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The complete blood count (CBC) is frequently ordered but often not cost-effective due to inaccurate white blood cell (WBC) counts. These counts lack specificity and sensitivity, limiting their use in diagnosing infections and assessing disease severity.
Area of Science:
- Clinical pathology
- Laboratory medicine
- Emergency medicine
Background:
- The complete blood count (CBC) is a common laboratory test in emergency settings.
- Current CBC (complete blood count) utilization may not be cost-effective.
- White blood cell (WBC) and differential counts have limitations in accuracy.
Purpose of the Study:
- To evaluate the reliability and cost-effectiveness of CBC (complete blood count).
- To explore variations in WBC (white blood cell) and differential counts.
- To review literature on CBC (complete blood count) use in appendicitis and fever.
Main Methods:
- Literature review of pediatric and adult appendicitis cases.
- Summary of laboratory, physiologic, and pathophysiologic causes of WBC (white blood cell) count variation.
- Analysis of CBC (complete blood count) accuracy and cost-effectiveness.
Main Results:
- WBC (white blood cell) and differential counts lack specificity for distinguishing bacterial from viral infections.
- WBC (white blood cell) and differential counts lack sensitivity for assessing disease severity.
- The diagnostic and prognostic value of CBC (complete blood count) is limited in certain patient populations.
Conclusions:
- The routine use of CBC (complete blood count) in emergency departments needs re-evaluation for cost-effectiveness.
- Further research is required to improve the reliability of WBC (white blood cell) and differential counts.
- Alternative diagnostic strategies may be needed to overcome CBC (complete blood count) limitations.
Abstract:
The complete blood count (CBC) is the laboratory test most frequently ordered by emergency physicians. This is often not cost effective because of the relative inaccuracy of the white blood cell (WBC) and differential cell counts. The WBC and differential counts do not reliably distinguish between bacterial and viral infections because they lack specificity in many patients, nor do they reliably correlate with the severity of disease because they lack sensitivity in some patients. This article briefly summarizes the laboratory, physiologic, and pathophysiologic causes of variations in the WBC and differential counts; reviews some of the literature on pediatric patients with fever and appendicitis and on adult patients with appendicitis and abdominal pain; and presents suggestions for future research into the reliability and cost effectiveness of the CBC.