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Diagnostic Decision
The Complete Blood Count and Leukocyte Differential Count
An Approach to Their Rational Application
Abstract
The complete blood count and leukocyte differential count have no value in screening asymptomatic members of the general population. The complete blood count may be useful for screening infants in the first year of life, institutionalized elderly persons, pregnant women, and recent immigrants from Third World countries, if poor nutrition or inadequate iron intake is suspected. These tests are not useful for hospitalized patients, unless an abnormality is suspected or surgery with major blood loss is anticipated. It is appropriate to obtain the tests when a hematologic or infectious disorder is suspected, but they may not affect decision making if the diagnosis is clinically evident. The leukocyte differential count is unnecessary to confirm an infection in most cases in which leukocytosis is present. Repeat tests should be limited to situations where the clinical course is unclear, and at intervals long enough such that the results might affect clinical decision making.
- anemia
- appendicitis
- band neutrophil count
- blood cell count
- diagnostic tests
- routine
- hematocrit
- hematologic diseases
- hemoglobin
- homes for the aged
- infant
- infection
- kidney failure
- chronic
- leukocyte count
- leukocyte differential count
- malignancy
- neutrophil count
- pregnancy
- screening tests
- surgery
Article and Author Information
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▸From the Department of Medicine, University of California, Los Angeles, California.
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▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPCIM), and is the eleventh in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., M.D., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appeared on pages 60-66 in the January 1986 issue.—The Editor.
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▸Requests for reprints should be addressed to Martin F. Shapiro, M.D., Ph.D.; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles; Los Angeles, CA 90024.
- © 1987 American College of Physicians
