Parkview Health Laboratory: Test Directory

Medicare Medical Necessity Restrictions May Apply

Medical Necessity Documentation:

Patient Preparation:

Specimen Requirements: 3.0 mL Whole Blood in a Lavender Top Tube - EDTA

Collection Instructions: Mix tube by inversion 5 times

Specimens must not be clotted. Overfilling or underfilling may allow blood to clot.

Minimum Volume: 1.5 mL Whole Blood EDTA

Transport & Storage: Temperature/Stability: 24 hours Ambient
48 hours Refrigerated

Specimens may be rejected due to blood changes or deterioration resulting from improper storage or age of specimen

Reference Range:

For Pediatric Reference Ranges refer to Addendum B

Adult > 14 Yrs
Neuts: 45 - 75%

Lymphs: 17 - 43%

Monos: 0 - 12%

Eos: 0 - 4%

Basos: 0 - 2%
IGs (metas-Pros): 0 - 1%

Males > 14 Yrs

WBC: 3.5 - 10.5 th/ul

RBC: 4.3 - 5.7 mi/ul

Hgb: 13.5 - 17.2 g/dl

Hct: 40.0 - 54.0%

MCV: 82.0 - 98.0 fl

MCH: 27.0 - 33.0 pg

MCHC: 32.0 - 36.0 g/dl

Platelet: 150.0 - 450.0 th/ul

RDWSD: 36.4 - 54.5 fl

RDWCV: 11.5 - 14.5%
MPV: 8.6 - 12.6 fl PRMC/PVH/PCI/PDH: IPF: 0.9-7.2%

Females > 14 Yrs

WBC: 3.5 - 10.5 th/ul

RBC: 4.0 - 5.2 mi/ul

Hgb: 12.0 - 15.5 g/dl

Hct: 35.0 - 48.0%

MCV: 82.0 - 98.0 fl

MCH: 27.0 - 33.0 pg

MCHC: 32.0 - 36.0 g/dl

Platelet: 150.0 - 450.0 th/ul

RDWSD: 36.4 - 54.5 fl

RDWCV: 11.5 - 14.5%
MPV: 8.6 - 12.6 fl PRMC/PVH/PCI/PDH: IPF 0.9-7.2%

Critical Ranges:

Pediatric (< = 15 days old) Low Critical Limits

WBC: < = 2.0 th/ul

Hgb: < = 10.0 g/dl

Platelet: < = 30.0 th/ul

Pediatric (< = 15 days old) High Critical Limits

WBC: > = 39.0 th/ul

Hgb: > = 24.0 g/dl

Hct: > = 70.0%

Platelet: > = 850 th/ul

Low Critical Limits
Abs Neut: <=0.50 th/ul
WBC: < = 1.5 th/ul

Hgb: < = 6.0 g/dl

Platelet: < = 30 th/ul

High Critical Limits
WBC: > = 40.0 th/ul

Hgb: > = 19.0 g/dl

Platelet: > = 850 th/ul

NICU >= 15 days old Critical Limits:
HCT: <=30% and >=70%
Platelet: <= 100.0 th/ul

NICU >15 days old Critical Limits:
HCT: <=25% and >=70%
Platelet: >= 600 th/ul

Oncology Wards Low Critical Limits:
WBC: <=1.0 t/ul
Hgb: <=5.0 g/dl
Platelet: <=20 th/ul

OHP Low Critical Limit:
Hgb: <= 7.5 g/dl
Platelet: <=50 th/ul

Differential Critical Limit: Blasts, bacteria, fungi, malarial parasites

Test Comments:

If indicated, a Manual Differential will be performed and resulted in place of the Auto Differential.

IPF Result Comment: IPF is measurement of thromopoietic activity that helps determine the cause of thrombocytopenia (platelet production vs. plt destruction)

PRMC/PVH/PCI: If PLT <50,000, IPF% (Imm PH Fract) will be reflexed.

Methodology: Blood Cell Analyzer

Clinical Significance:

Documentation:

Custom Panel: No

Stat Eligible: Yes

Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday

Sites Performed: Parkview Cancer Institute, Parkview Dekalb Hospital, Parkview Huntington Hospital, Parkview LaGrange Hospital, Parkview Noble Hospital, Parkview Randallia Hospital, Parkview Regional Medical Center, Parkview Southwest , Parkview Wabash Hospital, Parkview Warsaw , Parkview Whitley Hospital

PHL Test Code: CBCWD

EPIC Test Code: LAB293

Alternate Test Names: BLHEM; CBC Auto Differential; CBC with Diff; CBC with manual differential; CBC with peripheral smear; Hemogram with Differential; Manual Differential; Peripheral Smear

Included Tests:

Automated Differential; Hematocrit (Hct); Hemoglobin (Hgb); Mean Corpuscular Hemoglobin (MCH); Mean Corpuscular Hemoglobin Concentration (MCHC); Mean Corpuscular Volume (MCV); Mean Platelet Volume (MPV); Platelet (PLT); Red Blood Cell Count (RBC); Red Cell Distribution Width Standard Deviation (RDWSD); Red Cell Distribution Width Coefficient Variation (RDWCV); White Blood Cell Count (WBC)

CPT Coding: 85025 (Reflex 85007, 85008) | PRMC/PVH/PCI <50,000 PLT reflex 85055

Parkview Laboratory: Test Directory

Complete Blood Count with Differential

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