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Test Code DIFF Differential Count

Specimen Type

Blood

Container/Tube

Lavender top, EDTA

Turnaround Time

8 hours

STAT Days and Times Performed

24/7

Days and Times Performed

24/7

Method Name

Sysmex XN automated hematology analyzer and Wright stain light microscopy

Test Includes

Manual and Automated WBC Differentials include percentage and absolute number of White Blood Cell types, RBC morphology, WBC Morphology and platelet estimate. Performed manually or automated per laboratory protocol.

To ensure absolute values are reported, please order a CBC and a DIFF. Automated Differentials that are released without review by technologist only include percentage and absolute number of WBC cell types.
 

The percentage of cells reported in a WBC Differential is based on counting 100 white blood cells. If the WBC is >15 x10³/µL, a 200 cell count is performed the percentage of each cell type counted is calculated (extrapolated to 100) and reported with the number of cells counted. When the WBC is very low (<1.5 x10³/µL) less than 100 cells are counted the percentage of each cell type counted is calculated (extrapolated to 100) and reported with the number of cells counted.

Only those cells seen during the count are reported. If the cell type is not reported, there were none of the cell type seen. For example, if 60% Neutrophils, 25% Lymphocytes, 12% Monocytes, 2% Eosinophils, 1% Basophils are reported; then no other cells (reactive lymphs, metamyelocytes, myelocytes, promyelocytes, blasts) were seen.

Preferred Volume

4 mL

STAT Turnaround Time

90 minutes

Critical Results

  • WBC: <1.0 or >30.0 (x 10³/µL)
  • White Cell Differential: <0.5 Combined Neutrophil when WBC is > 1.0 (x 10³/µL)
  • White Cell Differential: >4% blasts on outpatient or emergency room patient
  • Any intracellular bacteria /yeast/ parasites present

Coverage Information

CMS has established a national coverage policy (NCD) for Medicare for this test as of November 25, 2002. Please document medical necessity. For more details click this link:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=61&ncdver=1&bc=AgEAAAAAAAAA

Fee Code

53236

Synonyms

WBC Differential

UCMC Collection Instructions

Specimen must be received within 8 hours of collection.
Refrigerate sample if transportation is delayed

Specimen Minimum Volume

  • 2 mL blood in 4 mL tube
  • 1.5 mL blood in 3 mL tube.
  • If a microvette is collected, the minimum volume is 250 µL

CPT

85004

Reference Values

 

Parameter

Percentage (%) Absolute (K/uL)

Neutrophils/Granulocytes

39-75 1.12-6.72
Bands  0 – 6 0-0.66
Bands are counted on patients 6 years old and on all ED patients. On all other patients, “Left Shift” will be reported if Bands are 10% based on scan of the blood smear.

Lymphocytes

16-47 0.9-3.30

Monocytes

 4 – 12 0.16-0.92

Eosinophils

0-7 0.0-0.6

Basophils

0-2 0.0-0.21
Immature Granulocyte <0.5 <0.04

 Reference ranges confirmed November, 2009

Test Limitations

Transportation temperature: specimen cannot be frozen or heated
Rejection criteria: clotted or short specimen volume; microclot formation; improper tube
Specimen must be received within 8 hours of collection. Refrigerate sample if transportation is delayed