Complete Blood Count with Differential

Last Modified: 7/18/2019 1:06:09 PM


  Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:  
Client Notes:  
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
Transport & Storage: Temperature/Stability: 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 gm/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                    PCI: 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                        PCI: IPF 0.9-7.2%
Critical Ranges:
Pediatric (< = 15 days old) Low Critical Limits
WBC: < = 2.0 t/ul
Hgb: < = 10.0 g/dl
Platelet: < = 30.0 th/ul

Pediatric (< = 15 days old) High Critical Limits
WBC: > = 39.0 t/ul
Hgb: > = 24.0 g/dl
Hct: > = 70.0%
Platelet: > = 850 th/ul
 
Low Critical Limits 
WBC: < = 1.5 t/ul
Hgb: < = 6.0 g/dl
Platelet: < = 30 th/ul

High Critical Limits 
WBC: > = 40.0 t/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 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: <= 7.0 g/dl
Platelet: <=50 th/ul

Differential Critical Limit: Blasts, bacteria, fungi, malarial parasites
Test Comments:
If clinically indicated, a Manual Differential will be performed and resulted instead of the Auto Differential. 

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


PCI: If PLT <50,000, IPF% (Imm PH Fract) will be reflexed)
Methodology: Blood Cell Analyzer
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Stat Eligible: Yes
Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Cancer Institute, Parkview Hospital Randallia, Parkview Huntington, Parkview LaGrange, Parkview Noble, Parkview Regional Medical Center, Parkview Wabash, Parkview Warsaw , Parkview Whitley
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); 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) | PCI <50,000 reflex 85055

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