Complete blood count

A complete blood count (CBC), also known as a complete 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 patients blood, such as the
cell count for each cell type and the concentrations of various proteins and minerals. 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 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 generally divided into three types: white blood cells
(leukocytes), red blood cells (erythrocytes), and platelets
(thrombocytes). 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 patients general health status. A CBC is routinely
performed during annual physical examinations in some
jurisdictions.

clotting. The sample is then transported to a laboratory.

Sometimes the sample is drawn o a nger prick using
a Pasteur pipette for immediate processing by an automated counter.
In the past, counting the cells in a patients blood was
performed manually, by viewing a slide prepared with a
sample of the patients blood (a blood lm, or peripheral smear) under a microscope. Presently, this process
is generally automated by use of an automated analyzer,
with only approximately 1020% of samples now being
examined manually.

Medical uses
2.1 Automated blood count

Complete blood counts are done to monitor overall

health, to screen for some diseases, to conrm a diagnosis 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 unnecessary additional transfusions, and the extra unnecessary
treatment would be outside of medical guidelines.[3]

Complete blood count performed by an automated analyser. Differentials not seen here.

Procedure

A phlebotomist collects the sample through venipuncture, Most blood counts today include a CBC count and leukodrawing the blood into a test tube containing an cyte dierential count (LDC) (that is, not just the toanticoagulant (EDTA, sometimes citrate) to stop it from tal WBC count but also the count of each WBC type,
1

PROCEDURE

such as neutrophils, eosinophils, basophils, monocytes,

and lymphocytes). More sophisticated modern analyzers
can provide extended dierential 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 ow cells,
photometers and apertures that analyze dierent elements
in the blood. The cell counting component counts the
numbers and types of dierent 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 ow cell. Laser eye sensors count Manual blood counts use a light microscope, usually with a spethe number of cells passing through the aperture, and cialized microscope slide, which is called a hemocytometer.
can identify them; this is ow 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 (called front and side scatter). Other instruments measure dierent 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 identied correctly, requiring manual review of the instruments results
and identication 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 patients 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.

2.2

Manual blood count

Hemocytometers (counting chambers that hold a specied volume of diluted blood and divide it with grid lines)
are used to calculate the number of red and white cells
per litre of blood. (The dilution and grid lines are needed
because there are far too many cells without those aids.)
To identify the numbers of dierent white cells, a blood
lm is made, and a large number of white blood cells (at
least 100) are counted. This gives the percentage of cells
that are of each type. By multiplying the percentage with

This shows the view through the microscope of the specialized

hemocytometer slide. The built-in grid simplies counting cells
by helping the technician keep track of which cells have already
been counted.

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. 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.
Medical technologists examine blood lm via a microscope for some CBCs, not only to nd 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

3.2

Red cells

will see clumps of platelets and can estimate if there are

low, normal, or high numbers of platelets.

Included tests

3
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.[6]
Monocytes: May be raised in bacterial infection, 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 marrow 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 deciency anemia shows up as a Low RBC count.
LOINC codes for Whole Blood RBC Counting

3.3 Hemoglobin
A scanning electron microscope (SEM) image of normal circulating human blood. One can see red blood cells, several knobby
white blood cells including lymphocytes, a monocyte, a neutrophil, and many small disc-shaped platelets.

A complete blood count will normally include:

3.1

White cells

Total white blood cells are reported, and a dierential reports all the white cell types as a percentage
and as an absolute number per litre.[5] A high WBC
may indicate an infection.

Hemoglobin: The amount of hemoglobin in the

blood, expressed in grams per decilitre.[5] 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.)

3.4 Hematocrit
Hematocrit or packed cell volume (PCV): This is the
fraction of whole blood volume that consists of red
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 neutrophils is not segmented, but has a band or
Mean corpuscular volume (MCV): the average volrod-like shape. Less mature neutrophils
ume of the red cells, measured in femtolitres.[5]
those that have recently been released from
Anemia is classied as microcytic or macrocytic if
the bone marrow into the bloodstreamare
the MCV value is above or below the expected norknown as bands or stabs. Stab is a Germal range; anemias are classied as normocytic if
man term for rod.[6]
the MCV is within the expected range. Other con Lymphocytes: Higher with some viral inditions that can aect MCV include thalassemia,
reticulocytosis, alcoholism, chemotherapy, vitamin
fections such as glandular fever. Raised in
chronic lymphocytic leukemia (CLL). Can be
B12 deciency, and/or folic acid deciency.

3.6

MCH

Mean corpuscular hemoglobin (MCH): the average amount of hemoglobin per red blood cell, in
picograms.[5]

EXTERNAL LINKS

Pancytopenia is generally referred to as the result of

decreased production from the bone marrow, and is
a common complication of cancer chemotherapy

6 References
3.7

MCHC

Mean corpuscular hemoglobin concentration

(MCHC): the average concentration of hemoglobin
in the cells.

3.8

RDW

Red blood cell distribution width (RDW): the variation in cellular volume of the RBC population.

3.9

Platelets

Platelet numbers are given, as well as information

about their size and the range of sizes in the blood.[5]
Mean platelet volume (MPV): 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.

Example of reference ranges for blood tests of white blood

cells.[8]

Interpretation

Certain disease states are dened 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

[1] Verso, ML (May 1962). The Evolution of Blood Counting Techniques (PDF). Read at a meeting of the Section of the History of Medicine, First Australian Medical
Congress 8: 14958. doi:10.1017/s0025727300029392.
PMC 1033366. PMID 14139094. Retrieved 9 September 2013.
[2] Mayo Clinic (14 February 2014). Complete blood count
(CBC) Why its done - Tests and Procedures. mayoclinic.org. Retrieved 29 July 2014.
[3] American Association of Blood Banks (24 April 2014),
Five Things Physicians and Patients Should Question,
Choosing Wisely: an initiative of the ABIM Foundation
(American Association of Blood Banks), retrieved 25 July
2014, which cites
Napolitano, LM; Kurek, S; Luchette, FA; Corwin, HL; Barie, PS; Tisherman, SA; Hebert,
PC; Anderson, GL; Bard, MR; Bromberg, W;
Chiu, WC; Cipolle, MD; Clancy, KD; Diebel,
L; Ho, WS; Hughes, KM; Munshi, I; Nayduch,
D; Sandhu, R; Yelon, JA; American College of
Critical Care Medicine of the Society of Critical Care, Medicine; Eastern Association for the
Surgery of Trauma Practice Management, Workgroup (Dec 2009). Clinical practice guideline:
red blood cell transfusion in adult trauma and
critical care.. Critical Care Medicine 37 (12):
312457. doi:10.1097/CCM.0b013e3181b39f1b.
PMID 19773646.
[4] Buttarello, M; Plebani, M (Jul 2008). Automated
blood cell counts: state of the art..
American 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 National Library of Medicine. Retrieved 29 July 2014.
[6] Complete Blood count with Dierential. RbCeus.com.
2013. Retrieved 2014-11-21.
[7] RBC indices. MedlinePlus: U.S. National Library of
Medicine. Retrieved 1 June 2013.
[8] References at Reference ranges for blood tests#White
blood cells 2

7 External links
Blood Groups and Red Cell AntigensFree online
book at NCBI Bookshelf ID: NBK2261
Complete Blood CountLab Tests Online

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