Clinical Center National Institutes of Health

Understanding Your Complete Blood Count

This information was developed to  Red blood cell (RBC) count help you understand your complete Red blood cells carry oxygen to and blood count and describe neutropenia, remove waste products from the anemia, and thrombocytopenia. body’s tissues. These cells also con- Part 1: tain hemoglobin. Red blood cells are The measurements in a measured in millions per cubic mil- limeter (mil/uL) of blood. complete blood count  Hemoglobin (HGB) value What is a complete blood count? Hemoglobin gives red blood cells A complete blood count, often referred their color. Hemoglobin carries oxy- to as a CBC, is a common blood test. A gen from the lungs to the tissues and CBC provides detailed information takes carbon dioxide (the waste prod- about three types of cells in your blood: ucts) from the tissues to the lungs. red blood cells, white blood cells, and From the lungs, carbon dioxide is platelets. These blood cells are made in exhaled. Hemoglobin is measured in the bone marrow, the spongy tissue fill- grams per deciliter (g/dL) of blood. ing the center of your bones. Bone mar- row in the skull, sternum (breast bone),  Hematocrit (HCT) value ribs, vertebral column (backbone), and The hematocrit is the percentage of pelvis produces these blood cells. red blood cells in relation to your total Each type of blood cell plays an impor- blood volume. tant role in your body’s normal function.  Platelet count What does a complete blood count Platelets help to stop bleeding by measure? forming blood clots. They are meas- A complete blood count includes five ured in thousands per cubic millime- major measurements: ter (m/uL) of blood. A platelet count  White blood cell (WBC) count of 200 K/uL is 200,000 cells. White blood cells fight infections. They are measured in thousands per cubic milliliter (K/uL) of blood. A WBC of 4.8 K/uL is 4,800 cells.

Patient Education 1 Understanding Your Complete Blood Count What are the normal ranges of these the “soldiers” that fight infections. They measurements? eat or gobble up the infectious particles Each measurement in a complete blood (bacteria) in your body. count has a normal range that will be On your lab sheet, you will see the words noted on your complete blood count: “polys” and “bands.” Polys are mature  WBC: 3.3-8.7 K/uL neutrophils. Bands are young polys, which also fight infections.  RBC: 3.93-5.69 M/uL  HGB: 12.6-16.1 g/dL What is the ANC or AGC? The absolute neutrophil count (ANC),  HCT: 38-47.7% also called absolute granulocyte count  Platelets: 147-347 K/uL (AGC), is the measure of the number of infection-fighting white blood cells in your Part 2: blood. A more detailed look at what the How is the ANC calculated? complete blood count measures To calculate the ANC, the number of White blood cells white blood cells (WBC) and the percent- These cells are the mobile units of the age of polys and bands must be known. body’s infection-fighting system. White Then, the number of white blood cells is blood cells travel in the bloodstream to multiplied by the percentage of polys and areas of infection and destroy the bands. responsible bacteria. However, the WBC For example, let the number of white lab value is not meaningful unless the blood cells be 300. (This number would “differential” is also known. be 0.3 K/mm3 on the lab sheet. To get The differential measures each of the five this number, move the decimal three types of white blood cells: places to the right.) Let the number of  neutrophils (polys and bands) polys be 10 percent (0.10), and bands 5 percent (0.05). The ANC is found by  basophils doing the following:  eosinophils  lymphocytes 300 x (0.10 + 0.05)  monocytes = 300 x 0.15 The differential is usually based on 100 = 45 cells counted in a laboratory sample. The ANC is 45. What are neutrophils? Neutrophils are the most numerous white blood cells. They make up about 56 per- cent of white blood cells. Neutrophils are

Patient Education 2 Understanding Your Complete Blood Count Part 3: If you are neutropenic and have any of Low blood counts—neutropenia these signs or symptoms, contact your doctor immediately. What does it mean to have a low ANC or an ANC lower than 500? If I am neutropenic, how can I prevent The normal neutrophil count is 2,500-6,000. myself from getting infections? When you have 1,000 or fewer neutrophils, The following list contains information to your risk of infection is increased. When help you care for yourself while you are your ANC is lower than 500, you are at risk neutropenic. for getting a serious infection. This condition is called “neutropenia.” General precautions If you are neutropenic and develop a fever  Wash your hands before eating and after or signs of infection, contact your doctor using the toilet, blowing your nose, immediately. coughing, or sneezing. Washing your hands frequently is very important. You may be given antibiotics to fight the infection.  Check your temperature once a day when you are neutropenic. If your tem- If I am neutropenic, should I take special perature is between 100.4 and 100.9 care of myself? degrees F two times in 24 hours, or if If your ANC is low, be alert for the following your temperature 101.0 degrees F or signs and symptoms of infection: higher once, notify your nurse or doctor immediately. Take Tylenol only on your  fever (temperature of 100.4 degrees F doctor’s advice. Do not take aspirin. (38.0 degrees C) or higher)  Check for signs of infection in such  shaking chills areas as the site of a central venous  flushed skin catheter or port, or any tube or catheter  sweating site. Also check the mouth, groin, and  frequent urination or burning when urinat- perineum (the area between the penis ing and the rectum in men, and between the vagina and rectum in women).  redness, tenderness, or pain anywhere on the body  Signs of infection include redness, swelling, tenderness, drainage, or odor.  general feeling of tiredness or flu-like If you have any signs of infection, notify symptoms (sore throat, sneezing, runny your nurse or doctor. nose, coughing, nausea, vomiting, diar- rhea, shortness of breath, chest discom-  Shower or bathe daily. If your skin fort) becomes dry, use unscented lotion or oils to soften it and prevent cracking. Use an electric shaver rather than a razor.

Patient Education 3 Understanding Your Complete Blood Count Mouth care checklist  Limit your exposure to pet excrement,  Rinse teeth and gums with plain water fresh flowers, house plant, and stagnant after meals and at bedtime. water. Wash your hands after touching  Use a soft toothbrush. Floss only if your any of these items. ANC is greater than 500 and platelet  If you cut or scrape your skin, clean the count is greater than 50,000. area immediately with soap and warm  Use a lubricant (such as A & D ointment) water. Then apply a bandage. on the lips to prevent chapping.  Avoid using enemas, rectal thermome-  Wear well-fitting dentures. ters, and suppositories. Women should not douche or use tampons or vaginal  Have dental work done only if you first suppositories. consult your doctor. Precautions to take during daily Anemia activities What happens when I don’t have enough  Avoid having contact with crowds, and red blood cells? people with illness / infections. When you do not have enough red blood  Avoid working with dirt/soil cells, you develop a condition called “ane- mia.” When you are anemic, your hemat-  Avoid cleaning bird cages, cat litter ocrit and hemoglobin levels will be below boxes, and fish tanks. normal. You may feel weak and tired, and  Wear shoes in the hospital and at home. you may also have these symptoms:  Do not have manicures or pedicures, and  dizziness do not have nail tips or false nails  shortness of breath applied.  heart palpitations (racing heartbeat)  To promote hygiene during sexual activi- ty, avoid excessive friction during inter-  pounding in your head course by using a water-based lubricant.  ringing in your ears Avoid rectal intercourse. Use a birth con- Anemia precautions list trol method recommended by your nurse or doctor. By following these suggestions, you can lessen or prevent some of the symptoms of  Avoid hot tubs and Jacuzzis. Swim only anemia. in chlorinated swimming pools.  Rest often during the day and sleep  Avoid immunizations unless directed by enough at night. your doctor.  Rest between activities.

Patient Education 4 Understanding Your Complete Blood Count  Get up slowly from a sitting or reclining You can also observe the following position. This will lessen dizziness. precautions to prevent bleeding when your You may need blood transfusions if platelets are low: your hematocrit or hemoglobin is too low. Personal hygiene Thrombocytopenia  Use a soft toothbrush. If your gums bleed What happens when I don’t have during brushing, use Toothettes instead enough platelets? of a toothbrush. Do not floss if platelets When you do not have enough platelets, are less than 50,000. you have a condition called “thrombocy-  Use an electric shaver rather than a topenia.” You may bruise easily, and you razor, especially if your platelet count is may also have some of the following signs: lower than 20,000.  tiny, pinpoint-sized red or purple spots on  Wear shoes in the hospital and at home. your skin (petechiae)  When you blow your nose, do it gently.  nose bleeds  Avoid using enemas, rectal thermome-  bleeding gums ters, and suppositories. Women should not douche or use tampons or vaginal  prolonged bleeding from a cut suppositories.  black or bloody stool  Eat properly so that you do not become  brown or red urine constipated.  increased vaginal bleeding  Avoid eating irritating foods such as popcorn or apple peels. Thrombocytopenia precautions list Many over-the-counter drugs contain Precautions to take during daily aspirin, and aspirin prevents platelets from activities working as they should. Avoid taking any  Avoid wearing tight-fitting clothing. drug that contains aspirin. (The table For example, do not wear shirts with included in this information lists common elastic wristbands, or skirts or slacks with aspirin-containing products.) Other over- tight waist-bands. the-counter drugs for pain or fever may  Avoid cutting with sharp knives or also affect platelet function. Examples working with sharp blades. include ibuprofen (Motrin, Advil, Midol, Wear gloves when gardening. Pediacare Fever) and naproxen (Naprosyn,  Avoid contact sports such as football Naprelan, Aleve, Anaprox). Speak with your and hockey. doctor before taking medication.

Patient Education 5 Understanding Your Complete Blood Count  Speak with your doctor about sexual Aspercin intercourse. Aspergum If your platelet count is too low, sexual aspirin intercourse may not be advisable. Aspirtab If you have sexual intercourse, use water-based lubricants as needed. Aspir-mox Back-Quell Other ways to prevent bleeding Bayer products  Notify your nurse or doctor if you notice new petechiae or bruises. BC Powder  Notify your nurse or doctor immediately if BC products you have a nosebleed, bleeding gums, Buffasal bleeding from a procedure or incision Bufferin products site, or blood in your urine or stool. Butalbital compound  Notify your nurse or doctor if you have Carisoprodol compound Combiflex headaches, extreme drowsiness (unrelat- ed to medication), confusion, or falls. Cope Durabac Common Aspirin-Containing Easprin Products Ecotrin Acetylsalicylic acid Emagrin Forte ASA Emagrin Adprin-B Empirin Adult Analgesic Pain Reliever Empirin with codeine Aggrenox Equagesic Alka Seltzer products Excedrin products Alor 5/500 Fiorinal tablets and capsules Anacin products Goody’s Extra Strength Arthritis Foundation Pain Reliever Goody’s Headache Powder Arthritis Pain Formula Goody’s Body Pain Powder Ascomp with codeine Halfprin Ascriptin products Heartline

Patient Education 6 Understanding Your Complete Blood Count Levacet Lortab ASA Momentum Orphengesic products Norgesic Norgesic Forte Norwich products PAC Analgesic PAC tablets and capsules Painaid products Pain Reliever Pamprin products Panasal 5/500 Pepto-Bismol Percodan Robaxisal Saleto Sodol compound Soma Compound Soma Compound with codeine St. Joseph Low Dose Adult Aspirin Stanback powder and tablets Synalgos-DC Talwin compound Vanquish Zee-Seltzer Zorprin

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Patient Education 7 Understanding Your Complete Blood Count