What are the key components measured in a Complete Blood Count. How does a CBC help diagnose various health conditions. What insights can be gleaned from abnormal CBC results.

Understanding the Complete Blood Count (CBC): A Comprehensive Blood Test

The Complete Blood Count (CBC) is a crucial diagnostic tool used by healthcare professionals to assess a patient’s overall health and detect various medical conditions. This comprehensive blood test provides valuable information about the different components of blood, offering insights into potential health issues ranging from anemia to infections and blood disorders.

What Does a CBC Measure?

A CBC test evaluates several key components of blood, including:

• White Blood Cells (WBCs)
• Red Blood Cells (RBCs)
• Platelets
• Hemoglobin
• Hematocrit

Additionally, the CBC provides information on various blood cell indices, which help in further analysis of blood cell characteristics.

Decoding the CBC: Key Components and Their Significance

White Blood Cells (WBCs)

White blood cells, also known as leukocytes, play a crucial role in the body’s immune system. The CBC measures the total number of WBCs and provides a breakdown of the different types of white blood cells, including neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

Why are WBC counts important? An elevated WBC count may indicate the presence of an infection, inflammation, or certain blood disorders. Conversely, a low WBC count could suggest an immune system deficiency or bone marrow problems.

Red Blood Cells (RBCs)

Red blood cells, or erythrocytes, are responsible for carrying oxygen throughout the body. The CBC measures the total number of RBCs as well as their size and shape.

What can abnormal RBC counts reveal? A low RBC count may indicate anemia, while a high count could be a sign of polycythemia, a condition where the body produces too many red blood cells.

Platelets

Platelets are cell fragments essential for blood clotting. The CBC measures the number of platelets in the blood.

Why is the platelet count significant? A low platelet count (thrombocytopenia) can lead to easy bruising and bleeding, while a high count (thrombocytosis) may increase the risk of blood clots.

Hemoglobin

Hemoglobin is the protein in red blood cells responsible for carrying oxygen. The CBC measures the total amount of hemoglobin in the blood.

How does hemoglobin level impact health? Low hemoglobin levels may indicate anemia, while high levels could suggest polycythemia or other blood disorders.

Hematocrit

Hematocrit is the percentage of blood volume occupied by red blood cells. This measurement provides information about the concentration of RBCs in the blood.

What can hematocrit levels indicate? Abnormal hematocrit levels may suggest conditions such as anemia, dehydration, or polycythemia.

Beyond the Basics: Additional CBC Measurements and Their Importance

In addition to the primary components, a CBC also provides valuable information through various blood cell indices:

• Mean Corpuscular Volume (MCV): Measures the average size of red blood cells
• Mean Corpuscular Hemoglobin (MCH): Indicates the average amount of hemoglobin in each red blood cell
• Mean Corpuscular Hemoglobin Concentration (MCHC): Measures the average concentration of hemoglobin in red blood cells

These indices help healthcare providers further analyze blood cell characteristics and identify specific types of anemia or other blood disorders.

The CBC in Action: Diagnosing and Monitoring Health Conditions

The Complete Blood Count is a versatile diagnostic tool used to identify and monitor a wide range of health conditions. Some of the key applications of CBC include:

Anemia Detection and Classification

CBC results can help diagnose various types of anemia, such as iron-deficiency anemia, vitamin B12 deficiency anemia (megaloblastic anemia), and hemolytic anemia. For example, in megaloblastic anemia caused by vitamin B12 deficiency, the CBC may reveal large, dense, oversized red blood cells.

Infection and Inflammation Assessment

An elevated white blood cell count can indicate the presence of an infection or inflammation in the body. The CBC can also provide information about specific types of infections based on the distribution of different white blood cell types.

Blood Disorders Evaluation

The CBC is crucial in identifying and monitoring various blood disorders, including:

• Sickle Cell Anemia: Characterized by abnormally shaped red blood cells
• Thalassemia: A group of inherited blood disorders affecting hemoglobin production
• Leukemia: A cancer of blood-forming tissues
• Polycythemia: A condition characterized by an increased number of red blood cells

Monitoring Treatment Effectiveness

CBC tests are often used to monitor the effectiveness of treatments for various conditions, such as chemotherapy for cancer or medications for blood disorders.

Interpreting CBC Results: Understanding Normal Ranges and Abnormalities

Interpreting CBC results requires an understanding of normal ranges for each component. While these ranges may vary slightly between laboratories, general guidelines exist for each measurement.

Normal Ranges for Key CBC Components

• White Blood Cells: 4,500 to 11,000 cells per microliter (μL)
• Red Blood Cells: 4.5 to 5.5 million cells per microliter (μL)
• Hemoglobin: 13.5 to 17.5 grams per deciliter (g/dL) for men; 12.0 to 15.5 g/dL for women
• Hematocrit: 38.8% to 50% for men; 34.9% to 44.5% for women
• Platelets: 150,000 to 450,000 per microliter (μL)

It’s important to note that these ranges are general guidelines, and individual results should be interpreted in the context of a patient’s overall health and medical history.

Common CBC Abnormalities and Their Potential Meanings

Abnormal CBC results can provide valuable clues about underlying health conditions:

• High WBC count: May indicate infection, inflammation, or certain types of leukemia
• Low WBC count: Could suggest bone marrow problems, autoimmune disorders, or certain medications
• Low RBC count or hemoglobin: Often indicates anemia
• High RBC count or hemoglobin: May suggest polycythemia or dehydration
• Low platelet count: Can indicate thrombocytopenia, which may lead to easy bruising or bleeding
• High platelet count: May suggest thrombocytosis, increasing the risk of blood clots

Advanced CBC Analysis: Examining Blood Cell Morphology

In addition to quantitative measurements, CBC analysis often includes an examination of blood cell morphology, or the physical characteristics of blood cells. This can provide further insights into various blood disorders and conditions.

Red Blood Cell Morphology

Abnormalities in red blood cell shape and size can indicate specific conditions:

• Sickle cells: Crescent-shaped RBCs indicative of sickle cell anemia
• Spherocytes: Small, spherical RBCs associated with certain types of anemia
• Elliptocytes: Oval-shaped RBCs seen in hereditary elliptocytosis
• Target cells: RBCs resembling a bullseye, often seen in liver disease or thalassemia

White Blood Cell Morphology

Examining the characteristics of white blood cells can provide information about various conditions:

• Reactive lymphocytes: Larger lymphocytes often seen in viral infections
• Blasts: Immature white blood cells that may indicate leukemia
• Hypersegmented neutrophils: Neutrophils with more than five lobes, often associated with vitamin B12 or folate deficiency

Platelet Morphology

While less common, platelet abnormalities can also be observed:

• Giant platelets: Larger than normal platelets, which may be seen in certain inherited disorders
• Platelet clumps: Aggregates of platelets that can affect platelet count accuracy

The Role of CBC in Diagnosing Specific Blood Disorders

The Complete Blood Count plays a crucial role in diagnosing and monitoring various blood disorders. Let’s explore how CBC results contribute to the identification of specific conditions:

Sickle Cell Anemia

In sickle cell anemia, the CBC may reveal:

• Low red blood cell count
• Low hemoglobin levels
• Presence of sickle-shaped red blood cells in blood smear examination

These abnormal, crescent-shaped red blood cells can lead to blockages in small blood vessels, causing pain and organ damage.

Iron Deficiency Anemia

CBC results indicative of iron deficiency anemia may include:

• Low red blood cell count
• Low hemoglobin levels
• Low mean corpuscular volume (MCV), indicating smaller than normal red blood cells

Additional tests, such as serum ferritin levels, are often required to confirm the diagnosis.

Vitamin B12 Deficiency Anemia (Megaloblastic Anemia)

CBC findings suggestive of vitamin B12 deficiency may include:

• Low red blood cell count
• Low hemoglobin levels
• High mean corpuscular volume (MCV), indicating larger than normal red blood cells
• Presence of hypersegmented neutrophils in blood smear examination

The presence of large, dense, oversized red blood cells is characteristic of megaloblastic anemia.

Leukemia

CBC results that may indicate leukemia include:

• Abnormally high white blood cell count
• Presence of immature white blood cells (blasts) in the blood
• Low red blood cell and platelet counts

Further testing, including bone marrow biopsy, is typically required to confirm a leukemia diagnosis.

The Importance of CBC in Monitoring Overall Health

Beyond diagnosing specific conditions, the Complete Blood Count serves as a valuable tool for monitoring overall health and detecting potential issues before they become severe.

Routine Health Screenings

CBC is often included in routine health check-ups to:

• Assess general health status
• Screen for underlying conditions that may not have apparent symptoms
• Establish baseline values for future comparisons

Monitoring Chronic Conditions

For patients with chronic health conditions, regular CBC tests can help:

• Track disease progression
• Evaluate treatment effectiveness
• Detect potential complications early

Assessing Nutritional Status

CBC results can provide insights into a patient’s nutritional status, particularly in terms of:

• Iron levels (through red blood cell and hemoglobin measurements)
• Vitamin B12 and folate status (through mean corpuscular volume and red blood cell distribution width)

Evaluating Medication Effects

Some medications can affect blood cell production or survival. Regular CBC tests can help monitor:

• Potential side effects of medications on blood cells
• The impact of blood-modifying treatments, such as chemotherapy

Advances in CBC Technology and Future Directions

As medical technology continues to advance, the field of hematology and CBC analysis is also evolving. Some recent developments and future directions include:

Automated Cell Morphology Analysis

Advanced CBC analyzers now incorporate artificial intelligence and machine learning algorithms to:

• Automatically identify and classify abnormal blood cells
• Improve the accuracy and consistency of cell morphology analysis
• Reduce the need for manual microscopic examination in many cases

Point-of-Care CBC Testing

The development of portable, rapid CBC analyzers allows for:

• Faster turnaround times for results
• CBC testing in remote or resource-limited settings
• Immediate decision-making in emergency situations

Integration with Other Diagnostic Tools

Future advancements may include:

• Combining CBC analysis with genetic testing for more comprehensive diagnostics
• Integration of CBC results with electronic health records for improved patient monitoring
• Development of predictive models using CBC data to assess disease risk

As these technologies continue to evolve, the Complete Blood Count will likely become an even more powerful and versatile tool in healthcare diagnostics and patient management.

The Complete Blood Count remains a cornerstone of medical diagnostics, providing crucial information about a patient’s health status and potential underlying conditions. By understanding the components of a CBC and their significance, healthcare providers can make informed decisions about patient care, leading to more accurate diagnoses and effective treatments. As technology advances, the CBC will continue to play a vital role in improving patient outcomes and advancing our understanding of hematological disorders.

CBC blood test Information | Mount Sinai

Complete blood count; Anemia – CBC

A complete blood count (CBC) test measures the following:

• The number of white blood cells (WBC count)
• The number of red blood cells (RBC count)
• The number of platelets
• The total amount of hemoglobin in the blood
• The fraction of the blood composed of red blood cells (hematocrit)

The CBC test also provides information about the following measurements:

• Mean red blood cell volume (MCV)
• Mean hemoglobin amount per red blood cell (MCH)
• The mean amount of hemoglobin relative to the size of the cell (hemoglobin concentration) per red blood cell (MCHC)

The complete blood count (CBC) is test, used to diagnose and monitor numerous diseases. It can reflect problems with fluid volume (such as dehydration) or loss of blood. It can show abnormalities in the production, life span, and destruction of blood cells. It can reflect acute or chronic infection, allergies, and problems with clotting. The CBC test identifies and counts the 7 types of cells found in the blood, red blood cell, neutrophil, eosinophil, basophil, lymphocyte, monocyte, and platelet.

Sickle cell anemia is an inherited blood disease in which the red blood cells produce abnormal pigment (hemoglobin). The abnormal hemoglobin causes deformity of the red blood cells into crescent or sickle-shapes, as seen in this photomicrograph.

This picture shows large, dense, oversized, red blood cells (RBCs) that are seen in megaloblastic anemia. Megaloblastic anemia can occur when there is a deficiency of vitamin B-12.

This photomicrograph shows one of the abnormal shapes that red blood cells (RBCs) may assume, a tear-drop shape. Normally, RBCs are round.

This photomicrograph shows normal red blood cells (RBCs) as seen in the microscope after staining.

Elliptocytosis is a hereditary disorder of the red blood cells (RBCs). In this condition, the RBCs assume an elliptical shape, rather than the typical round shape.

Spherocytosis is a hereditary disorder of the red blood cells (RBCs), which may be associated with a mild anemia. Typically, the affected RBCs are small, spherically shaped, and lack the light centers seen in normal, round RBCs.

Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

Basophils are a specific type of white blood cell. These cells are readily stained with basic dyes (this is where the name comes from). Note the dark grains inside the cellular fluid (cytoplasm) of this basophil. Basophils make up only a small portion of the number of white blood cells but are important parts of the body’s immune response. They release histamine and other chemicals that act on the blood vessels when the immune response is triggered.

Malarial parasites are visible within the red blood cells. They are stained a dark bluish color.

Malaria is a disease caused by parasites. This picture shows dark orange-stained malaria parasites inside red blood cells (a) and outside the cells (b). Note the large cells that look like targets; it is unknown how these target cells are related to this disease.

These crescent or sickle-shaped red blood cells (RBCs) are present with Sickle cell anemia, and stand out clearly against the normal round RBCs. These abnormally shaped cells may become entangled and block blood flow in the small blood vessels (capillaries).

This photomicrograph of red blood cells (RBCs) shows both sickle-shaped and Pappenheimer bodies.

These abnormal red blood cells (RBCs) resemble targets. These cells are seen in association with some forms of anemia, and following the removal of the spleen (splenectomy).

Blood transports oxygen and nutrients to body tissues and returns waste and carbon dioxide. Blood distributes nearly everything that is carried from one area in the body to another place within the body. For example, blood transports hormones from endocrine organs to their target organs and tissues. Blood helps maintain body temperature and normal pH levels in body tissues. The protective functions of blood include clot formation and the prevention of infection.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

There is no special preparation needed.

How the Test will Feel

When the needle is inserted to draw blood, you may feel moderate pain. Some people feel only a prick or stinging. Afterward there may be some throbbing or slight bruising. This soon goes away.

Why the Test is Performed

A CBC is a commonly performed lab test. It can be used to detect or monitor many different health conditions. Your health care provider may order this test:

• If you are having symptoms, such as fatigue, weight loss, fever or other signs of an infection, weakness, bruising, bleeding, or any signs of cancer
• When you are receiving treatments (medicines or radiation) that may change your blood count results
• To monitor a long-term (chronic) health problem that may change your blood count results, such as chronic kidney disease

Normal Results

Blood counts may vary with altitude. In general, normal results are:

RBC count:

• Male: 4.7 to 6.1 million cells/mcL
• Female: 4.2 to 5.4 million cells/mcL

WBC count:

• 4,500 to 10,000 cells/mcL

Hematocrit:

• Male: 40. 7% to 50.3%
• Female: 36.1% to 44.3%

Hemoglobin:

• Male: 13.8 to 17.2 gm/dL
• Female: 12.1 to 15.1 gm/dL

Red blood cell indices:

• MCV: 80 to 95 femtoliter
• MCH: 27 to 31 pg/cell
• MCHC: 32 to 36 gm/dL

Platelet count:

• 150,000 to 450,000/dL

The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

High RBC, hemoglobin, or hematocrit may be due to:

• A lack of enough water and fluids, such as from severe diarrhea, excessive sweating, or water pills used to treat high blood pressure
• Kidney disease with high erythropoietin production
• Low oxygen level in the blood for a long time, most often due to heart or lung disease, chronic carbon monoxide exposure, or living at a high altitude
• Polycythemia vera
• Smoking
• Use of testosterone

Low RBC, hemoglobin, or hematocrit is a sign of anemia, which can result from:

• Blood loss (either sudden, or from problems such as heavy menstrual periods over a long time)
• Bone marrow failure (for example, from radiation, infection, or tumor)
• Breakdown of red blood cells (hemolysis)
• Cancer and cancer treatment
• Certain long-term (chronic) medical conditions, such as chronic kidney disease, ulcerative colitis, or rheumatoid arthritis
• Iron deficiency
• Leukemia
• Long-term infections such as hepatitis
• Poor diet and nutrition, causing too little iron, folate, vitamin B12, or vitamin B6
• Multiple myeloma

A lower than normal white blood cell count is called leukopenia. A decreased WBC count may be due to:

• Alcohol abuse and liver damage
• Autoimmune diseases (such as systemic lupus erythematosus)
• Bone marrow failure (for example, due to infection, tumor, radiation, or fibrosis)
• Chemotherapy medicines used to treat cancer
• Disease of the liver or spleen
• Enlarged spleen
• Infections caused by viruses, such as mono or AIDS
• Medicines

A high WBC count is called leukocytosis. It can result from:

• Certain medicines, such as corticosteroids
• Infections
• Diseases such as lupus, rheumatoid arthritis, or allergy
• Leukemia
• Severe emotional or physical stress
• Tissue damage (such as from burns or a heart attack)

A high platelet count may be due to:

• Bleeding
• Diseases such as cancer or blood disease
• Iron deficiency
• Problems with the bone marrow

A low platelet count may be due to:

• Disorders where platelets are destroyed
• Pregnancy
• Enlarged spleen
• Bone marrow failure (for example, due to infection, tumor, radiation, or fibrosis)
• Chemotherapy medicines used to treat cancer

Risks

There is very little risk involved with having your blood taken. Veins and arteries vary in size from one person to another, and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight, but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Considerations

RBCs transport hemoglobin which, in turn, carries oxygen. The amount of oxygen received by body tissues depends on the amount and function of RBCs and hemoglobin.

WBCs are mediators of inflammation and the immune response. There are various types of WBCs that normally appear in the blood:

• Neutrophils (polymorphonuclear leukocytes)
• Band cells (slightly immature neutrophils)
• T-type lymphocytes (T cells)
• B-type lymphocytes (B cells)
• Monocytes
• Eosinophils
• Basophils

Lin JC, Benz Jr. EJ. Approach to anemia in the adult and child. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 35.

Means RT. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 149.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 31.

Last reviewed on: 10/16/2022

Reviewed by: Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

WBC count Information | Mount Sinai

Leukocyte count; White blood cell count; White blood cell differential; WBC differential; Infection – WBC count; Cancer – WBC count

A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC).

WBCs are also called leukocytes. They help fight infections. There are five major types of white blood cells:

• Basophils
• Eosinophils
• Lymphocytes (T cells, B cells, and Natural Killer cells)
• Monocytes
• Neutrophils

Basophils are a specific type of white blood cell. These cells are readily stained with basic dyes (this is where the name comes from). Note the dark grains inside the cellular fluid (cytoplasm) of this basophil. Basophils make up only a small portion of the number of white blood cells but are important parts of the body’s immune response. They release histamine and other chemicals that act on the blood vessels when the immune response is triggered.

Blood transports oxygen and nutrients to body tissues and returns waste and carbon dioxide. Blood distributes nearly everything that is carried from one area in the body to another place within the body. For example, blood transports hormones from endocrine organs to their target organs and tissues. Blood helps maintain body temperature and normal pH levels in body tissues. The protective functions of blood include clot formation and the prevention of infection.

The White Blood Cell (WBC) Count measures two components; the total number of WBC’s (leukocytes) and the differential count. The differential count measures the percentages of each type of leukocyte present. WBC’s are composed of granulocytes (neutrophils, eosinophils, and basophils) and non-granulocytes (lymphocytes and monocytes). White blood cells are a major component of the body’s immune system. Indications for a WBC count include infectious and inflammatory diseases; leukemia and lymphoma; and bone marrow disorders.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

Most of the time, you do not need to take special steps before this test. Tell your health care provider the medicines you are taking, including the ones without a prescription. Some drugs may change the test results.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.

Why the Test is Performed

You will have this test to find out how many WBCs you have. Your provider may order this test to help diagnose conditions such as:

• An infection
• Allergic reaction
• Inflammation
• Blood cancer such as leukemia or lymphoma

Normal Results

The normal number of WBCs in the blood is 4,500 to 11,000 WBCs per microliter (4.5 to 11.0 × 10⁹/L).

Normal value ranges may vary slightly among different labs. Some labs use different measurements or may test different specimens. Talk to your provider about your test results.

What Abnormal Results Mean

LOW WBC COUNT

A low number of WBCs is called leukopenia. A count less than 4,500 cells per microliter (4.5 × 10⁹/L) is below normal.

Neutrophils are one type of WBC. They are important for fighting infections.

A lower than normal WBC count may be due to:

• Bone marrow deficiency or failure (for example, due to infection, tumor, or abnormal scarring)
• Cancer treating drugs, or other medicines (see list below)
• Certain autoimmune disorders such as lupus (SLE)
• Disease of the liver or spleen
• Radiation treatment for cancer
• Certain viral illnesses, such as mononucleosis (mono)
• Cancers that damage the bone marrow
• Very severe bacterial infections
• Severe emotional or physical stress (such as from an injury or surgery)
• An ethnic/genetic trait (not uncommon in African Americans)

HIGH WBC COUNT

A higher than normal WBC count is called leukocytosis. It may be due to:

• Certain drugs or medicines (see list below)
• Cigarette smoking
• After spleen removal surgery
• Infections, most often those caused by bacteria
• Inflammatory disease (such as rheumatoid arthritis or allergy)
• Leukemia or Hodgkin disease
• Tissue damage (for example, burns)
• Pregnancy

There may also be less common reasons for abnormal WBC counts.

Drugs that may lower your WBC count include:

• Antibiotics
• Anticonvulsants
• Antithyroid drugs
• Arsenicals
• Captopril
• Chemotherapy drugs
• Chlorpromazine
• Clozapine
• Diuretics (water pills)
• Histamine-2 blockers
• Sulfonamides
• Quinidine
• Terbinafine
• Ticlopidine

Drugs that may increase WBC counts include:

• Beta adrenergic agonists (for example, albuterol)
• Corticosteroids
• Epinephrine
• Granulocyte colony stimulating factor
• Heparin
• Lithium

Risks

There is little risk involved with having your blood taken. Veins and arteries vary in size from one person to another, and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight, but may include:

• Excessive bleeding
• Fainting or feeling lightheaded
• Multiple punctures to locate veins
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Marcogliese AN, Hensch L. Resources for the hematologist: interpretive comments and selected reference values for neonatal, pediatric, and adult populations. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 159.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 31.

Last reviewed on: 2/2/2023

Reviewed by: Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Hemogram with leukogram (B-CBC 5-diff, B-CBC 3-diff )

Hemogram with leukogram (B-CBC 5-diff, B-CBC 3-diff ) – SYNLAB Eesti

A hemogram is a comprehensive study in which the content of hemoglobin in the blood is measured, blood cells are counted: leukocytes, erythrocytes, platelets, and erythrocyte and platelet indices are calculated.

Leukogram with 5-component leukogram presented in absolute values:

• neutrophils
• eosinophils
• basophils
• lymphocytes
• monocytes

Leukogram with 3-component leukogram presented in absolute values:

• neutrophils
• lymphocytes
• MXD cells (monocytes, eosinophils, basophils)

Readings:

• Diagnosis of anemia. In addition to measuring hemoglobin and RBC levels, red blood evaluation also considers mean red cell volume (MCV), mean hemoglobin per erythrocyte (MCH), and mean hemoglobin concentration in erythrocyte (MCHC), as well as the red blood cell distribution index by volume (anisocytosis index RDW) .
• Determination of the presence of a pathological process based on changes in the number of leukocytes and in the leukogram, for example, infection, inflammation, allergy, malignancy, immunosuppression,.
• Determination of the platelet count is an important test in the presence of signs of bleeding. A change in the number of platelets, together with the indices characterizing them (MPV – mean platelet volume, PDW – platelet distribution width by volume) indicates a possible disturbance in platelet production or their accelerated destruction.

Analysis method: Flow cytometry

See table for reference values ​​

See table for critical values ​​

Interpretation of the result:

HEMOGLOBIN, HEMATOCRITE, RED CYTES

Normally, the values ​​of hemoglobin, hematocrit and erythrocytes are interconnected and change in the same direction.

• Low values: anemia
• High values: hypovolemia, polycythemia, chronic oxygen deficiency, smoking.

RBC INDICES: MCV, MCH, MCHC, RDW-CV

RBC indices characterize the morphological type of anemia.

Normocytic normochromic (MCV normal, MSI normal):

• Early stage iron deficiency
• Chronic disease (e.g. cancer)
• Acute blood loss
• Aplastic anemia
• Acquired hemolytic anemia (e.g. prosthetic heart valves)

Microcytic hypochromic (MCV ↓, MCH ↓):

• Advanced iron deficiency
• Thalassemia
• Lead poisoning

Microcytic normochromic (MCV ↓, MCH normal):

• Kidney disease (erythropoietin deficiency)

Macrocytic normochromic (MCV ↑, MCH normal):

• Folic acid or vitamin B12 deficiency
• Chemotherapy

Other possible causes of MCV ↑: pregnancy, certain drugs, alcohol.

With significant changes in MCV, it is necessary to evaluate the morphology of erythrocytes in the blood smear preparation.

RDW

Indicates Indicates the variability in RBC volume (anisocytosis).

L LEUKOCYTES, LEUKOGRAM

• There are many possible causes of leukocytosis. More accurate information is given by an automatic 5-component leukogram of 5 types of leukocytes.
• A total white blood cell count that falls within the reference interval does not rule out abnormalities in different white blood cell populations.
• Neutrophilia – acute inflammation, toxic injury, immune disease, myeloproliferative disease.
• Eosinophilia – allergies, parasites, immune syndromes, malignant diseases (lymphoma, carcinoma).
• Basophilia – allergy, myeloproliferative diseases.
• Monocytosis – chronic inflammation, diseases occurring with tissue damage, chronic myeloproliferative diseases.
• Lymphocytosis – viral infections, reactive conditions, malignant lymphoproliferative diseases.
• Leukopenia – usually occurs from neutropenia. Occurs with viral infections, toxic (for example, drugs) or immune damage to the hematopoietic function, and with acute leukemia.

PLATELETS

• Thrombocytopenia most often occurs in connection with viral infections, the use of drugs, some autoimmune diseases, liver diseases, megaloblastic anemia, alcoholism, diseases of the hematopoietic system, hypersplenism.
• So-called pseudothrombocytopenia occurs when several aggregated platelets are counted by the analyzer as one large platelet.
  • This may be due to insufficient mixing of blood with anticoagulant after sample collection or platelet sensitivity to EDEDTA. In this case, to count the platelets, the test should be repeated by taking the blood into the citrate tube used for coagulation tests (with a blue stopper). Platelet aggregates are clearly visible by microscopic examination of a blood smear.
  • Thrombocytosis usually occurs in association with myeloproliferative disorders such as polycythemia and essential thrombocythemia and after splenectomy.
• Elevated platelet values ​​often occur together with reactive changes in leukocytes in bacterial infections.

PLATELET INDICES: MPV, PDW

MPV and PDW are important in clarifying the essence of the nature of thrombocytopenia and thrombocytosis.

• Elevated MRV and thrombocytopenia – indicates a normal regenerative ability of thrombocytopenia.
• Artifact MPV increase:
  • Long time between sample collection and analysis itself – platelets swell in blood sample cells EDTA
  • Platelet aggregates
• High PDW and MPV values ​​are a common finding in chronic myeloproliferative diseases.
• Increased PDW and decreased platelet count are common findings in megaloblastic anemias.
• Normal PDW and platelet count >500 × 109/L – often associated with reactive changes

Indications for blood smear microscopy

If the result of the absolute blood count is one If any of the following indicators are present in the hemogram, and if the analyzer reports atypical morphology, then blood smear microscopy is performed as a clarifying study.

Parameter	Hemogram with 3-component leukogram	Hemogram with 5-component leukogram
Erythrocytes	< 2.0 x 10 12 /L > 6.5 x 10 12 /L	< 2.0 x 1012/L > 6.5 x 1012/L
Hemoglobin	< 80 g/L > 200 g/L	< 80 g/L > 200 g/L
Leukocytes	< 1. 5 x 109/L > 15 x 109/L (> 2 l) > 20 x 109/L (< 2 l) ≤ 2 x 10 9 /L	< 1.5 x 109/L > 15 x 109/L (> 2 l) > 20 x 109/L (< 2 l) ≤ 2 x 10 9 /L
Neutrophils	< 1.0 x 109/L > 20 x 109/L	< 1.0 x 109/L > 20 x 109/L
Lymphocytes	< 0.8 x 109/L > 5.0 x 109/L (> 12 l) > 7.0 x 109/L (< 12 l)	< 0.8 x 109/L > 5.0 x 109/L (> 12 l) > 7.0 x 109/L (< 12 l)
Monocytes		> 1.5 x 109/L (> 12 l) > 3.0 x 109/L (< 12 l)
MXD cells (monocytes, eosinophils, basophils)	> 2 x 109/L (> 12 l) > 3.5 x 109/L (< 12 l)
Platelets	< 100 x 109/L > 1000 x 109/L	< 100 x 109/L > 1000 x 109/L

Windows 11 System requirements

Published August 2021

Note:
This article explains the minimum system requirements for Windows 11 on a PC. The minimum system requirements ensure a great computing experience on a variety of devices now and in the future. Some features, as well as applications and hardware that you add to your computer, may exceed these minimum requirements. See the Windows 11 Specifications page for more information about certain feature requirements. For more information about additional application or hardware requirements, contact your specific publisher or manufacturer.

Windows 11 brings you closer to the things you love, and comes at a time when the PC is even more central to how we connect, create, and play. When deciding where to set the minimum system requirements for Window 11, we focus on three principles that will help ensure a great user experience.

• Reliability

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  Security

• Compatibility

If you’d like to learn more about the minimum system requirements and how these principles have helped us make decisions, see this blog for more details on our approach.

Minimum system requirements and computer

These are the minimum system requirements that a computer must meet to provide a great computing experience.

• Processors and CPUs (CPU units ): 1 or faster with 2 or more cores that appear in the list of approved CPUs. The processor on the computer will be the main factor that determines how Windows 11 will run. Clock speed (1 or faster need) and number of cores (2 or more) are an integral part of the processor as it is released and are not considered upgradeable components.

• RAM: 4 GB. If your computer has less than 4 GB of memory, you can sometimes upgrade options to get more RAM. Check your computer manufacturer’s website or your retailer to see if there are simple, affordable options available that meet the minimum requirements for Windows 11.

  storage service: 64 GB or more storage. If your computer doesn’t have enough disk space, there are sometimes options to upgrade it. Check your computer manufacturer’s website or your retailer to see if there are simple, affordable options that meet the minimum requirements of Windows 11.

  System Software: UEFI (for single extensible Firmware Interface, modern PC BIOS) and Secure Boot. If your device doesn’t meet the minimum requirements because it doesn’t provide secure boot, check out this article to see if you can take the necessary steps to enable it. Secure Boot can only be enabled using UEFI, and this article will show you what settings can be changed to make this possible.

  TPM: Trusted Platform Module (TPM) version 2.0. If your device doesn’t meet the minimum requirements due to TPM, check out this article to see if there are steps you can take to fix it.

  Video cards: Compatible with DirectX 12 or later with WDDM 2.0 driver.

  Displays: A high-definition (720p) display that is larger than 9″ diagonally, 8 bits per color channel. If the screen size is less than 9″, the intended Windows user interface may not be fully visible.

  Internet connection and Microsoft accounts: Windows 11 Internet connection and Microsoft account required for first use.

• Windows version to upgrade: To upgrade to Windows 10 version 2004 or later Windows device. Free updates are available on Windows at Settings > Update and Security.

Update: Special Requirements for S Mode

For Windows 10 Pro, Education, and Enterprise, S mode is no longer available in Windows 11. Users who want to upgrade to Windows 11 will need to exit S mode and will not be able to switch back again. Windows 10 Home allows you to upgrade to Windows 11 Home in S mode without moving out of S mode.

Instructions for exiting S mode (which must be completed before updating):

1. On a computer running Windows 10 S mode, open Settings > updates & security > activation .

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   Look for section Go Windows 10 Home or Go Windows 10 Pro, and then select the Go to link in the Store.

   Note: Do not select the link in article Update for Windows edition . This is a different process that will allow you to work in S mode.

3. On the page that appears in the Microsoft Store (sign out of S mode or similar), select the Get button. After confirming this action, you will be able to install apps from outside the Microsoft Store.

Evaluate the possibility of updating

We know that some customers will need an easy-to-use process to determine if their PC meets the minimum system requirements for Windows 11 and is eligible for the upgrade. To do this, we provide the “Check Computer Status” application for Windows 10 computers. In addition to diagnostic checks, there is an easy way to check if Windows 11 is upgradable. After Windows 11, Windows Update also offers a way to evaluate upgradeability. You will be able to access it from Options > update & Security. These settings are for client computers that are not managed by an IT administrator. If your computer is managed by an IT administrator, check with your IT administrator for eligibility assessment and Windows 11 upgrade options.

Important: In any of these scenarios in which you modify your PC to make it eligible for the update, we recommend that you wait until Windows Update reports that Windows 11 is ready for your device.

If you end up failing to upgrade your existing PC to Windows 11 because your device is not eligible and you’re not ready to move to a new one, Windows 10 remains the right option. Windows 10 will continue to be supported through October 14, 2025, and we recently announced that the next feature update for Windows 10 will be updated later this year.