INFO: Understanding the Complete Blood Count (CBC) with Differential

[Guest guest]

Understanding the Complete Blood Count (CBC) with Differential

by V. J. , RN, BSN, MA

Article Date: 4/9/2004

The Complete Blood Count (or CBC) is a measure of erythrocytes (red blood cells), leukocytes (white blood cells), and platelets. The "differential" part of the test divides the white blood cell count into the different kinds of white blood cells.

Red Blood Cell Measures

RBC Count. Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. The normal RBC count is 4.7 to 6.1 million/mm3 for males and 4.2 to 5.4 million/mm3 for females.

Hemoglobin. Hemoglobin measures the amount of oxygen-carrying protein in the blood. The normal range is 14 to 18 gms/Dl for males, and 12 to 16 gms/Dl for females.

Hematocrit. Hematocrit measures the amount of space red blood cells take up in the blood. It is reported as a percentage. The normal range is 42 to 52 percent for males and 37 to 47 percent for females.

Conditions that can cause increased RBC count, hemoglobin and hematocrit include:

High altitudes

Congenital heart disease

Congestive heart failure

Dehydration / hemoconcentration

Lung diseases (COPD, fibrosis)

Polycythemia vera

Severe burns

Diseases causing intravascular fluid loss (diarrhea, burns).

Conditions that can cause decreased RBC count, hemoglobin and hematocrit include:

Diseases causing anemia

Bleeding / hemorrhage

Destruction of cells (hemolysis)

Hodgkin's disease

Leukemia and other cancers

Rheumatic diseases

Autoimmune diseases, such as systemic lupus erythematosus

Kidney disease / failure

Enlarged spleen

Cirrhosis

Bone marrow failure.

Mean corpuscular volume. Mean corpuscular volume (MCV) is a measurement of the average size of your red blood cells (RBC). The normal range is 80 to 95 femoliters. When the MCV is elevated, RBCs are larger than normal, or macrocytic. Causes of increased MCV include vitamin B12 or folic acid deficiency. When the MCV is decreased, RBCs are smaller than normal, or microcytic. Causes include iron deficient anemia or thalassemia.

Mean corpuscular hemoglobin. Mean corpuscular hemoglobin (MCH) is a calculation of the amount of oxygen-carrying hemoglobin inside RBCs. The normal range is 27 to 31 picograms. This value is closely related to mean corpuscular volume, since RBCs with larger amounts of hemoglobin tend to be larger (macrocytic) and RBCs with less hemoglobin tend to be smaller (microcytic).

Mean corpuscular hemoglobin concentration. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the percentage of hemoglobin in the RBCs. The normal range is 32 to 36 gm/DL. When the amount of hemoglobin inside the cell is low, cells are hypochromic. Causes of decreased MCH include iron deficient anemia or thalassemia.

Red Cell Distribution Width. Red Cell Distribution Width (RDW) is a calculation of the variation in the size of RBCs.The normal range is 11 to 14.5 percent. The RDW is essentially an indicator of anisocytosis (variation in RBC size) and poikilocytosis (variation in RBC shape). This measure can be useful in identifying certain anemias.

White Blood Cell Measures

The white blood cell (WBC) count has two components: the leukocyte count and the differential.

The Leukocyte Count. The first component is a simple count of the total number of leukocytes (WBCs) in a volume of blood. The normal range for the WBC count is 5,000 to 10,000 WBCs per mm3 of blood.

Many diseases and some non-pathological situations can cause an increased WBC count. Conditions not directly related to illness that can increase the WBC count include:

Eating, physical activity or stress

Pregnancy and labor

Patients who have had their spleen removed

Many medications, including aspirin, heparin, steroids, quinine, and others.

Illness and diseases associated with an increased WBC count include:

Viral, bacterial and parasitic infections

Inflammatory diseases, tissue inflammation and necrosis

Autoimmune diseases

Leukemias

Metabolic disorders

Exposure to radiation

Physical trauma.

A decreased WBC count can be associated with:

Certain medications and medication toxicities

Chemotherapy

Bone marrow infiltration and failure

Overwhelming infection

Autoimmune disease.

The DifferentialThe second component, the differential, breaks down the WBC count into each WBC subtype: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Differential WBC counts are reported in percentages of the WBC count.

Neutrophils. Neutrophils (also called polymorphonuclear leukocytes or PMN's) are white blood cells that digest bacteria and cellular debris. The normal range for neutrophils is 55 to 70 percent. Neutrophils are further subdivided into "Band" and "Segmented" neutrophils. "Segs" are mature neutrophils. Although segmented neutrophils make up the majority of neutrophils, an abnormally high percentage of segmented neutrophils suggest the hepatic disease and pernicious anemia. The normal range for segmented neutrophils is 50 to 65 percent.

"Bands" (also called "stabs") are immature neutrophils, and their presence indicates stimulation of neutrophil production and early release of neutrophils into circulation, characteristic of an ongoing, acute bacterial infection. The normal range for band neutrophils is 0 to 5 percent.

Lymphocytes. There are two forms of lymphoctyes: B cells and T Cells. B lymphocytes produce antibodies, which are protein substances that bind with antigens (foreign particles), neutralizing their ability to cause infection, and providing a "handle" to which neutrophils can attach and then ingest the antigen. The normal range is 25 to 45 percent.

T lymphocyes have the ability to recognize cells that are infected. They bind to and destroy infected cells by releasing chemicals onto the cell's surface.

The differential WBC test does not differentiate between B and T cells, they are reported as a single, combined number. Increased lymphocyte percentages are found mainly in cases of viral infection, but can also be associated with:

Bacterial infection, such as measles, mumps, rubella, infectious mononucleosis and infectious hepatitis

Hormonal disorders, such as hypothyroidism and hypoadrenalism

Cancers, including lymphocytic leukemia and lymphosarcome

HIV / AIDS.

Decreased lymphocyte counts are associated with:

Hodgkin's disease

Systemic Lupus Erythematosus

Steroid use

Burns and trauma.

Monocytes. Monocytes are scavenger leukocytes that dispose of noninfectious foreign particles, so they are not as diagnostically significant as other leukocytes. The normal range for monocytes is 2 to 6 percent of the total leukocyte count.

Monocyte percentages may be increased viral, bacterial and parasitic infections, as well as collagen diseases and some malignant blood disorders. Decreased monocyte counts are not associated with disease, but may be found in patients taking steroids.Eosinophils. Eosinophils are leukocytes that destroy parasites either by engulfing them or by attaching to them and releasing chemicals that destroy the parasites. The substances released by eosinophils have been implicated in allergic reactions, especially in the airway constriction seen in asthma.The normal range is 1 to 4 percent of the total leukocyte count.

Elevated levels of eosinophils are found in hyperimmune or allergic reactions, parasitic infection, and some cancers. Decreased eosinophil counts are found in congestive heart failure, infectious mononucleoisis, hormonal disorders, some anemias, and increased degrees of physical stress.

Interestingly, the number of eosinophils follows a circadian rhythm; that is, it fluctuates during the day. The count is lowest in the morning and increases throughout the day, peaking late in the evening. This trend is reversed in people who work at night. Basophils. The function of basophils is not as clear as other leukocytes. They appear to have a role in allergic reaction, and may have activity against parasites, but they do not phagocytize (ingest) foreign particles. The normal range for basophils is 0.5 to 1.0 percent of the total leukocyte count.

Increased basophil numbers are associated with malignancies of the blood. Decreased counts are found in stress reactions associated with some disease states and in steroid therapy. Platelet Measures

Platelets, also called thrombocytes, are the component of blood that control bleeding by clotting. At any one time, two-thirds of the platelets in the body are found in circulation, and one-third is found in the spleen. The normal range is for adults is 150,000 to 450,000 per mm3. Thus, diseases which affect the spleen (such as portal hypertension secondary to cirrhosis) will interfere with platelet activity and predispose the person to bleeding disorders.

The platelet count is the number of platelets in a given volume of blood. Platelet counts below 20,000 are very serious and may cause spontaneous hemorrhage. Platelet counts above 40,000 rarely result in spontaneous bleeding, but the patient may experience prolonged bleeding secondary to injury.

There are many non-pathological conditions that can cause variations in the platelet count, including:

Onset of menses (decreases platelet count)

Intense physical exercise (increases platelet count)

Living at high altitude (increases platelet count).

Additionally, platelets are usually increased in the winter and decreased in the summer.

Pathological conditions that can decrease platelet counts include:

Idiopathic thrombocytopenia purpura

Bone marrow injury or failure

Malignancies of the bone marrow (carcinoma, leukemia, lymphoma)

Vitamin B12 or folic acid deficiency

Infection

Hemorrhage or massive transfusion

Hemolytic anemias

Systemic lupus erythematosus.

Many drugs are also associated with decreased platelet counts.

Elevated platelets can be found in:

Hemorrhage

Surgery, including surgical removal of the spleen

Iron deficiency

Chronic inflammatory disorders

Certain cancers and Hodgkin's disease.

Summary of Reference Ranges

RBC count: 4.7 to 6.1 million/mm3 (male) and 4.2 to 5.4 million/mm3 (female)

Hemoglobin: 14 to 18 gms/Dl (male) and 12 to 16 gms/Dl (female)

Hematocrit: 42 to 52 percent (male) and 37 to 47 percent (female)

MCV: 80 to 95 femoliters

MCH: 27 to 31 picograms

MCHC: 32 to 36 gm/DL

RDW: 11 to 14.5 percent

WBC count: 5,000 to 10,000 / mm3

Neutrophils: 55 to 70 percent

Lymphocytes: 25 to 45 percent

Moncytes: 2 to 6 percent

Eosinophils: 1 to 4 percent

Basophils: 0.5 to 1.0 percent

Platelets: 150,000 to 450,000 / mm3

Source

McFarland M, Grant M. Nursing Implications of Laboratory Tests, 3rd ed. Delmar Publishers Inc., 1994.Pagana K, Pagana T. Mosby's Diagnostic and Laboratory Test Reference. 2nd ed. Mosby, 1995. Traub S. Basic Skills in Interpreting Laboratory Data, 2nd ed. American Society of Health-System Pharmacists, 1996.

[Guest guest]

wow Deb thanks so much for this wonderful info. Sick today started procrit shots last night. Don't like them at all that sucker hurts the insulin syringe needle that is. Think it gets dull when inserting into rubber stopper to get med out. Sorry gotta go to bed. hugs...WwDeb wrote: Understanding the Complete Blood Count (CBC) with

Differential Reviewed 7/14/05 by V. J. , RN, BSN, MA The Complete Blood Count

(or CBC) is a measure of erythrocytes (red blood cells), leukocytes (white blood cells), and platelets. The "differential" part of the test divides the white blood cell count into the different kinds of white blood cells. Red Blood Cell Measures RBC Count. Red blood cell (RBC) count is a count of the actual number of red blood cells in a certain volume of blood. The normal RBC count is 4.7 to 6.1 million/mm3 for males and 4.2 to 5.4 million/mm3 for females. Hemoglobin. Hemoglobin measures the amount of oxygen-carrying protein in the blood. The normal range is 14 to 18 gms/Dl for males, and 12 to 16 gms/Dl for females. Hematocrit. Hematocrit measures the amount of space red blood cells take up in the blood.

It is reported as a percentage. The normal range is 42 to 52 percent for males and 37 to 47 percent for females. Conditions that can cause increased RBC count, hemoglobin and hematocrit include: High altitudes Congenital heart disease Congestive heart failure Dehydration / hemoconcentration Lung diseases (COPD, fibrosis) Polycythemia vera Severe burns Diseases causing intravascular fluid loss (diarrhea, burns). Conditions that can cause decreased RBC count, hemoglobin and hematocrit include: Diseases causing anemia Bleeding / hemorrhage Destruction of cells (hemolysis) Hodgkin's disease Leukemia and other cancers Rheumatic diseases Autoimmune diseases, such as systemic lupus erythematosus Kidney disease / failure Enlarged spleen Cirrhosis Bone marrow failure. Mean corpuscular volume. Mean corpuscular volume (MCV) is a measurement of the average size of your red blood cells (RBC). The normal range is 80 to 95 femoliters. When the MCV is elevated, RBCs are larger than normal, or macrocytic. Causes of increased MCV include vitamin B12 or folic acid deficiency. When the MCV is decreased, RBCs are smaller than normal, or microcytic. Causes include iron deficient anemia or thalassemia. Mean corpuscular hemoglobin. Mean corpuscular hemoglobin (MCH) is a calculation of the amount of oxygen-carrying hemoglobin inside RBCs. The normal range is 27 to 31 picograms. This value is closely related to mean corpuscular volume, since RBCs with larger amounts of hemoglobin tend to be larger (macrocytic) and RBCs with

less hemoglobin tend to be smaller (microcytic). Mean corpuscular hemoglobin concentration. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the percentage of hemoglobin in the RBCs. The normal range is 32 to 36 gm/DL. When the amount of hemoglobin inside the cell is low, cells are hypochromic. Causes of decreased MCH include iron deficient anemia or thalassemia. Red Cell Distribution Width. Red Cell Distribution Width (RDW) is a calculation of the variation in the size of RBCs.The normal range is 11 to 14.5 percent. The RDW is essentially an indicator of anisocytosis (variation in RBC size) and poikilocytosis (variation in RBC shape). This measure can be useful in identifying certain anemias. White Blood Cell Measures The white blood cell (WBC) count has two components: the leukocyte count and the differential. The Leukocyte Count. The first component is a simple count of the total number of leukocytes (WBCs) in a volume of blood. The normal range for the WBC count is 5,000 to 10,000 WBCs per mm3 of blood. Many diseases and some non-pathological situations can cause an increased WBC count. Conditions not directly related to illness that can increase the WBC count include: Eating, physical activity or stress Pregnancy and labor Patients who have had their spleen removed Many medications, including aspirin, heparin, steroids, quinine, and others. Illness and diseases associated with an increased WBC count include: Viral, bacterial and

parasitic infections Inflammatory diseases, tissue inflammation and necrosis Autoimmune diseases Leukemias Metabolic disorders Exposure to radiation Physical trauma. A decreased WBC count can be associated with: Certain medications and medication toxicities Chemotherapy Bone marrow infiltration and failure Overwhelming infection Autoimmune disease. The DifferentialThe second component, the differential, breaks down the WBC count into each WBC subtype: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Differential WBC counts are reported as percentages of the WBC count. Neutrophils. Neutrophils (also called polymorphonuclear leukocytes or PMN's) are white blood

cells that digest bacteria and cellular debris. The normal range for neutrophils is 55 to 70 percent. Neutrophils are further subdivided into "Band" and "Segmented" neutrophils. "Segs" are mature neutrophils. Although segmented neutrophils make up the majority of neutrophils, an abnormally high percentage of segmented neutrophils suggest the hepatic disease and pernicious anemia. The normal range for segmented neutrophils is 50 to 65 percent. "Bands" (also called "stabs") are immature neutrophils, and their presence indicates stimulation of neutrophil production and early release of neutrophils into circulation, characteristic of an ongoing, acute bacterial infection. The normal range for band neutrophils is 0 to 5 percent. Lymphocytes. There are two forms of lymphoctyes: B cells and T Cells. B lymphocytes produce antibodies, which are protein substances

that bind with antigens (foreign particles), neutralizing their ability to cause infection, and providing a "handle" to which neutrophils can attach and then ingest the antigen. The normal range is 25 to 45 percent. T lymphocyes have the ability to recognize cells that are infected. They bind to and destroy infected cells by releasing chemicals onto the cell's surface. The differential WBC test does not differentiate between B and T cells, they are reported as a single, combined number. Increased lymphocyte percentages are found mainly in cases of viral infection, but can also be associated with: Bacterial infection, such as measles, mumps, rubella, infectious mononucleosis and infectious hepatitis Hormonal disorders, such as hypothyroidism and hypoadrenalism Cancers, including lymphocytic leukemia and lymphosarcome HIV /

AIDS. Decreased lymphocyte counts are associated with: Hodgkin's disease Systemic Lupus Erythematosus Steroid use Burns and trauma. Monocytes. Monocytes are scavenger leukocytes that dispose of noninfectious foreign particles, so they are not as diagnostically significant as other leukocytes. The normal range for monocytes is 2 to 6 percent of the total leukocyte count. Monocyte percentages may be increased viral, bacterial and parasitic infections, as well as collagen diseases and some malignant blood disorders. Decreased monocyte counts are not associated with disease, but may be found in patients taking steroids.Eosinophils. Eosinophils are leukocytes that destroy parasites either by engulfing them or by attaching to them and releasing chemicals that destroy the parasites. The substances released

by eosinophils have been implicated in allergic reactions, especially in the airway constriction seen in asthma.The normal range is 1 to 4 percent of the total leukocyte count. Elevated levels of eosinophils are found in hyperimmune or allergic reactions, parasitic infection, and some cancers. Decreased eosinophil counts are found in congestive heart failure, infectious mononucleoisis, hormonal disorders, some anemias, and increased degrees of physical stress. Interestingly, the number of eosinophils follows a circadian rhythm; that is, it fluctuates during the day. The count is lowest in the morning and increases throughout the day, peaking late in the evening. This trend is reversed in people who work at night. Basophils. The function of basophils is not as clear as other leukocytes. They appear to have a role in allergic reaction, and may have

activity against parasites, but they do not phagocytize (ingest) foreign particles. The normal range for basophils is 0.5 to 1.0 percent of the total leukocyte count. Increased basophil numbers are associated with malignancies of the blood. Decreased counts are found in stress reactions associated with some disease states and in steroid therapy. Platelet Measures Platelets, also called thrombocytes, are the component of blood that control bleeding by clotting. At any one time, two-thirds of the platelets in the body are found in circulation, and one-third is found in the spleen. The normal range is for adults is 150,000 to 450,000 per mm3. Thus, diseases which affect the spleen (such as portal hypertension secondary to cirrhosis) will interfere with platelet activity and

predispose the person to bleeding disorders. The platelet count is the number of platelets in a given volume of blood. Platelet counts below 20,000 are very serious and may cause spontaneous hemorrhage. Platelet counts above 40,000 rarely result in spontaneous bleeding, but the patient may experience prolonged bleeding secondary to injury. There are many non-pathological conditions that can cause variations in the platelet count, including: Onset of menses (decreases platelet count) Intense physical exercise (increases platelet count) Living at high altitude (increases platelet count). Additionally, platelets are usually increased in the winter and decreased in the summer. Pathological conditions that can decrease platelet counts include: Idiopathic thrombocytopenia purpura Bone marrow injury or failure Malignancies of the bone marrow (carcinoma, leukemia, lymphoma) Vitamin B12 or folic acid deficiency Infection Hemorrhage or massive transfusion Hemolytic anemias Systemic lupus erythematosus. Many drugs are also associated with decreased platelet counts. Elevated platelets can be found in: Hemorrhage Surgery, including surgical removal of the spleen Iron deficiency Chronic inflammatory disorders Certain cancers and Hodgkin's disease. Summary of Reference Ranges RBC count: 4.7 to 6.1 million/mm3 (male) and 4.2 to 5.4 million/mm3 (female) Hemoglobin: 14 to 18 gms/Dl (male) and 12 to 16 gms/Dl (female) Hematocrit: 42 to 52 percent (male) and 37 to 47 percent

(female) MCV: 80 to 95 femoliters MCH: 27 to 31 picograms MCHC: 32 to 36 gm/DL RDW: 11 to 14.5 percent WBC count: 5,000 to 10,000 / mm3 Neutrophils: 55 to 70 percent Lymphocytes: 25 to 45 percent Moncytes: 2 to 6 percent Eosinophils: 1 to 4 percent Basophils: 0.5 to 1.0 percent Platelets: 150,000 to 450,000 / mm3 Source McFarland M, Grant M. Nursing Implications of Laboratory Tests, 3rd ed. Delmar Publishers Inc., 1994.Pagana K, Pagana T. Mosby's Diagnostic and Laboratory Test Reference. 2nd ed. Mosby, 1995. Traub S. Basic Skills in Interpreting Laboratory

Data, 2nd ed. American Society of Health-System Pharmacists, 1996.Reviewed 7/14/05 by V. J. , RN, BSN, MA http://www.hepatitisneighborhood.com/content/understanding_hepatitis/diagnosing_hepatitisc_1669.aspx

[Guest guest]

wow Deb thanks so much for this wonderful info. Sick today started procrit shots last night. Don't like them at all that sucker hurts the insulin syringe needle that is. Think it gets dull when inserting into rubber stopper to get med out. Sorry gotta go to bed. hugs...WwDeb wrote: Understanding the Complete Blood Count (CBC) with

Differential Reviewed 7/14/05 by V. J. , RN, BSN, MA The Complete Blood Count

(or CBC) is a measure of erythrocytes (red blood cells), leukocytes (white blood cells), and platelets. The "differential" part of the test divides the white blood cell count into the different kinds of white blood cells. Red Blood Cell Measures RBC Count. Red blood cell (RBC) count is a count of the actual number of red blood cells in a certain volume of blood. The normal RBC count is 4.7 to 6.1 million/mm3 for males and 4.2 to 5.4 million/mm3 for females. Hemoglobin. Hemoglobin measures the amount of oxygen-carrying protein in the blood. The normal range is 14 to 18 gms/Dl for males, and 12 to 16 gms/Dl for females. Hematocrit. Hematocrit measures the amount of space red blood cells take up in the blood.

It is reported as a percentage. The normal range is 42 to 52 percent for males and 37 to 47 percent for females. Conditions that can cause increased RBC count, hemoglobin and hematocrit include: High altitudes Congenital heart disease Congestive heart failure Dehydration / hemoconcentration Lung diseases (COPD, fibrosis) Polycythemia vera Severe burns Diseases causing intravascular fluid loss (diarrhea, burns). Conditions that can cause decreased RBC count, hemoglobin and hematocrit include: Diseases causing anemia Bleeding / hemorrhage Destruction of cells (hemolysis) Hodgkin's disease Leukemia and other cancers Rheumatic diseases Autoimmune diseases, such as systemic lupus erythematosus Kidney disease / failure Enlarged spleen Cirrhosis Bone marrow failure. Mean corpuscular volume. Mean corpuscular volume (MCV) is a measurement of the average size of your red blood cells (RBC). The normal range is 80 to 95 femoliters. When the MCV is elevated, RBCs are larger than normal, or macrocytic. Causes of increased MCV include vitamin B12 or folic acid deficiency. When the MCV is decreased, RBCs are smaller than normal, or microcytic. Causes include iron deficient anemia or thalassemia. Mean corpuscular hemoglobin. Mean corpuscular hemoglobin (MCH) is a calculation of the amount of oxygen-carrying hemoglobin inside RBCs. The normal range is 27 to 31 picograms. This value is closely related to mean corpuscular volume, since RBCs with larger amounts of hemoglobin tend to be larger (macrocytic) and RBCs with

less hemoglobin tend to be smaller (microcytic). Mean corpuscular hemoglobin concentration. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the percentage of hemoglobin in the RBCs. The normal range is 32 to 36 gm/DL. When the amount of hemoglobin inside the cell is low, cells are hypochromic. Causes of decreased MCH include iron deficient anemia or thalassemia. Red Cell Distribution Width. Red Cell Distribution Width (RDW) is a calculation of the variation in the size of RBCs.The normal range is 11 to 14.5 percent. The RDW is essentially an indicator of anisocytosis (variation in RBC size) and poikilocytosis (variation in RBC shape). This measure can be useful in identifying certain anemias. White Blood Cell Measures The white blood cell (WBC) count has two components: the leukocyte count and the differential. The Leukocyte Count. The first component is a simple count of the total number of leukocytes (WBCs) in a volume of blood. The normal range for the WBC count is 5,000 to 10,000 WBCs per mm3 of blood. Many diseases and some non-pathological situations can cause an increased WBC count. Conditions not directly related to illness that can increase the WBC count include: Eating, physical activity or stress Pregnancy and labor Patients who have had their spleen removed Many medications, including aspirin, heparin, steroids, quinine, and others. Illness and diseases associated with an increased WBC count include: Viral, bacterial and

parasitic infections Inflammatory diseases, tissue inflammation and necrosis Autoimmune diseases Leukemias Metabolic disorders Exposure to radiation Physical trauma. A decreased WBC count can be associated with: Certain medications and medication toxicities Chemotherapy Bone marrow infiltration and failure Overwhelming infection Autoimmune disease. The DifferentialThe second component, the differential, breaks down the WBC count into each WBC subtype: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Differential WBC counts are reported as percentages of the WBC count. Neutrophils. Neutrophils (also called polymorphonuclear leukocytes or PMN's) are white blood

cells that digest bacteria and cellular debris. The normal range for neutrophils is 55 to 70 percent. Neutrophils are further subdivided into "Band" and "Segmented" neutrophils. "Segs" are mature neutrophils. Although segmented neutrophils make up the majority of neutrophils, an abnormally high percentage of segmented neutrophils suggest the hepatic disease and pernicious anemia. The normal range for segmented neutrophils is 50 to 65 percent. "Bands" (also called "stabs") are immature neutrophils, and their presence indicates stimulation of neutrophil production and early release of neutrophils into circulation, characteristic of an ongoing, acute bacterial infection. The normal range for band neutrophils is 0 to 5 percent. Lymphocytes. There are two forms of lymphoctyes: B cells and T Cells. B lymphocytes produce antibodies, which are protein substances

that bind with antigens (foreign particles), neutralizing their ability to cause infection, and providing a "handle" to which neutrophils can attach and then ingest the antigen. The normal range is 25 to 45 percent. T lymphocyes have the ability to recognize cells that are infected. They bind to and destroy infected cells by releasing chemicals onto the cell's surface. The differential WBC test does not differentiate between B and T cells, they are reported as a single, combined number. Increased lymphocyte percentages are found mainly in cases of viral infection, but can also be associated with: Bacterial infection, such as measles, mumps, rubella, infectious mononucleosis and infectious hepatitis Hormonal disorders, such as hypothyroidism and hypoadrenalism Cancers, including lymphocytic leukemia and lymphosarcome HIV /

AIDS. Decreased lymphocyte counts are associated with: Hodgkin's disease Systemic Lupus Erythematosus Steroid use Burns and trauma. Monocytes. Monocytes are scavenger leukocytes that dispose of noninfectious foreign particles, so they are not as diagnostically significant as other leukocytes. The normal range for monocytes is 2 to 6 percent of the total leukocyte count. Monocyte percentages may be increased viral, bacterial and parasitic infections, as well as collagen diseases and some malignant blood disorders. Decreased monocyte counts are not associated with disease, but may be found in patients taking steroids.Eosinophils. Eosinophils are leukocytes that destroy parasites either by engulfing them or by attaching to them and releasing chemicals that destroy the parasites. The substances released

by eosinophils have been implicated in allergic reactions, especially in the airway constriction seen in asthma.The normal range is 1 to 4 percent of the total leukocyte count. Elevated levels of eosinophils are found in hyperimmune or allergic reactions, parasitic infection, and some cancers. Decreased eosinophil counts are found in congestive heart failure, infectious mononucleoisis, hormonal disorders, some anemias, and increased degrees of physical stress. Interestingly, the number of eosinophils follows a circadian rhythm; that is, it fluctuates during the day. The count is lowest in the morning and increases throughout the day, peaking late in the evening. This trend is reversed in people who work at night. Basophils. The function of basophils is not as clear as other leukocytes. They appear to have a role in allergic reaction, and may have

activity against parasites, but they do not phagocytize (ingest) foreign particles. The normal range for basophils is 0.5 to 1.0 percent of the total leukocyte count. Increased basophil numbers are associated with malignancies of the blood. Decreased counts are found in stress reactions associated with some disease states and in steroid therapy. Platelet Measures Platelets, also called thrombocytes, are the component of blood that control bleeding by clotting. At any one time, two-thirds of the platelets in the body are found in circulation, and one-third is found in the spleen. The normal range is for adults is 150,000 to 450,000 per mm3. Thus, diseases which affect the spleen (such as portal hypertension secondary to cirrhosis) will interfere with platelet activity and

predispose the person to bleeding disorders. The platelet count is the number of platelets in a given volume of blood. Platelet counts below 20,000 are very serious and may cause spontaneous hemorrhage. Platelet counts above 40,000 rarely result in spontaneous bleeding, but the patient may experience prolonged bleeding secondary to injury. There are many non-pathological conditions that can cause variations in the platelet count, including: Onset of menses (decreases platelet count) Intense physical exercise (increases platelet count) Living at high altitude (increases platelet count). Additionally, platelets are usually increased in the winter and decreased in the summer. Pathological conditions that can decrease platelet counts include: Idiopathic thrombocytopenia purpura Bone marrow injury or failure Malignancies of the bone marrow (carcinoma, leukemia, lymphoma) Vitamin B12 or folic acid deficiency Infection Hemorrhage or massive transfusion Hemolytic anemias Systemic lupus erythematosus. Many drugs are also associated with decreased platelet counts. Elevated platelets can be found in: Hemorrhage Surgery, including surgical removal of the spleen Iron deficiency Chronic inflammatory disorders Certain cancers and Hodgkin's disease. Summary of Reference Ranges RBC count: 4.7 to 6.1 million/mm3 (male) and 4.2 to 5.4 million/mm3 (female) Hemoglobin: 14 to 18 gms/Dl (male) and 12 to 16 gms/Dl (female) Hematocrit: 42 to 52 percent (male) and 37 to 47 percent

(female) MCV: 80 to 95 femoliters MCH: 27 to 31 picograms MCHC: 32 to 36 gm/DL RDW: 11 to 14.5 percent WBC count: 5,000 to 10,000 / mm3 Neutrophils: 55 to 70 percent Lymphocytes: 25 to 45 percent Moncytes: 2 to 6 percent Eosinophils: 1 to 4 percent Basophils: 0.5 to 1.0 percent Platelets: 150,000 to 450,000 / mm3 Source McFarland M, Grant M. Nursing Implications of Laboratory Tests, 3rd ed. Delmar Publishers Inc., 1994.Pagana K, Pagana T. Mosby's Diagnostic and Laboratory Test Reference. 2nd ed. Mosby, 1995. Traub S. Basic Skills in Interpreting Laboratory

Data, 2nd ed. American Society of Health-System Pharmacists, 1996.Reviewed 7/14/05 by V. J. , RN, BSN, MA http://www.hepatitisneighborhood.com/content/understanding_hepatitis/diagnosing_hepatitisc_1669.aspx

[Guest guest]

wow Deb thanks so much for this wonderful info. Sick today started procrit shots last night. Don't like them at all that sucker hurts the insulin syringe needle that is. Think it gets dull when inserting into rubber stopper to get med out. Sorry gotta go to bed. hugs...WwDeb wrote: Understanding the Complete Blood Count (CBC) with

Differential Reviewed 7/14/05 by V. J. , RN, BSN, MA The Complete Blood Count

(or CBC) is a measure of erythrocytes (red blood cells), leukocytes (white blood cells), and platelets. The "differential" part of the test divides the white blood cell count into the different kinds of white blood cells. Red Blood Cell Measures RBC Count. Red blood cell (RBC) count is a count of the actual number of red blood cells in a certain volume of blood. The normal RBC count is 4.7 to 6.1 million/mm3 for males and 4.2 to 5.4 million/mm3 for females. Hemoglobin. Hemoglobin measures the amount of oxygen-carrying protein in the blood. The normal range is 14 to 18 gms/Dl for males, and 12 to 16 gms/Dl for females. Hematocrit. Hematocrit measures the amount of space red blood cells take up in the blood.

It is reported as a percentage. The normal range is 42 to 52 percent for males and 37 to 47 percent for females. Conditions that can cause increased RBC count, hemoglobin and hematocrit include: High altitudes Congenital heart disease Congestive heart failure Dehydration / hemoconcentration Lung diseases (COPD, fibrosis) Polycythemia vera Severe burns Diseases causing intravascular fluid loss (diarrhea, burns). Conditions that can cause decreased RBC count, hemoglobin and hematocrit include: Diseases causing anemia Bleeding / hemorrhage Destruction of cells (hemolysis) Hodgkin's disease Leukemia and other cancers Rheumatic diseases Autoimmune diseases, such as systemic lupus erythematosus Kidney disease / failure Enlarged spleen Cirrhosis Bone marrow failure. Mean corpuscular volume. Mean corpuscular volume (MCV) is a measurement of the average size of your red blood cells (RBC). The normal range is 80 to 95 femoliters. When the MCV is elevated, RBCs are larger than normal, or macrocytic. Causes of increased MCV include vitamin B12 or folic acid deficiency. When the MCV is decreased, RBCs are smaller than normal, or microcytic. Causes include iron deficient anemia or thalassemia. Mean corpuscular hemoglobin. Mean corpuscular hemoglobin (MCH) is a calculation of the amount of oxygen-carrying hemoglobin inside RBCs. The normal range is 27 to 31 picograms. This value is closely related to mean corpuscular volume, since RBCs with larger amounts of hemoglobin tend to be larger (macrocytic) and RBCs with

less hemoglobin tend to be smaller (microcytic). Mean corpuscular hemoglobin concentration. Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the percentage of hemoglobin in the RBCs. The normal range is 32 to 36 gm/DL. When the amount of hemoglobin inside the cell is low, cells are hypochromic. Causes of decreased MCH include iron deficient anemia or thalassemia. Red Cell Distribution Width. Red Cell Distribution Width (RDW) is a calculation of the variation in the size of RBCs.The normal range is 11 to 14.5 percent. The RDW is essentially an indicator of anisocytosis (variation in RBC size) and poikilocytosis (variation in RBC shape). This measure can be useful in identifying certain anemias. White Blood Cell Measures The white blood cell (WBC) count has two components: the leukocyte count and the differential. The Leukocyte Count. The first component is a simple count of the total number of leukocytes (WBCs) in a volume of blood. The normal range for the WBC count is 5,000 to 10,000 WBCs per mm3 of blood. Many diseases and some non-pathological situations can cause an increased WBC count. Conditions not directly related to illness that can increase the WBC count include: Eating, physical activity or stress Pregnancy and labor Patients who have had their spleen removed Many medications, including aspirin, heparin, steroids, quinine, and others. Illness and diseases associated with an increased WBC count include: Viral, bacterial and

parasitic infections Inflammatory diseases, tissue inflammation and necrosis Autoimmune diseases Leukemias Metabolic disorders Exposure to radiation Physical trauma. A decreased WBC count can be associated with: Certain medications and medication toxicities Chemotherapy Bone marrow infiltration and failure Overwhelming infection Autoimmune disease. The DifferentialThe second component, the differential, breaks down the WBC count into each WBC subtype: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Differential WBC counts are reported as percentages of the WBC count. Neutrophils. Neutrophils (also called polymorphonuclear leukocytes or PMN's) are white blood

cells that digest bacteria and cellular debris. The normal range for neutrophils is 55 to 70 percent. Neutrophils are further subdivided into "Band" and "Segmented" neutrophils. "Segs" are mature neutrophils. Although segmented neutrophils make up the majority of neutrophils, an abnormally high percentage of segmented neutrophils suggest the hepatic disease and pernicious anemia. The normal range for segmented neutrophils is 50 to 65 percent. "Bands" (also called "stabs") are immature neutrophils, and their presence indicates stimulation of neutrophil production and early release of neutrophils into circulation, characteristic of an ongoing, acute bacterial infection. The normal range for band neutrophils is 0 to 5 percent. Lymphocytes. There are two forms of lymphoctyes: B cells and T Cells. B lymphocytes produce antibodies, which are protein substances

that bind with antigens (foreign particles), neutralizing their ability to cause infection, and providing a "handle" to which neutrophils can attach and then ingest the antigen. The normal range is 25 to 45 percent. T lymphocyes have the ability to recognize cells that are infected. They bind to and destroy infected cells by releasing chemicals onto the cell's surface. The differential WBC test does not differentiate between B and T cells, they are reported as a single, combined number. Increased lymphocyte percentages are found mainly in cases of viral infection, but can also be associated with: Bacterial infection, such as measles, mumps, rubella, infectious mononucleosis and infectious hepatitis Hormonal disorders, such as hypothyroidism and hypoadrenalism Cancers, including lymphocytic leukemia and lymphosarcome HIV /

AIDS. Decreased lymphocyte counts are associated with: Hodgkin's disease Systemic Lupus Erythematosus Steroid use Burns and trauma. Monocytes. Monocytes are scavenger leukocytes that dispose of noninfectious foreign particles, so they are not as diagnostically significant as other leukocytes. The normal range for monocytes is 2 to 6 percent of the total leukocyte count. Monocyte percentages may be increased viral, bacterial and parasitic infections, as well as collagen diseases and some malignant blood disorders. Decreased monocyte counts are not associated with disease, but may be found in patients taking steroids.Eosinophils. Eosinophils are leukocytes that destroy parasites either by engulfing them or by attaching to them and releasing chemicals that destroy the parasites. The substances released

by eosinophils have been implicated in allergic reactions, especially in the airway constriction seen in asthma.The normal range is 1 to 4 percent of the total leukocyte count. Elevated levels of eosinophils are found in hyperimmune or allergic reactions, parasitic infection, and some cancers. Decreased eosinophil counts are found in congestive heart failure, infectious mononucleoisis, hormonal disorders, some anemias, and increased degrees of physical stress. Interestingly, the number of eosinophils follows a circadian rhythm; that is, it fluctuates during the day. The count is lowest in the morning and increases throughout the day, peaking late in the evening. This trend is reversed in people who work at night. Basophils. The function of basophils is not as clear as other leukocytes. They appear to have a role in allergic reaction, and may have

activity against parasites, but they do not phagocytize (ingest) foreign particles. The normal range for basophils is 0.5 to 1.0 percent of the total leukocyte count. Increased basophil numbers are associated with malignancies of the blood. Decreased counts are found in stress reactions associated with some disease states and in steroid therapy. Platelet Measures Platelets, also called thrombocytes, are the component of blood that control bleeding by clotting. At any one time, two-thirds of the platelets in the body are found in circulation, and one-third is found in the spleen. The normal range is for adults is 150,000 to 450,000 per mm3. Thus, diseases which affect the spleen (such as portal hypertension secondary to cirrhosis) will interfere with platelet activity and

predispose the person to bleeding disorders. The platelet count is the number of platelets in a given volume of blood. Platelet counts below 20,000 are very serious and may cause spontaneous hemorrhage. Platelet counts above 40,000 rarely result in spontaneous bleeding, but the patient may experience prolonged bleeding secondary to injury. There are many non-pathological conditions that can cause variations in the platelet count, including: Onset of menses (decreases platelet count) Intense physical exercise (increases platelet count) Living at high altitude (increases platelet count). Additionally, platelets are usually increased in the winter and decreased in the summer. Pathological conditions that can decrease platelet counts include: Idiopathic thrombocytopenia purpura Bone marrow injury or failure Malignancies of the bone marrow (carcinoma, leukemia, lymphoma) Vitamin B12 or folic acid deficiency Infection Hemorrhage or massive transfusion Hemolytic anemias Systemic lupus erythematosus. Many drugs are also associated with decreased platelet counts. Elevated platelets can be found in: Hemorrhage Surgery, including surgical removal of the spleen Iron deficiency Chronic inflammatory disorders Certain cancers and Hodgkin's disease. Summary of Reference Ranges RBC count: 4.7 to 6.1 million/mm3 (male) and 4.2 to 5.4 million/mm3 (female) Hemoglobin: 14 to 18 gms/Dl (male) and 12 to 16 gms/Dl (female) Hematocrit: 42 to 52 percent (male) and 37 to 47 percent

(female) MCV: 80 to 95 femoliters MCH: 27 to 31 picograms MCHC: 32 to 36 gm/DL RDW: 11 to 14.5 percent WBC count: 5,000 to 10,000 / mm3 Neutrophils: 55 to 70 percent Lymphocytes: 25 to 45 percent Moncytes: 2 to 6 percent Eosinophils: 1 to 4 percent Basophils: 0.5 to 1.0 percent Platelets: 150,000 to 450,000 / mm3 Source McFarland M, Grant M. Nursing Implications of Laboratory Tests, 3rd ed. Delmar Publishers Inc., 1994.Pagana K, Pagana T. Mosby's Diagnostic and Laboratory Test Reference. 2nd ed. Mosby, 1995. Traub S. Basic Skills in Interpreting Laboratory

Data, 2nd ed. American Society of Health-System Pharmacists, 1996.Reviewed 7/14/05 by V. J. , RN, BSN, MA http://www.hepatitisneighborhood.com/content/understanding_hepatitis/diagnosing_hepatitisc_1669.aspx