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Related Experiment Videos

When to do diffs: how often should differential counts be repeated?

G Brecher, R E Anderson, P D McMullen

    Blood Cells
    |January 1, 1980
    PubMed
    Summary
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    Monitoring white blood cell (WBC) counts can effectively track polymorphonuclear neutrophil (PMN) changes, minimizing the need for daily differential counts. This strategy avoids unnecessary lab tests and reduces costs without significant information loss.

    Area of Science:

    • Clinical Pathology
    • Laboratory Medicine
    • Hematology

    Background:

    • Hospital laboratories frequently perform daily differential counts to monitor polymorphonuclear neutrophils (PMN).
    • Physicians use these counts to detect infection or monitor effects of marrow-depressant drugs.
    • Increasing workloads necessitate efficient laboratory strategies, prompting interest in automated differential counters.

    Purpose of the Study:

    • To evaluate a cost-saving strategy of performing differential counts only when significant changes in total white blood cell (WBC) counts occur.
    • To determine if WBC trends can reliably indicate significant PMN changes, thereby avoiding routine differential counts.

    Main Methods:

    • Analysis of 415 sequences of WBC and differential counts (four determinations within 10 days).

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  • Established criteria for significant WBC and PMN trends based on clinical judgment and physiological variations.
  • Compared changes in PMN counts against concurrent changes in total WBC counts.

    • Main Results:

    • Only four out of 415 sequences showed a significant PMN change without a corresponding significant WBC change.
    • The proposed strategy would have resulted in a loss of information in approximately 1% of cases.
    • Significant cost savings in differential counts are achievable with this approach.

    Conclusions:

    • Using total WBC counts as an indicator for potential neutropenia or neutrophilia is a sound and effective strategy.
    • This approach significantly reduces the number of differential counts performed, leading to considerable laboratory cost savings.
    • The proposed method minimizes information loss, making it a viable alternative for routine monitoring.