CBC with Manual Differential - Fairbanks Memorial Hospital

Additional Codes

Cerner	NextGen
CBC w/Manual Diff	CBC with Manual Differential

Useful For

Examination of the numerical and/or morphological findings of the complete blood count by the physician are useful in the diagnosis of disease states such as anemias, leukemias, allergic reactions, viral, bacterial, and parasitic infections.

The white blood cell differential assesses the body's ability to respond to and eliminate infection. It also detects the severity of allergic and drug reactions, plus the response to viral, parasitic, and other types of infection. It is essential in identifying various stages of leukemia and monitoring response to chemotherapy.

Methodology

Sysmex XN: The analyzer performs hematology analysis according to the hydrodynamic focusing (DC Detection), flow cytometry method (semiconductor laser), and SLS-hemoglobin methods.
Manual Microscopy

Patient Preparation

None

Collection Instructions

Standard phlebotomy practices.
Do not place samples on a mechanical rocker.

Specimen Requirements

Preferred Volume	12 x 75 mm tube EDTA-2K or EDTA-3K Lavender filled to capacity
Minimum Volume	1mL of whole blood in 12 x 75 mm tube EDTA-2K or EDTA-3K Lavender 250 μL of whole blood in microtube EDTA-2K or EDTA-3K Lavender
Container	12 x 75 mm tube EDTA-2K or EDTA-3K Lavender or Microtube EDTA-2K or EDTA-3K Lavender
Stability	Sample stability at room temperature is 24 hours. Stored at 2-8^oC, EDTA blood samples with normal results may be analyzed up to 48 hours
Rejection Criteria	Clotted samples or those containing clots, fibrin strands, or platelet clumps. All specimens will be checked visually for obvious clots prior to sampling by the analyzer. Grossly hemolyzed samples. Samples drawn above an IV line.

Result Reporting and Reference Values

Reference Ranges

Parameter	Units	Sex	Age	Reference Range
WBC	x10³/µL	M	0D-15D	5	--	30
			15D-30D	5	--	20
			30D-1Y	5	--	17.5
			1Y-10Y	4	--	13.5
			10Y-15Y	4.5	--	13
			15Y-150Y	4.8	--	10.5
		F	0D-15D	5	--	30
			15D-30D	5	--	20
			30D-1Y	5	--	17.5
			1Y-10Y	4.5	--	13.5
			10Y-15Y	4.5	--	13
			15Y-150Y	4	--	11

RBC	x10⁶/µL	All	0D-30D	3.8	--	6.4
			30D-3Y	3.1	--	5.1
			3Y-10Y	3.8	--	5.1
			10Y-12Y	3.9	--	5.2
		M	12Y-15Y	4.2	--	5.5
		M	15Y-150Y	4.4	--	5.8
		F	12Y-15Y	4	--	5.4
		F	15Y-150Y	3.9	--	5.2

HGB	gm/dL	All	0D-15D	12	--	23
			15D-30D	10	--	20
			30D-60D	11	--	14.5
			60D-120D	10	--	14.5
			120D-150D	10.5	--	14.5
			150D-180D	10.8	--	14.5
		M	180D-3Y	11	--	14.5
			3Y-4Y	11.4	--	14.5
			4Y-8Y	11.5	--	14.5
			8Y-12Y	11.8	--	14.5
			12Y-15Y	13	--	15
			15Y-150Y	13.5	--	17.5
		F	180D-2Y	11	--	14.5
			2Y-3Y	11.4	--	14.5
			3Y-7Y	11.5	--	14.5
			7Y-11Y	11.8	--	14.5
			11Y-12Y	12	--	14.5
			12Y-120Y	11.7	--	15.7

HCT	vol%	All	0D-15D	36	--	64
		All	15D-30D	31	--	55
		M	30D-60D	31	--	56
		F	30D-60D	30	--	56
		All	60D-90D	28	--	49
			90D-1Y	30	--	49
			1Y-7Y	30	--	40
			7Y-15Y	33	--	44
		M	15Y-150Y	40	--	52
		F	15Y-150Y	35	--	46

MCV	fL	All	0D-3D	95	--	121
			3D-7D	88	--	126
			7D-14D	86	--	124
			14D-30D	85	--	123
			30D-60D	77	--	115
			60D-6Months	74	--	108
			6Months-2Y	70	--	86
			2Y-6Y	75	--	87
			6Y-12Y	77		95
			12Y-18Y	78		98
		M	18Y-150Y	81	--	100
		F	18Y-150Y	82	--	102

MCH	pcg	M	0D-30D	32	--	41
			30D-60D	32	--	40
			60D-90D	29	--	35
			90D-1Y	27	--	30
			1Y-4Y	24	--	30
			4Y-5Y	24	--	32
			5Y-15Y	25	--	34
			15Y-150Y	26	--	34
		F	0D-30D	32	--	41
			30D-60D	32	--	40
			60D-90D	29	--	35
			90D-1Y	27	--	30
			1Y-4Y	24	--	30
			4Y-5Y	24	--	32
			5Y-15Y	25	--	34
			15Y-120Y	25.5	--	34
			120Y-150Y	26	--	34

MCHC	gm/dL	M	0D-30D	30	--	36
			30D-180D	32	--	36
			180D-15Y	30	--	35
			15Y-150Y	32	--	36
		F	0D-30D	30	--	36
			30D-180D	32	--	36
			180D-15Y	30	--	36
			15Y-120Y	31	--	35
			120Y-150Y	32	--	36

RDW-CV	%	All	0D-150Y	11	--	15

PLT	10³/µL	All	0D-30D	100	--	300
PLT	10³/µL	All	30D-150Y	150	--	450

Metamyelocyte	%	All	0D-150Y	0	--	0
Myelocyte	%	All	0D-150Y	0	--	0
Promyelocyte	%	All	0D-150Y	0	--	0
Blasts	%	All	0D-150Y	0	--	0
Plasma cell	%	All	0D-150Y	0	--	1
Prolymphocyte	%	All	0D-150Y	0	--	0
Atypical Lymph	%	All	0D-150Y	0	--	4

Metamyelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Myelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Promyelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Blasts	10^3/µL	All	0D-150Y	0	--	0.1
Plasma cell	10^3/µL	All	0D-150Y	0	--	1
Prolymphocyte	10^3/µL	All	0D-150Y	0	--	0.1
Atypical Lymph	10^3/µL	All	0D-150Y	0	--	4

Critical Ranges

Parameter	Units	Sex	Age	Critical
WBC	10³/µL	All	0D- 150Y	<2	>50
HGB	gm/dL	All	0D-15D	<6	>24
HGB	gm/dL	All	0D-150Y	<6	>22
HCT	vol%	All	0D-15D	<18	>65
HCT	vol%	All	15D-150Y	<18	>58
PLT	10³/µL	All	0D- 150Y	<30	>1000

Other Reporting Notes

The following WBC Morphology will be noted if present
- Toxic Granulation
- Vacuoles (In neutrophils)
- Döhle Bodies
- Pelger-Huët
- Auer Rods
- Hypersegmentation
- Smudge cells
Giant platelets will be noted only if >5 are observed throughout the smear.
Abnormal red blood cell quantitations.

Reflex Testing

A fluorescent platelet may be performed when:
- Red cell fragments, microcytic RBC's or white cell cytoplasmic fragments may interfere with automated platelet counts.
- If >10 megakaryocytes/100 WBC are seen on Slide examination
Abnormal Heme Smear Path Review will be performed for:
- Unexplained Hgb <7 gm/dL if accompanied by abnormal RBC morphology or low or high MCV.
- Unexplained presence of normoblasts
- >2 metamyelocytes or earlier precursors, including blasts, present for no obvious reason such as infection.
- Monocytosis or Eosinophilia with other abnormalities present.
- 5.Any unexplained absolute deficiency of lymphs or granulocytes
- Any unexplained absolute increase of lymphocytes.
- Any bizarre cells
- Atypical lymphs greater than 20/100 WBCs or greater than 10 % if accompanied by an absolute lymphocytosis.
- MCV > 110 fL
- MCH < 2 pcg or > 37 pcg
- MCHC >37 gm/dL
- RDW >22%
- PLT <50,000/ µL or > 1,000,000/ µL (first time only).

Limitations

Delta check: Hgb change of > 2 gm/dL without explanation requires a rerun or redrawn specimen.
Marked changes in plasma constituents (e.g., low sodium, extremely elevated glucose) may cause cells to swell or shrink. The blood to anticoagulant ratio is important.
Red cell fragments, microcytic RBC's or white cell cytoplasmic fragments may interfere with automated platelet counts. A fluorescent platelet may be performed to avoid this interference.
WBC's greater than 100,000/µL may cause turbidity and falsely increase the hemoglobin, RBC and HCT values.
Giant platelets and clumped platelets may falsely elevate the WBC count and falsely decrease the platelet count.
Abnormal paraproteins found in blood from patients with Multiple Myeloma can falsely increase the HGB.
Severely icteric samples may falsely elevate the HGB value and related indices
Megakaryocytes may falsely increase WBC counts on automated hematology analyzers.

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Test Code CBCMD CBC with Manual Differential