Blood count

One of the most commonly ordered clinical laboratory tests, a blood count, also called a complete blood count (CBC), is a basic evaluation of the cells (red blood cells, white blood cells, and platelets) suspended in the liquid part of the blood (plasma). It involves determining the numbers, concentrations,and conditions of the different types of blood cells.

The CBC is a useful screening and diagnostic test that is often done as partof a routine physical examination. It can provide valuable information aboutthe blood and blood-forming tissues (especially the bone marrow), as well asother body systems. Abnormal results can indicate the presence of a variety of conditions including anemias, leukemias, and infections, sometimes before the patient experiences symptoms of the disease.

A complete blood count is actually a series of tests in which the numbers ofred blood cells, white blood cells, and platelets in a given volume of bloodare counted. The CBC also measures the hemoglobin content (important to the transport of oxygen) and the packed cell volume (hematocrit)of the red blood cells. It assesses the size and shape of the red blood cells, and determines the types and percentages of white blood cells.

The blood count is relatively inexpensive and quick. Most laboratories routinely use automated equipment to dilute the blood, sample a measured volume ofthe diluted suspension, and count the cells in that volume. In addition to counting actual numbers of red cells, white cells, and platelets, the automatedcell counters also measure the hemoglobin and calculate the hematocrit and the red blood cell indices (measures of the size and hemoglobin content of thered blood cells). Technologists then examine a stained blood smear under themicroscope to identify any abnormalities in the appearance of the red bloodcells and to report the types and percentages of white blood cells observed.

The red blood cell (RBC) count determines the total number of red cells (erythrocytes) in a sample of blood. Hemoglobin (Hgb) is the protein-iron compoundin the red blood cells that enables them to transport oxygen. Its concentration corresponds closely to the RBC count. Also closely tied to the RBC and hemoglobin values is the hematocrit (Hct), which measures the percentage of redblood cells in the total blood volume. The hematocrit is normally about three times the hemoglobin concentration.

Red blood cell indices are useful in differentiating types of anemias. The indices include four measurements that are calculated using the RBC count, hemoglobin, and hematocrit results. Mean corpuscular volume (MCV) is a measurement of the average size of the red blood cells. The red blood cell distributionwidth (RDW) is an indication of the variation in RBC size. Mean corpuscularhemoglobin (MCH) measures the average weight of hemoglobin within a red bloodcell. A similar measurement, mean corpuscular hemoglobin concentration (MCHC), expresses the average concentration of hemoglobin in the red blood cells.

The white blood cell (WBC) count determines the total number of white cells (leukocytes) in the blood sample. Fewer in number than the red cells, WBCs arethe body's primary means of fighting infection. There are five main types ofwhite cells (neutrophils, lymphocytes, monocytes, eosinophils, and basophils). A differential white cell count is done by staining a smear of the patient's blood with a Wright's stain, allowing the different types of white cells to be clearly seen under the microscope. A technologist then counts a minimumof 100 WBCs and reports each type of white cell as a percentage of the totalwhite blood cells counted.

The platelet count is an actual count of the number of platelets (thrombocytes) in a given volume of blood. Platelets are involved in blood clotting. Because platelets can clump together, the automated counting method may not be accurate enough for low platelet counts. For this reason, very low platelet levels are often counted manually.

Blood count values vary by age and sex. The normal red blood cell count ranges from 4.2-5.4 million RBCs per microliter of blood for men and 3.6-5.0 million for women. Hemoglobin values range from 14-18 grams per deciliter of bloodfor men and 12-16 grams for women. The normal hematocrit is 42-54% for men and 36-48% for women. The normal number of white blood cells for both men andwomen is approximately 4,000-10,000 WBCs per microliter of blood.

Abnormal blood count results are seen in a variety of conditions. One of themost common is anemias, which are characterized by low RBC counts, hemoglobins, and hematocrits. Infections and leukemias are associated with increased numbers of WBCs.

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