Complete Blood Count

Last Modified: 7/18/2019 1:10:15 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. Specimens may be rejected due to blood changes or deterioration resulting from improper storage or age of specimen
Minimum Volume: 1.5 mL
Transport & Storage: Temperature/Stability: 24 hours Ambient
72 hours Refrigerated
Reference Range:
For Pediatric Reference Ranges refer to Addendum B
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 T/UL

Pediatric (< = 15 days old) High Critical Limits
WBC: > = 39.0 T/UL
Hgb: > = 24.0 G/DL
Hct: > = 70.0%
Platelet: > = 850 T/UL 
 
Low Critical Limits 
WBC: < = 1.5 T/UL
Hgb: < = 6.0 G/DL
Platelet: < = 30 T/UL

High Critical Limits 
WBC: > = 40.0 T/UL
Hgb: > = 19.0 G/DL
Platelet: > = 850 T/UL

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

NICU >15 days old Limits: 
HCT:  <=25% and >=70%
Platelet: >= 600 T/UL

Oncology Wards Low Critical Limits: 
WBC: <=1.0 T/UL                          
Hgb: <=5.0 G/dL
Platelet: <=20 T/UL 

OHP Low Critical Limit: 
Hgb: <= 7.0 G/dL
Platelet: <=50 TH/UL
Test Comments:  
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: CBCND
EPIC Test Code: LAB294
Alternate Test Names: CBC; CBC No Differential; Hemogram; Hemogram (CBC/No Diff)
Included Tests: 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: 85027

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