The complete blood count is performed as an automated procedure. A sample of blood is placed in an analyzer and the cells are sorted by a laser by size, granularity, and shape. In a manual review, a drop of the blood is placed on a slide, smeared to a thin layer, and stained with a Wright-Giemsa stain. The slide is then reviewed under the microscope and differential count of the white cells as well as an assesment of the red cells and platelets is given.
CLINICAL UTILITY CHARACTERIZATION How Useful Are CBC and Reticulocyte Reports to Clinicians?
Linda M. Sandhaus, MD
and Pamela Meyer, MBA
Am J Clin Pathol 2002;118:787-793 Abstract quote
We surveyed 1,353 attending and 689 house staff physicians of the University Hospitals of Cleveland to ascertain the parameters of the CBC, leukocyte differential, and reticulocyte reports perceived as useful in clinical practice. The response rate was 33% for attending and 22% for house staff physicians.
Only 4 of 11 parameters routinely reported in the CBC battery were selected as frequently or always useful by more than 90% of physicians: hemoglobin, hematocrit, platelet count, and WBC count. Among primary care physicians, the mean cell volume also attained this level of usefulness for the evaluation of anemia.
There were no differences between academic physicians and community physicians in the use of RBC indices; however, physicians who had been in practice for fewer than 10 years indicated higher use of the red cell distribution width than physicians practicing for more than 10 years.
Most physicians prefer differentials reported as percentages rather than absolute counts. Among physicians who monitor reticulocyte counts, the immature reticulocyte fraction is not widely used.
Our results indicate that many physicians do not use much of the data provided in routine CBC/differential and reticulocyte reports. Some modifications of report formats may facilitate physician perception of hematology laboratory results.
INTERFERING DISEASES OR SUBSTANCES THAT ALTER LEVELS CHARACTERIZATION STORAGE AT ROOM TEMPERATURE
Changes in automated complete blood cell count and differential leukocyte count results induced by storage of blood at room temperature.
Gulati GL, Hyland LJ, Kocher W, Schwarting R.
Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Arch Pathol Lab Med 2002 Mar;126(3):336-42 Abstract quote
OBJECTIVE: To delineate changes that occur in various parameters of automated complete blood cell count (CBC) and differential leukocyte count (differential) on prolonged storage of blood at room temperature.
DESIGN: A CBC and an automated differential were performed on the Coulter Gen.S on 40 K(3) (tripotassium ethylenediamine-tetraacetate) EDTA-anticoagulated blood specimens once daily, specimen volume permitting, for 3 to 7 days. Specimens were kept at room temperature throughout the study. The results were tabulated using a personal computer with Excel software. Percent change or absolute difference from the initial value for each parameter for each subsequent day of the study period was calculated.
RESULTS: Among the CBC parameters, hemoglobin, red blood cell count, and mean corpuscular hemoglobin were stable for the duration of the study (7 days), white blood cell count was stable for at least 3 days (up to 7 days, if the count was within or above the normal range), and platelet count was stable for at least 4 days (up to 7 days, if the count was within or above the normal range). The mean corpuscular volume, mean platelet volume, hematocrit, and red blood cell distribution width each increased, and the mean corpuscular hemoglobin concentration decreased from day 2 onward. Among the differential parameters, the relative percentages and absolute numbers of neutrophils, lymphocytes, and eosinophils tended to increase, whereas those of monocytes trended downward over time. Limited data on basophils did not reveal an appreciable change.
CONCLUSION: Blood specimens stored at room temperature for more than 1 day (up to 3 days or possibly longer) were found to be acceptable with some limitations for CBC but not for the differential.
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
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