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Total and differential leukocyte counts in clinically well children. Information or misinformation?
1Kelsey-Seybold Clinic, School of Medicine, University of Texas Health Science Center, Houston 77030.
Insights
Total and differential leukocyte counts are not valuable case-finding tests for well children. Abnormal results in healthy children did not lead to the discovery of unsuspected illnesses, indicating limited clinical utility.
Area of Science:
- Pediatric medicine
- Diagnostic test evaluation
- Clinical laboratory science
Background:
- The total and differential leukocyte count is a common laboratory test.
- Its utility as a case-finding tool in asymptomatic pediatric populations requires evaluation.
- Established criteria exist for assessing the effectiveness of preventive health measures.
Purpose of the Study:
- To evaluate the value of total and differential leukocyte counts as a case-finding test in pediatric patients.
- To assess if abnormal leukocyte counts in clinically well children lead to the diagnosis of unsuspected illnesses.
Main Methods:
- Literature search for existing patient data on leukocyte counts as case-finding tests.
- Chart review of complete blood cell counts from clinically well children over a one-year period.
- Application of US Preventive Services Task Force evaluation criteria.
Main Results:
- No patient data from literature search met the study criteria.
- Abnormal leukocyte counts (outside published normal ranges) were found in 74.7% of tests performed on clinically well children.
- No unsuspected illnesses were identified through abnormal leukocyte count results.
Conclusions:
- Total and differential leukocyte counts lack value as a case-finding test in well pediatric populations.
- Routine screening with leukocyte counts in asymptomatic children does not effectively identify unsuspected diseases.
- The findings suggest that leukocyte counts should not be routinely used for case-finding in healthy children.
Abstract:
To determine whether the total and differential leukocyte count is of value as a case-finding test, we applied the evaluation criteria developed by the US Preventive Services Task Force. The criteria comprise review of the current burden of suffering of the disease to be prevented, the attributes of the intervention to be used, and the quality of the evidence available. A literature search revealed no evidence in the form of data from patients, so a chart review of all complete blood cell counts ordered during a 1-year period by one group of pediatricians was undertaken. At least one value outside of published normal ranges was found on 74.7% of the tests performed on clinically well children. No unsuspected illness was discovered as a result of an abnormal total and differential leukocyte count.