CBC and PLATELETS

1. Definition
The complete blood count (CBC) is one of the most commonly ordered
blood tests. The complete blood count is the calculation of the cellular
(formed elements) of blood. These calculations are generally determined by
special machines that analyze the different components of blood in less than
a minute.
What are the components of the complete blood count (CBC)?
The complete blood count, or CBC, lists a number of many important
values. Typically, it includes the following:

White blood cell count (WBC or leukocyte count)

WBC differential count
Red blood cell count (RBC or erythrocyte count)
Hematocrit (Hct)
Hemoglobin (Hbg)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
Red cell distribution width (RDW)
Platelet count
Mean Platelet Volume (MPV)

2. Indications/Contraindications
Abnormal blood count results are seen in a variety of conditions. One
of the most common is anemia, which is characterized by a low RBC
count, hemoglobin, and hematocrit. The category into which a person's
anemia is placed is in part based upon the red blood cell indices
provided. The indices provide a significant clue as to the cause of the
anemia, but further testing is needed to confirm a specific diagnosis.
The most common causes of macrocytic anemia (high MCV) are
vitamin B 12 and folic acid deficiencies. Lack of iron in the diet,
thalassemia (a type of hereditary anemia), and chronic illness are the
most common causes of microcytic anemia (low MCV). Normocytic
anemia (normal MCV) can be caused by kidney and liver disease, bone
marrow disorders, leukemia, excessive bleeding, or hemolysis of the
red blood cells. Iron deficiency and thalassemia are the most common
causes of hypochromic anemia (low MCHC). Normocytic anemias are
usually also normochromic and share the same causes. The red cell
distribution width (RDW) is increased in anemias caused by
deficiencies of iron, vitamin B 12 , or folic acid. Abnormal hemoglobins,
such as in sickle cell anemia, can change the shape of red blood cells
as well as cause them to hemolyze, or rupture. The abnormal shape
and the cell fragments resulting from hemolysis increase the RDW.
Conditions that cause more immature cells to be released into the
bloodstream, such as severe blood loss, will increase the RDW. The
larger size of immature cells creates a distinct size variation.
Infections and leukemias are associated with increased numbers of
WBCs. Increases or decreases in the percentage of each white cell can
be associated with a number of diseases or conditions, including

cancer, leukemia, anemia, multiple sclerosis, allergies, parasitic and

viral diseases, infections, and tissue damage.
3. Equipment used/ Procedure
How is the complete blood count test (CBC) done?
Blood is drawn from a vein, usually from the inside of the elbow or the
back of the hand. The puncture site is cleaned with antiseptic. An
elastic band is placed around the upper arm to apply pressure and
cause the vein to swell with blood.
A needle is inserted into the vein, and the blood is collected in an airtight vial or a syringe. During the procedure, the band is removed to
restore circulation. Once the blood has been collected, the needle is
removed, and the puncture site is covered to stop any bleeding.
In infants or young children, the area is cleansed with antiseptic and
punctured with a sharp needle or a lancet. The blood may be collected
in a pipette (small glass tube), on a slide, onto a test strip, or into a
small container. A bandage may be applied to the puncture site if there
is any bleeding. This sample is taken to the laboratory for analysis.
4. Nursing responsibilities (Pre test, During, Post test)
Pre-test:
Positively identify the patient using at least two unique identifiers
before providing care, treatment, or services.
Inform the patient this test can assist in evaluating the amount of
hemoglobin in the blood to assist in diagnosis and monitor therapy.
Obtain a history of the patient's complaints, including a list of known
allergens, especially allergies or sensitivities to latex.
Obtain a history of the patient's cardiovascular, gastrointestinal,
hematopoietic, hepatobiliary, immune, and respiratory systems;
symptoms; and results of previously performed laboratory tests and
diagnostic and surgical procedures.
Note any recent procedures that can interfere with test results.
Obtain a list of the patient's current medications, including herbs,
nutritional supplements, and nutraceuticals
Review the procedure with the patient. Inform the patient that
specimen collection takes approximately 5 to 10 min. Address concerns
about pain and explain that there may be some discomfort during the
venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty,
is important in providing psychological support before, during, and
after the procedure.
There are no food, fluid, or medication restrictions unless by medical
direction.
During test:
If the patient has a history of allergic reaction to latex, avoid the use of
equipment containing latex.
Instruct the patient to cooperate fully and to follow directions. Direct
the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines.
Positively identify the patient, and label the appropriate tubes with the
corresponding patient demographics, date, and time of collection.
Perform a venipuncture; collect the specimen in a 5-mL lavender-top
(EDTA) tube. An EDTA Microtainer sample may be obtained from
infants, children, and adults for whom venipuncture may not be
feasible. The specimen should be mixed gently by inverting the tube
10 times. The specimen should be analyzed within 24 hr when stored

at room temperature or within 48 hr if stored at refrigerated

temperature. If it is anticipated the specimen will not be analyzed
within 24 hr, two blood smears should be made immediately after the
venipuncture and submitted with the blood sample. Smears made from
specimens older than 24 hr may contain an unacceptable number of
misleading artifactual abnormalities of the RBCs, such as echinocytes
and spherocytes, as well as necrobiotic white blood cells.
Remove the needle and apply direct pressure with dry gauze to stop
bleeding. Observe/assess venipuncture site for bleeding or hematoma
formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and
analysis
Post test:
A report of the results will be sent to the requesting HCP, who will
discuss the results with the patient.
Depending on the results of this procedure, additional testing may be
performed to evaluate or monitor progression of the disease process
and determine the need for a change in therapy. Evaluate test results
in relation to the patient's symptoms and other tests performed.
5. Possible Complications
Other than potential bruising at the puncture site, and/or dizziness,
there are no complications associated with this test.
6. Normal values
The following are normal complete blood count results for adults:
Red blood cell count
Male: 4.32-5.72 trillion cells/L*
(4.32-5.72 million cells/mcL**)
Female: 3.90-5.03 trillion cells/L
(3.90-5.03 million cells/mcL)
Hemoglobin
Male: 13.5-17.5 grams/dL***
(135-175 grams/L)
Female: 12.0-15.5 grams/dL
(120-155 grams/L)
Hematocrit
Male: 38.8-50.0 percent
Female: 34.9-44.5 percent
White blood cell count
3.5-10.5 billion cells/L
(3,500 to 10,500 cells/mcL)
Platelet count
150-450 billion/L
(150,000 to 450,000/mcL**)
* L = liter
** mcL = microliter
*** dL = deciliter
7. Significant results/ interpretations
8. Validity of the test
9. Latest update of the study