Complete blood count

A complete blood count (CBC), also known as a com-

plete blood cell count, full blood count (FBC), or
full blood exam (FBE), is a blood panel requested
by a doctor or other medical professional that gives
information about the cells in a patient’s blood, such as the
cell count for each cell type and the concentrations of var-
ious proteins and minerals. A scientist or lab technician
performs the requested testing and provides the request-
ing 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 CBC being performed in a hospital using an Abbott Cell-Dyn
to carry out complete blood counts was developed in the 1700 automatic analyzer.
1950s and 1960s.[1]
The cells that circulate in the bloodstream are gen-
erally divided into three types: white blood cells clotting. The sample is then transported to a laboratory.
(leukocytes), red blood cells (erythrocytes), and platelets Sometimes the sample is drawn off a finger prick using
(thrombocytes). Abnormally high or low counts may in- a Pasteur pipette for immediate processing by an auto-
dicate the presence of many forms of disease, and hence mated counter.
blood counts are amongst the most commonly performed In the past, counting the cells in a patient’s blood was
blood tests in medicine, as they can provide an overview performed manually, by viewing a slide prepared with a
of a patient’s general health status. A CBC is routinely sample of the patient’s blood (a blood film, or periph-
performed during annual physical examinations in some eral smear) under a microscope. Presently, this process
jurisdictions. is generally automated by use of an automated analyzer,
with only approximately 10–20% of samples now being
examined manually.
1 Medical uses
2.1 Automated blood count
Complete blood counts are done to monitor overall
health, to screen for some diseases, to confirm a diag-
nosis of some medical conditions, to monitor a medical
condition, and to monitor changes in the body caused by
medical treatments.[2]
For patients who need blood transfusion, a blood count
may be used to get data which would help plan an amount
of treatment.[3] 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.[3]
Multiple blood draws and counts throughout the day are
an excessive use of phlebotomy and can lead to unnec-
essary additional transfusions, and the extra unnecessary
treatment would be outside of medical guidelines.[3]

Complete blood count performed by an automated analyser. Dif-

2 Procedure ferentials not seen here.

A phlebotomist collects the sample through venipuncture, Most blood counts today include a CBC count and leuko-
drawing the blood into a test tube containing an cyte differential count (LDC) (that is, not just the to-
anticoagulant (EDTA, sometimes citrate) to stop it from tal WBC count but also the count of each WBC type,

1
2 2 PROCEDURE

such as neutrophils, eosinophils, basophils, monocytes,

and lymphocytes). More sophisticated modern analyzers
can provide extended differential counts, which include
hematopoietic progenitor cells, immature granulocytes,
and erythroblasts.[4]
The blood is well mixed (though not shaken) 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 Manual blood counts use a light microscope, usually with a spe-
the number of cells passing through the aperture, and cialized microscope slide, which is called a hemocytometer.
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 ana-
lyzing data about the size and aspects of light as they pass
through the cells (called front and side scatter). Other in-
struments 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, cer-
tain abnormal cells in the blood may not be identified cor-
rectly, 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, auto-
This shows the view through the microscope of the specialized
mated hematology analyzers also measure the amount
hemocytometer slide. The built-in grid simplifies counting cells
of hemoglobin in the blood and within each red blood by helping the technician keep track of which cells have already
cell. This is done by adding a diluent that lyses the cells been counted.
which is then pumped into a spectro-photometric mea-
suring cuvette. The change in color of the lysate equates
to the hemoglobin content of the blood. This informa- the total number of white blood cells, the absolute num-
tion can be very helpful to a physician who, for example, ber of each type of white cell can be obtained.
is trying to identify the cause of a patient’s anemia. If the
Manual counting is useful in cases where automated ana-
red cells are smaller or larger than normal, or if there is
lyzers cannot reliably count abnormal cells, such as those
a lot of variation in the size of the red cells, this data can
cells that are not present in normal patients and are only
help guide the direction of further testing and expedite
seen in peripheral blood with certain haematological con-
the diagnostic process so patients can get the treatment
ditions. Manual counting is subject to sampling error be-
they need quickly.
cause so few cells are counted compared with automated
analysis. A manual count will also give information about
other cells that are not normally present in peripheral
2.2 Manual blood count blood, but may be released in certain disease processes.
Medical technologists examine blood film via a micro-
Hemocytometers (counting chambers that hold a speci- scope for some CBCs, not only to find abnormal white
fied volume of diluted blood and divide it with grid lines) cells, but also because variation in the shape of red cells
are used to calculate the number of red and white cells is an important diagnostic tool. Although automated
per litre of blood. (The dilution and grid lines are needed analysers give fast, reliable results regarding the num-
because there are far too many cells without those aids.) ber, average size, and variation in size of red blood cells,
To identify the numbers of different white cells, a blood they do not detect cells’ shapes. Also, some normal pa-
film is made, and a large number of white blood cells (at tients’ platelets will clump in EDTA anticoagulated blood,
least 100) are counted. This gives the percentage of cells which causes automatic analyses to give a falsely low
that are of each type. By multiplying the percentage with platelet count. The person viewing the slide in these cases
3.2 Red cells 3

will see clumps of platelets and can estimate if there are decreased by HIV infection. In adults, lym-
low, normal, or high numbers of platelets. phocytes are the second most common WBC
type after neutrophils. In young children un-
der age 8, lymphocytes are more common than
3 Included tests neutrophils.[6]
• Monocytes: May be raised in bacterial infec-
tion, tuberculosis, malaria, Rocky Mountain
spotted fever, monocytic leukemia, chronic
ulcerative colitis and regional enteritis[6]
• Eosinophils: Increased in parasitic infections,
asthma, or allergic reaction.
• Basophils: May be increased in bone mar-
row related conditions such as leukemia or
lymphoma.[6]

3.2 Red cells

• Total red blood cells: The number of red cells is

given as an absolute number per litre.[5] Iron defi-
ciency anemia shows up as a Low RBC count.

• LOINC codes for Whole Blood RBC Count-

ing

3.3 Hemoglobin

A scanning electron microscope (SEM) image of normal circu- • Hemoglobin: The amount of hemoglobin in the
lating human blood. One can see red blood cells, several knobby blood, expressed in grams per decilitre.[5] A low
white blood cells including lymphocytes, a monocyte, a neu- level of hemoglobin is a sign of anemia.
trophil, and many small disc-shaped platelets.
• LOINC codes for this test (Note: not all the
A complete blood count will normally include: codes in the search result are suitable for this
test.)

3.1 White cells

3.4 Hematocrit
• Total white blood cells are reported, and a differen-
tial reports all the white cell types as a percentage • Hematocrit or packed cell volume (PCV): This is the
and as an absolute number per litre.[5] A high WBC fraction of whole blood volume that consists of red
may indicate an infection. blood cells.[5]
• Neutrophils: May indicate bacterial infection. • Red blood cell indices[7]
May also be raised in acute viral infections.
Because of the segmented appearance of the
nucleus, neutrophils are sometimes referred to 3.5 MCV
as “segs”. The nucleus of less mature neu-
trophils is not segmented, but has a band or • Mean corpuscular volume (MCV): the average vol-
rod-like shape. Less mature neutrophils— ume of the red cells, measured in femtolitres.[5]
those that have recently been released from Anemia is classified as microcytic or macrocytic if
the bone marrow into the bloodstream—are the MCV value is above or below the expected nor-
known as “bands” or “stabs”. Stab is a Ger- mal range; anemias are classified as normocytic if
man term for rod.[6] the MCV is within the expected range. Other con-
• Lymphocytes: Higher with some viral in- ditions that can affect MCV include thalassemia,
fections such as glandular fever. Raised in reticulocytosis, alcoholism, chemotherapy, vitamin
chronic lymphocytic leukemia (CLL). Can be B12 deficiency, and/or folic acid deficiency.
4 7 EXTERNAL LINKS

3.6 MCH • Pancytopenia is generally referred to as the result of

decreased production from the bone marrow, and is
• Mean corpuscular hemoglobin (MCH): the aver- a common complication of cancer chemotherapy
age amount of hemoglobin per red blood cell, in
picograms.[5]
6 References
3.7 MCHC
[1] Verso, ML (May 1962). “The Evolution of Blood Count-
ing Techniques” (PDF). Read at a meeting of the Sec-
• Mean corpuscular hemoglobin concentration
tion of the History of Medicine, First Australian Medical
(MCHC): the average concentration of hemoglobin Congress 8: 149–58. doi:10.1017/s0025727300029392.
in the cells. PMC 1033366. PMID 14139094. Retrieved 9 Septem-
ber 2013.

3.8 RDW [2] Mayo Clinic (14 February 2014). “Complete blood count
(CBC) Why it’s done - Tests and Procedures”. may-
• Red blood cell distribution width (RDW): the vari- oclinic.org. Retrieved 29 July 2014.
ation in cellular volume of the RBC population. [3] American Association of Blood Banks (24 April 2014),
“Five Things Physicians and Patients Should Question”,
Choosing Wisely: an initiative of the ABIM Foundation
3.9 Platelets (American Association of Blood Banks), retrieved 25 July
2014, which cites
• Platelet numbers are given, as well as information
about their size and the range of sizes in the blood.[5] • Napolitano, LM; Kurek, S; Luchette, FA; Cor-
win, HL; Barie, PS; Tisherman, SA; Hebert,
• Mean platelet volume (MPV): a measurement of the PC; Anderson, GL; Bard, MR; Bromberg, W;
average size of platelets. Chiu, WC; Cipolle, MD; Clancy, KD; Diebel,
L; Hoff, WS; Hughes, KM; Munshi, I; Nayduch,
D; Sandhu, R; Yelon, JA; American College of
Critical Care Medicine of the Society of Criti-
4 Results cal Care, Medicine; Eastern Association for the
Surgery of Trauma Practice Management, Work-
An example report format for a complete blood count. group (Dec 2009). “Clinical practice guideline:
Note that test names, measurement units and reference red blood cell transfusion in adult trauma and
critical care.”. Critical Care Medicine 37 (12):
ranges may vary between countries and laboratories. Pa-
3124–57. doi:10.1097/CCM.0b013e3181b39f1b.
tient results should always be interpreted using the units PMID 19773646.
and reference ranges from the laboratory that produced
the results. [4] Buttarello, M; Plebani, M (Jul 2008). “Automated
blood cell counts: state of the art.”. Ameri-
can journal of clinical pathology 130 (1): 104–
16. doi:10.1309/EK3C7CTDKNVPXVTN. PMID
18550479.
[5] David C., Dugdale (19 March 2012). “CBC: MedlinePlus
Medical Encyclopedia”. MedlinePlus. United States Na-
Example of reference ranges for blood tests of white blood tional Library of Medicine. Retrieved 29 July 2014.
cells.[8] [6] “Complete Blood count with Differential”. RbCeus.com.
2013. Retrieved 2014-11-21.
[7] “RBC indices”. MedlinePlus: U.S. National Library of
5 Interpretation Medicine. Retrieved 1 June 2013.
[8] References at Reference ranges for blood tests#White
Certain disease states are defined by an absolute increase blood cells 2
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 7 External links
count:
• Blood Groups and Red Cell Antigens—Free online
book at NCBI Bookshelf ID: NBK2261
• Leukocytosis can be a sign of infection
• Complete Blood Count—Lab Tests Online
• Thrombocytopenia can result from drug toxicity
 5

8 Text and image sources, contributors, and licenses

8.1 Text
• Complete blood count Source: https://en.wikipedia.org/wiki/Complete_blood_count?oldid=730245502 Contributors: Alex.tan, Rmher-
men, William Avery, Stevertigo, Edward, Karada, Mcarling, Ugen64, Tristanb, Cherkash, Jouster, Denelson83, Meelar, Diberri, DocWat-
son42, Nunh-huh, Varlaam, Jfdwolff, PeterC, Stephan Leclercq, Jeremykemp, Arcturus, Guanabot, JJJJust, Meamemg, Pt, Davidruben,
Arcadian, Mote, Alansohn, Wouterstomp, Wtmitchell, Alai, Mindmatrix, Povmcdov, SCEhardt, Rjwilmsi, Arisa, Ace-o-aces, Pe-
terl, Gwernol, YurikBot, Raccoon Fox, Polacrilex, Pronsias, Keithonearth, Howcheng, Chrishota, Samir, Stainless steel, Cubic Hour,
KnightRider~enwiki, Xlenka~enwiki, EJVargas, McGeddon, InvictaHOG, Fallj, HalfShadow, Betacommand, Bluebot, Dethme0w, Or-
phanBot, Hasan 3, TornadoCreator, Renwick, Kyoko, Jon186, Chirality, Schulj, Eggman64, Fedra, UncleBubba, Kristoferb, Darklilac,
Wayiran, JAnDbot, PhilKnight, Jarkeld, Morrillonline, Magioladitis, WhatamIdoing, Scottalter, MartinBot, Jim.henderson, R'n'B, Oz-
maweezer, Boghog, Mikael Häggström, Major Small, Bigdumbdinosaur, Vanished user 39948282, Mlewis000, VolkovBot, TXiKiBoT,
Oshwah, Trevor Wennblom, ACEOREVIVED, Doc James, AlleborgoBot, SieBot, Graham Beards, Flyer22 Reborn, Fimbriata, Steven
Crossin, Chemmaj, ImageRemovalBot, Linforest, ClueBot, Niceguyedc, Excirial, Versus22, Vojtěch Dostál, Addbot, Jafeluv, Diptanshu.D,
Quercus solaris, Tide rolls, Zorrobot, Luckas-bot, Ptbotgourou, Orac29, Axelarater, HazyShades, Bluerasberry, Materialscientist, Jmarchn,
ArthurBot, Xqbot, Longdaom, Schekinov Alexey Victorovich, FrescoBot, Taweetham, Cannolis, MastiBot, Wordwriter123456789, Kala-
iarasy, Dinamik-bot, JarodRoland, Immunize, AsceticRose, ZéroBot, Stageivsupporter, Donner60, Hazard-Bot, Ian.morison, ClueBot
NG, Smtchahal, Horoporo, MelbourneStar, Jarkeld.alt, JoePdw, Siloxane, BattyBot, TheJJJunk, TylerDurden8823, Ducknish, Elliott.jd,
‫ابراهيم نصار‬, Mantrova, Me, Myself, and I are Here, LT910001, Arripay, Daemyth, Howey.r, Monkbot, Cardiac-master, SongofSol,
McortNGHH and Anonymous: 109

8.2 Images
• File:CBC_blood_test.ogv Source: https://upload.wikimedia.org/wikipedia/commons/b/be/CBC_blood_test.ogv License: CC BY-SA 3.0
Contributors: Own work Original artist: K
• File:CBC_report.JPG Source: https://upload.wikimedia.org/wikipedia/commons/1/1d/CBC_report.JPG License: GFDL Contributors:
Own work Original artist: Bobjgalindo
• File:Manual_Yeast_Cell_counting_with_a_Microscope.jpg Source: https://upload.wikimedia.org/wikipedia/commons/d/da/Manual_
Yeast_Cell_counting_with_a_Microscope.jpg License: CC BY-SA 2.0 Contributors: Manual yeast cell counting with a microscope Original
artist: Jeff Warren from Lima, Peru
• File:Neubauer_improved_with_cells.jpg Source: https://upload.wikimedia.org/wikipedia/commons/b/bf/Neubauer_improved_with_
cells.jpg License: Public domain Contributors: Self-made during work Original artist: User:Alcibiades
• File:Reference_ranges_for_blood_tests_-_white_blood_cells.png Source: https://upload.wikimedia.org/wikipedia/commons/b/b5/
Reference_ranges_for_blood_tests_-_white_blood_cells.png License: Public domain Contributors: Own work Original artist: Mikael Häg-
gström.
• File:SEM_blood_cells.jpg Source: https://upload.wikimedia.org/wikipedia/commons/8/82/SEM_blood_cells.jpg License: Public do-
main Contributors: Image and description: National Cancer Institute Original artist: Bruce Wetzel (photographer). Harry Schaefer (pho-
tographer)

8.3 Content license

• Creative Commons Attribution-Share Alike 3.0