Automated CBC Parameters
and
Quality Control
Joanna Ellis, MLS(ASCP)
The Automated
Complete Blood Count
Most common test in the Hematology lab.
Main Components of the CBC:
Cell counts
Hgb
RBC indices
WBC differential absolute values and percent
Indications for CBC:
Fatigue
Weakness
Infection
Inflammation
Bruising
Bleeding
CBC Parameters
PARAMET
ER
UNIT OF
REPORTING
COMMON METHOD OF DETERMINATION
WBC
X 103 /L
Impedance count X calibration (cal) factor
RBC
X 106 /L
Impedance count X calibration factor
HGB
g/dL
Colorimetric absorbance in proportion to hemoglobin
fL
From RBC histogram,
#of RBCs X size of RBCs X cal constant OR Calculated:
HCT X 10
MCV
RBC
Calculated: RBC X MCV
10
HCT
MCH
Pg
MCHC
g/dL or %
Calculated: HGB X 100
HCT
RDW
Impedance (from histogram)
Platelet
X 103 /L
Impedance count X cal factor
WBC Diff
Absolute: X103 /L
Percent of WBC : %
Light Scatter , flow cytometry
Calculated:
HGB X 10
RBC
M77221
CBC
Adult Reference Ranges
Parameter
Adult Reference Range
WBC
4.5-11.0 X 103/L
RBC
Male: 4.5-5.5 X 106 /L
Female: 4.0-5.0 X 106 /L
HGB
Male: 14-17.4 g/dL
Female: 12.0-16.0 g/dL
HCT
Male: 42-52%
Female: 36-46%
MCV
80-100 fl
MCH
28-34 pg
MCHC
32-36 g/dL or %
RDW
12.0-14.6%
PLT
150-450 X 103 /L
MPV
6.8-10.2 fl
Linearity
(Reportable Range)
Instruments are calibrated for each analyte
with a range that is clinically relevant.
With concentrations above or below the
reportable range or Linearity range, the
result does not correspond with the
calibration curve in linear fashion.
Results outside of linearity are NOT
acceptable.
Linearity ranges vary by instrument.
Example:
Parameter
Coulter STKS
Advia
WBC
0.0 -99.9 X
103 /L
0.02-400 X
103 /L
Advia
Linearity Instrument Codes
Code
Cause
Action Indicated
+++++
Result exceeds
reportable range
Dilute 1:2 and rerun.
Continue further
dilutions until result is
within linearity
Result higher than the
laboratory set patient
high action limit
Review Result
Result is lower than the
laboratory set patient
low action limit
Review Result
CBC Quality Control
Commercial Controls:
3 levels (low, normal, high)
Values stored in instrument computer
Levey-Jennings graph generated and stored for each
parameter
Mode to Mode QC:
Most automated hematology instruments have a primary
and secondary mode of sample aspiration. Controls must
be run on BOTH and correlate.
Primary=Automated or Closed
Secondary=Manual or Open
Delta Checks
When the Laboratory Information System (LIS) and the
instrument are interfaced (connected) delta checks are
conducted by the LIS on select parameters.
Current values compared to most previous result
Differences greater than the limits set within the LIS
are flagged
WBC Parameter
Interfering substances and
Implications
Tes
t
Na
me
WB
C
Unusual RBC abnormalities
that resist lysis
Nucleated RBCs
Whit Fragmented WBCs
e
Unlysed particles greater
Bloo than 35 fL
Very large or aggregated
d
Cell plts
Cou Specimens containing fibrin,
nt
cell fragments or other
debris (esp
pediatric/oncology
specimens
Interfering Agent
Clinical Implications
LOW <4.5 X103 /L
some medications (such as
methotrexate),
some
autoimmune conditions
some severe infections
bone marrow failure
HIGH: >11.0 X103 /L
Infections
Inflammation
cancer, leukemia
RBC Parameter
Interfering substances and
Implications
Tes
t
Nam
e
Interfering Agent
Very high WBC count (greater than
99.9)
High concentration of very large
Red platelets
Blood Agglutinated RBCs, rouleaux will
RBC Cell break up when Istoton is added
Coun RBCs smaller than 36 fL
t
Specimens containing fibrin, cell
fragments or other debris (esp
pediatric/oncology specimens
Clinical
Implications
LOW:
Male: < 4.5 X
106 /L
Female: < 4.0 X
106 /L
Anemia
HIGH:
Male: > 5.5 X
106 /L
Female: > 5.0 X
106 /L
Polycythemia
vera,
HGB Parameter
Interfering substances and
Implications
Tes
t
Name
Interfering Agent
Very high WBC count
Severe lipemia
Heparin
HGB
Certain unusual RBC
Hemoglob
Or
abnormalities that resist lysing
in
Anything that increases the
Hb
turbidity of the sample such as
elevated levels of triglycerides
High bilirubin
Clinical
Implications
LOW:
Male: <14 g/dL
Female: <12.0 g/dL
Anemia
HIGH:
Male: > 17.4 g/dL
Female: >16.0 g/dL
Polycythemia vera
fluid loss due to
diarrhea, dehydration,
burns
HCT Parameter
Interfering substances and
Implications
Tes
t
Name
Interfering Agent
Clinical
Implications
LOW:
Male: <42%
Female: <36%
Anemia
Known factors that interfere
Hematocri
HCT
with the parameters used for
t
computation, RBC and MCV
HIGH:
Male: >52%
Female: <46%
Polycythemia vera
fluid loss due to
diarrhea, dehydration,
burns
MCV Parameter
Interfering substances and
Implications
Tes
t
MC
V
Name
Interfering Agent
Very high WBC count
High concentration of very
Mean
large platelets
Corpuscu
Agglutinated RBCs
lar (Cell)
RBC fragments that fall below
Volume
the 36 fL threshold
Rigid RBCs
Clinical
Implications
LOW: <80 fL
Iron deficiency
anemia
Thalassemia
HIGH: >100 fL
B12
Folate Deficiency
RDW Parameter
Interfering substances and
Implications
Tes
t
RD
W
Name
Interfering Agent
Very high WBC
High concentration of very
large or clumped platelets
Red Cell
RBCs below the 36 fL threshold
Distributi
Two distinct populations of
on Width
RBCs
RBC agglutinates
Rigid RBCs
Clinical
Implications
HIGH: >14.6%
Mixed population of
RBCs
Immature RBCs tend
to be larger
Plt Parameter
Interfering substances and
Implications
Tes
Name
t
Plt
Interfering Agent
Very small red cells
near the upper
threshold
Platele Cell fragments
Clumped platelets
t
Count Cellular debris near
the lower platelet
threshold
Clinical Implications
LOW: < 150 X 103 /L
Bleeding
Wiskott-Aldrich,
Bernard-Soulier
Systemic lupus erythematosus
Pernicious anemia
Hypersplenism (spleen takes too
many out of circulation)
Leukemia
Chemotherapy
HIGH: >450 X 103 /L
Benign idiopathic thrombocytosis
Myeloproliferative disorders
Polycythemia vera
WBC Differential Parameters
Clinical Implications in Adults
Test
Name
Clinical
Implications of
LOW %
Clinical Implications of HIGH
%
Neut %
Neutrophil
%
In 100 WBC
differential
LOW: <40%
Chemotherapy
Severe infection
HIGH: >80%
Bacterial infection
Inflammatory disease
Chronic myelogenous leukemia
Lymph
%
Lymphocyte
%
LOW: <25%
Lupus
Later stages of HIV
infection.
HIGH: >35%
Viral infection
Chronic or Acute Lymphocytic
Leukemia
Mono
%
Monocyte %
LOW: <2%
Bone Marrow
Insufficiency
HIGH: >10%
Inflammatory disorders
Myelomonocytic leukemia
Eos %
Eosinophil
%
HIGH: >5%
Parasitic infection
Allergic reaction
Baso %
Basophil %
HIGH: >1%
Allergic reaction to food
Chronic inflammation
References
Harmening., Denise, Clinical Hematology and
Fundamentals of
Hemostasis, 3rd edition, pp. 593599.
Turgeon, Mary Louise, Clinical Hematology - Theories and
Procedures,
3rd edition, pp373, 376-382.
Rodak, Bernadette, Diagnostic Hematology, 1st edition,
p.605-606.
Coulter STKS Operating Manual
McKenzie, Shirlyn, Clinical Laboratory Hematology, 2nd
edition,pp
813-829.
"Complete Blood Count: The Test." Lab Tests Online:
Welcome!
American Association for Clinical Chemistry,
18 June 2010. Web. 13 Sept. 2010.
<http://www.labtestsonline.org/understanding/analytes/cbc
/test.html#how>.
"WBC Differential Count: The Test." Lab Tests Online:
Welcome! American Association for Clinical Chemistry, 18
June 2010. Web. 13 Sept.
2010.http://www.labtestsonline.org/understanding/analytes/
