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List blood tests performed as part of a CBC.

WBC
WBC with differential
RBC
Hct
Hgb
Platelets
RBC indices: mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCV], mean corpuscular
hemoglobin concentration [MCVC].

Recognize the influence of the patient’s hydration status on accurate CBS results.
Overhydration overexpands the plasma compoenet of blood, diluting the % of formed blood cell elements.
Dehydration causes hemoconcentration, resulting in a deceptively inflated number of formed elements in the
blood.

State normal adult values for CBC test results.

RBC
Newborns: 4.8 – 7.2 million
Adult Male: 4.6 - 6.0 million
Adult Female: 4.2 – 5.0 million
Pregnancy: slightly lower than adult values
Children: 3.8 – 5.5 million

Reticulocyte
Men 0.5% - 1.5% of the total number of RBCs
Women 0.5% - 2.5%

Hematocrit (% of RBCs in plasma)

Newborns: up to 60%
Adult Male: 40% – 54%
Adult Female: 36% - 46%
Pregnancy: decreased as plasma volume increases
Children: varies with age

Hemoglobin
Adult Male: 13.5 – 17 g/dl
Adult Female: 12 – 15 g/dl
Pregnancy: 11- 12 g/dl
Children: 11 – 16 g/dl

Erythrocyte Indices
MCV: (mean or average size of individual red blood cells)
Men: 80 – 98 fl (femoliters)
Women: 96 – 108 fl
MCH: 17 – 31 pg (picograms) [the amount or mass of hemoglibn present in one RBC]
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MCHC: 32% – 36% (proportion of each cell taken up by hemoglobin)

WBC
Total WBC: 4,500 - 10,000
Bands or stabs: 3 - 5 %
Granulocytes (or polymorphonuclears)
 Neutrophils (or segs): 50 - 70% relative value (2500-7000 absolute value)
 Eosinophils: 1 - 3% relative value (1 00-300 absolute value)
 Basophils: 0.4% - 1% relative value (40-100 absolute value)
Agranulocytes (or mononuclears)
 Lymphocytes: 25 - 35% relative value (1 700-3500 absolute value)
 Moncytes: 4 - 6% relative value (200-600 absolute value)

Lymphocytes Cells Percent Number of Cells /microL

T Cells 60-95% 800-2,500/microL
T-helper [CD4] Cells 60-75% 600-1,500/ microL
T-Suppressor [CD8] Cells 25-30% 300-1,000/ microL
B-Cells 4-25% 100-450/ microL
NK Cells 4-30% 75-500/ microL
CD4/CD8 Rauo >1

Platelets
150,000-350,000

Describe two physiologic reasons and two pathological reasons for an increase in red blood cells.
Physiologic:
1. High altitudes; less atmospheric pressure pushing oxygen into lungs
2. After strenuous exercise;  muscle mass demands more oxygen

Pathologic:
1. Polycythemia vera is a disease of unknown origin that result in anbanormal  in RBCs not caused by
physiologic need. Treated by radioactive phosphorus to slow down bone marrow overproduction of
RBCs.
2. Hemolysis – each result in stepped up production of RBCs in the bone marrow
a. hemolytic anemias: RBCs are destroyed at a faster rate than normal
b. erythroblastosis fetalis: immune-mediated destruction of RBCs
3. Hemorrhage [3-4 days later]

Describe four reasons for a decrease in red blood cells.

1. Massive RBC loss, i.e. hemorrhage
2. Abnormal destruction of RBCs
3. Lack of substances need for RBC production (e.g. B12 or folate deficiency)
4. Chemotherapy or radiation
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Explain the clinical significance of a low reticulocyte count.

Useful in classifying anemias. Also, the reticulocyte count is a test for determining bone marrow function and
evaluating eruthropoietic activity; it gives an indication of RBC production by the bone marrow. A
reticulocyte is an immature RBC.
Low reticulocyte counts are seen with cirrhosis, folic acid deficiency, and bone marrow failure.
A low or normal count in a patient with anemia indicates the marrow response to anemia is inadequate and
perhaps is contributing to or is the cause of the anemia.
A high count indicates that the bone marrow is responding to the need for  RBC production, either for anemia
or in response to ongoing loss of RBC, as in hemolysis or hemorrhage.

Explain the purpose of the reticulocyte index.

To get a true idea of the reticulocyte count – and the appropriateness of the RBC marrow response – by
controlling for the possibility of a low RBC count in a patient with anemia. Reticulocyte values are a % of the
total number of RBCs, so a low RBC count can make a normal or low number of reticulocytes look high.

Identify panic values for hematocrit, hemoglobin, WBCs, and platelets.

Hematocrit
< 15% can result in cardiac failure
> 60% may result in spontaneous blood clotting
Hemoglobin
<5 g/dL may cause heart failure
>20 g/dL may cause clogging of capillaries due to hemoconcentration

Recognize the purpose of hemoglobin in RBCs

The oxygen-carrying capacity of the blood is determined by the Hgb concentration; Hgb serves as a vehicle for
oxygen and carbon dioxide transport. The oxygen carrying ability of blood is directly proportional to its
hemoglobin concentration.

Describe the calculation relationship between hematocrit and hemoglobin.

If a person’s RBC and hemoglobin are both normal, estimate the hematocrit as being approximately 3x the
hemoglobin. If Hct = 30%, Hgb = 10g

Identify the purpose of erythrocyte indices.

When a patient has a lower than normal hemoglobin it important to determine whether RBCs are of normal
size and if they have a normal concentration of hemoglobin.
These indices provide information about the size [MCV and RDW], weight [MCH], and hemoglobin
concentration [MCHC] of RBCs.
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Describe classifications of anemia based on the results or erythrocyte indices.

1. Normocytic, normochromic anemia: most often caused by acute blood loss. Normal MCV, MCH
and MCHC
2. Microcytic, hypochromic anemia: most often caused by iron deficiency, thalassemia, lead poisoning.
 MCV, MCH, and MCHC.
3. Macrocytic anemia: most often caused by vitamin B12 and folic acid deficiency.
 MCV, MCH, and MCHC

List five types of white blood cells and state the function of each type of cell.
1. Basophils
 Least common type of granulocyte
 Non-phagocytic
 Contain proteins and chemials such as heparin, histamine, bradykinin
 Tend to appear during inflammatory responses, particlalty allergic reactions
 Imortant source of Interleukin-4, which is critical in the development of allergies and the
production of IgE antibodies
 Basoophil counts are used to analyze allergic reaction.
2. Eosinophils
 Responsible for combating infection by parasites in the body
 Found in large numbers in the respiratory and GI tract
 Play a role in the allergic response
 Allergic reactions (hay fever, asthma) increase eosinophil count
 Corticosteroid drug decrease eosinophil count
3. Neutrophils
 Most plentiful of granuloctyes
 Phagocytic cells
 They are the body’s primary defense against bacterial infection and physiologic stress.
4. Lymphocytes
 Primary component of the body’s immune system
 Protect the body from microorganisms, foreign tissue and cell alterations and also monitor the
body for cancerous cells.
 Primary function is to fight chronic bacterial infection and acute viral infections.
 Are the source of serum immunoglobulins and cellular immune response.
5. Monocytes
 Largest leukocyte/blood cell
 Monocytes are immature WBCs; released by bone marrow and circulate for 1-2 days in the blood
 Once in tissue they mature into macrophages
 Act as scavengers, secrete a variety of powerful chemicals and activate T-cells
 Body’s second line of defense; identify and present foreign antigens to lymphocytes

State the implications of a “shift to the left” on a white blood cell differential.
A shift to the left indicates an increase in the amount of bands or stabs (immature WBCs) in the blood,
indicating an infection in progress.

Identify common patterns of white blood cell increase or decrease in disease processes.
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Leukopenia (WBC < 4,000)

Common causes include:
 viral infections;
 overwhelming bacterial infections; and
 bone marrow disorders.

Leukocytosis (WBC > 10,000)

Common causes include:
 acute infections
 trauma
 imflammation
 leukemia and other bone marrow disorders

Recognize the function of platelets in normal coagulation.

Platelets form the initial plug in a broken blood vessel, which stems the loss of blood until clotting factors and
fibrinogen can form a clot. A dearth of platelets can result in prolonged and potentially life-threatening
bleeding.

Formulate nursing diagnoses and describe interventions for a patient with an elevated RBC count, a 
hematocrit, a  neutrophil count, and a  platelet count.

STUDY POINTS - RBCs

What is the clinical significance of high reticulocyte count?
This indicates that the bone marrow is responding to the need for  RBC production.

What should the reticulocyte index be for a patient with a positive bone marrow response to anemia?
1.

What clinical situations would you expect a decreased reticulocyte count?

Cirrhosis, folic acid deficiency, and bone marrow failure.

What does a normal or low reticulocyte count indicate in a patient with anemia?
A low reticulocyte count could be either an indication of anemia – that the bone marrow response is
inadequate – or the cause of it.

STUDY POINTS – HEMATOCRIT

What does the term hematocrit mean?
It’s a measure of the percentage of RBCs in blood.

State the normal value for the adult.

Males: 40%-54%, Females: 36%-46%

What can affect the hematorcit value?

Fluid status, abnormalities in RBC size, extreme elevation in WBC count, some drugs, pregnancy, high
altitudes, hemorrhage (3-4 days later).
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What is the clinical significance of low hematocrit?

 Anemia
 Hemoglobinopathy – hemoglobin disorders
 Cirrhosis – chronic fluid overload  hemodilution  Hct
 Hemolytic anemia – premature RBC destruction
 Hemorrhage – plasma levels return to normal faster than RBCs are produced
 Dietary deficiency – iron deficiency most often
 Bone marrow failure
 Prosthetic valves – cause mechanical trauma to RBCs   RBC lifespan
 Renal disease – erythropoietin is made in the kidney and is a strong stimulant of RBC production
 Arthritis and chronic diseases – associated with  Hct

What is the clinical significance of high hematocrit?

 Erythrocytosis - RBCs due to illness or external factors
 CHD – chronically low PO2  RBC production
 Polycythemia vera – bone marrow dysfunction; inappropriate production of RBCs
 Server dehydration; burn injury – in proportion to  plasma, Hct appears high
 Severe COPD – same as CHD

If the RBC and hemoglobin are both normal, is it possible to determine the hematocrit?
Yes. All things being normal, the Hct is generally 3x the Hgb.

If Hgb = 10g, what would the Hct be?

30%.

STUDY POINTS – HEMOGLOBIN

What is the significance of Hgb?
Hgb is the oxygen and CO2 transport component of RBCs.

State the normal Hgb value for the adult.

Adult male: 13.5–17 g/dL; Adult female: 12–15 g/dL

What can affect the Hgb value?

 Diurnal variations
 Pregnancy – hemodilution =  Hgb
 Smoking –  RBC production
 High altitudes -  RBC production
 Drugs that  Hgb: gentamicin, methyldopa
 Drugs that  Hgb: antibiotics, chemotherapy, aspirin, indomethacin rafampin, sulfonamides

What is the clinical significance of low Hgb?

 Blood loss and bone marrow suppression
 Abnormal hemoglobin or hemoglobinopathies (RBCs with these are usually fragile)
o Thalassemia
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o Sickle cell anemia

What is the clinical significance of high Hgb?

 Erythrocytosis -  RBCs due to illness or external factors
 CHD – chronically low PO2   RBC production
 Polycythemia vera – bone marrow dysfunction; inappropriate production of RBCs
 Server dehydration; burn injury – in proportion to  plasma, Hct appears high
 Severe COPD – same as CHD

If the RBC and Hgb are both normal, is it possible to determine the Hgb?
Yes. The Hgb value will generally be 1/3 of the Hct value.

If a person’s Hct = 30%, what would the Hgb be?

10g.

STUDY POINTS – ELECTROLYTE INDICES

What is the clinical significance of the erythrocyte indices?
These indices proved information about the size, weight and Hgb concentration of RBCs. Diagnostic test used
in the treatment of anemia.

When would the erythrocyte indices be ordered?

When a patient has a lower than normal Hgb.

What does the MCV, MCH and MCHC measure?

MCV [Mean Corpuscular Volume] measures the RBC size.
MCH [Mean Corpuscular Hgb] measures the amount (mass) of Hgb in one RBC.
MCHC [Mean Corpuscular Hgb Concentration] measure the % of each RBC taken up by Hgb.

What are the normal ranges for RBC indices?

MCV - Men: 80-98 fl; Women: 96-108 fl
MCH – 7-31 pg
MCHC – 32-36%

What changes in RBC indices would you most likely see in acute blood loss?
All normal.

What changes in RBC indices would you most likely see in iron deficiency anemia, Thalassemia, and
lead poisoning?
MCV, MCHC, MCH

What changes in RBC indices would you most likely see in pernicious (B12) anemia and folic acid
deficiency?
MCV, variable MCHC and MCH

Define the following terms:

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 normocytic – RBC is normal size

 microcytic - RBC is undersized
 macrocytic - RBC is oversized
 normochromic - RBC is normal color
 hypochronic - RBC is pale ( Hgb conent)

STUDY POINTS – WBC: NEUTROPHILS

What is the normal WBC count?
Total WBC: 4,500 - 10,000

What is the purpose and function of the neutrophils?

They are the body’s primary defense against bacterial infection and physiologic stress; first phagocytic cell to
arrive on the scene.

What is the normal range for neutrophils?

50%-70% relative value (2,500-7,000 absolute value)

Identify and describe five [5] characteristics of neutrophils?

1. Most plentiful granulocyte
2. Phagocytic cells
3. They are the body’s primary defense against foreign invaders
4. After release from the bone marrow they circulate for 8 hours before settling into tissue, where they
live for about one week; the most short-lived in circulation of all leukocytes.
5. Also play a key role in inflammation

What are "bands"?

Immature WBCs.

What are “segmented" neutrophils?

Mature WBCs and one of the three types of granulocytes.

What is the clinical significance of increased neutrophil count?

 infection in progress
 inflammatory processes
 physical stress
 severe burn or a MI
 leukemia

What is the clinical significance of decreased neutrophil count?

 Viral infections (influenza, mumps) and some bacterial infections (typhoid)
 Overwhelming infection
 Chemotherapy
 Some antibiotics, lithium, tricyclic antidepressants
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STUDY POINTS – WBC: EOSINOPHILS

What is the purpose and function of the eosinophils?
Eosinophils are responsible for combating infection by parasite in the body; found in large numbers in
respiratory and GI tract.

What is the normal range for eosinophils?

1%-3% relative value (100-300 absolute value)

Identify and describe five [5] characteristics of eosinophils?

1. A type of granulocyte accounting for 1-4% of total leukocyte count
2. Phagocyte cells, but less effective than neutrophils
3. Eosinophils contain histamine and other chemicals toxic to parasites and host tissue
4. Play a role in the allergic response
5. Are considered the main effector in asthma pathogenesis

What is the clinical significance of increased eosinophil count?

 Parasitic infections
 Allergic reactions, i.e. hay fever, asthma, drug hypersensitivity

What is the clinical significance of decreased eosinophil count?

 Patient receiving corticosteroids

STUDY POINTS – WBC: BASOPHILS

What is the purpose and function of the basophils?
What is the normal range for basophils?
Identify and describe five [5] characteristics of basophils?
What is the clinical significance of increased basophil count?
What is the clinical significance of decreased basophil count?

STUDY POINTS – WBC: LYMPHOCYTES

What is the purpose and function of the lymphocytes?
What is the normal range for lymphocytes?
Identify and describe five [5] characteristics of lymphocytes?
Identify and describe the three [3] types of lymphocytes?
What is the purpose and function of B-Cells?
What is the purpose and function of T-Cells?
What is the purpose and function of NK-Cells?
Compare and contrast CD-4 Count; CD-4% and CD4:CD8 Ratio.