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The ABC of a CBC (Complete Blood Count)
Another tip that can help you understand your lab results! When you have been here around for a while, you probably have seen plenty! This tip will explain to you:- What a CBC is.
- How to read it.
- And why it is important that you know!
Let’s start with that last one.A doctor often sees a lot of patients in a day. Missing something is human and it happens. In fact, it happened to one of my clients yesterday. The education you will get here can also help you to understand the doctor better and makes you able to better talk to your GP.
So let’s go:
What is a CBC (Complete Blood Count)?
A Complete Blood Count often abbreviated as CBC provides us with insight into the composition of red blood cells, white blood cells and platelets. A CBC can therefore be useful when patients feel tired or are suffering from infections. Since white blood cells are a topic on their own, I wrote a separate article about them. You can find the article here. CBCs are valuable and one of the most used lab tests in the world.How to read a CBC?
On a typical CBC you can find different lab values. You can find the amount of red & white blood cells, how much hemoglobin is in your red blood cells, the average size of your red blood cells, how much of different family members of white blood cells you have and more.You see! It isn’t hard at all!
You just need to recognize their difficult scientific dull names! Here we go:
Erythrocytes
Erythrocytes are just a fancy way of saying ‘red blood cells’. Red blood cells can get 3-4 months old. If you are working out, red blood cells, because of the pressure, get damaged when they are squeezed into the tiniest blood vessels and live on average a month shorter. We make about 17 million red blood cells per second, but under stress, this production can go up to 119 million red blood cells per second!Red blood cell (RBC) count.
The Red Blood Cell count is a measure of how many blood cells are present in your blood. If your RBC is low we talk about anemia. This can be caused for example by a lack of:- Iron
- Vitamin B12
- Folate (vitamin B9)
- Zinc
- Copper
- Vitamin A
Hemoglobin (Hb)
The protein hemoglobin carries oxygen. You can find hemoglobin in the red blood cell. At the core of this protein is an iron atom. If you are low on iron for a while, this can cause low hemoglobin values. This is often the cause of iron deficient anemia or microcytic anemia. What happens to the average size of the red blood cell is that it can shrink. Some people might experience anemia symptoms already when Hb gets close to the border of the reference ranges. This is why I often recommend my clients have their hemoglobin concentrations in the middle of the reference range.Mean Corpuscular Value (MCV)
This is a fancy word/abbreviation of the average size of the red blood cells. It’s really that simple. Like I said: a low Hb causes the red blood cells to shrink. This results in a lower MCV. Typical reference ranges for the MCV are between the 80 and 100 fL (Femtoliters). The optimal reference range is between 80 and 90 fL.Can the MCV also get too high?
Yes! This is called ‘macrocytic anemia‘. It causes the same type of symptoms as any other anemia, but in this case, the cause is often a deficiency in vitamin B12, folate or vitamin B6.
But what if you have macrocytic anemia and microcytic anemia at the same time? This can lead to a normal average and a perfect-looking MCV. In some cases, this can mean that anemia gets missed. This is why I always recommend measuring iron, vitamin B12, folate and vitamin B6 besides Hb and MCV as well.
Hematocrit(Hct)
This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood’s volume is made of red blood cells.A low Hct is also often an indication of anemia. This can also be caused by a lack of the nutrients you need to build red blood cells (See the list of nutrients above!). Asthma, COPD and sleep apnea can cause hematocrit to rise. It is the body’s attempt to try to get more oxygen to the cells of the body.
Thrombocytes or Platelet Count (Plt)
Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, a blood clot can form in a blood vessel. I usually aim to have platelets in the upper half of the reference range.Stress can lead to an elevation in platelets. Why? You could think of it as a way to prepare the body for injuries. With stress, the body is anticipating a physical attack. But it makes the blood also thicker and can contribute to the hardening of the arteries (atherosclerosis). Reducing unnecessary stress and stressful thinking patterns is good for cardiovascular health!
Mean Platelet Volume (MPV)
Mean platelet volume measures the average amount (volume) of platelets. MPV is used along with platelet count to diagnose some diseases. If the platelet count is normal, the MPV can still be too high or too low.MCH and MCHC
You will find these values often grouped together under the MCV. Again: difficult names but an easy explanation! The- MCH stands for Mean Corpuscular Hemoglobin. It is the average amount of hemoglobin inside the red blood cell.
- MCHC stands for Mean Corpuscular Hemoglobin Concentration. It is the average concentration of hemoglobin
Although these numbers are often on a panel, they aren’t used often, or at least where I come from, but they can provide extra insight into understanding anemia.Next time you get your results from the doctor, ask them to print! Take a look and have fun understanding your lab results. See if you can spot what lab values are in the optimal range… or which values were missed by doctors!
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15 Replies
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This is brilliant Sir and the article you posted two weeks ago
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Thank you!!
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thank you for the excellent write-up!
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I just compared your notes with mine and happy to report I am learning the right way! From your notes I learnt in addition about macrocytic anemia, which is the case with me from what I can from my last blood test, low RBC and Hemoglobin but high MCV.
Thank you for explaining everything in easy English! -
This was very informative – just recently did a blood test that included CBC – results were low for MCH & MCHC and high for platelet count. Iron came back normal per their testing approach as attached. Curious what could high platelet count be from (I do have elevated blood pressure & was recently diagnosed with TMJ)
[IMG_8961.jpeg][IMG_8960.jpeg] -
Hey ,
Thank you for sharing your labs! Is this the full report? Or are there more lab values assessed? If there is more, it would help you to provide you with more answers.
Funny you mention iron coming back as ‘normal’. A lot of iron markers are indeed in the reference range, but just barely.
A lack of iron can contribute to a lower MCH, MCHC and also cause platelets to elevate.
In my opinion, getting your iron up would be wise. Iron can be low because of dietary insufficiencies, low stomach acid, gut inflammation and even chronic infections can play a role. Looking at your full CBC could help us rule out chronic infections for example.
With iron deficiency, you could also experience different types of symptoms. Fatigue, shortness of breath, looking pale, cold hands and feet, hair loss, brittle nails, a sore tongue, headaches… all these can be symptoms of an iron deficiency. Are there symptoms you recognize?
It might be a good idea to follow how your platelets develop in the next year to rule out other issues.
Are you taking medications for your high blood pressure? Diuretics for example dehydrate, which causes some lab values to become more elevated and therefore mask a potential iron deficiency.
Did you already read this handout? It sums up the root causes of hypertension and might help you to lower your blood pressure in a natural way.
I hope this answers your question… but I can imagine it might lead to more questions. If this is the case, please share!
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since you asked the entire lab results attached (had to screenshot – couldn’t find a proper download from the clinic app). As for symptoms, hair loss is definitely one. The blood pressure medication I’be been taking for a month now is hydrochlorothiazide (12.5mg 1X a day) which is a diuretic but I’m stopping it to use labetalol – I view BP med as short term – it is my first time taking such meds. I have started a rigorous workout routine (F45 bootcamp ) and watching my food intake – adding in more protein, taking Redmond’s electrolytes in the morning.
Just wanted to add that I have labs I’m working on with Dr. Stacy Barczak Baker – Functional Medicine Testing (HTMA, OAT, Total Tox (3), DUTCH) – those i can share once received but may take a few weeks
I’ve also been seeing a cardiologist since my BP was elevated – I did a stress test which I stopped at 6 min 40 seconds because my lower back started to hurt so I wasn’t completely breathless – the Dr decided the test had abnormalities and ordered a nuclear test which I completely refused! I’m not sure what was abnormal since he looked at the printed echodiagram for only a few seconds – my BP did not go over the 180/90 mark at peak. It’s frustrating when Doctors see you as another case to make money off of – he initially requested a nuclear test which insurance didn’t cover & I was definitely not going to do it!
[2023 Lab Results .pdf] -
Hey ,
Thank you for sharing this! There are some other advice I would like to give you:
WBC or White Bloodcel Count
I do see a white blood cell count and although these numbers might seem normal because they are in the reference range, I still wonder about a full differential. A WBC differential looks at a range of different types of white blood cells. I actually wrote a tip earlier about this topic which you can find here. It is for you to find out since simmering infections can make it harder for iron to be absorbed.Hydrochlorothiazide & High Blood pressure.
The diuretic hydrochlorothiazide definitely could have influenced the measurements, changing the lab values a bit and masking a true iron deficiency. If you like to use iron supplements, be aware that iron can decrease the absorption of hydrochlorothiazide.I’m glad to hear you have started a workout routine! This can defenitly help you with blood pressure issues. I usually see improvements within 2-3 months. It al depends on where your blood pressure comes from. The higher the levels, the longer it can take, but you are for sure on the good road!
Elevated Cholesterol values
Cholesterol can be elevated for different reasons. Dietary reasons are one of them since the main function of LDL and HDL is transporting lipids and lipid like structures.But there are other reasons worth exploring in your specific case. With these numbers, to me, there are clues visible with imbalances in thyroid hormone production (which can cause high blood pressure and elevations in cholesterol). Only a full thyroid panel will provide you with more insight. Here is a video on which lab markers are important to measure. It can provide you with a different angle on how to approach your specific situation.
There is much more to say about this topic, but let me ask you this first before I dive deeper into this topic. Are you experiencing hypo- or hyperthyroid symptoms? And if you are experiencing one of the 2, are you also using medications for this?
Vitamin D & B12
With my clients I usually aim for serum vitamin values in the upper half of the reference range at least. For vitamin B12 I usually aim for serum levels above the 600. For vitamin D I would aim for serum levels of 50. Here is a handout that I love and gives you recommendations on how to achieve this. Retesting serum vitamin D levels after no more then 2-3 months is something I recommend since there are some genetic differences between how people absorb and transport vitamin D.Vitamin B6
Your liver enzymes are a bit on the lower end. Normally low liver enzymes is considered a good thing since elevations indicate some damage to liver cells. But low (but still normal) levels can indicate a need for vitamin B6. Of course the other tests (like the OAT) can provide you more information on vitamin B6 status.Once you have the other labs returned I would be curious to take a look at them as well! If you feel like sharing, please do!
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Hi thanks for this- so simplified. I actually just got back my sons blood test results from yesterday and would love your insight. Because from the results I am doubting anemia now- maybe? But I feel something is off.
Just a little background – he is 15, has UC and is currently on remicade.[image0-2.jpeg][image1-2.jpeg]
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Hi , I just saw your post and since I am learning to read and interprete blood panels myself, I though I share with you my thoughts ☺️ Without knowing any of his currents symptoms and from the blood test you shared, I believe he is low in iron and B6 vitamins, since his UC prevents the body to absorb both of these nutrients. However, without a full iron panel I would not start supplementing with iron blindly.
His Eosonophils are high as well, which often is a indicator for parasites, and parasites feed off of iron, that’s why blindly supplementing might not be the best idea.
Please see also my notes attached.[IMG_6535.heic]
But pls wait for B. or Daniel to comment -
there does seem to be a pattern of possible anemia, but always keep in mind his symptoms and current experience, and ask why.
With ulcerative colitis, the ulceration of the colon’s lining can lead to bleeding so this could affect his red blood cell values.
And inflammation in the colon can impair the absorption of essential nutrients, including iron and vitamin B12, in the small intestine. A deficiency in these nutrients can lead to different types of anemia.
Additional testing such as an iron panel with ferritin, and vitamin B12 or methylmalonic acid can help confirm/rule this out.
But ultimately, given the autoimmune dynamic, focusing on bringing better balance to his gut microbiome is the goal while his medication helps reduce the inflammation temporarily.
For example, UC flares are associated with low butyrate, while remission is associated with increasing levels of Faecalibacterium prausnitzii (butyrate producer). Here’s the study on that.
Other things to consider and keep in mind to help gut and digestion:
• How well does he digest his food and therefore absorb nutrients? Digestive enzymes can be considered as rapid relief. Was H Pylori overgrowth ruled out? If not, it’s probably worth testing it with a comprehensive stool test.• 100% gluten-free and dairy-free diet and optimize vitamin D, zinc and vitamin A (for immune support) . A food sensitivity test like KBMO can help remove highly sensitive foods that are likely contributing to the inflammation as well. These should be removed temporarily while actively working on gut healing and microbiome balancing.
• Oral aloe vera gel (gut soothing); collagen (arginine, glutamine, histidine, glycine, threonine, serine, proline) plus tryptophan;
• Certain herbs: ex. quercetin (anti-inflammatory and shifts microbiome), tormentil (for diarrhea, intestinal inflammation), wheat grass juice; curcumin; chamomile (apigenin); white willow bark, evening primrose oil, Andrographis, Boswellia (especially if curcumin not tolerated) bilberries; astragalus, Scutellaria Baicalensis Georgi, Wedelia chinensis, cardamom, ginseng, colostrum
• Probiotics (like Visbiome brand, Lactobacillus plantarum 299V,
Bifidobacterium longum35624)• Butyrate (oral, suppository) as mentioned above.
Hope this helps give you some other things to consider.
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Thanks for the response – so i guess will start by asking for an iron panel with ferritin and vitamin B12.
Wondering what is the accuracy of the KBMO food sensitivity test. So much mixed reviews on sensitivity tests. But in concept like that idea cause for them to get convinced in eliminating something they kind of need evidence. Or rather it helps in convincing and in commitment.
Thankfully he is not in a flare and his calprotectin is within the normal phase. But will look into some of the other suggestions to help further support. For example focus on butyrate was a new one for me.
Probiotics I have been told that Saccharomyces Boulardii is good for UC particularly since we cant get the Visbiome here since it needs refrigeration. Or should i try to seek one of the other strains you mentioned instead?
Vitamin D and Zinc I keep following up with testing and supplement accordingly.
Thanks
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Thanks for taking the time and for your input 🙂
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I’m actually finalising the details with the owner of KBMO to be our December guest expert! For this session, he’ll be discussing the difference in KBMO technology and accuracy. I’ve also asked him to provide a nice discount for our members to be able to order a test and have a few members’ results interpreted by him on the call. We’ll be sending out an email announcement about that soon!!
And yes, it’s a great way to get “buy-in”. Data can be a powerful driver to make changes.
Regarding the probiotic, if there’s anyone travelling that can hand-carry it, that’s how some of my clients do it. And you can check specific strains in the Fullscript search for ingredients to help you find one with those strains. But again, refrigeration might be required.
And I’m glad to hear that his inflammation is being well managed. Removing food sensitivities will continue to help with that as well.
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Amazing- I cant wait for that December talk then. Can test for both my daughter -crohns and son- UC.
Thanks!
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