Complete Blood Count (CBC)
- Also Known As:
- Complete Blood Count With Differential
- CBC With Diff
- Full Blood Count
- Blood Cell Count
Test Quick Guide
The complete blood count, also known as the CBC, is an essential comprehensive blood panel that allows your doctor to evaluate each type of cell in your blood.
The CBC measures the amount of red blood cells (RBC), white blood cells (WBC), and platelets (PLT). Each of these types of blood cells performs important functions, so determining their levels can provide important health information.
A CBC may be used to help diagnose a range of health conditions and also monitor how the body is affected by different diseases or medical treatments.
About the Test
Purpose of the test
The purpose of a complete blood count is to give your health care provider details about the state of your health. It is an important medical tool because it uses one sample to analyze the complete spectrum of cells found in the blood as well as some of the characteristics of those cells.
Because it provides information about every type of cell in the blood, the CBC can provide information related to a wide variety of medical problems.
The primary uses for the CBC are diagnosis, monitoring, and screening:
- Diagnosis is determining the cause of a patient’s symptoms. The CBC can identify many different abnormalities in the blood that can be linked to distinct medical problems. For this reason, the CBC is frequently used as a diagnostic test. In many cases, it can confirm or rule out certain conditions and may be used alongside other tests to arrive at a definitive diagnosis.
- Monitoring is the process of following a patient’s condition over time. A CBC can be used to monitor patients who have previously been diagnosed with blood disorders. It can help see how a person’s condition has responded to treatment, and it may be used to watch for side effects of some medical treatments.
- Screening is testing to find health problems before there are any symptoms. In some cases, a doctor may prescribe a CBC as a screening test during routine check-ups.
What does the test measure?
A CBC involves multiple measurements that include the number of blood cells and some of their physical features. A standard CBC includes several elements related to red blood cells, white blood cells, and platelets that are described in the following sections.
Red blood cell measurements
Red blood cells (RBCs) are also called erythrocytes. They carry oxygen from your lungs to the tissues and organs in your body. A CBC test includes several basic measurements of RBCs:
- RBC count is the total number of red blood cells in your blood sample.
- Hemoglobin measures the amount of this oxygen-carrying protein that is found inside RBCs.
- Hematocrit measures the proportion of your total blood volume that consists of red blood cells.
A CBC also provides details about the physical features of red blood cells. These are known as RBC indices. There are several kinds of RBC indices:
- Mean corpuscular volume (MCV) is a measurement of the average size of red blood cells.
- Mean corpuscular hemoglobin (MCH) is the average amount of hemoglobin inside each red blood cell.
- Mean corpuscular hemoglobin concentration (MCHC) is a calculated measurement of how concentrated hemoglobin is within red blood cells.
- Red cell distribution width (RDW) is a measurement of the variation in the size of your red blood cells.
The CBC may include the reticulocyte count, which is the total number of newly released young red blood cells in your blood sample. It may also be measured as a percentage.
White blood cell measurements
White blood cells (WBCs) are also called leukocytes. They are an important part of the body’s immune system.
A standard CBC measures the WBC count, which is the total number of white blood cells in a sample of blood.
A common variation of the CBC is the complete blood count with differential. The white blood cell differential is a breakdown of the amount of each of five different types of WBCs:
- Neutrophils: Neutrophils make up the greatest percentage of WBCs and are produced by the bone marrow to fight a diverse array of inflammatory and infectious diseases.
- Lymphocytes: Lymphocytes such as B-cells and T-cells are found primarily in the lymph system and fight bacteria and other pathogens in the blood.
- Monocytes: Monocytes work in conjunction with neutrophils to combat infections and other illnesses while removing damaged or dead cells.
- Eosinophils: Eosinophils are WBCs that are activated in response to allergies and some types of infections.
- Basophils: Basophils are involved in early identification of infections as well as wound repair and allergic reactions.
Initial blood testing may include a CBC with differential, or this test may be done after an initial standard CBC was abnormal. Because each white blood cell type has a different function, the CBC with differential can be used to identify abnormal levels of specific WBCs, which may offer clues about an underlying health concern.
Platelets, also called thrombocytes, are cell fragments that circulate in blood and play an essential role in blood clotting. When there is an injury and bleeding begins, platelets help stop bleeding by sticking to the injury site and clumping together to form a temporary plug.
A standard component of the CBC is the platelet count, which is the number of platelets in your blood sample.
In some cases, your doctor may have the laboratory also measure the mean platelet volume (MPV), which determines the average size of platelets.
When should I get a complete blood count?
The CBC is a very common test. You may have a CBC performed when you have a routine health examination, when you are being diagnosed or assessed for a disease or condition, or when your provider is monitoring the effectiveness of a treatment.
Because blood counts can be affected by a diverse range of health conditions, the CBC may be recommended by your doctor to help identify the cause of many different kinds of symptoms. Your health care provider is in the best position to address whether a CBC is appropriate in your specific situation.
Finding a Complete Blood Count Test
How to get tested
A complete blood count requires a needle blood draw and is most commonly conducted by a licensed professional in a health care setting like a hospital or doctor’s office.
Can I take the test at home?
There are few options available for at-home CBC testing. At-home test kits involve a fingerstick, which means that you prick your finger with a small needle to produce a drop of blood. That blood is applied to a special test paper and is then sent to a lab.
After the lab is done analyzing the blood, it provides results either online or through a smartphone app. Results usually take 2-3 days after the sample is received.
These at-home tests do not provide a diagnosis or confirm a specific illness or disease. Diagnosis and disease confirmation can only be provided by a doctor. For this reason, it is important to talk to a doctor before and after taking an at-home blood count test.
How much does the test cost?
The cost of a complete blood count depends on several factors, including whether or not the patient is paying out of pocket or has health insurance. Because the CBC is common and has many uses, the cost is often covered by insurance. However, there may still be charges for copays and deductibles.
Talk to your doctor or insurance provider for specific details about expected costs for a complete blood count. If you do not have insurance, a hospital or laboratory administrator may be able to provide information about typical costs for uninsured patients.
Taking a Complete Blood Count Test
The complete blood count is ordered and conducted by a licensed professional. The blood sample is drawn from a vein, usually on the inside of your elbow.
Before the test
Unless specified by your provider, there is no special preparation required before a complete blood count.
In some instances, a complete blood count is done along with other blood tests. When you are getting more than one blood test, your provider may ask you to not eat anything for a certain amount of time prior to your test.
If you have questions or concerns about any test preparation, contact your health care provider for specific instructions.
During the test
There are several steps that you can expect during a needle blood draw for a CBC:
- An antiseptic alcohol wipe is used to cleanse your arm in the area that needle will be inserted. This is most often either inside the elbow or at the top of the hand.
- To make the vein in your arm more visible and easier to access with a needle, a band, called a tourniquet, is tied around your upper arm.
- A needle is placed in your vein, and a test tube attached to the needle is filled with blood. When the needle is inserted there may be a pinch or a little pain.
- After the test tube or vial is filled, the needle is removed, and the test is over.
After the test
After the needle is removed, a bandage will be placed over the puncture site.
Slight bruising is a common side effect after any blood draw while dizziness, or lightheadedness are less common. Your provider may have you stay for a few minutes after the blood draw to monitor you until they are sure you are safe to walk and/or drive.
If you notice any other effects or signs of bleeding or infection after your blood draw, it is important to promptly contact your health care provider.
Complete Blood Count Test Results
Receiving test results
Depending on the laboratory equipment that is used, the results from a CBC can be available in a few minutes to a few days after the blood sample arrives at the laboratory. You may receive a copy of your results by mail or through an electronic health portal. Your doctor may also call you to discuss the results or to schedule an appointment to review them together.
The results from a CBC test will include separate levels listed for each component of the test including red blood cells, white blood cells, and platelets.
For each test component, the report will also show a reference range. The reference range defines what the laboratory that performed the test considers normal. These ranges, which can vary from lab to lab, are based on the results of a large sample of healthy people and help your doctor determine typical and atypical blood levels.
It is essential to talk with your doctor about the significance of your CBC test results. Your doctor will review your levels and how they compare to the laboratory’s reference ranges. They may also look at the relationships between your different blood levels and will consider your current symptoms and health history.
The following sections describe some potential causes of high or low levels of RBCs, WBCs, or platelets, but it is important to remember that an abnormal test result is not always a sign of a medical problem. Some healthy people may have blood counts that fall outside the standard reference range.
Red blood cell measurements
Red blood cells carry oxygen through the body, and the RBC count shows the total number of RBCs found in your blood. Hematocrit and hemoglobin are other measures related to red blood cells.
Anemia is a condition marked by low levels of RBCs. There are many potential causes of abnormally low levels of RBCs, hematocrit, and/or hemoglobin, including:
- Excessive acute or chronic bleeding
- Destruction of RBCs, such as in a condition called hemolytic anemia
- Disorders that affect the bone marrow, which produces new RBCs
- Nutritional deficiencies such as low iron, folate, or vitamin B12
- Some types of cancer and cancer treatment
- Chronic illnesses involving inflammation or disrupted organ function
High levels of RBCs, hematocrit, and/or hemoglobin can also have a number of possible causes. Examples include:
- Heart or lung disease that reduces oxygen levels
- Certain kinds of kidney diseases
- Cigarette smoking
- Polycythemia vera, a rare disease causing overproduction of RBCs
In many cases, the CBC will include a set of measurements known as RBC indices that include the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and the mean corpuscular hemoglobin concentration (MCHC). These indices can help distinguish between the most likely causes of anemia.
Red blood cell counts are influenced by many different systems of the body, and sometimes abnormal levels are related to more than one factor. Your health care provider is in the best position to explain what the red blood cell measurements on your CBC mean for your health.
White blood cell counts
White blood cells are the main players of the immune system, and the WBC count is the sum total of five different kinds of white blood cells that each play a role in immune function.
A low level of WBCs is known as leukopenia. Some of the possible causes of leukopenia include:
- Liver damage, including from alcohol abuse
- Severe infections
- An enlarged or damaged spleen
- Autoimmune diseases
- Conditions that disrupt bone marrow function
- Certain medications, including many chemotherapies for cancer
Having too many white blood cells is known as leukocytosis. Excess WBCs may be related to several potential causes:
- Tissue death from injury, burns, or other physical trauma
- Allergies and autoimmune conditions
- Some medications
- Leukemia and some other cancers
If you have a CBC with WBC differential, your test report will show the specific levels of each kind of WBC. These are known as neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Knowing the counts of each specific type of white blood cell can provide more detailed information that can help your doctor interpret the findings of your CBC.
Platelets are responsible for clotting the blood. Abnormal platelet function can mean that you bleed too easily because your blood doesn’t clot properly, or it can mean that your blood is prone to excess clotting.
A low platelet count is called thrombocytopenia, and it puts you at risk of excess bleeding or bruising. Possible causes of a low platelet count include:
- Blood disorders that cause platelet destruction
- Some medications, including many chemotherapies
- An enlarged spleen
- Damage to the bone marrow
Having too many platelets is called thrombocytosis, and it is associated with a higher risk of cardiovascular complications from blood clots. Abnormally high platelet counts may be caused by several conditions including:
- Iron deficiency
- Some cancers
- Bone marrow dysfunction
- Recent infection or other tissue trauma
The test may also measure the mean platelet volume (MPV), which is the size of your platelets. The MPV level can help your doctor understand how rapidly your body is producing new platelets.
Are test results accurate?
The complete blood count is one of the most common and useful blood tests, and modern laboratory methods make it generally accurate and precise.
However, no tests are perfect. Because the CBC is comprehensive and because many factors can influence blood counts, it is possible to have abnormal results on a CBC that don’t necessarily mean that you have a health problem.
You can talk with your health care team to learn more about the accuracy and significance of a CBC test in your specific case.
Do I need follow-up tests?
Abnormal complete blood count test results may require additional follow-up testing. Your blood affects every part of your body, and many health conditions can cause changes in your blood counts.
As a result, further tests may be needed to learn more about the cause of an abnormal CBC. Additional blood testing, other laboratory tests, and imaging tests may all be considered based on the outcome of your initial CBC.
Follow-up testing is tailored to your situation and based on your symptoms, medical history, and the results of other tests. For questions about follow-up testing, make sure to speak with your health care provider.
Questions for your doctor about test results
Examples of questions that you can ask your doctor to learn more about your CBC test results include:
- What does my complete blood count indicate about my health?
- Were any results from the test abnormal? If so, which levels were abnormal?
- Are there any diagnoses to be made based on my complete blood count results?
- Will any follow up tests be needed based on my CBC results?
- Given my CBC results, is there anything that you would suggest I do to improve my health?
Complete blood count testing in children
CBC tests in adults and children are similar, but there are a few notable differences.
In infants, a blood sample may be taken by pricking their heel with a tiny needle instead of trying to draw blood from a vein.
In addition, many of the test results from a CBC may be interpreted differently based on a patient’s age. For that reason, it is important to know that the doctor may adjust the reference range listed by the laboratory to match the age of a child.
Complete blood count vs. complete blood count with differential
In the most basic version of the complete blood count, the only measurement of white blood cells is the total WBC count. In contrast, the CBC with differential specifically counts the number of each type of white blood cells in addition to the total amount of WBCs.
The five white blood cell types that are counted in the complete blood count with differential are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The purpose of the CBC with differential is to give your doctor greater insight into the health and function of your immune system.
Sometimes health care providers and laboratories will include the complete blood count with differential automatically, so having this test does not necessarily mean that there was anything abnormal in your blood work.
Complete blood count vs. reticulocyte count
The reticulocyte count is a test that may be ordered in addition to your complete blood count. Reticulocytes are a kind of immature red blood cell, and a reticulocyte count measures the amount of these cells in the blood.
While a standard CBC determines the amount of total RBCs, a reticulocyte count test helps assess whether new red blood cells are being produced at a normal rate.
Including a reticulocyte count in your blood work can serve multiple purposes including helping to distinguish between various causes of anemia, identify conditions affecting the liver or kidney, monitor side effects of certain treatments like chemotherapy on your bone marrow function, and evaluate how well treatments for anemia and other conditions are working.
Complete blood count vs. a red blood cell distribution width (RDW) test
The red blood cell distribution width (RDW) test may be ordered as an addition to the standard complete blood count. RDW analyzes the variation in the size of your red blood cells. Learning about the sizes of RBCs can provide relevant information when detecting various blood disorders like anemia as well as a number of other kinds of health conditions.
A.D.A.M. Medical Encyclopedia. Neutropenia – infants. Updated October 2, 2019. Accessed September 27, 2021. https://medlineplus.gov/ency/article/007230.htm
A.D.A.M. Medical Encyclopedia. RBC indices. Updated January 13, 2020. Accessed October 26, 2021. https://medlineplus.gov/ency/article/003648.htm
A.D.A.M. Medical Encyclopedia. Reticulocyte count. Updated January 13, 2020. Accessed October 1, 2021. https://medlineplus.gov/ency/article/003637.htm
A.D.A.M. Medical Encyclopedia. Anemia. Updated February 6, 2020. Accessed September 27, 2021. https://medlineplus.gov/ency/article/000560.htm
A.D.A.M. Medical Encyclopedia. Lymph system. Updated August 13, 2020. Accessed September 27, 2021 https://medlineplus.gov/ency/article/002247.htm
A.D.A.M. Medical Encyclopedia. CBC blood test. Updated October 16, 2020. Accessed October 26, 2021. https://medlineplus.gov/ency/article/003642.htm
A.D.A.M. Medical Encyclopedia. Platelet count. Updated January 19, 2021. Accessed October 26, 2021. https://medlineplus.gov/ency/article/003647.htm
A.D.A.M. Medical Encyclopedia. White blood cell count – series—indication. Updated January 19, 2021. Accessed September 27, 2021.
American Board of Internal Medicine. ABIM Laboratory Test Reference Ranges. Updated July 2021. Accessed September 27, 2021. https://www.abim.org/Media/bfijryql/laboratory-reference-ranges.pdf
American Cancer Society. Low red blood cell counts (anemia). Updated February 1, 2020. Accessed September 27, 2021. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/anemia.html
American Cancer Society. Low white blood cell counts (neutropenia). Updated February 1, 2020. Accessed September 27, 2021.
American Society of Clinical Oncology. Understanding your complete blood count (CBC) tests. Updated June 2019. Accessed September 27, 2021.
Arnold DM, Cuker A. Diagnostic approach to the adult with unexplained thrombocytopenia. In: Leung LLK, ed. UpToDate. Updated May 18, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/diagnostic-approach-to-the-adult-with-unexplained-thrombocytopenia
Berliner N. Approach to the adult with pancytopenia. In: Newburger P, ed. UpToDate. Updated October 1, 2019. Accessed September 27, 2021. https://www.uptodate.com/contents/approach-to-the-adult-with-pancytopenia
Berliner N. Lab interpretation: Abnormal white blood cell count in adults. In: Newburger P, ed. UpToDate. Updated May 18, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/abnormal-white-blood-cell-count-in-adult
Berliner N. Lab interpretation: Low neutrophils in adults. In: Newburger P, ed. UpToDate. Updated July 27, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/low-neutrophils-in-adults
Braunstein EM. Evaluation of anemia. Merck Manuals Professional Edition. Updated September 2020. Accessed October 26, 2021. https://www.merckmanuals.com/en-ca/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/evaluation-of-anemia
Bush LM. Defense against infection. Merck Manuals Consumer Edition. Updated July 2020. Accessed September 27, 2021. https://www.merckmanuals.com/home/infections/biology-of-infectious-disease/defenses-against-infection
Camaschella C. Microcytosis/microcytic anemia. In: Mentzer M, Means R, eds. UpToDate. Updated April 10, 2020. Accessed September 27, 2021. https://www.uptodate.com/contents/microcytosis-microcytic-anemia
Coates T. Congenital neutropenia. In: Newburger P, ed. UpToDate. Updated June 1, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/congenital-neutropenia
Davids M. Approach to the adult with lymphocytosis or lymphocytopenia. In: Newburger P, ed. UpToDate. Updated May 11, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/approach-to-the-adult-with-lymphocytosis-or-lymphocytopenia
Davidson MH. Overview of allergic and atopic disorders. Merck Manuals Professional Edition. Updated December 2019. Accessed September 27, 2021. https://www.merckmanuals.com/professional/immunology-allergic-disorders/allergic,-autoimmune,-and-other-hypersensitivity-disorders/overview-of-allergic-and-atopic-disorders
Eyth E, Naik R. Hemoglobin A1C. In: StatPearls. Updated April 5, 2021. Accessed October 27, 2021. https://www.ncbi.nlm.nih.gov/books/NBK549816/
Feller-Kopman D, Schwartzstein RM. The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure. In: Stoller JK, ed. UpToDate. Updated October 1, 2019. Accessed September 27, 2021. https://www.uptodate.com/contents/the-evaluation-diagnosis-and-treatment-of-the-adult-patient-with-acute-hypercapnic-respiratory-failure
George T. Automated hematology instrumentation. In: Uhl L, ed. UpToDate. Updated June 3, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/automated-hematology-instrumentation
Kovtun A, Messerer DAC, Scharffetter-Kochanek K, Huber-Lang M, Ignatius A. neutrophils in tissue trauma of the skin, bone, and lung: Two sides of the same coin. J Immunol Res. 2018;2018:8173983. Published 2018 Apr 23. doi:10.1155/2018/8173983
Kuter DJ. Overview of platelet disorders. Merck Manuals Consumer Edition. Updated July 2020. Accessed September 27, 2021. https://www.merckmanuals.com/home/blood-disorders/platelet-disorders/overview-of-platelet-disorders
Leisveld J. Polycythemia vera. Merck Manuals Consumer Edition. Updated September 2020. Accessed September 27, 2021. https://www.merckmanuals.com/home/blood-disorders/myeloproliferative-disorders/polycythemia-vera
Leukemia and Lymphoma Society. Understanding blood counts.. Date unknown. Accessed September 27, 2021. https://www.lls.org/treatment/lab-and-imaging-tests/understanding-blood-counts
Leung LLK. Overview of homeostasis. In: Mannucci PM, ed. UpToDate. Updated October 1, 2019. Accessed September 27, 2021. https://www.uptodate.com/contents/overview-of-hemostasis
Likic R, Kuzmanic D. Severe thrombocytopenia as a complication of acute Epstein-Barr virus infection. Wien Klin Wochenschr. 2004;116(1-2):47-50. doi:10.1007/BF03040424
Means R, Brodsky R. Diagnostic approach to anemia in adults. In: Mentzer W, ed. UpToDate. Updated June 10, 2021. Accessed September 27, 2021. https://www.uptodate.com/contents/diagnostic-approach-to-anemia-in-adults
MedlinePlus: National Library of Medicine. MPV blood test. Updated July 31, 2020. Accessed September 27, 2021. https://medlineplus.gov/lab-tests/mpv-blood-test/
MedlinePlus: National Library of Medicine. Blood disorders. Updated September 23, 2021. Accessed September 27, 2021. https://medlineplus.gov/blooddisorders.html
National Cancer Institute. Bleeding and bruising (thrombocytopenia) and cancer treatment. Updated September 14, 2018. Accessed September 27, 2021. https://www.cancer.gov/about-cancer/treatment/side-effects/bleeding-bruising
National Cancer Institute. CBC with differential. Date Unknown. Accessed September 27, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cbc-with-differential
National Cancer Institute. Red blood cell. Date Unknown. Accessed September 27, 2021. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/red-blood-cell
National Heart, Lung, and Blood Institute. Blood tests. Date unknown. Accessed September 12, 2021. https://www.nhlbi.nih.gov/health-topics/blood-tests
Kumar KP, Nicholls AJ, Wong CHY. Partners in crime: neutrophils and monocytes/macrophages in inflammation and disease. Cell Tissue Res. 2018;371(3):551-565. doi:10.1007/s00441-017-2753-2
Rai D, Wilson AM, Moosavi L. Histology, reticulocytes. In: StatPearls. Updated February 19, 2021. https://www.ncbi.nlm.nih.gov/books/NBK542172/
Tefferi A. Approach to the patient with thrombocytosis. In: Leung LLK, ed. UpToDate. Updated October 2, 2020. Accessed September 27, 2021. https://www.uptodate.com/contents/approach-to-the-patient-with-thrombocytosis
Tefferi A. Diagnostic approach to the patient with polycythemia. In: Larson R, ed. UpToDate. Updated October 2 2020. Accessed September 27, 2021. https://www.uptodate.com/contents/diagnostic-approach-to-the-patient-with-polycythemia
Territo M. Basophilic disorders. Merck Manuals Consumer Edition. Updated August 2021. Accessed September 27, 2021. https://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/lymphocytopenia
Territo M. High white blood cell count (leukocytosis). Merck Manuals Consumer Edition. Updated August 2021. Accessed September 27, 2021. https://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/high-white-blood-cell-count
Territo M. Lymphocytopenia. Merck Manuals Consumer Edition. Updated August 2021. Accessed September 27, 2021. https://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/monocyte-disorders
Weller P, Klion A. Approach to the patient with unexplained eosinophilia. In: Newburger P, ed. UpToDate. Updated October 1, 2019. Accessed September 27, 2021. https://www.uptodate.com/contents/approach-to-the-patient-with-unexplained-eosinophilia
Witter AR, Okunnu BM, Berg RE. The essential role of neutrophils during infection with the intracellular bacterial pathogen listeria monocytogenes. J Immunol. 2016;197(5):1557-1565. doi:10.4049/jimmunol.1600599