Understanding the Complete Blood Count (CBC)
The complete blood count (CBC) is the most commonly performed laboratory test. It involves a series of tests that examine the different types of cells circulating in the blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). By evaluating these cells, along with other lab tests, the CBC can provide valuable insights into your overall health and help detect various conditions such as infections, anemia, and leukemia.
Most CBC results are reported as quantities in a blood sample (e.g., cells per milliliter) or as percentages. Blood cells are produced in the bone marrow and are released into the bloodstream as needed. However, certain medications or diseases can damage the bone marrow, leading to a decrease in the numbers of specific types of blood cells.
It’s important to note that each laboratory has its own set of reference ranges or normal values for CBC test results. Lab reports generally include these normal ranges and highlight any results that fall outside of them.
Exploring Red Blood Cell (RBC) Tests
Red blood cells, also known as erythrocytes, are responsible for carrying oxygen from the lungs to cells throughout the body. The following are the three main tests used to measure RBC performance:
Red Blood Cell (RBC) Count
The RBC count reveals the total number of red blood cells in a blood sample.
Hemoglobin (HGB)
Hemoglobin is a protein found in red blood cells that transports oxygen from the lungs to the rest of the body. HGB measurement reflects the overall amount of this oxygen-carrying protein in the blood, which typically correlates with the number of RBCs.
Hematocrit (HCT)
Hematocrit measures the percentage of total blood volume occupied by RBCs.
A high RBC count is often observed in individuals living at high altitudes, as the body adapts to lower oxygen levels. On the other hand, abnormally low readings for RBC count, HGB, and HCT may indicate anemia. Anemia occurs when cells receive insufficient oxygen to function properly, resulting in constant fatigue and a pale appearance.
RBC indices provide further information about the physical characteristics of RBCs:
- Mean Corpuscular Volume (MCV): Measures the average size of RBCs. A low MCV indicates smaller-than-normal cells, often caused by iron deficiency or chronic disease. Conversely, a high MCV can indicate megaloblastic anemia, characterized by larger, pale RBCs resulting from a folic acid deficiency or certain HIV medications.
- Mean Corpuscular Hemoglobin (MCH): Measures the average amount of hemoglobin within RBCs. MCH is calculated by dividing the total hemoglobin by the total number of RBCs.
- Mean Corpuscular Hemoglobin Concentration (MCHC): Measures the average concentration of hemoglobin within RBCs.
- Red Cell Distribution Width (RDW): Measures variations in RBC size. RDW can aid in the diagnosis of anemia or certain vitamin deficiencies.
Understanding White Blood Cell (WBC) Tests
White blood cells, or leukocytes, play a crucial role in the body’s immune system, defending against infections, regulating inflammation, and facilitating allergic reactions. There are five main types of WBCs, each performing a unique function: neutrophils, lymphocytes, monocytes, basophils, and eosinophils.
White Blood Cell (WBC) Count
The WBC count provides the total number of white blood cells in a blood sample. Elevated WBC counts generally indicate an ongoing infection, while very low counts may be indicative of bone marrow issues. A low count, known as cytopenia or leukopenia, suggests reduced infection-fighting abilities.
WBC Differential
The WBC differential identifies and quantifies the five types of WBCs present in the blood sample. The individual counts can be presented as absolute counts and/or as percentages of the total. The percentages are multiplied by the WBC count to obtain absolute counts. For instance, if lymphocytes account for 30% and the WBC count is 10,000, the absolute lymphocyte count would be 30% of 10,000, or 3,000.
- Neutrophils: Also called polymorphonuclear cells, neutrophils combat bacterial infections. They typically constitute 55-70% of WBCs. A severely low count may increase vulnerability to bacterial infections, a condition referred to as neutropenia. Neutropenia can occur in advanced HIV disease or due to certain medications like ganciclovir, commonly used to treat cytomegalovirus (CMV).
- Lymphocytes: Lymphocytes exist in two forms. T cells attack and eliminate germs while contributing to immune system regulation, while B cells produce antibodies that target pathogens. Lymphocytes normally account for 20-40% of WBCs. Although a regular CBC cannot provide T-cell counts, they are typically assessed using specialized tests in individuals with HIV. However, CBC results are necessary for calculating T-cell counts, so both tests are conducted simultaneously.
- Monocytes: Monocytes or macrophages constitute 2-8% of WBCs. They combat infections by engulfing pathogens and providing information to the immune system. Elevated monocyte counts often indicate a bacterial infection.
- Basophils: Basophils play a role in long-term allergic reactions such as asthma or skin allergies. They typically account for less than 1% of WBCs.
- Eosinophils: Eosinophils normally make up 1-4% of WBCs and are involved in allergic reactions and responses to parasites. Increased eosinophil counts, particularly when accompanied by symptoms such as diarrhea, gas, or stomach bloating, may indicate the presence of parasites or HIV infection.
Platelet Tests and Their Significance
Platelets are essential for blood clotting and wound healing. Insufficient platelets can result in internal bleeding or easy bruising. Individuals with HIV infection may experience low platelet counts (thrombocytopenia), which is usually corrected with HIV medications. Extremely high platelet counts rarely cause health issues.
Conclusion
Understanding the complete blood count (CBC) provides valuable insights into your overall health and helps identify various conditions. By examining red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs), medical professionals can assess your wellbeing and detect potential abnormalities. Regular blood tests, including the CBC, are essential for maintaining good health.
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Reviewed March 2021
