Automated CBC Parameters

and

Quality Control
Joanna Ellis, MLS(ASCP)

The Automated
Complete Blood Count
Most common test in the Hematology lab.
Main Components of the CBC:

Cell counts
Hgb
RBC indices
WBC differential absolute values and percent

Indications for CBC:

Fatigue
Weakness
Infection
Inflammation
Bruising
Bleeding

CBC Parameters
PARAMET
ER

UNIT OF
REPORTING

COMMON METHOD OF DETERMINATION

WBC

X 103 /L

Impedance count X calibration (cal) factor

RBC

X 106 /L

Impedance count X calibration factor

HGB

g/dL

Colorimetric absorbance in proportion to hemoglobin

fL

From RBC histogram,

#of RBCs X size of RBCs X cal constant OR Calculated:
HCT X 10

MCV

RBC
Calculated: RBC X MCV
10

HCT

MCH

Pg

MCHC

g/dL or %

Calculated: HGB X 100

HCT

RDW

Impedance (from histogram)

Platelet

X 103 /L

Impedance count X cal factor

WBC Diff

Absolute: X103 /L
Percent of WBC : %

Light Scatter , flow cytometry

Calculated:

HGB X 10
RBC

M77221

CBC
Adult Reference Ranges
Parameter

Adult Reference Range

WBC

4.5-11.0 X 103/L

RBC

Male: 4.5-5.5 X 106 /L

Female: 4.0-5.0 X 106 /L

HGB

Male: 14-17.4 g/dL

Female: 12.0-16.0 g/dL

HCT

Male: 42-52%
Female: 36-46%

MCV

80-100 fl

MCH

28-34 pg

MCHC

32-36 g/dL or %

RDW

12.0-14.6%

PLT

150-450 X 103 /L

MPV

6.8-10.2 fl

Linearity
(Reportable Range)
Instruments are calibrated for each analyte
with a range that is clinically relevant.
With concentrations above or below the
reportable range or Linearity range, the
result does not correspond with the
calibration curve in linear fashion.
Results outside of linearity are NOT
acceptable.
Linearity ranges vary by instrument.
Example:

Parameter

Coulter STKS

Advia

WBC

0.0 -99.9 X
103 /L

0.02-400 X
103 /L

Advia
Linearity Instrument Codes
Code

Cause

Action Indicated

+++++

Result exceeds
reportable range

Dilute 1:2 and rerun.

Continue further
dilutions until result is
within linearity

Result higher than the

laboratory set patient
high action limit

Review Result

Result is lower than the

laboratory set patient
low action limit

Review Result

CBC Quality Control

Commercial Controls:
3 levels (low, normal, high)
Values stored in instrument computer
Levey-Jennings graph generated and stored for each
parameter
Mode to Mode QC:
Most automated hematology instruments have a primary
and secondary mode of sample aspiration. Controls must
be run on BOTH and correlate.
Primary=Automated or Closed
Secondary=Manual or Open
Delta Checks
When the Laboratory Information System (LIS) and the
instrument are interfaced (connected) delta checks are
conducted by the LIS on select parameters.
Current values compared to most previous result
Differences greater than the limits set within the LIS
are flagged

WBC Parameter
Interfering substances and
Implications
Tes
t

Na
me

WB
C

Unusual RBC abnormalities

that resist lysis
Nucleated RBCs
Whit Fragmented WBCs
e
Unlysed particles greater
Bloo than 35 fL
Very large or aggregated
d
Cell plts
Cou Specimens containing fibrin,
nt
cell fragments or other
debris (esp
pediatric/oncology
specimens

Interfering Agent

Clinical Implications
LOW <4.5 X103 /L
some medications (such as
methotrexate),
some
autoimmune conditions
some severe infections
bone marrow failure
HIGH: >11.0 X103 /L
Infections
Inflammation
cancer, leukemia

RBC Parameter
Interfering substances and
Implications
Tes
t

Nam
e

Interfering Agent

Very high WBC count (greater than

99.9)
High concentration of very large
Red platelets
Blood Agglutinated RBCs, rouleaux will
RBC Cell break up when Istoton is added
Coun RBCs smaller than 36 fL
t
Specimens containing fibrin, cell
fragments or other debris (esp
pediatric/oncology specimens

Clinical
Implications
LOW:
Male: < 4.5 X
106 /L
Female: < 4.0 X
106 /L
Anemia
HIGH:
Male: > 5.5 X
106 /L
Female: > 5.0 X
106 /L
Polycythemia
vera,

HGB Parameter
Interfering substances and
Implications
Tes
t

Name

Interfering Agent

Very high WBC count

Severe lipemia
Heparin
HGB
Certain unusual RBC
Hemoglob
Or
abnormalities that resist lysing
in
Anything that increases the
Hb
turbidity of the sample such as
elevated levels of triglycerides
High bilirubin

Clinical
Implications
LOW:
Male: <14 g/dL
Female: <12.0 g/dL
Anemia
HIGH:
Male: > 17.4 g/dL
Female: >16.0 g/dL
Polycythemia vera
fluid loss due to
diarrhea, dehydration,
burns

HCT Parameter
Interfering substances and
Implications
Tes
t

Name

Interfering Agent

Clinical
Implications
LOW:
Male: <42%
Female: <36%
Anemia

Known factors that interfere

Hematocri
HCT
with the parameters used for
t
computation, RBC and MCV

HIGH:
Male: >52%
Female: <46%
Polycythemia vera
fluid loss due to
diarrhea, dehydration,
burns

MCV Parameter
Interfering substances and
Implications
Tes
t

MC
V

Name

Interfering Agent

Very high WBC count

High concentration of very
Mean
large platelets
Corpuscu
Agglutinated RBCs
lar (Cell)
RBC fragments that fall below
Volume
the 36 fL threshold
Rigid RBCs

Clinical
Implications

LOW: <80 fL
Iron deficiency
anemia
Thalassemia
HIGH: >100 fL
B12
Folate Deficiency

RDW Parameter
Interfering substances and
Implications
Tes
t

RD
W

Name

Interfering Agent

Very high WBC

High concentration of very
large or clumped platelets
Red Cell
RBCs below the 36 fL threshold
Distributi
Two distinct populations of
on Width
RBCs
RBC agglutinates
Rigid RBCs

Clinical
Implications

HIGH: >14.6%
Mixed population of
RBCs
Immature RBCs tend
to be larger

Plt Parameter
Interfering substances and
Implications
Tes
Name
t

Plt

Interfering Agent

Very small red cells

near the upper
threshold
Platele Cell fragments
Clumped platelets
t
Count Cellular debris near
the lower platelet
threshold

Clinical Implications
LOW: < 150 X 103 /L
Bleeding
Wiskott-Aldrich,
Bernard-Soulier
Systemic lupus erythematosus
Pernicious anemia
Hypersplenism (spleen takes too
many out of circulation)
Leukemia
Chemotherapy
HIGH: >450 X 103 /L
Benign idiopathic thrombocytosis
Myeloproliferative disorders
Polycythemia vera

WBC Differential Parameters

Clinical Implications in Adults
Test

Name

Clinical
Implications of
LOW %

Clinical Implications of HIGH

%

Neut %

Neutrophil
%
In 100 WBC
differential

LOW: <40%
Chemotherapy
Severe infection

HIGH: >80%
Bacterial infection
Inflammatory disease
Chronic myelogenous leukemia

Lymph
%

Lymphocyte
%

LOW: <25%
Lupus
Later stages of HIV
infection.

HIGH: >35%
Viral infection
Chronic or Acute Lymphocytic
Leukemia

Mono
%

Monocyte %

LOW: <2%
Bone Marrow
Insufficiency

HIGH: >10%
Inflammatory disorders
Myelomonocytic leukemia

Eos %

Eosinophil
%

HIGH: >5%
Parasitic infection
Allergic reaction

Baso %

Basophil %

HIGH: >1%
Allergic reaction to food
Chronic inflammation

References
Harmening., Denise, Clinical Hematology and
Fundamentals of
Hemostasis, 3rd edition, pp. 593599.
Turgeon, Mary Louise, Clinical Hematology - Theories and
Procedures,
3rd edition, pp373, 376-382.
Rodak, Bernadette, Diagnostic Hematology, 1st edition,
p.605-606.
Coulter STKS Operating Manual
McKenzie, Shirlyn, Clinical Laboratory Hematology, 2nd
edition,pp
813-829.
"Complete Blood Count: The Test." Lab Tests Online:
Welcome!
American Association for Clinical Chemistry,
18 June 2010. Web. 13 Sept. 2010.
<http://www.labtestsonline.org/understanding/analytes/cbc
/test.html#how>.
"WBC Differential Count: The Test." Lab Tests Online:
Welcome! American Association for Clinical Chemistry, 18
June 2010. Web. 13 Sept.
2010.http://www.labtestsonline.org/understanding/analytes/