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 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
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
PRODUCTION SCHEDULE
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
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:
DACBC
EPIC Test Code:
LAB3259
Alternate Test Names:
CBC with Diff; CBCWD Direct Access Testing
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