COMPLETE BLOOD COUNT (CBC)

What is a Complete Blood Count?

A complete blood count, or CBC, is a blood test that measures many different parts and features of your blood, including:

 Red blood cells, which carry oxygen from your lungs to the rest of your body.
 White blood cells, which fight infections and other diseases. There are five major types of white blood cells. A CBC test measures the
total number of white cells in your blood. A different test called a CBC with differential measures the number of each type of these
white blood cells.
 Platelets, which stop bleeding by helping your blood to clot.
 Hemoglobin, a protein in red blood cells that carries oxygen from your lungs to the rest of your body.
 Hematocrit, a measurement of how much of your blood is made up of red blood cells.
 Mean corpuscular volume (MCV), a measure of the average size of your red blood cells.
Other names for a complete blood count: CBC, full blood count, blood cell count

What is it used for?

A complete blood count is a common blood test that is often part of a routine checkup. Complete blood counts can help detect a
variety of disorders including infections, anemia, diseases of the immune system, and blood cancers.

Why do I need a complete blood count?

Your health care provider may have ordered a complete blood count as part of your checkup or to monitor your overall health. The test
may also be used to:
 Help diagnose blood diseases, infection, immune system disorders, or other medical conditions
 Check for changes in an existing blood disorder

What happens during a complete blood count?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small
amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes
less than five minutes.

Will I need to do anything to prepare for the test?

Usually there is no special preparation necessary for a complete blood count. But if your provider ordered other tests on your blood
sample, you may need to fast (not eat or drink) for several hours before the test. Your provider will let you know if there are any
special instructions to follow.

Are there any risks to the test?

There is very little risk to having a blood test. You may experience slight pain or bruising at the spot where the needle went in, but
most symptoms go away quickly.

What do the results mean?

A CBC counts the cells in your blood. There are many reasons your levels may not be in the normal range. For example:
 Abnormal levels of red blood cells, hemoglobin, or hematocrit may be a sign of anemia, heart disease, or too little iron in your body.
 Low white cell count may be a sign of an autoimmune disorder, bone marrow disorder, or cancer.
 High white cell count may be a sign of an infection or a reaction to medicine.
If any of your levels are abnormal, it doesn't always mean you have a medical condition that needs treatment. Diet, activity level,
medicines, a menstrual period, not drinking enough water, and other factors can affect the results. Talk with your provider to learn
what your results mean.
Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a complete blood count?

A complete blood count is only one tool your health care provider uses to learn about your health. Your provider will consider your
medical history, symptoms, and other factors to make a diagnosis. You may also need additional tests.

https://medlineplus.gov/lab-tests/complete-blood-count-cbc/#:~:text=Abnormal%20levels%20of%20red%20blood,or%20a
%20reaction%20to%20medicine.

1.  Red Blood Cells (RBCs)

The levels of red blood cells and haemoglobin can indicate her capability to carry oxygen via blood to the fetus. Low haemoglobin
levels make pregnant women prone to fatigue and sickness. Iron supplements are prescribed to correct this situation. 

2. White Blood Cells (WBCs)

White blood cells play an important role in the human body, especially during pregnancy. There are five types of WBCs- basophils,
neutrophils, eosinophils, lymphocytes and monocytes. All of these are important parts of the immune system, which is greatly
responsible for keeping the mother and the child free from any type of infection. This also finds out if the mother has any blood-
related diseases, like sickle cell anaemia or leukaemia.

3. Platelets
Platelets make up the trio of the types of blood cells and are the smallest of the three types; however, their importance is huge.
Platelets are responsible for clotting of the blood. If the count of platelets is too low, it means that the blood will not clot soon enough,
while the number being high means that the mother is susceptible to sudden internal blood clots and haemorrhages.

4. Haemoglobin (Hb/Hgb)
Haemoglobin is the protein in your blood that holds oxygen.
 5. Hematocrit (Hct)
This calculates the percentage of red blood cells in your blood.

6. Mean Corpuscular Volume (MCV)

MCV measures the average size of your red blood cells.

THE RH FACTOR
 Why is Rh incompatibility a problem?
When the blood of a Rh-positive fetus gets into the bloodstream of a Rh-negative woman, her body will recognize that the Rh-positive
blood is not hers. Her body will try to destroy it by making anti-Rh antibodies.
These antibodies can cross the placenta and attack the fetus's blood cells. This can lead to serious health problems, even death, for a
fetus or a newborn.

 How can Rh antibodies affect a fetus?

During a pregnancy, Rh antibodies made in a woman's body can cross the placenta and attack fetal blood cells. This can cause a
serious type of anemia in the fetus in which red blood cells are destroyed faster than the body can replace them.
Red blood cells carry oxygen to all parts of the body. Without enough red blood cells, the fetus will not get enough oxygen. In some
cases, a fetus or a newborn can die from anemia. Rh incompatibility can also cause jaundice in a newborn.

https://www.acog.org/womens-health/faqs/the-rh-factor-how-it-can-affect-your-pregnancy#:~:text=How%20can%20Rh
%20antibodies%20affect,the%20body%20can%20replace%20them.

Rh incompatibility
Rh incompatibility is a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has Rh-
positive blood.

Causes
During pregnancy, red blood cells from the unborn baby can cross into the mother's blood through the placenta.
If the mother is Rh-negative, her immune system treats Rh-positive fetal cells as if they were a foreign substance. The mother's body
makes antibodies against the fetal blood cells. These antibodies may cross back through the placenta into the developing baby. They
destroy the baby's circulating red blood cells.

When red blood cells are broken down, they make bilirubin. This causes an infant to become yellow (jaundiced). The level of bilirubin
in the infant's blood may range from mild to dangerously high.

Firstborn infants are often not affected unless the mother had past miscarriages or abortions. This would sensitize her immune system.
This is because it takes time for the mother to develop antibodies. All children she has later who are also Rh-positive may be affected.

Rh incompatibility develops only when the mother is Rh-negative and the infant is Rh-positive. This problem has become less
common in places that provide good prenatal care. This is because special immune globulins called RhoGAM are routinely used.

https://medlineplus.gov/ency/article/001600.htm#:~:text=The%20mother's%20body%20makes%20antibodies,broken%20down%2C
%20they%20make%20bilirubin.

BLOOD TYPES IN PREGNANCY

Every person has a blood type (O, A, B, or AB) and an Rh factor, either positive or negative. The blood type and the Rh factor simply
mean that a person's blood has certain specific features. The blood type is found as proteins on red blood cells and in body fluids. The
Rh factor is a protein that is found on the covering of the red blood cells. If the Rh factor protein is on the cells, the person is Rh-
positive. If there is no Rh factor protein, the person is Rh- negative.
The following are the possible combinations of blood types with the Rh factors:
Blood A B O AB
Type
Rh positive A B O+ AB
+ + +
Rh A- B- O- AB-
negative
Rh factors are genetically determined. A baby may have the blood type and Rh factor of either parent, or a combination of both
parents. Rh factors follow a common pattern of genetic inheritance. The Rh-positive gene is dominant (stronger) and even when
paired with an Rh-negative gene, the positive gene takes over:
 If a person has the genes + +, the Rh factor in the blood will be positive.
 If a person has the genes + -, the Rh factor will also be positive.
 If a person has the genes - -, the Rh factor will be negative.

https://www.stanfordchildrens.org/en/topic/default?id=blood-types-in-pregnancy-90-P02342

ANTIBODIES IN PREGNANCY
What are red cell antibodies?
Antibodies are your body’s natural defense against anything which is different from yourself. For example, a virus, vaccine or a
different blood group. They are part of your immune system and protect your body against harmful invasions like infections. You may
form antibodies if blood cells with a different blood group from your own enter your blood stream. This can happen because of a
blood transfusion or during pregnancy.

How are these antibodies made during pregnancy?

A few of your baby’s blood cells may ‘leak’ into your blood during pregnancy. This usually happens when the baby is born. If your
baby’s blood group is different from your own, your immune system may produce antibodies. This is rare. Only about three in 100
pregnant women develop antibodies, and most of these are harmless. The illustrations over the page show how this happens.

https://www.chesterfieldroyal.nhs.uk/application/files/1015/4168/6988/Blood_groups__red_cell_antibodies_in_pregnancy.pdf

SUBCHORIONIC HEMATOMA
A subchorionic hematoma is when blood collects under the chorion membrane during pregnancy. This membrane attaches the
mother’s uterine wall to her baby’s amniotic sac. The most common symptom is vaginal bleeding. But some people don’t have
symptoms. Most subchorionic membranes go away on their own without causing pregnancy complications.
Subchorionic hematoma is when blood accumulates between the placenta and the uterine wall during pregnancy.

What is a subchorionic hematoma?

A subchorionic hematoma (also called subchorionic hemorrhage or subchorionic bleeding) is when blood forms between the wall of
your uterus and the chorionic membrane during pregnancy. The chorionic membrane is the outermost layer separating your baby’s
amniotic sac from the wall of your uterus. It can be associated with vaginal bleeding during pregnancy. A subchorionic hematoma can
shrink in size and resolve on its own without treatment. In some cases, your healthcare provider will recommend a plan for follow-up
after assessing the hematoma. It rarely causes serious health complications.

How common is a subchorionic hematoma?

Subchorionic hematomas are most common in people who are between 10 to 20 weeks pregnant. It accounts for approximately 10%
of all vaginal bleeding. Most hematomas are not a cause for concern because they are small or cause light bleeding.

What are the symptoms of a subchorionic hematoma?

The most common symptom of a subchorionic hematoma is vaginal bleeding in the first half of pregnancy. The bleeding can range
from heavy with clotting to light spotting. It can be accompanied by pelvic cramping, but this is usually not the case. Many people
experience no bleeding at all, and the hematoma is discovered during a routine ultrasound. If you experience any bleeding during
pregnancy, it’s always a good idea to talk to your healthcare provider so they can rule out any serious complications.

What causes a subchorionic hematoma?

A subchorionic hematoma occurs when the chorion membrane detaches from the wall of the uterus. The chorion membrane is the
outermost layer of the amniotic sac. The amniotic sac, or the bag of waters, is where your baby develops in your uterus. This
detachment from the uterine wall can be small or large. Healthcare providers are not entirely sure what causes this separation to occur.
However, certain conditions may put you at a higher risk of developing a subchorionic hematoma.

Who is at a higher risk for a subchorionic hematoma?

Several factors have been associated with a subchorionic hematoma. Some of these include:
 Uterine irregularities.
 History of uterine infections.
 History of uterine trauma.
 History of miscarriages.
 IVF pregnancy.
 High blood pressure.

What are the complications of a subchorionic hematoma?

Subchorionic bleeding may increase your chances of pregnancy complications. Some of the possible complications are:
 Excess vaginal bleeding.
 Miscarriage.
 Preterm delivery.
 Placental abruption.
Most subchorionic hematomas resolve on their own without intervention and don't cause complications to the pregnancy. Your
healthcare provider will evaluate your hematoma and determine if treatment is necessary based on several factors, including the size of
the hematoma and how far along you are in pregnancy.

CARE AND TREATMENT

How is subchorionic hematoma treated?
Many subchorionic hematomas will heal on their own over time — just as other cuts on your skin’s surface would. Your healthcare
provider will evaluate your symptoms, review your health history and determine the location and size of the hematoma with
ultrasound. A treatment plan is dependent on those factors, plus your baby’s gestational age.
Some possible treatments for subchorionic hematomas are:
 Reduction in activities like exercise and lifting heavy objects.
 Complete bed rest.
 Avoiding sex.
 Follow-up ultrasounds to assess the size of the hematoma.
 Monitoring of symptoms that suggest early labor like contractions and cramping.
 Hospitalization.
 Anti-D immune globulin (Rh0(D)) for people who are RhD negative.
Contact your healthcare provider immediately if you experience bleeding during pregnancy. Finding the cause of vaginal bleeding as
early as possible is always better.
How long do subchorionic hematomas last?
There is no set amount of time for how long it takes a subchorionic hematoma to heal. In some cases, it will shrink in size on its own
over a few weeks without causing any complications. Other times the hematoma can be large and problematic. Your healthcare
provider may be able to predict if your subchorionic hematoma will resolve after an evaluation and ultrasound.

Does subchorionic hematoma harm my baby?

Most of the time a subchorionic hematoma does not harm your baby. If your hematoma is small, it may never cause problems or heal
on its own as your pregnancy grows. In the case of large hematomas or hematomas that occur late in pregnancy, your healthcare
provider may be more concerned about pregnancy complications.
It’s important to know that in most cases, a subchorionic hematoma will not affect your baby, and your baby will be born healthy.

Is having a subchorionic hematoma considered a high-risk pregnancy?

It depends on how severe the hematoma is and if you have other medical conditions. If your bleeding is excessive or the hematoma is
large, you will likely be considered a high-risk pregnancy. However, if your hematoma is small or causing minor spotting, your
healthcare provider may suggest a follow-up ultrasound in several weeks.

WHEN TO CALL THE DOCTOR

When should I call my doctor if I have subchorionic hematoma?

If you have been diagnosed with a subchorionic hematoma, you should contact your healthcare provider if:
 There are changes in your symptoms.
 The amount of bleeding increases.
 You have contractions or cramping.
 You feel dizzy or lightheaded.

What are other causes of bleeding in pregnancy?

Bleeding during pregnancy is common and many conditions can cause bleeding while pregnant. Some of these are:
 Miscarriage.
 Ectopic pregnancy.
 Implantation bleeding.
 Bleeding after sex while pregnant.
 Infection.
 Placenta conditions like placenta previa or placental abruption.
If you're bleeding during pregnancy, contact your healthcare provider immediately. They may want to discuss your symptoms and
examine you as soon as possible.

FREQUENTLY ASKED QUESTIONS

Can a subchorionic hematoma cause a miscarriage?

There’s a small risk of a miscarriage if you have a subchorionic hematoma. However, most of the time, subchorionic hematomas do
not cause a miscarriage and your baby is born healthy.

A note from Cleveland Clinic

If you have been diagnosed with a subchorionic hematoma, it's natural to be worried or concerned. Talk to your healthcare provider
about how you feel so they can offer reassurance. In most cases, hematomas resolve without causing any serious complications to
pregnancy.

https://my.clevelandclinic.org/health/symptoms/23511-subchorionic-hematoma

HCG BLOOD TEST - QUANTITATIVE

A quantitative human chorionic gonadotropin (HCG or hCG) blood test measures the specific level of HCG in the blood. HCG is a
hormone produced in the body during pregnancy.

Other HCG tests include:

 HCG urine test
 HCG blood test -- qualitative

Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the
vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.

How the Test is Performed

A blood sample is needed. This is most often taken from a vein. The procedure is called a venipuncture.

How to Prepare for the Test

No special preparation is needed.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging sensation. Afterward,
there may be some throbbing.

Why the Test is Performed

HCG appears in the blood and urine of pregnant women as early as 10 days after conception. Quantitative HCG measurement helps
determine the exact age of the fetus. It can also assist in the diagnosis of abnormal pregnancies, such as ectopic pregnancies, molar
pregnancies, and possible miscarriages. It is also used as part of a screening test for Down syndrome.
This test is also done to diagnose abnormal conditions not related to pregnancy that can raise HCG level.

Normal Results
Results are given in milli-international units per milliliter (mUI/mL).
Normal levels are found in:
 Non-pregnant women: less than 5 mIU/mL
 Healthy men: less than 2 mIU/mL
In pregnancy, HCG level rises rapidly during the first trimester and then declines slightly. The expected HCG ranges in pregnant
women are based on the length of the pregnancy.
 3 weeks: 5 - 72 mIU/mL
 4 weeks: 10 -708 mIU/mL
 5 weeks: 217 - 8,245 mIU/mL
 6 weeks: 152 - 32,177 mIU/mL
 7 weeks: 4,059 - 153,767 mIU/mL
 8 weeks: 31,366 - 149,094 mIU/mL
 9 weeks: 59,109 - 135,901 mIU/mL
 10 weeks: 44,186 - 170,409 mIU/mL
 12 weeks: 27,107 - 201,165 mIU/mL
 14 weeks: 24,302 - 93,646 mIU/mL
 15 weeks: 12,540 - 69,747 mIU/mL
 16 weeks: 8,904 - 55,332 mIU/mL
 17 weeks: 8,240 - 51,793 mIU/mL
 18 weeks: 9,649 - 55,271 mIU/mL
Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your
specific test result.

What Abnormal Results Mean

Higher than normal level may indicate:
 More than one fetus, for example, twins or triplets
 Choriocarcinoma of the uterus
 Hydatidiform mole of the uterus
 Ovarian cancer
 Testicular cancer (in men)
During pregnancy, lower than normal levels based on the gestational age may indicate:
 Fetal death
 Incomplete miscarriage
 Threatened spontaneous abortion (miscarriage)
 Ectopic pregnancy

Risks
Risks of having blood drawn are slight, but may include:
 Excessive bleeding
 Fainting or feeling lightheaded
 Blood accumulating under the skin (hematoma)
 Infection (a slight risk any time the skin is broken)
https://www.mountsinai.org/health-library/tests/hcg-blood-test-quantitative