Complete blood picture (CBC)
Complete blood picture ( CBC ) test can reveal numerous conditions such
as leukemia, anemia and other infections. The test specifically measures:
Blood platelets
White Blood Cells (WBC) total count and differential count and
morphology
Red Blood Cells (RBCs) count and morphology
Hemoglobin (Hb)
Hematocrit (HCT or PCV)
RBCs indices, which important in diagnosis the of anaemia.
The blood sample drawn for a complete blood count is collected on
EDTA tubes. The complete blood count analysis is routinely and reliably
done by automated machines (Cell counter) in most laboratories. A small
sample of the blood drawn from a sample is fed into the machine and
within a few minutes, the values of the components of the complete blood
count are displayed and printed for review. This is called an automated
cell count and differential.
The conventional method to analyze these data is to obtain a small sample
of the collected blood and place it on a glass slide (To make Blood film)
for visual review under a microscope using special stains. This is usually
done by a trained laboratory technologist or a doctor. This method is still
widely used when results of a complete blood count need further review
to confirm certain abnormal values, or a doctor wants to see how the
blood cells look (for example, if any abnormal features are present which
would not be reported by an automated complete blood count). This is
called the manual differential analysis using stained blood film.
Red blood cell measurements
RBC count is the total number of RBCs in the blood sample.
Hemoglobin measures the amount of this oxygen-carrying protein
that is found inside RBCs.
Hematocrit measures the proportion of total blood volume that
consists of RBCs.
A CBC also provides details about the physical features of RBC. These
are known as RBC indices, of which there are several kinds:
Mean corpuscular volume (MCV) is a measurement of the
average size of RBC. (Normal adult: 80 – 100 fl/cell)
Mean corpuscular hemoglobin (MCH) is the average amount of
hemoglobin content inside RBCs. (Normal adult: 26 – 31 pg/cell)
Mean corpuscular hemoglobin concentration (MCHC) is a
calculated measurement of how concentrated hemoglobin is within
single RBC. (Normal adult: 30 – 34 pg/cell)
Red cell distribution width (RDW) is a measurement of the variation in
the size of RBC
o elevated RDW implies a high degree of RBC size variation as in
iron deficiency anemia
myelodysplastic syndromes
hemoglobinopathies
o low RDW implies a more homogenous RBC size
The CBC may include the reticulocyte count, the total number of newly
released young RBCs in blood sample. It may also be measured as a
percentage.
Increased in RBCs or HCT
White blood cell (WBC) count test
There are several types of white blood cells, blood usually contains a
percentage of each type. Sometimes, however, white blood cell count can
fall or rise out of the healthy range. This may be due to an underlying
condition or infection also the total count and differential count differ
according to the patients age.
In normal adult total leucocyte count (WBCs or TLC.): 4 – 11 x 103 /uL
From total leukocyte count and differential leukocyte count, the absolute
count of each leukocyte type can be calculated. The absolute leucocyte
count provides a more accurate picture than the differential
leucocyte count. (For example, a chronic lymphocytic leukemia patient
has a total leukocyte count of 100 x 103 cells µI and a differential
leukocyte count of 7 percent neutrophils and 90 percent lymphocytes. By
looking at the differential leukocyte count of 7 percent neutrophils alone
one get the impression of very low neutrophils in this patient But if the
absolute count of neutrophils is calculated, one will be surprised to see a
normal neutrophil number in this patient.
Absolute neutrophil count = Total leukocyte count x neutrophil percent
=100 x 103 x 7/100 = 7 x 103 = 7000 / µl
Differential count also differ by age and the clinical conditions of the
patients
Leucocytosis
The terms leucocytosis and leucopenia indicate increase or decrease in
the total number of leukocytes, respectively. Increase in numbers of
neutrophils, eosinophils, lymphocytes, and monocytes are known as
neutrophilia, eosinophilia, lymphocytosis, and monocytosis respectively.
Neutrophilia is the increase in peripheral blood absolute neutrophil
count, above the upper limit of normal of 7.5 x 109/L (in adults). Bacterial
infection is one of the common causes of neutrophilia. Neutrophilia is not
a feature of viral infections (However, the development of neutrophila
late in the course of a viral infection may indicate the emergence of
secondary bacterial infection).
Increased neutrophil production during bacterial infection is usually
associated with the entry of less mature neutrophils from bone marrow
into blood. This is indicated by the appearance of neutrophils with lesser
number of nuclear segmentation in the peripheral blood picture. Band
cells may also be seen in the peripheral blood [Link] is referred to as
a ‘shift to the left’.
The leukemoid reaction is a reactive and excessive leukocytosis, wherein
the peripheral blood smear shows the presence of immature cells (e.g.
myeloblasts, promyelocytes, and myelocytes). Leukemoid picture occurs
in severe or chronic infections and hemolysis. Another most common
change that occurs in neutrophils during infection is the presence of toxic
basophilic granulations in the cytoplasm.
Eosinophilia is an increase in peripheral blood absolute eosinophil count
beyond 0.4 x 109/L (in adults). Eosinophilia is usually associated with
allergic conditions such as asthma and hay fever and parasitic infections.
Eosinophilia may also occur in reactions to drugs.
Lymphocytosis
Leucopenia
Decrease in total leukocyte count is known as leucopenia. Reduction in
the number of neutrophils is called neutropenia
i. Neutropenia is the decrease in peripheral blood absolute neutrophil
count below the lower limit of normal of 2 x 10 9/L (in adults).
Neutropenic patients are more vulnerable to infection.
ii. Lymphopenia in adults is the decrease in peripheral blood absolute
lymphocyte count below the lower limit of normal of 1.5 x 10 9/L.
Lymphopenia is common in the leukopenic prodromal phase of many
viral infections as in covid 19 infection. A selective depletion of helper T
lymphocytes (CD4+) with or without absolute lymphopenia occurs in
acquired immunodeficiency disease (AIDS).
Platelet count
A normal platelet count ranges from 150,000 to 450,000 per microliter
of blood. Having more than 450,000 platelets is a condition called
thrombocytosis; having less than 150,000 is known as thrombocytopenia.
Thrombocytopenia
Thrombocytosis