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Blood counts explained


Blood count numbers and what they mean

Normal or reference ranges are simply calculated from the range of values of various samples of the healthy population. Different labs sometimes use slightly different reference ranges so if the reference range on your lab work report are not identical do not let that alarm you. Be sure that you check the measurement units as well as the reference range. Most labs will use metric units, but even with standard metric units there will be differences due to counting by millions, or billions.

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Complete Blood Count

Red Blood Count

Red Blood Count (RBC) is the count of red blood cells These cells carry oxygen throughout the body. Normal RBC values for men are higher than for women and range from 3.6 to 6.1 million per cubic millimetre. Too many RBCs (or platelets) in the bloodstream may cause slow blood flow and compromise circulation. A low RBC may signify anaemia, a shortage of red blood cells, or haemoglobin the oxygen- carrying part of the RBC; this usually reflects underproduction or premature destruction of the cells. 


Haemoglobin (HGB) is a protein that enables RBCs to carry oxygen from the lungs to the rest of the body. The amount of haemoglobin determines how much oxygen the RBCs are capable of carrying to other cells. Normal haemoglobin levels for adult males range from 130 to 180 grams per litre for men and approximately 120 to 160 grams for women. Levels for children vary with age but are generally 1 to 2 grams lower than adult female values. Smokers often show an increase in their haemoglobin level. Epogen is an injectable drug that stimulates the production of red cells. It is used in anaemic patients to reduce the frequency of transfusions.


Hematocrit (HCT) is the volume of red blood cells expressed as a percentage of the total blood volume. If you spin a sample of blood so that the cells settle to the bottom of the tube, the percentage of volume occupied by the cells alone is called the "hematocrit". The hematocrit shows the oxygen-carrying capacity of the blood. This value also tells whether the blood is too thick or too thin. The average range is 40%-54% in adult males and 37%-47% in adult females. As a general rule, the hematocrit value is approximately three times the haemoglobin value, and doctors will refer to either of the values interchangeably.

Mean Corpuscular Volume

Mean Corpuscular Volume (MCV) is the average volume of the individual red blood cells. MCV is calculated by dividing the hematocrit by the total RBCs. The average range is 78-96 femtoliters. A low MCV indicates the cells are smaller than normal. This most commonly occurs because of an iron deficiency or chronic disease and may also happen if there is a Vitamin B12 deficiency.

Mean Corpuscular Haemoglobin

Mean Corpuscular Haemoglobin (MCH) and Mean Corpuscular Haemoglobin Concentration (MCHC) are measures of the amount and volume of haemoglobin in the average cell. The MCH average range is 28-32 picograms. The MCH results from dividing total hemogloblin by total RBCs. The average range for MCHC is 310-360 g/l.


Platelets (PLT or PT) are important for clotting, and are formed in the marrow. Low counts of platelets is called thrombocytopenia, and is quite common during chemotherapy. During thrombocytopenia the risk of bleeding and bruising is higher. Dangerously low platelet counts (<10; 10^9 / Litre )can put the patient at risk for brain Haemorrhages. High levels of platelets can cause circulation problems as the blood becomes too "thick".

White Blood Count

White Blood Cell Count (WBC) is the count of white blood cells called leukocytes. WBCs defend the body against infection and make up part of the immune system. Like other blood cells they are produced in the bone marrow. The total number of white blood cells has a wide range from 4,000 to 11,000 per cubic millimeter in the average healthy adult. While it can mean many things, a high WBC may mean you are fighting an infection, or that your immune system has been activated for some other reason. A low WBC might mean there is a problem with production in the bone marrow, which could be the result of various chronic diseases. It can also be a side effect of various different drugs, particularly chemotherapeutic drugs for cancer treatment. 


CBC Differential is a breakdown of the different types of white blood cells and is usually expressed as a percentage of total WBCs. Multiplying these percents by the total WBCs gives the "absolute" counts. For example, if the percent of lymphocytes is 30% and the total WBCs is 10,000, the absolute lymphocyte count is 3,000.


Neutrophils are WBCs involved in fighting bacterial infections, and they are the most common of all the white blood cells.  With a lifespan of just about 8 hours your body has to produce about 5 billion neutrophils every hour of the day. Neutropenia is a drop in the absolute neutrophil count to below 1000 and places the patient at increased risk of infection and is defined as follows.

  • Neutropenia in general = ANC < 2000 (slight risk of infection) 
  • Mild Neutropenia = ANC > 1000 & < 1500 (minimal risk of infection) 
  • Moderate Neutropenia = ANC > 500 & < 1000 (moderate risk of infection) 
  • Severe Neutropenia = ANC < 500 (severe risk of infection)


Lymphocytes  (lymphs), the second most common type, are cells that produce antibodies, regulate the immune system, and fight viruses and tumors. Ranges vary from 10%-45%.


Monocytes or Macrophages (Monos) are WBCs involved in fighting bacterial infections. After monocytes circulate in the blood stream, these cells settle in various tissues and become macrophages. 


Eosinophils  (Eos) are WBCs usually involved in allergic-type and parasitic reactions. The make up only a very small portion of the WBC.


Basophils (Bas) are WBCs usually involved in fighting parasitic infections. Increases reflect a possibility of parasitic activity in the body. If you have an abnormal basophil count and are experiencing diarrhea, loose stools, gas or stomach bloating, you may want to ask your doctor to be tested for parasites. Basophils are the least common of the WBC's and a count of zero is quite normal. 

Chemistry (Chem) Screen


Calcium is the mineral which carries protein across the intestinal membrane. Therefore calcium represents the primary protein and fat digestion in the gut. Poor digestion here will affect further digestion in the liver. Increased calcium indicates poor emulsification (the breakdown of larger fat molecules into much smaller ones so they will become water soluble and therefore easily processed and eliminated from the body after use), and therefore improper protein digestion at the liver. Gallbladder function may be involved. Decreased calcium indicates poor enzymation (down translate) of fatty acids and improper protein digestion to the liver.


Phosphorous is the mineral which carries whole carbohydrates to the liver. The proper bowel pH (acid/alkaline balance) is needed for complete digestion, storage, and utilization of carbohydrates. Increased phosphorous indicates an alkaline gut; i.e., a deficiency of hydrochloric acid (HCL).  Carbohydrates are oxidized and energy is wasted. Decreased phosphorous indicates an over-acid condition in the gut and carbohydrate congestion in the liver.


Glucose is sugar in the blood, most commonly used to monitor the disease diabetes mellitus.

Sodium, Potassium, and Chloride

These are also known as electrolytes. These must be monitored carefully in dehydration, kidney disease, and during intravenous therapy.


Sodium levels reflect the salt/water balance as well as fluid control and kidney and/or adrenal function. Increases indicate an alkaline kidney and lack of membrane lubrication. Often fluid retention is seen. Decreases indicate an acid kidney membrane and a need for calcium.


Potassium reflects tissue composition of several major organs including the heart. Potassium levels rise in kidney failure, and may be low after severe vomiting or diarrhea.  Potassium levels may also decline if one is taking forms of licorice, especially the purified form glycyrrhizin (GL), and may need to be supplemented.


Chloride reflects the proper fluid exchange membranes of the bowel and the bladder. Increased chloride indicates improper membrane lubrication with Vitamin A. Decreases indicate tissue decomposition.

Blood Urea Nitrogen (BUN)

Blood Urea Nitrogen (BUN) is waste from the liver, processed by the kidneys. It also reflects whole carbohydrate storage, liberation, and continuation in the liver associated with many glands (i.e., kidneys). BUN tends to rise in dehydration and in kidney or heart failure. Prednisone and other steroids may cause BUN to rise. Increases in BUN can also indicate liver and/or thyroid inactivity. Decreased BUN indicates pancreas and/or adrenal inactivity.  BUN can also be elevated by a high protein diet or recent exercise.

Uric Acid

Uric Acid is the end product of protein digestion. The level in the blood is dependent on liver production and kidney elimination. Increased uric acid indicates incomplete protein digestion and/or an over-acid kidney membrane.


Albumin is one of the two major types of protein in the blood and promotes the transfer of nutrients and wastes to and from the blood and cells. Manufactured in the liver, albumin decreases in chronic liver disease. It also reflects one's general nutritional status. Increases indicate thick blood which could be due to improper protein digestion or dehydration. Decreases indicate thin blood with possible water retention, nutritional congestion, toxic buildup and edema (swelling). Usually the liver production of albumin is sluggish.


Creatinine is a waste product and a measure of kidney function as well as skeletal muscle buildup and breakdown in body maintenance. Increases indicate muscle breakdown, often to supply amino acids to the body when protein digestion is impaired. Decreases indicate low protein intake or impaired protein digestion.


Bilirubin derives from the haemoglobin of dead RBCs. Bilirubin is excreted by the liver as part of the bile. Bilirubin causes the yellow color of the skin and eyes (jaundice) which occurs in hepatitis, bile duct obstruction, and other liver disorders. It also reflects the function of the lymph and spleen systems. Increases in Bilirubin indicates inefficient lymphatic or liver/gallbladder function. Decreases in Bilirubin indicates inefficient blood cell breakdown by the spleen.

Alkaline Phosphatase (ALK PHOS )

Alkaline Phosphatase (ALK PHOS ) reflects the alkaline blood pH and its effect on adrenal function (and posterior pituitary). Note: In growing children, there is an increased amount of alkaline minerals in the blood for bone growth. An elevation can be normal in children. An increased alkaline phosphatase indicates an alkaline blood system and inefficient mineral transfer to the cells. A decreased alkaline phosphatase expresses an exhausted adrenal system and an acid blood system (common in chronic disease). If both LDH and alkaline phosphatase are elevated together a primary liver condition exists. If both LDH and alkaline phosphatase are decreased together, a primary thyroid deficiency may be present with a need for Vitamin B-12.


AST can also reflect gonandal function and shows the amount of oxygen available at membranes. Aside from liver/heart/muscle damage, elevations in AST can indicate a deficiency of hormones and Vitamin E. Decreases indicate a deficiency of the gonad itself.


ALT also reflects liver function and increases can mean problems with this organ as well as possible heart damage.


LDH can also reflect blood acidity and pancreatic function as well as being an intercellular enzyme prominent in heart and skeletal muscles. Persons on nucleoside analogues (AZT, DDI, DDC) who exercise frequently commonly have an elevated LDH from muscle tissue breakdown. Others who do not exercise, but are on these drugs -or are wasting- may also have an increased LDH. Persons with Pneumocystis pneumonia tend to have a more serious prognosis if they have an elevated LDH. Decreases indicate an alkaline tendency to the blood. A high LDH often indicates that a heart attack has recently occurred. It can also be high during active cancer growth, however it cannot be considered a specific cancer indicator.