Blood Count

Description: A CBC or Complete Blood Count with Differential and Platelets test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test  

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

What does a Complete Blood Count test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests often ordered with a Complete Blood Count test: 

• Reticulocytes
• Iron and Total Iron Binding Capacity
• Basic Metabolic Panel
• Comprehensive Metabolic Panel
• Lipid Panel
• Vitamin B12 and Folate
• Prothrombin with INR and Partial Thromboplastin Times
• Sed Rate (ESR)
• C-Reactive Protein
• Epstein-Barr Virus
• Von Willebrand Factor Antigen

Conditions where a Complete Blood Count test is recommended: 

• Anemia
• Aplastic Anemia
• Iron Deficiency Anemia
• Vitamin B12 and Folate Deficiency
• Sickle Cell Anemia
• Heart Disease
• Thalassemia
• Leukemia
• Autoimmune Disorders
• Cancer
• Bleeding Disorders
• Inflammation
• Epstein-Barr Virus
• Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Reflex Parameters for Manual Slide Review

CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

• Confirmation of differential percentages
• WBC and platelet estimates, when needed
• Full review of RBC morphology
• Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
• significant findings
• If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

• Immature, abnormal, or toxic cells
• nRBC’s
• Disagreement with automated differential
• Atypical/abnormal RBC morphology
• Any RBC inclusions

Step 3 - If any of the following are seen on the manual differential, a Pathologist will review the slide:

• WBC<1,500 with abnormal cells noted
• Blasts/immature cells, hairy cell lymphs, or megakaryocytes
• New abnormal lymphocytes or monocytes
• Variant or atypical lymphs >15%
• Blood parasites
• RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
• crystals, Pappenheimer bodies or bizarre morphology
• nRBC’s

Description: A Complete Blood Count or CBC (H/H, RBC, Indices, WBC, Plt) test is a blood test that measures many important features of your blood and counts your red blood cells, white blood cells, and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen.

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with White Blood Cell Count and Platelets Test, Hemogram Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a CBC test ordered?

The complete blood count is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary.

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding.

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working.

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis.

What does a CBC blood test check for?

The complete blood count is a blood test that determines the number of cells in circulation. White blood cells, red blood cells, and platelets are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances.

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. The following items are included in a conventional CBC:

• White blood cell count.
• RBC count, hemoglobin, hematocrit, and RBC indicators such as mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width are all used to assess red blood cells. The reticulocyte count may or may not be included in the RBC evaluation.
• Platelet count; may or may not include mean platelet volume and platelet distribution width in platelet evaluation

The CBC focuses on three different types of cells:

White Blood Cells

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more in order to combat bacterial infection. The amount of white blood cells in the body may increase as a result of allergies. A viral infection may cause an increase in white blood cell production. Abnormal white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count.

Red Blood Cells

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity.

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood, and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood. This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances.

Platelets

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC.

Lab tests often ordered with a CBC test:

• Reticulocytes
• Iron and Total Iron Binding Capacity
• Basic Metabolic Panel
• Comprehensive Metabolic Panel
• Lipid Panel
• Vitamin B12 and Folate
• Prothrombin with INR and Partial Thromboplastin Times
• Sed Rate (ESR)
• C-Reactive Protein
• Epstein-Barr Virus
• Von Willebrand Factor Antigen

Conditions where a CBC test is recommended:

• Anemia
• Aplastic Anemia
• Iron Deficiency Anemia
• Vitamin B12 and Folate Deficiency
• Sickle Cell Anemia
• Heart Disease
• Thalassemia
• Leukemia
• Autoimmune Disorders
• Cancer
• Bleeding Disorders
• Inflammation
• Epstein-Barr Virus
• Mononucleosis

Commonly Asked Questions:

How does my health care provider use a CBC test?

The complete blood count is a common, comprehensive screening test used to measure a person's overall health status. It can be used for a variety of purposes, including:

• To check for a variety of ailments and disorders.
• Assist in the diagnosis of a variety of illnesses, including anemia, infection, inflammation, bleeding disorders, and leukemia, to mention a few.
• After a diagnosis has been made, keep an eye on the patient's condition and/or the treatment's effectiveness.
• Treatments that are known to influence blood cells, such as chemotherapy or radiation therapy, should be monitored.

A complete blood count is a set of tests that assesses the three types of cells that circulate in the bloodstream. The following items are included in a CBC:

White blood cells, which are part of the body's defensive system against infections and cancer, as well as playing a role in allergies and inflammation, are assessed:

• The total number of white blood cells in a person's blood sample is measured by a white blood cell count.

Red blood cells, which transport oxygen throughout the body, are assessed as follows:

• The quantity of red blood cells in a person's blood sample is measured by a red blood cell count.
• The overall amount of oxygen-carrying protein in the blood is measured by hemoglobin, which generally indicates the number of red blood cells in the blood.
• Hematocrit is a measurement of how many red blood cells make up a person's total blood volume.
• RBC indices are calculations that give information about the physical features of RBCs:
• The average size of a single red blood cell is measured by the mean corpuscular volume.
• The average quantity of hemoglobin inside a single red blood cell is calculated as mean corpuscular hemoglobin.
• The average concentration of hemoglobin inside a single red blood cell is calculated as mean corpuscular hemoglobin concentration.
• The red cell distribution width is a measurement of RBC size variation.

The reticulocyte count, which is a measurement of the absolute count or percentage of immature red blood cells in the blood, may also be included in the CBC.

Platelets, which are cell fragments that are critical for proper blood coagulation, are assessed as follows:

• The number of platelets in a person's blood sample is known as the platelet count.

With a CBC, the mean platelet volume can be reported. It's a calculation of platelet size on average.

A CBC can also reveal the platelet distribution width. It reflects the size uniformity of platelets.

Can a blood transfusion affect my CBC results?

Yes, a recent blood transfusion will have an effect on your CBC test results.

What do my Complete Blood Count results mean?

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health.

What do my Platelet results mean?

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

NOTE: Only measurable biomarkers will be reported.

Absolute Lymphocyte Count includes: WBC, Absolute Lymphocytes, % Lymphocytes, % Reactive Lymphocytes

Clinical Significance

Increased understanding of immunodeficiency syndrome and AIDS have identified the importance of absolute lymphocyte count in addition to the specific cell type such as CD4 lymphocytes. In pediatric ages up to 14 years old, acute infectious lymphocytosis is a clinical disorder, suspected to be of enterovirus-Coxsackie A subgroup that may have upper respiratory symptoms, fever, diarrhea and abdominal pain or a totally asymptomatic clinical course. Other conditions with absolute lymphocytosis are B. pertussis infection and lymphocytic leukemoid reaction. The most commonly known lymphocytosis with atypical morphology is due to cytomegalovirus and infectious mononucleosis. The malignant forms of absolute lymphocytosis are mostly due to lymphoproliferative disorders.

Description: The Hematocrit test is a blood test used to measure the percentage of red blood cells in your blood, usually for determining anemia.

Also Known As: HCT Test, Crit Test, Packed Cell Volume Test, PCV Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Hematocrit test ordered?

A full blood count usually includes a hematocrit measurement. It can also be ordered as part of a general health assessment, either by itself or in conjunction with a hemoglobin level. When a person develops signs and symptoms of a disorder that affects RBCs, such as anemia or polycythemia, these tests are frequently done.

When someone has signs and symptoms of severe dehydration, such as intense thirst, dry mouth or mucous membranes, and a lack of perspiration or urination, a hematocrit may be requested.

When someone has been identified with recurrent bleeding difficulties, anemia, or polycythemia, this test may be repeated numerous times or on a regular basis to check the success of treatment. It may also be ordered on a regular basis for persons receiving therapy for cancers that affect the bone marrow.

What does a Hematocrit blood test check for?

A hematocrit is a test that determines the percentage of red blood cells in a person’s blood. RBCs, white blood cells, and platelets are suspended in plasma, a fluid component of blood. The hematocrit is a ratio that compares the volume of red blood cells to the volume of all of these components together, which is known as whole blood. A percentage or fraction is used to express the value. A hematocrit of 40%, for example, indicates that there are 40 milliliters of red blood cells per 100 milliliters of blood.

The hematocrit is a quick and easy approach to assess a person’s red blood cells and screen for disorders like anemia. It’s frequently done in conjunction with a hemoglobin level, and it’s also a part of a complete blood count, which is commonly used to assess a person’s overall health.

RBCs are made in the bone marrow and discharged into the bloodstream when they are fully mature or almost so. They normally constitute about 37 to 49 percent of the blood volume. Hemoglobin, a protein that binds to oxygen, is found in RBCs. RBCs’ main job is to transport oxygen from the lungs to the body’s tissues and organs. They also transfer a little amount of carbon dioxide from tissues and organs back to the lungs, where it is exhaled.

RBCs have a 120-day lifespan, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage. A variety of disorders can impact the bone marrow’s ability to produce new RBCs or the longevity of those already in circulation, as well as cause substantial bleeding.

The hematocrit measures both the number and volume of red blood cells. The hematocrit will drop when the size of the RBCs decreases, and vice versa. In general, the hematocrit will rise as the number of red blood cells increases, and it will fall to less than normal when the number of RBCs produced by the bone marrow decreases, the number of RBCs destroyed increases, or blood is lost due to hemorrhage. The overall amount of RBCs and hematocrit will diminish if the bone marrow is unable to manufacture new RBCs quickly enough, resulting in anemia.

Anemia is a condition in which the body is unable to provide adequate oxygen to tissues and organs, resulting in weariness and weakness. Too many RBCs are created in polycythemia, and the blood thickens, causing sluggish blood flow and other complications.

Lab tests often ordered with a Hematocrit test:

• Hemoglobin
• RBC Count
• Blood Smear
• Iron Total
• Iron and Total Iron Binding Capacity
• Ferritin
• Reticulocyte Count
• Vitamin B12
• Folate
• Complete Blood Count (CBC)
• G6PD
• Erythropoietin
• Hemoglobinopathy Evaluation

Conditions where a Hematocrit test is recommended:

• Anemia
• Sickle Cell Anemia
• Thalassemia
• Myeloproliferative Neoplasms
• Bone Marrow Disorders

How does my health care provider use a Hematocrit test?

The hematocrit test is frequently used to diagnose anemia, usually in conjunction with a hemoglobin test or as part of a full blood count. The test can be used to detect, diagnose, or track a variety of illnesses and disorders that impact the amount of red blood cells in the blood. RBCs are red blood cells that circulate in the blood and transport oxygen throughout the body.

Some circumstances influence RBC formation in the bone marrow, resulting in an increase or decrease in the number of mature RBCs discharged into circulation. The longevity of RBCs in the circulation may be affected by other factors. The overall number of RBCs and hematocrit will diminish if there is increased destruction or loss of RBCs, and/or the bone marrow is unable to make new ones quickly enough, leading in anemia.

The hematocrit can tell if there's a problem with RBCs, but it can't tell what's causing it. A blood smear, reticulocyte count, iron studies, vitamin B levels, and, in more severe cases, a bone marrow examination are some of the other tests that may be conducted at the same time or as follow-up to establish a reason.

What do my Hematocrit test results mean?

Red blood cells make up between 37 percent to 49 percent of the total amount of blood.

Because a hematocrit is frequently performed as part of a complete blood count, other components including RBC count, hemoglobin, reticulocyte count, and/or red blood cell indices are taken into account. Other considerations include age, gender, and race. In general, the hematocrit reflects the RBC count and hemoglobin readings.

Anemia is diagnosed by a low hematocrit, low RBC count, and low hemoglobin.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Description: A Hemoglobin (Hgb) test is a blood test that measures the amount of hemoglobin your red blood cells contain.

Also Known As: Hb Test, Hgb Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Hemoglobin test ordered?

The hemoglobin test may be requested as part of a general health assessment or when a person exhibits signs and symptoms of a red blood cell disorder such as anemia or polycythemia.

When someone has been diagnosed with recurrent bleeding difficulties, chronic anemias, or polycythemia, this test may be done numerous times or on a regular basis to check the effectiveness of treatment. It's also possible that it'll be ordered on a regular basis for those having therapy for cancers that are known to harm the bone marrow.

What does a Hemoglobin blood test check for?

Hemoglobin is an iron-containing protein found in all red blood cells, which gives them their distinctive red color. RBCs use hemoglobin to bind to oxygen in the lungs and transport it to tissues and organs all over the body. It also aids in the movement of a little amount of carbon dioxide, which is a byproduct of cell metabolism, from tissues and organs to the lungs, where it is exhaled.

The hemoglobin test determines how much hemoglobin is present in a person's blood sample. To swiftly assess an individual's red blood cells, a hemoglobin level can be used alone or in conjunction with a hematocrit, a test that assesses the fraction of blood made up of RBCs. Red blood cells, which account for roughly 40% of the amount of blood, are created in the bone marrow and released into the bloodstream when they are mature, or nearly so. RBCs have a 120-day lifespan, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage.

RBCs, and thus the level of hemoglobin in the blood, can be affected by a variety of diseases and situations. When the quantity of red blood cells grows, the hemoglobin level and hematocrit both rise. When the synthesis of RBCs by the bone marrow decreases, RBC destruction increases, or blood is lost owing to hemorrhage, the hemoglobin level and hematocrit fall below normal. Anemia is a disorder in which the body's tissues and organs do not acquire enough oxygen, causing exhaustion and weakness. It is caused by a decline in RBC count, hemoglobin, and hematocrit. Polycythemia occurs when the body produces too many RBCs, causing the blood to thicken, resulting in sluggish blood flow and other complications.

Lab tests often ordered with a Hemoglobin test:

• Complete Blood Count (CBC)
• Hematocrit
• Red Blood Cell Count (RBC Count)
• Blood Smear
• Iron Total
• Ferritin
• Reticulocyte Count
• Vitamin B12
• Folate
• Red Cell Indices
• G6PD
• Erythropoietin
• Hemoglobinopathy Evaluation

Conditions where a Hemoglobin test is recommended:

• Anemia
• Sickle Cell Anemia
• Thalassemia
• Myeloproliferative Neoplasms
• Hemoglobin Abnormalities
• Bone Marrow Disorders

How does my health care provider use a Hemoglobin test?

Anemia is commonly detected with a hemoglobin test in conjunction with a hematocrit or as part of a complete blood count. The test can be used to detect, diagnose, or track a variety of illnesses and disorders that impact red blood cells and/or hemoglobin levels in the blood. All red blood cells include hemoglobin, an iron-containing protein that allows RBCs to bind to oxygen in the lungs and transport it to tissues and organs throughout the body.

A hemoglobin test can be used for a variety of purposes, including:

• Anemia and polycythemia are diagnosed, diagnosed, and measured.
• Assess the patient's reaction to anemia or polycythemia treatment.
• If the anemia is severe, you can help make decisions about blood transfusions or other therapies.

Some factors influence RBC production in the bone marrow, resulting in an increase or decrease in the quantity of mature RBCs discharged into the bloodstream. The longevity of RBCs in the circulation can be influenced by a variety of factors. The overall amount of RBCs and hemoglobin will diminish if there is greater destruction of RBCs or loss of RBCs through bleeding, and/or the bone marrow is unable to make new ones quickly enough, leading in anemia.

This test can tell you if you have an issue with red blood cell production or longevity, but it can't tell you what's causing it. A blood smear, reticulocyte count, iron studies, vitamin B12 and folate levels, and, in more severe cases, a bone marrow examination are some of the other tests that may be conducted at the same time or as follow-up to establish a reason.

What do my Hemoglobin test results mean?

Because hemoglobin levels are frequently measured as part of a complete blood count, the results of other components are taken into account. Hemoglobin levels must be interpreted in conjunction with other indicators such as RBC count, hematocrit, reticulocyte count, and/or red blood cell indices when they rise or fall. Other characteristics to consider are age, gender, and race. Hemoglobin reflects the RBC count and hematocrit results in general.

Anemia is defined as a low hemoglobin level combined with a low RBC count and a low hematocrit. Among the causes are:

• Excessive blood loss-as a result of severe trauma or continuous bleeding from the digestive tract, bladder, or uterus.
• Iron, folate, or B12 deficiency are examples of nutritional inadequacies.
• Toxins, radiation, chemotherapy, infection, and medicines can all cause damage to the bone marrow.
• Myelodysplastic syndrome, aplastic anemia, or tumors of the bone marrow, such as lymphoma, leukemia, multiple myeloma, or other cancers of the bone marrow
• Renal failure—severe and chronic kidney illnesses cause the kidneys to produce less erythropoietin, a hormone that drives RBC synthesis in the bone marrow.
• Inflammatory diseases or disorders that last a long time
• Hemoglobin production is reduced.
• Excessive destruction of red blood cells, such as hemolytic anemia caused by autoimmunity or faults in the red blood cell itself, such as hemoglobinopathy, RBC membrane abnormalities, or RBC enzyme.

Polycythemia is defined as a high hemoglobin level combined with a high RBC count and hematocrit. Among the causes are:

• Lung disease-when a person's body is unable to breathe in and absorb enough oxygen. As a result, the body produces more red blood cells to compensate.
• Congenital heart disease—in some cases, an improper connection between the two sides of the heart occurs, resulting in lower blood oxygen levels. The body responds by creating extra red blood cells in an attempt to compensate.
• Excess erythropoietin-producing kidney tumors
• Hemoglobin levels in heavy smokers are higher than in nonsmokers.
• Genetic factors
• Having to live at a high altitude
• Dehydration causes hemoglobin to rise unnaturally when the volume of liquid in the blood declines.
• Polycythemia vera-a rare condition in which the body creates too many RBCs.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Brief Description: A Hemoglobinopathy Evaluation test is used to detect hemoglobin abnormalities and forms that may be causing problems with hemoglobin production.

Also Known As: Hemoglobin Evaluation Test, Hb ELP Test, Hb IEF, Sickle Cell Screen Test, Hemoglobin Fraction Test, Hemoglobinopathies Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Hemoglobinopathy Evaluation test ordered?

Hemoglobinopathies must be tested for as part of the state-mandated newborn screening program. Additionally, when a parent is at high risk or when parents have a kid with hemoglobinopathy, it is frequently utilized for prenatal screening.

When a complete blood count and/or blood smear reveal that a person may have an atypical form of hemoglobin, an assessment is typically requested.

It might be prescribed if a medical professional believes that a patient's signs and symptoms are brought on by irregular hemoglobin production. Hemolytic anemia is frequently brought on by abnormal types of hemoglobin and is characterized by symptoms like:

• weakness, exhaustion
• Not enough energy
• Jaundice
• light skin

A few severe hemoglobinopathies can cause episodes of excruciating pain, shortness of breath, an enlarged spleen, and issues with a child's growth.

What does a Hemoglobinopathy Evaluation blood test check for?

An individual with a hemoglobinopathy has an inherited blood ailment in which their hemoglobin is produced at a reduced rate or in an aberrant form. The goal of a hemoglobinopathy evaluation is to screen for and/or diagnose a hemoglobin disease by identifying aberrant forms of or indicating issues with hemoglobin production.

All red blood cells include hemoglobin, an iron-containing protein that binds to oxygen in the lungs and enables RBCs to transport the oxygen throughout the body, supplying it to the body's cells and tissues. Heme, the molecule with iron at its center, makes up one portion of hemoglobin. The other portion is made up of four globin chains. The globin chains are referred to as alpha, beta, gamma, and delta depending on their structural makeup. The functions of hemoglobin and its capacity to carry oxygen depend on the kinds of globin chains that are present.

Types of normal hemoglobin include:

• About 95%–98% of the hemoglobin (Hb) found in adults is hemoglobin A, which has two alpha and two beta protein chains.
• About 2%–3% of adult hemoglobin is hemoglobin A2, which has two alpha and two delta protein chains.
• In adults, hemoglobin F, which contains two alpha and two gamma protein chains, accounts for 1% to 2% of all hemoglobin. The fetus produces the majority of this hemoglobin during pregnancy; production typically declines after birth and approaches adult levels in 1-2 years.

When the genes that produce the globin chains mutate, it results in hemoglobinopathies, which modify the proteins. One of the typical globin chains may produce less as a result of these genetic modifications, or they may produce globin chains with different structural characteristics. The behavior, stability, production rate, and/or structure of hemoglobin can all be impacted by genetic changes. Red blood cells' appearance and functionality can be changed by the presence of aberrant hemoglobin within them.

Hemolytic anemia is caused by red blood cells with defective hemoglobin, which may not transport oxygen effectively and may be broken down by the body earlier than usual. The three most prevalent hemoglobin variants are hemoglobin C, which can cause a slight amount of hemolytic anemia, hemoglobin E, which may or may not cause any symptoms, and hemoglobin S, which is the primary hemoglobin in people with sickle cell disease and causes the RBC to become misshapen and reduce the cell's survival.

A gene mutation causes diminished synthesis of one of the globin chains, which leads in the disorder known as thalassemia. This may throw off the ratio of alpha to beta chains, leading to the formation of aberrant hemoglobin or an increase in minor hemoglobin components like Hb A2 or Hb F.

There are many more uncommon variations of hemoglobin. Some have no visible signs or symptoms, while others have an impact on the stability and/or performance of the hemoglobin molecule. The types and levels of hemoglobin present in a person's sample of blood are often assessed during an assessment of a hemoglobin problem. Several instances include:

• Tests for hemoglobin S, the primary hemoglobin associated with sickle cell disease, are performed using the hemoglobin solubility method.
• Blood-hematology electrophoresis
• High performance liquid chromatography for isoelectric focusing of hemoglobin

Lab tests often ordered with Hemoglobinopathy Evaluation test:

• Complete Blood Count (CBC)
• Hemoglobin
• Hematocrit
• Sickle Cell Tests
• Iron Tests

Conditions where a Hemoglobinopathy Evaluation test is recommended:

• Hemolytic Anemia
• Sickle Cell Anemia
• Thalassemia
• Hemoglobin Abnormalities
• Pregnancy

How does my health care provider use a Hemoglobinopathy Evaluation test?

The protein found in all red blood cells that carries oxygen is called hemoglobin, and a hemoglobinopathy examination is used to find aberrant types and/or relative levels of it. Tests might be conducted for:

Screening

Newborns must be checked in every state for specific hemoglobin variations.

High-risk parents with an ethnic origin linked to a higher prevalence of hemoglobin abnormalities and those with affected family members frequently undergo prenatal screening. Prior to becoming pregnant, screening may be done in addition to genetic counseling to ascertain whether the parents are carriers.

To find variations among asymptomatic parents with an ill child

Diagnosis

To find and/or identify hemoglobinopathy in those who have unexplained anemic symptoms or abnormal complete blood count results

A person's hemoglobin type can be determined using a variety of laboratory techniques. A few of these are:

• Tests for hemoglobin S, the primary hemoglobin associated with sickle cell disease, are performed using the hemoglobin solubility method.
• Blood-hematology electrophoresis
• Isoelectric focusing of hemoglobin
• High performance liquid chromatography of hemoglobin

Based on the physical and chemical characteristics of the various hemoglobin molecules, these approaches assess the various hemoglobin subtypes.

One of these tests, or a combination of them, can be used to diagnose the majority of common hemoglobin variations or thalassemias. Any observed variant hemoglobin's relative concentrations can help with a diagnosis. However, it is typically insufficient to diagnose hemoglobinopathy with a single test. Instead, the outcomes of numerous tests are taken into account. Other possible laboratory examinations include, for instance:

• CBC Reticulocyte count Blood smear
• Studies on iron using transferrin, TIBC, and serum iron

Genetic testing: can be used to find changes in the genes that produce the chains of proteins that make up hemoglobin. This is not a common test, but it can be used to determine if a person has one or two copies of a mutant gene.

What do my Hemoglobinopathy Evaluation test results mean?

When evaluating the findings of an assessment for hemoglobinopathy, care must be exercised. The laboratory report typically comes with an interpretation from a pathologist with knowledge in hematology.

The types and relative amounts of hemoglobin present are often reported in the evaluation's findings. The percentages of adults' normal hemoglobins are as follows:

• Hemoglobin A: between 95% and 98%
• Hemoglobin A2: between 2% and 3%
• 2% or less for hemoglobin F

Testing may be used to identify a disorder that results in the production of hemoglobin with structural changes or a condition known as thalassemia, where a gene mutation reduces the production of one of the globin chains. This may throw off the ratio of alpha to beta chains, leading to the formation of aberrant hemoglobin or an increase in minor hemoglobin components like Hb A2 or Hb F.

These tests can measure and detect some of the most prevalent types of aberrant hemoglobin, including:

The main hemoglobin in persons with sickle cell disease is hemoglobin S. According to the Centers for Disease Control and Prevention, around 1 in 500 African American infants are born with this ailment, and more than 70,000 Americans currently have it. The proportion of Hb S in sickle cell disease patients is high. In spite of having a modest amount of Hb S, people with sickle cell trait nonetheless have the regular type of Hb A. When exposed to low oxygen levels, Hb S makes red blood cells distorted. Red blood cells with scleroderma can obstruct small blood vessels, resulting in discomfort, poor circulation, decreased oxygen delivery to tissues and cells, and reduced cell survival. High levels of hemoglobin A or F can keep red blood cells well-oxygenated and prevent sickling.

Hemoglobin C: Approximately 2 to 3 percent of people of African origin have the hemoglobin C trait. Hemoglobin C disease is uncommon and often not severe. It typically results in a mild to moderate spleen enlargement and a little amount of hemolytic anemia.

One of the most prevalent beta chain hemoglobin variants in the world is hemoglobin E. It is especially common among people with Southeast Asian ancestry. Homozygous carriers of Hb E typically have mild hemolytic anemia, microcytic red blood cells, and a minor splenic enlargement. Unless another mutation is present, a single copy of the hemoglobin E gene does not cause symptoms.

The main hemoglobin that a growing fetus produces is hemoglobin F. Normal Hb F production starts to decline after birth and reaches adult levels between the ages of 1-2. In many diseases, including beta thalassemia and sickle cell anemia, Hb F may be high.

In a few instances of alpha thalassemia, hemoglobin H is present. It is created because there is a severe lack of alpha chains and is made up of four beta globin chains. The four beta chains do not function appropriately even though each beta globin chain is healthy.

Babies with alpha thalassemia develop hemoglobin Barts, a particular type. When there are not enough alpha chains, it is made of four gamma protein chains, much as how Hb H is made. Due to declining gamma chain synthesis, Hb Barts vanishes quickly after delivery.

Additional types that could be found include:

• hematoxylin D
• Blood globin G
• hematoxylin J
• hematoxylin M

Spring Constant Hemoglobin

Additionally, a person can receive two distinct defective genes from each parent. Compound heterozygosity or doubly heterozygosity are terms used to describe this. Hemoglobin SC illness, sickle cell - hemoglobin D disease, hemoglobin E - beta thalassemia, and hemoglobin S - beta thalassemia are a few examples of clinically relevant combos. See the articles on Thalassemia and Hemoglobin Abnormalities for more information on this.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Clinical Significance

Assists in evaluating helper and suppressor cell immune status in immunodeficiency diseases such as AIDS.

Includes

• CBC (includes Differential and Platelets)
• Antibody Screen, RBC with Reflex to Identification, Titer, and Antigen Typing 
• ABO Group and Rh Type
• RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing
• Hepatitis B Surface Antigen with Reflex Confirmation*
• Rubella Antibody (IgG), Immune Status
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• If Antibody Screen is positive, Antibody Identification, Titer, and Antigen Typing will be performed at an additional charge (CPT code(s): 86870, 86886, 86905).
• If RPR screen is reactive, RPR Titer and FTA Confirmatory testing will be performed at an additional charge (CPT code(s): 86593, 86780).
• If Hepatitis B Surface Antigen is positive, confirmatory testing based on the manufacturer's FDA approved recommendations will be performed at an additional charge (CPT code(s): 87341).
•  

Description: Reticulocytes are red blood cells that are not fully developed yet. The reticulocyte test is used to measure the amount of underdeveloped red blood cells.

Also Known As: Retic Count Reticulocyte Percent Test, Reticulocyte Index Test, Corrected Reticulocyte Test, Reticulocyte Production Index Test, RPI Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Reticulocyte Count test ordered?

A reticulocyte count may be requested in the following situations:

• A low RBC count, as well as a low hemoglobin and hematocrit, are found on a complete blood count.
• A doctor wants to check the function of the bone marrow.
• Paleness, loss of energy, exhaustion, weakness, shortness of breath, and/or blood in the stool are signs and symptoms of anemia or persistent bleeding.
• A disorder known to impact RBC production, such as iron deficiency anemia, vitamin B12 or folate deficiency, or renal illness, has been recognized and is being treated.
• A person is receiving radiation or chemotherapy.
• A bone marrow transplant has been performed.

When a person has an increased quantity of RBCs and an elevated hemoglobin and hematocrit, a blood test is performed to evaluate the degree and pace of RBC overproduction.

What does a Reticulocyte Count blood test check for?

Reticulocytes are young red blood cells that have just been created. The number and/or percentage of reticulocytes in the blood is determined by a reticulocyte test, which is a reflection of recent bone marrow function or activity.

Red blood cells are made in the bone marrow, where blood-forming stem cells differentiate and grow into reticulocytes, which then mature into mature RBCs. When compared to mature RBCs, reticulocytes have a volume of about 24 percent more. Although adult RBCs do not have a nucleus like most other cells in the body, reticulocytes still contain some genetic material. Reticulocytes lose the last traces of RNA as they mature, and most of them are fully matured within a day of being released from the bone marrow into the bloodstream. The reticulocyte count or percentage is an excellent measure of a person's ability to manufacture enough red blood cells in their bone marrow.

RBCs last around 120 days in circulation, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage. Normally, a steady number of RBCs is maintained in the blood by replacing deteriorated or lost RBCs on a regular basis.

A range of diseases and conditions, including those that cause severe bleeding, can impair the creation of new RBCs and/or their survival. These situations can cause an increase or decrease in the number of RBCs, as well as a change in the reticulocyte count.

Reticulocyte % higher than normal: Anemia is caused by a lack of RBCs in the blood due to acute or chronic bleeding or enhanced RBC breakdown (hemolysis). The body adjusts for this loss or responds to deficiency anemia treatment by increasing RBC production and releasing RBCs into the bloodstream before they mature. When this happens, the number and percentage of reticulocytes in the blood grows until the bone marrow's production capacity is reached or until a sufficient number of RBCs replaces those that were lost.

A lower-than-normal percentage of reticulocytes: When the bone marrow isn't working properly, RBC production can suffer. A bone marrow condition, such as aplastic anemia, can cause this. Other causes that might cause decreased production include liver cirrhosis, kidney disease, cancer treatments such as radiation or chemotherapy, a low amount of the hormone erythropoietin, or dietary shortages such as iron, vitamin B12, or folate. As old RBCs are eliminated from the blood but not entirely replaced, there are fewer RBCs in circulation, poorer hemoglobin and oxygen-carrying capacity, a lower hematocrit, and a lower number of reticulocytes.

Due to excessive RBC production by the bone marrow, both the reticulocyte and RBC counts might occasionally rise. This could be caused by increased erythropoietin production, diseases that cause chronic RBC overproduction (polycythemia vera), or cigarette smoking.

Some medications can increase or reduce the number of reticulocytes in the body.

Lab tests often ordered with a Reticulocyte Count test:

• Complete Blood Count (CBC)
• Red Blood Cell Count
• Hemoglobin
• Hematocrit
• Blood Smear
• Erythropoietin
• Vitamin B12
• Folate
• Haptoglobin
• G6PD
• Iron Total
• Iron and Total Iron Binding Capacity
• Ferritin

Conditions where a Reticulocyte Count test is recommended:

• Anemia
• Bone Marrow Disorders
• Myeloproliferative Neoplasms

How does my health care provider use a Reticulocyte Count test?

A reticulocyte test is used to assess the number and/or percentage of reticulocytes in the blood to aid in the diagnosis of red blood cell abnormalities such as anemia and bone marrow illnesses. Reticulocytes are young red blood cells that have just been created. Before being released into the circulation, they develop and mature in the bone marrow.

The reticulocyte test can be used in the following situations:

• To help determine the reason of aberrant results on a complete blood count, RBC count, hemoglobin, or hematocrit.
• To see if the bone marrow is appropriately functioning and reacting to the body's need for red blood cells.
• To aid in the detection and differentiation of various kinds of anemia
• To track how well people are responding to treatments, such as those for iron deficiency anemia.
• To track the activity of the bone marrow after therapies like chemotherapy.
• To keep track of how well you're doing after a bone marrow transplant.

A reticulocyte count is usually done using an automated device and can be done in conjunction with a complete blood count, which includes an RBC count, hemoglobin, and hematocrit. It is possible to report either an absolute number of reticulocytes or a percentage of reticulocytes. The number of reticulocytes is compared to the total number of red blood cells as a percentage:

[ Number of Reticulocytes / Total Red Blood Cells ] X 100 = Reticulocyte Percentage

Several more tests, in addition to a reticulocyte count, can be done to further screen someone for a disorder that affects RBC production. Here are a few examples:

• Iron testing
• Haptoglobin
• G6PD
• Erythropoietin
• Vitamin B12 and Folate

Following up on abnormal results from early tests, a bone marrow aspiration and biopsy may be performed. This is an invasive operation that is not performed on everyone. If necessary, it can, however, supply extra information.

What do my reticulocyte count test results mean?

The results must be carefully evaluated in conjunction with the results of other tests, such as a red blood cell count, hemoglobin, hematocrit, or a complete blood count. The reticulocyte count, in general, reflects recent bone marrow activity. The results could reveal whether a disease or condition is present that is causing an elevated need for new RBCs, as well as whether the bone marrow is capable of meeting that demand. Overproduction of RBCs may be detected in some cases.

When anemia is present and the bone marrow responds adequately to the demand for more RBCs, the bone marrow will create more and allow for the early release of more immature RBCs, resulting in an increase in the number of reticulocytes in the blood.

A high reticulocyte count along with low RBCs, hemoglobin, and hematocrit may indicate the following conditions:

• When a person bleeds, the number of reticulocytes increases after a few days to make up for the loss of red blood cells. If someone has chronic blood loss, the marrow will try to keep up with the need for new RBCs by increasing the number of reticulocytes.
• Anemia is caused by an increase in the breakdown of RBCs in hemolytic anemia. To compensate, the bone marrow boosts RBC production, resulting in a high reticulocyte count.
• Hemolytic illness of the newborn: Similar to hemolytic anemia, this syndrome causes an increase in RBC destruction.

For example, a low reticulocyte count with low hemoglobin, low red blood cells, and low hematocrit can be detected when:

• Anemia due to a lack of iron
• Folic acid deficiency or pernicious anemia
• Aplastic anemia is a kind of anemia that occurs when the
• Radiation therapy is a type of treatment that uses a
• Infection or malignancy can induce bone marrow failure.
• A low level of erythropoietin can be caused by severe kidney disease.
• Alcoholism
• Endocrine illness

When a person has anemia, the percentage of reticulocytes in their blood may appear to be higher than the total number of RBCs. A calculation known as a corrected reticulocyte count or reticulocyte index may be reported to get a more accurate estimate of bone marrow function. When a person's hematocrit is compared to a normal hematocrit reading, the RI is computed. The reticulocyte production index and an immature reticulocyte fraction are two more estimates that may be presented. The IRF was once known as the reticulocyte maturity index, but it is currently the most widely used phrase to describe the younger percentage of reticulocytes.

The existence of a disease or condition is indicated by the reticulocyte test, however it is not specifically diagnostic of any disease. It's a warning that more research is needed, as well as a method for monitoring therapy effectiveness.

When reticulocyte numbers increase after chemotherapy, a bone marrow transplant, or treatment for an iron, vitamin B12, or folate shortage, bone marrow RBC production is on the mend.

A high reticulocyte count can indicate an overproduction of RBCs in people who do not have anemia or have a high RBC count. This can be caused by a variety of factors, including:

• Polycythemia vera
• Excess erythropoietin-producing tumor

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Includes

• Hemoglobin A, Hemoglobin F, Hemoglobin A2 (Quant), Hemoglobin A2 Prime, Hemoglobin S, Hemoglobin C, Hemoglobin D, Hemoglobin G, Hemoglobin Lepore, Hemoglobin E, Hemoglobin Barts, Variant Hemoglobin, HPLC, Hemogram (Red Blood Cell Count, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW), Ferritin and Interpretation
•  
• This is a reflexive profile. Additional testing, such as molecular tests, will be added at an additional charge, if indicated.
•  
• If results suggest sickling hemoglobin, Sickle Cell Screen will be performed at an additional charge (CPT code(s): 85660). 
•  
• If results suggest an unstable hemoglobin based on % of the variant and pattern seen on HPLC and Electrophoresis , Unstable Hemoglobin (Isopropanol) will be performed at an additional charge (CPT code(s): 83068).
•  
• If the hemogram shows microcytosis or decreased MCH or both and, there is no evidence of beta thalassemia (i.e., normal A2 and HbF), Alpha Globin common mutation analysis will be performed at an additional charge (CPT code(s): 81257). In consultation with the client, this test may also be performed (at an additional charge) in an individual with a normal hemogram for genetic counseling purposes as individuals with mild alpha thalassemia commonly have a normal hemogram and normal fractions.
•  
• If HPLC or CZE, point to an unidentified alpha globin variant, the sample will be sent for DNA sequencing and Alpha Globin Complete will be performed at an additional charge (CPT code(s): 81259).
•  
• If the genotyping results for the common deletions do not match the phenotype, Alpha Globin Gene Deletion or Duplication will be performed at an additional charge (CPT code(s): 81269) and Alpha Globin Complete will be performed at an additional charge (CPT code(s): 81259).
•  
• If a rare beta globin variant cannot be definitively identified by HPLC or CZE, Beta Globin Complete will be performed at an additional charge (CPT code(s): 81364).
•  
• If result suggests Hereditary persistence of fetal hemoglobin or Delta beta thalassemia or a beta thalassemia with negative beta globin sequencing, Beta globin gene dosage assay will be performed at an additional charge (CPT code(s) 81363).
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• Gamma globin gene sequencing or delta globin gene sequencing may be added at an additional charge, if clinically indicated. These tests are performed at an outside reference lab. Not applicable to CA and FL clients.
• If a reflex test is added, Genotype/phenotype review will be added at an additional charge (CPT code(s) 80500).

Clinical Significance

Thalassemia and Hemoglobinopathy Comprehensive Evaluation - Thalassemia and hemoglobinopathies are disorders related to hemoglobin pathophysiology. Although hemoglobinopathies and thalassemias are two genetically distinct disease groups, the clinical manifestations of both include anemia of variable severity and variable pathophysiology.
Thalassemias are group of autosomal recessive disorder of hemoglobin synthesis characterized by the reduction in the rate of synthesis of globin chain of one or more globin chain. The decreased synthesis of globin chain may result from gene deletion, non-sense mutation or mutation that affects the transcription or stability of mRNA products. Thalassemias are classified by the type and magnitude of decreased synthesis of the globin chain and severity of the clinical symptoms. The clinical manifestation ranges from mild anemia with microcytosis to fatal severe anemia.
In the alpha-thalassemias, there is absence or decreased production of beta-globin subunits, whereas in the beta- thalassemias, there is absent or reduced production of beta globin subunits. Rare thalassemias affecting the production of delta or gamma globin subunits have also been described but are not clinically significant disorders.
The beta-thalassemias can be sub-classified into those in which there is total absence of normal beta globin subunit synthesis or accumulation, the beta-zero thalassemias, and those in which some structurally normal beta globin subunits are synthesized, but in markedly decreased amounts, the beta-plus thalassemias. The alpha-thalassemia syndromes however, are usually caused by the deletion of one or more alpha globin genes and are sub-classified according to the number of alpha globin genes that are deleted (or mutated): one gene deleted (alpha-plus thalassemia); two genes deleted on the same chromosome or in cis (alpha-zero thalassemia); three genes deleted (HbH disease); or four genes deleted (hydrops fetalis with Hb Bart's).
Hemoglobinopathies results from the abnormal structure of One of the globin chains of the hemoglobin molecule (mutation of alpha and/or beta globin chain resulting in a variant form of Hemoglobin A). They are inherited single- gene disorders and in most cases, they are inherited as autosomal co-dominant traits. A large number (>800) of variants of hemoglobin (Hb) have been recognized. They are identified by capital letters (eg, Hb A or Hb S), or by the city in which the variant was first discovered (eg, Hb Koln).
Alpha chain variants usually form less than 25% of the total hemoglobin because the mutation typically occurs in one of the four genes that codes for alpha globin chain. For beta globin variants in the heterozygous state the variant forms more than 25% but less than 50% of the total hemoglobin. Ranked in order of relative frequency, these are: Hb S (sickle cell disease and trait), C, E, Lepore, G-Philadelphia, D-Los Angeles, Koln, Constant Spring, O-Arab, and others.
Most common beta globin variants include HbS, HbC, HbD, HbE and HbG. A mutation in one beta globin subunit results in a combination of variant and normal hemoglobin and denotes carrier or trait status, also known as the heterozygote state. Mutations in both beta globin subunits result in disease based on a homozygous expression such as sickle cell anemia (HbSS). Other diseases under sickle cell disease (SCD) are HbSE, HbSC and HbS beta-thalassemia.

Description: A White Blood Cell Count and Differential is a blood test used to measure the number of white blood cells in your blood and to provide a breakdown of the different types of white blood cells and their percentages.

Also Known As: White Blood Cell Count Test, WBC Test, Leukocyte Test, Leukocyte Differential Test, White Count Test, Blood Differential Test, Diff Test, Peripheral Differential Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a White Blood Cell Count and Differential test ordered?

A complete blood count, which may be carried out when a person gets a standard health assessment, is typically requested together with a WBC count. A person may undergo the test if they exhibit any of the following general indications of an infection or inflammation:

• fever and chills
• body discomfort and pains
• headache
• a number of additional symptoms, varying according to the likely site of infection or inflammation

When there are signs and symptoms that a doctor believes could be caused by a blood condition, an autoimmune disorder, or an immunological deficiency, testing may be done.

A WBC may be requested frequently and routinely to keep track of a patient who has been identified as having an infection, a blood or immunological problem, or another illness that affects WBCs. Additionally, it may be required when a particular therapy, like radiation or chemotherapy, is known to have an impact on WBCs in order to assess the efficacy of the treatment.

A complete blood count, which may be requested in conjunction with a standard physical examination, frequently includes the differential as part of the procedure.

If a differential is not performed concurrently with a CBC, it may be requested if the CBC findings go outside of the reference ranges.

What does a White Blood Cell Count and Differential test check for?

Leukocytes, commonly known as white blood cells, are circulating lymphatic and blood cells that aid in the body's defense against infection. They have a key function in the body's immune system, as well as in inflammation, allergic reactions, and cancer prevention. The total number of each type of WBC in a person's blood sample is known as the WBC difference.

White blood cells come in five different varieties, each of which has a unique purpose. The differential shows if the cells are distributed normally in relation to one another, whether one cell type is more or less prevalent, and/or whether aberrant and/or immature cells are present. The diagnosis of particular disorders that impact the immune system and bone marrow can be helped by the information provided.

A complete blood count, which is frequently used as a routine health checkup, may be combined with a differential, or it may be used as a follow-up to aberrant CBC results. The most common way to perform a differential is using an automated blood analyzer, but it can also be done manually by a skilled laboratory technician looking at a blood smear under a microscope. The data can be given as relative percentages of the total number of WBCs but are commonly expressed as absolute numbers of cells.

Precursor cells made in the bone marrow give rise to white blood cells. The five different kinds of WBCs are as follows:

These white blood cells, called granulocytes, have granules in their cytoplasm. The chemicals and other materials in the granules are released as a result of an immunological response. There are three different kinds of granulocytes:

Normally, the majority of WBCs in circulation are neutrophils. They enter a damaged or contaminated tissue area where they consume and kill bacteria and occasionally fungus.

Eosinophils react to parasite infections, contribute to allergy reactions, and regulate the intensity of immunological reactions and inflammation.

It is believed that basophils, which typically make up the smallest percentage of circulating WBCs, are implicated in allergic reactions.

Blood and the lymphatic system both include lymphocytes. Although they are split up into three sorts, the differential does not make a distinction between them. From shared lymphoid progenitor cells in the bone marrow, all lymphocytes develop. All lymphocytes are counted and reported together by the differential. The three categories must be distinguished using various, specialist testing:

The production of antibodies by B lymphocytes is necessary for adaptive, antigen-specific immune reactions. B-cells that have completed their differentiation into plasma cells create antibodies, which are immunological proteins that hunt down and eliminate bacteria, viruses, and other "non-self" foreign antigens.

T cells are made up of a few different types and complete their maturation in the thymus. The body can discriminate between "self" and "non-self" antigens with the aid of some T cells. Others start and regulate the size of an immune response, raising it as necessary and then reducing it as the illness gets better. Other T cell subtypes target and kill malignant or virus-infected cells directly.

Natural killer cells go after and kill aberrant cells like cancerous or virus-infected ones directly.

Similar to neutrophils, monocytes migrate to an infection site, engulfing and killing germs. They are more frequently linked to chronic infections than acute ones. They also play a role in immune system-related processes like tissue healing.

The bone marrow makes more WBCs and releases them into the blood when there is an infection or an inflammatory event anywhere in the body. One type of WBC may be elevated above others depending on the origin of the infection or inflammation. The creation of that kind of WBC declines as the disease gets better, and the number returns to normal.

The creation of WBCs by the bone marrow or their survival in the blood can be impacted by a number of illnesses, in addition to infections and inflammation, and this can lead to either increased or decreased numbers. The differential notifies the healthcare provider of any potential health problems, together with the other CBC components. The existence of aberrant and/or immature populations of WBCs can be detected by additional tests, such as a blood smear review, which is frequently used to interpret the results.

Some immature cell types are discharged from the bone marrow into the circulation in a few critical disorders, and the WBC differential may be used to identify them. This could happen as a result of a bacterial infection, leukemia, a solid tumor affecting the bone marrow, the myelodysplastic syndrome, or myeloproliferative neoplasms, for instance. Myelocytes, promyelocytes, blasts, and metamyelocytes are a few immature cells that could be found.

A wide range of additional tests may be carried out to help identify the issue's root cause if results point to a problem. When determining what additional tests could be required, a healthcare professional will frequently take into account a patient's indications and symptoms, medical history, and the outcomes of a physical examination. For instance, a bone marrow biopsy will be carried out as needed to assess the bone marrow status.

Lab tests often ordered with a White Blood Cell Count and Differential test:

• Complete Blood Count (CBC)
• Comprehensive Metabolic Panel (CMP)
• Lipid Panel
• Urinalysis, Complete
• HIV
• ANA Screen
• Rheumatoid Factor

Conditions where a White Blood Cell Count and Differential test is recommended:

• Leukemia
• Lymphoma
• Autoimmune Diseases
• HIV
• Rheumatoid Arthritis
• Bone Marrow Disorders
• Myeloproliferative Disorders
• Meningitis
• Allergies
• Asthma

How does my health care provider use a White Blood Cell Count and Differential test?

The white blood cell count is used to:

Check for a variety of illnesses and disorders

• Determine the existence of various diseases that influence WBCs, such as allergies, leukemia, or immunological disorders, to mention a few; assist in the diagnosis of an infection or inflammatory process.
• WBC counts may be used to track the evolution of illnesses like those mentioned above, the body's reaction to different therapies, and/or the health of the bone marrow. Some treatments, like radiation and chemotherapy, are known to alter white blood cells and may be tracked using WBC counts.

White blood cells are a vital component of the body's immune system and can be found in the blood, lymphatic system, and tissues. Some illnesses make the immune system react, which results in an increase in WBCs. The amount of circulating WBCs can change depending on other factors that impact the bone marrow's ability to produce WBCs or the survival of WBCs in the circulation.

The presence of a disease or condition that affects white blood cells can be detected by a WBC count, but the underlying cause cannot be established. To assist in making a diagnosis, a number of additional tests could be carried out concurrently or as a follow-up to an aberrant result. A WBC differential, a blood smear review, or in extreme cases, a bone marrow examination may be a few of these extra tests. While a blood smear and/or bone marrow biopsy can show the existence of aberrant and/or immature WBCs, a differential can identify which type of WBC is low or high.

A complete blood count is frequently used as part of a general health check to determine the white blood cell differential. When a CBC shows a high or low white blood cell count, it may be utilized to assist identify the cause. Other illnesses and ailments that impact one or more different types of WBCs may also be monitored and/or helped with the diagnosis.

Neutrophils, lymphocytes, monocytes, eosinophils, and basophils are the five different types.

The differential counts all the cells of each kind and assesses whether they are distributed in their expected ratios, whether one cell type is increased or decreased, or whether any immature cells are present. These details are helpful in determining the precise origin of an illness, including:

• bacterial, viral, fungal, or parasitic infections
• Inflammation
• asthma and allergies
• autoimmune diseases
• Leukemia
• The Myelodysplastic Syndrome
• A myeloproliferative tumor

Specific types of WBCs rise as a result of the immune system's reaction to some diseases. A difference may provide information about the precise origin of that immune response. For instance, it might be used to identify if a virus or bacterium is to blame for an infection.

Other factors impact the amount of specific WBCs by reducing or increasing their production by the bone marrow or by reducing their survival in the blood. The healthcare provider can determine which type of WBC is low or high using a differential.

Other tests, such as a blood smear, bone marrow biopsy, chromosomal analysis, or immunophenotyping, may be performed after an aberrant differential result. These examinations may detect populations of WBCs that are aberrant or immature.

What do my White Blood Cell Count and Differential test results mean?

A WBC count shows if there has been a general rise or fall in the quantity of white blood cells. A health professional will take into account a variety of additional aspects, including a physical examination, medical history, and signs and symptoms, in addition to the results of a WBC count and other parts of a complete blood count.

Numerous illnesses and circumstances can cause leukocytosis, a high white blood cell count. Several instances include:

• Bacteria, some viruses, and less frequently fungi or parasites, are the most prevalent causes of infections.
• inflammation or inflammatory diseases such inflammatory bowel illness, vasculitis, or rheumatoid arthritis
• Myeloproliferative neoplasms and leukemia
• conditions that cause tissue death, such as heart attack, surgery, burns, or trauma
• Allergy symptoms

Leukopenia, a low white blood cell count, can be brought on by illnesses like:

• loss of bone marrow
• Disorders of the bone marrow in which it fails to manufacture enough WBCs
• malignancy that has spread to the bone marrow, such as lymphoma
• Autoimmune diseases: the body targets and kills its own white blood cells
• nutritional deficits
• excessive infections
• immune system disorders that kill T cells, like HIV

When WBC counts are used as a monitoring tool, a string of WBC counts that rise or fall to abnormally high or low levels signifies that the condition or disease is deteriorating. WBC counts returning to normal signify progress and/or a successful course of treatment.

The results of a differential show how many and/or what proportion of each type of white blood cell are present in the sample of blood taken from the subject.

Results of a differential are often presented as the absolute values of the five different types of WBCs and/or as a percentage of all WBCs. Calculating absolute values involves multiplying the total number of white blood cells by the proportion of each type of white cell. This data can help with both disease diagnosis and treatment monitoring. The majority of WBC are normally neutrophils, followed by lymphocytes, monocytes, eosinophils, and basophils.

When analyzing the outcomes of a differential, caution must be used. A healthcare professional will take into account a patient's indications and symptoms, medical history, and the degree of cell growth or decline. Any one type of cell's population can briefly increase or decrease due to a variety of circumstances. Further testing to identify the cause is typically prompted by an ongoing increase or reduction.

In some circumstances, blood may contain immature and/or aberrant types of the cells, which can be found using a differential. Metamyelocytes, myelocytes, promyelocytes, and/or blasts are examples of immature forms. There may be a need for more testing.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.