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Neutrophil to Lymphocyte Ratio (NLR), Complete Blood Count (CBC) With Differential and Platelet

CPT: 85025
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Synonyms

  • CBC/D/Plt+NLR

Expected Turnaround Time

Within 1 day


Related Documents


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). Note: This volume does not allow for repeat testing.


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)


Test Details


Use

NLR (Neutrophil to Lymphocyte Ratio) is a biomarker that can be used as an indication of subclinical inflammation. NLR is a calculation based on the Absolute Neutrophil Count divided by the Absolute Lymphocyte Count determined by the peripheral blood CBC differential. This calculation, according to recent literature, is useful in assessing the likelihood of severe progression of disease in SARS-CoV-2 positive patients.

CBC: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; NLR is a Calculation


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


Footnotes

1. Fernandes B, Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Pathol. 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. 2003 Nov;120(5):795-799.14608908
3. Kiechle FL, ed. CAP Today. August 2010, Q&A Section. Accessed December 2020 at http://www.captodayonline.com/Archives/0810/0808_QA.html.
4. Efrati P, Presentey B, Marglaith M, Rozenszajn L. Leukocytes of normal pregnant women. Obstet Gynecol. 1964 Mar;23:429-432.14128474

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
005013 CBC with Diff, Platelet, NLR 005025 WBC x10E3/uL 6690-2
005013 CBC with Diff, Platelet, NLR 005033 RBC x10E6/uL 789-8
005013 CBC with Diff, Platelet, NLR 005041 Hemoglobin g/dL 718-7
005013 CBC with Diff, Platelet, NLR 005058 Hematocrit % 4544-3
005013 CBC with Diff, Platelet, NLR 015065 MCV fL 787-2
005013 CBC with Diff, Platelet, NLR 015073 MCH pg 785-6
005013 CBC with Diff, Platelet, NLR 015081 MCHC g/dL 786-4
005013 CBC with Diff, Platelet, NLR 105007 RDW % 788-0
005013 CBC with Diff, Platelet, NLR 015172 Platelets x10E3/uL 777-3
005013 CBC with Diff, Platelet, NLR 015107 Neutrophils % 770-8
005013 CBC with Diff, Platelet, NLR 015123 Lymphs % 736-9
005013 CBC with Diff, Platelet, NLR 015131 Monocytes % 5905-5
005013 CBC with Diff, Platelet, NLR 015149 Eos % 713-8
005013 CBC with Diff, Platelet, NLR 015156 Basos % 706-2
005013 CBC with Diff, Platelet, NLR 115398 Immature Cells n/a
005013 CBC with Diff, Platelet, NLR 015909 Neutrophils (Absolute) x10E3/uL 751-8
005013 CBC with Diff, Platelet, NLR 015917 Lymphs (Absolute) x10E3/uL 731-0
005013 CBC with Diff, Platelet, NLR 015912 Neut/Lymph Ratio ratio n/a
005013 CBC with Diff, Platelet, NLR 015925 Monocytes(Absolute) x10E3/uL 742-7
005013 CBC with Diff, Platelet, NLR 015933 Eos (Absolute) x10E3/uL 711-2
005013 CBC with Diff, Platelet, NLR 015941 Baso (Absolute) x10E3/uL 704-7
005013 CBC with Diff, Platelet, NLR 015108 Immature Granulocytes % 71695-1
005013 CBC with Diff, Platelet, NLR 015911 Immature Grans (Abs) x10E3/uL 53115-2
005013 CBC with Diff, Platelet, NLR 015945 NRBC % 58413-6
005013 CBC with Diff, Platelet, NLR 015180 Hematology Comments: 18314-5
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115400 Bands % 35332-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115403 Myelocytes % 26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115404 Promyelocytes % 26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115405 Blasts/blast like cells % 26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115406 Megakaryocytes % 19252-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115265 Other, Lineage Uncertain % 55433-7

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