's general health status.
A CBC is routinely performed during annual physical examinations in some jurisdictions.
Medical uses Complete blood counts are done to monitor
overall health, to screen for some diseases, to confirm a diagnosis of some medical conditions,
to monitor a medical condition, and to monitor changes in the body caused by medical treatments.
For patients who need blood transfusion, a blood count may be used to get data which
would help plan an amount of treatment.
In such cases, the person should have only one blood count for the day, and the transfusion
of red blood cells or platelets should be planned based on that.
Multiple blood draws and counts throughout the day are an excessive use of phlebotomy
and can lead to unnecessary additional transfusions, and the extra unnecessary treatment would
be outside of medical guidelines.
Procedure
A phlebotomist collects the sample through venipuncture, drawing the blood into a test
tube containing an anticoagulant to stop it from clotting.
The sample is then transported to a laboratory.
Sometimes the sample is drawn off a finger prick using a Pasteur pipette for immediate
processing by an automated counter.
In the past, counting the cells in a patient's blood was performed manually, by viewing a
slide prepared with a sample of the patient's blood under a microscope.
Presently, this process is generally automated by use of an automated analyzer, with only
approximately 10–20% of samples now being examined manually.
Automated blood count
All blood counts include a CBC count and leukocyte differential count, but modern analyzers provide
much more in addition.
The blood is well mixed and placed on a rack in the analyzer.
This instrument has flow cells, photometers and apertures that analyze different elements
in the blood.
The cell counting component counts the numbers and types of different cells within the blood.
The results are printed out or sent to a computer for review.
Blood counting machines aspirate a very small amount of the specimen through narrow tubing
followed by an aperture and a laser flow cell.
Laser eye sensors count the number of cells passing through the aperature, and can identify
them; this is flow cytometry.
The two main sensors used are light detectors and electrical impedance.
The instrument measures the type of blood cell by analyzing data about the size and
aspects of light as they pass through the cells.
Other instruments measure different characteristics of the cells to categorize them.
Because an automated cell counter samples and counts so many cells, the results are
very precise.
However, certain abnormal cells in the blood may not be identified correctly, requiring
manual review of the instrument's results and identification of any abnormal cells the
instrument could not categorize.
In addition to counting, measuring and analyzing red blood cells, white blood cells and platelets,
automated hematology analyzers also measure the amount of hemoglobin in the blood and
within each red blood cell.
This is done by adding a diluent that lyses the cells which is then pumped into a spectro-photometric
measuring cuvette.
The change in color of the lysate equates to the hemoglobin content of the blood.
This information can be very helpful to a physician who, for example, is trying to identify
the cause of a patient's anemia.
If the red cells are smaller or larger than normal, or if there is a lot of variation
in the size of the red cells, this data can help guide the direction of further testing
and expedite the diagnostic process so patients can get the treatment they need quickly.
Manual blood count
Hemocytometers are used to calculate the number of red and white cells per litre of blood.
To identify the numbers of different white cells, a blood film is made, and a large number
of white blood cells are counted.
This gives the percentage of cells that are of each type.
By multiplying the percentage with the total number of white blood cells, the absolute
number of each type of white cell can be obtained.
Manual counting is useful in cases where automated analyzers cannot reliably count abnormal cells,
such as those cells that are not present in normal patients and are only seen in peripheral
blood with certain haematological conditions.
Manual counting is subject to sampling error because so few cells are counted compared
with automated analysis.
Medical technologists examine blood film via a microscope for some CBCs, not only to find
abnormal white cells, but also because variation in the shape of red cells is an important
diagnostic tool.
Although automated analysers give fast, reliable results regarding the number, average size,
and variation in size of red blood cells, they do not detect cells' shapes.
Also, some normal patients' platelets will clump in EDTA anticoagulated blood, which
causes automatic analyses to give a falsely low platelet count.
The person viewing the slide in these cases will see clumps of platelets and can estimate
if there are low, normal, or high numbers of platelets.
Included tests
A complete blood count will normally include: White cells
Total white blood cells — All the white cell types are given as a percentage and as
an absolute number per litre.
Red cells Total red blood cells — The number of red
cells is given as an absolute number per litre.
Iron deficiency Anemia shows up as a Low RBC count.
LOINC codes for Whole Blood RBC Counting
Hemoglobin Hemoglobin – The amount of hemoglobin in
the blood, expressed in grams per decilitre.
A low level of Hemoglobin is a sign of anemia.
LOINC codes for this test(Note: not all the codes in the search result are suitable for
this test.)
Hematocrit Hematocrit or packed cell volume – This
is the fraction of whole blood volume that consists of red blood cells.
Red blood cell indices MCV
Mean corpuscular volume – the average volume of the red cells, measured in femtolitres.
Anemia is classified as microcytic or macrocytic if the MCV value is above or below the expected
normal range; anemias are classified as normocytic if the MCV is within the expected range.
Other conditions that can affect MCV include thalassemia, reticulocytosis, alcoholism,
chemotherapy, Vitamin B12 deficiency, and/or Folic acid deficiency.
MCH Mean corpuscular hemoglobin – the average
amount of hemoglobin per red blood cell, in picograms.
MCHC Mean corpuscular hemoglobin concentration
– the average concentration of hemoglobin in the cells.
RDW Red blood cell distribution width – the
variation in cellular volume of the RBC population.
A complete blood count with differential/platelet will also include:
Neutrophil granulocytes — May indicate bacterial infection.
May also be raised in acute viral infections.
Because of the segmented appearance of the nucleus, neutrophils are sometimes referred
to as "segs."
The nucleus of less mature neutrophils is not segmented, but has a band or rod-like
shape.
Less mature neutrophils — those that have recently been released from the bone marrow
into the bloodstream — are known as "bands" or "stabs".
Stab is a German term for rod.
Lymphocytes — Higher with some viral infections such as glandular fever and.
Also raised in chronic lymphocytic leukemia.
Can be decreased by HIV infection.
In adults, lymphocytes are the second most common WBC type after neutrophils.
In young children under age 8, lymphocytes are more common than neutrophils.
Monocytes — May be raised in bacterial infection, tuberculosis, malaria, Rocky Mountain
spotted fever, monocytic leukemia, chronic ulcerative colitis and regional enteritis
Eosinophil granulocytes — Increased in parasitic infections, asthma, or allergic
reaction.
Basophil granulocytes — May be increased in bone marrow related conditions such as
leukemia or lymphoma.
A manual count will also give information about other cells that are not normally present
in peripheral blood, but may be released in certain disease processes.
Platelets Platelet numbers are given, as well as information
about their size and the range of sizes in the blood.
Mean platelet volume – a measurement of the average size of platelets.
Results An example report format for a complete blood
count.
Note that test names, measurement units and reference ranges may vary between countries
and laboratories.
Patient results should always be interpreted using the units and reference ranges from
the laboratory that produced the results.
Interpretation Certain disease states are defined by an absolute
increase or decrease in the number of a particular type of cell in the bloodstream.
For example: Many disease states are heralded by changes
in the blood count: Leukocytosis can be a sign of infection
Thrombocytopenia can result from drug toxicity Pancytopenia is generally referred to as the
result of decreased production from the bone marrow, and is a common complication of cancer
chemotherapy References
External links Blood Groups and Red Cell Antigens.
Free online book at NCBI Bookshelf ID: NBK2261 Complete Blood Count - Lab Tests Online