How to Read Your Blood Test (CBC) Report: A Plain Language Guide
A Complete Blood Count (CBC) is the most commonly ordered blood test in Nepal. It measures the cells in your blood — red cells, white cells, and platelets — and gives your doctor a broad picture of your health in minutes. This guide explains every parameter in plain language, provides normal ranges for Nepali adults, and explains what common abnormalities mean.
What Does a CBC Measure?
A CBC measures three main cell lines produced by the bone marrow: red blood cells (which carry oxygen), white blood cells (which fight infection and inflammation), and platelets (which stop bleeding). Each has multiple sub-measurements that add diagnostic precision.
What Are the Normal CBC Values for Nepali Adults?
People living at altitude, including residents of Pokhara (827 metres), tend to have slightly higher haemoglobin and haematocrit values than sea-level reference ranges because the body produces more red cells to compensate for lower oxygen partial pressure. The following ranges apply to adults in the Pokhara region:
| Parameter | Men | Women |
|---|---|---|
| Haemoglobin (Hb) | 13.5–17.5 g/dL | 12.0–15.5 g/dL |
| Haematocrit (Hct) | 41–53% | 36–46% |
| RBC count | 4.5–5.9 ×10¹²/L | 4.0–5.2 ×10¹²/L |
| MCV (mean cell volume) | 80–100 fL | 80–100 fL |
| MCH | 27–33 pg | 27–33 pg |
| WBC count | 4.5–11.0 ×10⁹/L | 4.5–11.0 ×10⁹/L |
| Platelets | 150–400 ×10⁹/L | 150–400 ×10⁹/L |
Note: At altitudes above 2,500 metres, haemoglobin values of 18–19 g/dL can be normal in acclimatised individuals.
How Do You Diagnose Anaemia From a CBC Report?
Anaemia is diagnosed when haemoglobin falls below the lower limit of normal for age and sex. Once anaemia is confirmed, the MCV (mean cell volume) tells you the likely type:
MCV Below 80 fL — Microcytic Anaemia
Small red cells indicate iron deficiency, thalassaemia trait, or (less commonly) anaemia of chronic disease. Iron deficiency is the most common cause in Nepal — especially in women of reproductive age and children. Further tests: serum ferritin, iron studies.
MCV 80–100 fL — Normocytic Anaemia
Normal-sized cells with low haemoglobin suggest acute blood loss, haemolysis (red cell destruction), chronic disease (kidney failure, hypothyroidism), or mixed deficiencies. Further tests: reticulocyte count, renal function.
MCV Above 100 fL — Macrocytic Anaemia
Large red cells suggest B12 or folate deficiency, liver disease, hypothyroidism, or alcoholism. Megaloblastic anaemia from B12 deficiency is common in vegetarians — a significant proportion of the Nepali population. Further tests: serum B12, folate, LFT, TFT.
What Do White Cell (WBC) Changes Mean?
The total WBC count and its differential (the proportion of each type) provide diagnostic information about infection, inflammation, allergy, and bone marrow disease.
Elevated WBC (Leukocytosis)
- Neutrophilia (raised neutrophils): Bacterial infection, physical stress, steroid use, tissue necrosis.
- Lymphocytosis (raised lymphocytes): Viral infection (dengue, EBV, CMV), pertussis, chronic lymphocytic leukaemia.
- Eosinophilia (raised eosinophils): Parasitic infection (hookworm, roundworm — common in Nepal), allergic disease, asthma.
Low WBC (Leukopenia)
A low total WBC — particularly a low neutrophil count (neutropenia) — raises concern for viral infections (dengue, typhoid, HIV), bone marrow suppression, and drug reactions. Dengue fever typically causes leukopenia combined with thrombocytopenia.
What Does a Low Platelet Count (Thrombocytopenia) Mean?
Platelets below 150 ×10⁹/L represent thrombocytopenia. The clinical urgency depends on how low the count is:
- 100–150: Mild; usually no spontaneous bleeding. Monitor.
- 50–100: Moderate; avoid surgery and invasive procedures.
- 20–50: Significant risk; avoid trauma.
- Below 20: Spontaneous bleeding risk — requires urgent evaluation.
In Nepal, the most common causes of acute thrombocytopenia are dengue fever, typhoid fever, malaria, and immune thrombocytopenic purpura (ITP). Platelet transfusion is indicated only when platelets fall below 10 ×10⁹/L or when there is active bleeding with platelets below 50 ×10⁹/L.
What Is Polycythaemia and Is It Normal in Pokhara?
Polycythaemia refers to an elevated red cell count and haemoglobin. At Pokhara’s altitude of 827 metres, mild elevation of haemoglobin above sea-level norms is physiologically normal and does not indicate disease. However, haemoglobin values above 18.5 g/dL in men or 16.5 g/dL in women at Pokhara’s altitude warrant investigation for polycythaemia vera or secondary causes (lung disease, sleep apnoea, renal tumour).
Residents who live or work at higher altitude zones in the Annapurna region may have haemoglobin values of 18–19 g/dL that are entirely appropriate for that altitude.
What Are LFT and RFT, and How Do You Read Them?
Liver Function Test (LFT)
| Parameter | What It Indicates | Normal Range |
|---|---|---|
| ALT (SGPT) | Liver cell damage | 7–56 U/L |
| AST (SGOT) | Liver/muscle damage | 10–40 U/L |
| Bilirubin (total) | Jaundice marker | 0.2–1.2 mg/dL |
| Albumin | Liver synthetic function | 3.5–5.0 g/dL |
| ALP | Bile duct disease, bone | 44–147 U/L |
ALT elevated above three times normal indicates significant liver injury — hepatitis A, B, C, alcoholic liver disease, or drug-induced liver injury. Low albumin indicates advanced liver disease or malnutrition.
Renal Function Test (RFT)
| Parameter | What It Indicates | Normal Range |
|---|---|---|
| Serum creatinine | Kidney filtration | 0.6–1.2 mg/dL (men), 0.5–1.1 mg/dL (women) |
| Blood urea nitrogen | Protein metabolism, hydration | 7–25 mg/dL |
| Sodium | Fluid balance | 136–145 mmol/L |
| Potassium | Cardiac and muscle function | 3.5–5.0 mmol/L |
Rising creatinine indicates declining kidney function. In Nepal, common causes include diabetes, hypertension, urinary obstruction from kidney stones, and interstitial nephritis from NSAIDs (widely used for pain in Nepal).
Blood Sugar: Fasting, Random, and HbA1c — What Each Means
- Fasting blood glucose (FBG): Taken after 8–12 hours of fasting. Normal is below 100 mg/dL. Prediabetes: 100–125 mg/dL. Diabetes: 126 mg/dL or above on two occasions.
- Random blood glucose: Taken at any time. Diabetes likely if 200 mg/dL or above with symptoms.
- HbA1c: Reflects average blood glucose over the past 2–3 months. Normal: below 5.7%. Prediabetes: 5.7–6.4%. Diabetes: 6.5% or above.
HbA1c is the preferred test for monitoring long-term diabetes control. Note that at high altitude, slightly falsely elevated HbA1c may occur due to increased red cell lifespan.
When Is a CBC Not Enough?
A CBC gives a broad overview but does not diagnose specific conditions on its own. Additional tests are needed in the following situations:
- Microcytic anaemia requires iron studies and possibly haemoglobin electrophoresis (for thalassaemia).
- Leukocytosis requires blood culture if infection is suspected.
- Thrombocytopenia requires peripheral blood smear examination.
- Elevated LFT requires hepatitis B and C serology, ultrasound.
- Abnormal kidney function requires urine protein, renal ultrasound.
Get Your Blood Tests Done at A&B International Hospital
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Full laboratory services including CBC, LFT, RFT, blood glucose, HbA1c, lipid profile, and infectious disease serology. Same-day results for most tests. ECHS cashless laboratory services available.
