Collect and label sample according to standard protocols. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE. Do not centrifuge.

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1 Complete Blood Count CPT Code: CBC with Differential: CBC without Differential: Order Code: CBC with Differential: C915 Includes: White blood cell, Red blood cell, Hematocrit, Hemoglobin, MCV, MCH, MCHC, RDW, MPV, Neutrophil, Lymphocyte, Monocyte, Eosinophil, and Basophil counts CBC without Differential: C917 Includes: the parameters above except Neutrophil, Lymphocyte, Monocyte, Eosinophil, and Basophil counts ABN Requirement: No Synonyms: CBC Specimen: EDTA Whole Blood Volume: 3.0 ml Minimum Volume: 1.0 ml Container: EDTA (Lavender Top tube) Collection: Collect and label sample according to standard protocols. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE. Do not centrifuge. Transport: Store EDTA whole blood at 2 C to 8 C after collection and ship the same day per packaging instructions provided with the Cleveland HeartLab, Inc. shipping box. Stability: Ambient (15-25 C): not acceptable Refrigerated (2-8 C): 5 days Frozen (-20 C): not acceptable Deep Frozen (-70 C): not acceptable Causes for Rejection: Clotted samples; grossly hemolyzed samples; samples drawn from above an IV; specimens other than EDTA whole blood; improper labeling; samples not stored properly; samples older than stability limits Methodology: Flow Cytometry Turn Around Time: 1 to 3 days Reference Range: See below Use: See below

2 Limitations: Characteristics that may affect test results: lipemia, icterus, cold agglutinins, warm agglutinins, hemolysis, electrolyte imbalances, and WBC fragments. Marked changes in plasma constituents (e.g., low sodium, extremely elevated glucose) may cause cells to swell or shrink. The blood to anticoagulant ratio is important. Refer to each individual test within the panel for specific limitations. Additional Information: See below Red Blood Cell Count: Synonyms: RBC; Erythrocyte Use: A red blood cell count measures the number of red blood cells, and is used to diagnose anemia and other conditions affecting red blood cells. The red blood cell count is also useful in individuals with symptoms of problems with red blood cell production, including fatigue and paleness. Limitations: Cold agglutinins and rare warm agglutinins causes decreased RBC counts. Increased white cell counts may cause falsely elevated RBC counts. Additional Information: A recent blood transfusion can affect red blood cell counts, as can pregnancy. Individuals who live at higher elevations may have higher red blood cell counts, and women have lower red blood cell counts than men. Hematocrit: Synonyms: Hct Use: The hematocrit test measures the fraction of blood comprised of red blood cells, and is used to screen for, diagnose and monitor conditions that affect the number and size of red blood cells. These conditions include anemia, leukemia or a deficient diet. The hematocrit test may also be used to evaluate dehydration. Limitations: Cold agglutinins and rare warm agglutinins may cause decreased hematocrit values. Additional Information: Hematocrit results can be affected by recent transfusions and during pregnancy. Hemoglobin: Synonyms: Hb; Hgb Use: The hemoglobin test is useful for identifying individuals with conditions affecting red blood cells, or individuals with symptoms including weakness, fatigue or shortness of breath. It can also be used to monitor the efficacy of treatment for anemia.

3 Limitations: An extremely elevated white blood cell count may cause an increased hemoglobin value. Abnormal paraproteins found in multiple myeloma patients, lipemia or severely icteric samples can falsely increase hemoglobin results. Hemoglobin S, C and F, or hereditary or acquired spherocytosis may cause an increase in hemoglobin values. Removal of plasma from a sample will cause falsely elevated hemoglobin results. Additional Information: Hemoglobin levels can be affected by recent transfusions, and are slightly lower during pregnancy. MCV: Synonyms: Mean Cell Volume Use: The MCV test measures the average red blood cell size, and is used to determine the presence and cause of anemias, such as microcytic anemia or macrocytic anemia. Limitations: Red cell agglutination or a severely elevated white cell count may cause falsely increased MCV values. Additional Information: A recent blood transfusion can affect the reported MCV. MCH: Synonyms: Mean Cell Hemoglobin Use: The MCH test measures the amount of hemoglobin in red blood cells and is another measure of cell size. The MCH test is used to determine the presence and cause of anemias, such as normochromic anemia or hyperchromic anemia. Limitations: An extremely elevated white blood cell count may cause an increased MCH value. Abnormal paraproteins found in multiple myeloma patients, lipemia or severely icteric samples can falsely increase MCH results. Cold agglutinins and rare warm agglutinins cause elevated MCH results. Hemoglobin S, C and F, or hereditary or acquired spherocytosis may cause an increase in MCH values. Additional Information: Anemias are defined on the red blood cell size (MCV) and the amount of hemoglobin (MCH) in each cell. MCHC: Synonyms: Mean Cell Hemoglobin Concentration Use: The MCHC test measures the amount of hemoglobin relative to the cell size per cell. This test can be used to help identify the cause of anemia, including genetic anemias such as

4 hereditary spherocytosis, and to monitor disease progression and treatment. Limitations: An extremely elevated white blood cell count may cause an increased MCHC value. Abnormal paraproteins found in multiple myeloma patients, lipemia or severely icteric samples can falsely increase MCHC results. Cold agglutinins and rare warm agglutinins cause an elevated MCHC results. Hemoglobin S, C and F, or hereditary or acquired spherocytosis may cause an increase in MCHC values. Additional Information: The MCHC test can be affected by certain medications, such as hydroxocobalamin. Cellular dehydration can also result in elevated concentrations. RDW: Synonyms: RBC Distribution Width Use: The RDW test measures the variation in red blood cell size within a blood sample, and may indicate the presence of immature and mature red blood cells. The RDW can be used, along with the mean corpuscular volume to identify the presence and cause of anemia. Limitations: Alcohol abuse can lead to an increased RDW while rheumatoid arthritis can lead to a decreased RDW. Platelet Count: Synonyms: Plt; Thrombocyte Use: A platelet count is used to identify the cause of excess bleeding, and for the diagnosis of a number of conditions, including bone marrow disease or clotting disorders. Limitations: Megakaryocytes, giant platelets, clumped platelets or platelet satellitism may falsely decrease the platelet count. Fibrin clots may affect the platelet count. Elevated platelet levels may occur after splenectomy. Additional Information: A platelet count may be performed on samples collected from sodium citrate anticoagulant tubes (light blue top) when results from EDTA (purple top) exhibit platelet clumping or platelet satellitism. MPV: Synonyms: Mean Platelet Volume Use: The MPV test measures the size of the platelets in the blood, and is used to diagnose diseases that affect platelet production or destruction, such as thrombocytosis or chronic myelogenous leukemia.

5 Limitations: Fibrin clots may affect results. White Blood Cell Count: Synonyms: WBC; Leukocyte Count Use: The WBC is used to diagnose and monitor infections or inflammatory processes, as well as screen for a number of diseases, including leukemia and lymphoma. The test can also be used to monitor bone marrow function. Limitations: Megakaryocytes, giant platelets, clumped platelets or platelet satellitism may falsely elevate the white blood cell count. Hemoglobin S, C and F, or hereditary or acquired spherocytosis may cause an increase in the WBC values. Abnormal proteins as seen in multiple myeloma and Waldenstrom s macroglobulinemia may falsely increase the WBC count. Fibrin clots may affect the white cell counts. Additional Information: The WBC may be affected by age and sex, as well as certain medications. In addition, individuals who have undergone splenectomy may have slightly elevated white blood cell counts. Neutrophil: Synonyms: Neut; % Neutrophil; Absolute Neutrophil Count Use: The neutrophil count is the absolute number of neutrophils among all white blood cells. A neutrophil count may be ordered to identify the presence and cause of an infection. The neutrophil count can be used to monitor the bone marrow during and after chemotherapy, radiation treatment or bone marrow transplantation. Limitations: The neutrophil count may be elevated in individuals under stress, those with certain types of sudden kidney failure, eclampsia or cancer metastasis and in individuals taking medications including corticosteroids and lithium carbonate. Lymphocyte: Synonyms: Lymph; % Lymphocyte; Absolute Lymphocyte Count Use: A lymphocyte count can be used to diagnose infections, leukemias and lymphomas, and autoimmune conditions resulting in chronic inflammation. A lymphocyte count may also be used to aid in the diagnosis of acquired or hereditary lymphocytopenias, including AIDS and severe combined immunodeficiency syndrome. Limitations: Long term exposure to toxic chemicals may affect the lymphocyte count.

6 Monocyte: Synonyms: Mono; % Monocyte; Absolute Monocyte Count Use: The monocyte count is used to diagnose infections, particularly chronic infections such as tuberculosis or infections of the heart, and collagen vascular diseases, as well as leukemias and bone marrow damage or failure. Limitations: Long term exposure to toxic chemicals may affect the lymphocyte count. Eosinophil: Synonyms: Eos, % Eosinophil, Absolute Eosinophil Count Use: The eosinophil count can aid in the diagnosis of allergies, inflammatory disorders, particularly those of the skin and the digestive tract, drug reactions, certain types of cancer and parasitic infections. Limitations: Eosinophil values increase with allergy and some parasitic conditions. They decrease with steroid administration. Additional Information: The eosinophil count is used to confirm, and not make, a diagnosis. Basophil: Synonyms: Baso, % Basophil; Absolute Basophil Count Use: A basophil count may be used to diagnose allergic disorders, hematologic disorders, certain malignancies and parasitic infections. Limitations: Basophil value increases in myeloproliferative diseases and in response to the healing phase of inflammation. Values decrease in severe allergic reactions. Reference Range: Test Age/Gender Reference Range Red Blood Cell Count 0-1 month M/uL 2-6 months M/uL 7 months-2 years M/uL 3-6 years M/uL 7-12 years M/uL years, Female M/uL years, Male M/uL 56 years, Female M/uL 66 years, Male M/uL

7 Hematocrit 0-1 month % 2-6 months % 7 months-2 years % 3-6 years % 7-12 years % years, Female % years, Male % 56 years, Female % 66 years, Male % Hemoglobin 0-1 month g/dl 2-6 months g/dl 7 months-2 years g/dl 3-6 years g/dl 7-12 years g/dl years, Female g/dl years, Male g/dl 56 years, Female g/dl 66 years, Male g/dl MCV 0-1 month fl 2-6 months fl 7 months-2 years fl 3-6 years fl 7-12 years fl 13 years, Female fl 13 years, Male fl MCH 0-1 month pg 2-6 months pg 7 months-2 years pg 3-6 years pg 7-12 years pg 13 years, Female pg 13 years, Male pg MCHC 0-1 month g/dl 2-6 months g/dl 7 months-2 years g/dl 3-6 years g/dl 7-12 years g/dl 13 years, Female g/dl RDW 13 years, Male g/dl 0-12 years, Female % 13 years, Female % All Ages, Male % Platelet All Ages K/uL MPV All Ages fl White Blood Cell Count 0-1 month K/uL 2-6 months K/uL 7 months 2 years K/uL 3-6 years K/uL 7-12 years K/uL Neutrophil % Neutrophil Absolute Lymphocyte % 13 years K/uL 0-12 years % 13 years % 0-12 years K/uL 13 years K/uL 0-12 years % 13 years %

8 Lymphocyte Absolute 0-12 years K/uL 13 years K/uL Monocyte % All Ages % Monocyte Absolute All Ages K/uL Eosinophil % All Ages % Eosinophil Absolute 0-12 years K/uL 13 years K/uL Basophil % All Ages % Basophil Absolute All Ages K/uL Critical Values: Test Age Critical Value Hematocrit All Ages 20% Hemoglobin 2 years old 6.0 g/dl, 20.0 g/dl Absolute Neutrophils All Ages 0.5 K/µL Platelet Count All Ages 40 K/µL, 1000 K/µL White Blood Count 2-11 years old 40 K/µL White Blood Count 12 years old 50 K/µL Urgent Values: Test Age Urgent Value Hematocrit All Ages % Hemoglobin 2 years old g/dl

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