The lysing solution used in WBC counting on some instruments removes rbcs leaving only nucleated cells for counting. The steps to interpreting the WBC are presented in Table 1. The white blood cell portion of the CBC includes the WBC and the wbc differential count (relative and absolute values, and morphological evaluation, if justified). It is important that no parameter is overlooked since the reported parameters provide related, but different, information for quality control assessment and patient diagnosis. Once an accurate WBC is assured, evaluating the total WBC (Step 2), is a sensible starting place for thorough interpretation of the results. Many modern instruments will recognize and automatically correct for some interferences so that an accurate WBC can be reported. With an inaccurate WBC, all other conclusions that follow will be inaccurate. However, the consistent use of Step 1 as the first step ensures that the white blood cell count (WBC) is accurate and not falsely affected by spurious results. The sequencing of the steps below is not necessarily fixed. This is especially helpful for laboratory science students since it does not make prior assumptions about the reader's vocabulary. Furthermore, there is an emphasis on translation of numerical data into a narrative description that is more easily communicated. The method recommended here differs from commonly published diagnostic algorithms in that it incorporates strategies for laboratorians to detect invalid results so they can be corrected before clinical interpretation. This article will focus on a method for interpreting the results of the wbc-related assays. However, it is helpful to review the multiple results for each of the cellular elements separately, correlating within that group of tests, before a comprehensive assessment is completed. Clinical interpretation of the CBC requires that all results be evaluated thoroughly since some patient conditions will affect all cell lines. Though a complete blood count (CBC) is ordered as a single test, it is a battery of multiple tests and calculations that collectively assess the cellular elements of the blood: red blood cells (rbcs), white blood cells (wbcs) and platelets. Make note of any morphological abnormalities of wbcs.Ĭorrelate the wbc findings with red blood cell and platelet findings for a complete clinical assessment of the patient's blood picture.Įxplanations for conducting the evaluations are provided and the above steps are applied to example cases to demonstrate how this approach is used to interpret the wbc parameters of the CBC.ĪBBREVIATIONS: CBC - complete blood count, dL-deciliter, fL-femtoliter, g-gram, NRBC-nucleated red blood cell, rbc-red blood cell, RNA-ribonucleic acid, wbc-white blood cell, WBC-white blood cell count, μL-microliter Make note of immature cells in any leukocyte cell line reported in the differential that should not appear in normal peripheral blood. percentages) to calculate absolute values. If absolute counts are not available from an instrument, use relative counts (i.e. Interpret absolute differential counts against appropriate reference intervals using proper terminology. The steps for interpreting the white blood cell portion of the CBC are:Įnsure that nucleated red blood cells or other conditions are not falsely affecting the white blood cell count (WBC) correct the WBC if needed, before proceeding.Įxamine the WBC for variations in the total number of white blood cells. It can also help ensure that no clinically important information is overlooked during diagnostic interpretation of the results. Consistent use of a methodical approach to interpreting complete blood count (CBC) results can help detect spurious results that require remedy before results are reported.
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