Complete Blood Count (CBC) With Differential

CPT: 85025
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Test Details

Test Includes

Hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); red cell distribution width (RDW); percentage and absolute differential counts; platelet count (RBC); red cell count; white blood cell count (WBC)

Use

As a screening test to evaluate overall health; detect and/or identify a wide range of hematologic disorders; assist in managing medications/chemotherapeutic decisions

Methodology

Automated cell counter with mixed technologies

Additional Information

Assessments of stained smears are performed if results meet specific numeric and/or instrument flagging criteria. Smear review includes assessment of WBC cell populations, presence of WBC and/or RBC inclusions, RBC morphology, and platelet evaluation.

Presence of one or more of the following may be indication for further investigation: hemoglobin <10 g/dL, hemoglobin >18 g/dL, MCV >100 fL, MCV <80 fL, MCHC >37%, WBC >20,000/mm3, WBC <2000/mm3, presence of sickle cells, spherocytes, Pappenheimer bodies, basophilic stippling, stomatocytes, schistocytes (fragmented RBCs), target cells, oval macrocytes, teardrop red blood cells, abnormal cell populations, nucleated red blood cells in other than the newborn, blood parasites (malarial or Babesia organisms or the possibility of parasitic organisms), hypersegmented neutrophils, agranular neutrophils, hyposegmented neutrophils (Pelger-Huët anomaly or pseudo-Pelger-Huët [pelgeroid] cells), mononuclear cells in which apparent nucleoli are prominent (blast-like cells), presence of metamyelocytes, myelocytes, promyelocytes, neutropenia, presence of plasma cells, peculiar atypical lymphocytes, significant increase or decrease in platelets or bizarre platelets.

A six-part differential reported in some lab locations includes IG % and IG absolute counts. IG (immature granulocytes) includes metamyelocytes and myelocytes. It does not include bands or blast cells.1,2 Promyelocytes and blasts are reported separately to denote the degree of left shift. An elevated percentage of IG has not been found to be clinically significant as a sole clinical predictor of disease. IGs are associated with infections, a variety of inflammatory disorders, cytokine therapy, neoplasia, hemolysis, tissue damage, seizures, metabolic abnormalities, myeloproliferative neoplasms, and with the use of certain medications such as steroids.3

Pregnancy-associated leukocytosis may also show increased immature granulocytes without clinical significance. There is a significant increase of normoblastic erythropoiesis and, to a lesser extent, of granulopoiesis during pregnancy, which is associated with an increase in immature cells (shift to the left) of both erythropoietic and granulopoietic tissues. A possible physiologic explanation for the appearance of immature granulocytes in the peripheral blood of pregnant women, increased alkaline phosphate activity in granulocytes, and increased glycogen content of lymphocytes may be found in the excretion curves of hormones during pregnancy. There is a sharp rise in the fifth month then a decrease in the eighth month and a subsequent rise in the ninth month.4

Specimen Requirements

Specimen

Whole blood

Volume

Fill tube to capacity.

Minimum Volume

0.5 mL (500 μL for pediatric microtainer capillary tubes; fill tube to capacity.)

Container

Lavender-top (EDTA) tube

Collection

Invert tube 8 to 10 times immediately after tube is filled at the time of collection.

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

1 day

Refrigerated

3 days

Frozen

Unstable

Freeze/thaw cycles

Unstable

Causes for Rejection

Hemolysis; clotted specimen; specimen drawn in any anticoagulant other than EDTA; specimen diluted or contaminated with IV fluid; tube not filled with minimum volume; improper labeling; transfer tubes with whole blood; specimen received with plasma removed (plasma is used for other testing)

Clinical Information

Footnotes

1. Fernandes B, Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Path. 2007 Sep; 128(3):454-463. 17709320
2. Ansari-Lari M, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2005 Nov; 120(5):795-799. 14608908
3. CAP Today. August 2010, Q&A Section.
4. Efrati P, Presentey B, Marglaith M, Rozenszajn L. Leukocytes of normal pregnant women. Obstet Gynecol. 1964 Mar; 23:431-432. 14128474

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
005009 CBC With Differential/Platelet 005025 WBC x10E3/uL 6690-2
005009 CBC With Differential/Platelet 005033 RBC x10E6/uL 789-8
005009 CBC With Differential/Platelet 005041 Hemoglobin g/dL 718-7
005009 CBC With Differential/Platelet 005058 Hematocrit % 4544-3
005009 CBC With Differential/Platelet 015065 MCV fL 787-2
005009 CBC With Differential/Platelet 015073 MCH pg 785-6
005009 CBC With Differential/Platelet 015081 MCHC g/dL 786-4
005009 CBC With Differential/Platelet 105007 RDW % 788-0
005009 CBC With Differential/Platelet 015172 Platelets x10E3/uL 777-3
005009 CBC With Differential/Platelet 015107 Neutrophils % 770-8
005009 CBC With Differential/Platelet 015123 Lymphs % 736-9
005009 CBC With Differential/Platelet 015131 Monocytes % 5905-5
005009 CBC With Differential/Platelet 015149 Eos % 713-8
005009 CBC With Differential/Platelet 015156 Basos % 706-2
005009 CBC With Differential/Platelet 115398 Immature Cells N/A
005009 CBC With Differential/Platelet 015909 Neutrophils (Absolute) x10E3/uL 751-8
005009 CBC With Differential/Platelet 015917 Lymphs (Absolute) x10E3/uL 731-0
005009 CBC With Differential/Platelet 015925 Monocytes(Absolute) x10E3/uL 742-7
005009 CBC With Differential/Platelet 015933 Eos (Absolute) x10E3/uL 711-2
005009 CBC With Differential/Platelet 015941 Baso (Absolute) x10E3/uL 704-7
005009 CBC With Differential/Platelet 015108 Immature Granulocytes % 38518-7
005009 CBC With Differential/Platelet 015911 Immature Grans (Abs) x10E3/uL 51584-1
005009 CBC With Differential/Platelet 015945 NRBC % 58413-6
005009 CBC With Differential/Platelet 015180 Hematology Comments: 18314-5
Reflex Table for Immature Granulocytes
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 015111 Please note: 015111 Please note: N/A
Reflex Table for Immature Grans (Abs)
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 015111 Please note: 015111 Please note: N/A
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115247 Neutrophils % 23761-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115250 Lymphs % 737-7
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115251 Monocytes % 744-3
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115252 Eos % 714-6
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115253 Basos % 707-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115398 Immature Cells N/A
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115254 Neutrophils Absolute X10E3/uL 753-4
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115255 Lymphs (Absolute) X10E3/uL 732-8
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115256 Monocytes(Absolute) X10E3/uL 743-5
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115257 Eos (Absolute Value) X10E3/uL 712-0
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115258 Baso(Absolute) X10E3/uL 705-4
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 115260 Differential Comment 18723-7
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 005034 RBC Comment 6742-1
Reflex Table for Hematology Comments:
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115246 Differential 015171 Platelet Comment 9317-9

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