adapted

The Complete Blood Count (CBC) test is an automated count of the cells in the blood. A standard CBC
includes the following:

 number of white blood cells (WBC)

 number of red blood cells (RBC)
 hemoglobin content (Hgb)
 hematocrit (Hct)
 mean corpuscular volume (MCV)
 mean corpuscular hemoglobin (MCH)
 mean corpuscular hemoglobin concentration (MCHC)
 platelet count and volume

The results of a CBC can provide information about not only the number of cell types but also can give an
indication of the size, shape, and some of the physical characteristics of the cells. In addition, a WBC
differential (identifies different types of WBCs) may be ordered and can be done on the same instrument or
performed manually.

Significant abnormalities in one or more of the cell populations may require visual confirmation by observing a
blood smear under a microscope. In this test, a drop of blood is placed on a glass slide, smeared into a thin
layer, allowed to dry, and then dyed with a special stain. A Clinical Laboratory Scientist can then evaluate the
physical characteristics of the red and white blood cells present. Any additional information is noted and
reported to the doctor.

Blood consists of cells suspended in a liquid called plasma. These cells - the RBCs, WBCs, and platelets - are
produced and mature primarily in the bone marrow. Under normal circumstances, they are released into the
bloodstream as needed.

White Blood Cells (WBCs)

There are five different types of WBCs 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 percentages. These numbers may temporarily shift higher or
lower depending on what is going on in the body. For instance, an infection can stimulate a higher concentration
of neutrophils (a “shift to the left”) to fight off bacterial infection. With allergies, there may be an increased
number of eosinophils that release certain chemicals (anti-histamines) that minimize the allergic effect.
Lymphocytes may be stimulated to produce immunoglobulins (antibodies). And in certain disease states, such
as leukemia, abnormal and immature white cells (blasts) rapidly multiply, increasing the WBC count.

Red Blood Cells (RBCs)

RBCs are pale red in color and shaped like a donut with a thinner section in the middle instead of a hole.
They have hemoglobin inside them, a protein that transports oxygen throughout the body. The CBC determines
whether there are sufficient RBCs present and whether the population of RBCs appears to be normal. RBCs are
normally all the same size and shape; however, variations can occur with vitamin B12 and folate deficiencies,
iron deficiency, and with a variety of other conditions. If there are insufficient normal RBCs present, the patient
is said to have anemia and may have symptoms such as fatigue and weakness. Much less frequently, there may

Page 1 of 4
 adapted

be too many RBCs in the blood (erythrocytosis or polycythemia). In extreme cases, this can interfere with the
flow of blood through the veins and arteries.

Platelets

Platelets are special cell fragments that play an important role in blood clotting. If a patient does not
have enough platelets, he will be at an increased risk of excessive bleeding and bruising. The CBC measures the
number and size of platelets present. With some conditions and in some people, there may be giant platelets or
platelet clumps that are difficult for the hematology instrument to accurately measure. In this case, a blood
smear test may be necessary.

How is the sample collected for testing?

The CBC is performed on a blood sample taken by a needle placed in a vein in the arm or by 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.

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,
granulocytes, 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.

Page 2 of 4
 adapted

 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?

The following table explains what increases or decreases in each of the components of the CBC may mean.

Page 3 of 4
 adapted

Components of the CBC

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/Gran
Lymphs Lymphocyte
% Mono  Monocyte This is a dynamic population that varies somewhat from day to
% Eos Eosinophil day depending on what is going on in the body.  Significant
% Baso Basophil increases in particular types are associated with different
Neutrophil Neutrophil/Ban/Seg/Gran temporary/acute and/or chronic conditions.  An example of this is
Lymphs Lymphocyte the increased number of lymphocytes seen with lymphocytic
Mono Monocyte leukemia. For more information, see Blood Smear and WBC.
Eos Eosinophil
Baso Basophil
Decreased with anemia; increased when too many made and with
RBC Red Blood Cell
fluid loss due to diarrhea, dehydration, burns
Hgb Hemoglobin Mirrors RBC results
Hct Hematocrit Mirrors RBC results
Increased with B12 and Folate deficiency; decreased with iron
MCV Mean Corpuscular Volume
deficiency and thalassemia
Mean Corpuscular
MCH Mirrors MCV results
Hemoglobin
Mean Corpuscular May be decreased when MCV is decreased; increases limited to
MCHC
Hemoglobin Concentration amount of Hgb that will fit inside a RBC
Increased RDW indicates mixed population of RBCs; immature
RDW RBC Distribution Width
RBCs tend to be larger
Decreased or increased with conditions that affect platelet
production; decreased when greater numbers used, as with
bleeding; decreased with some inherited disorders (such as
Platelet Platelet
Wiskott-Aldrich, Bernard-Soulier), with Systemic lupus
erythematosus, pernicious anemia, hypersplenism (spleen takes
too many out of circulation), leukemia, and chemotherapy
Vary with platelet production; younger platelets are larger than
MPV Mean Platelet Volume
older ones

Page 4 of 4