The Automated Blood Count: Its History, Utility and Need for Change

An automated complete blood cell count (CBC) is one of the most frequently ordered laboratory tests. The clinical utility of its 20 to 25 parameters, however, is variable depending, for example, upon the physician’s age, education and specialty. Likewise, the information value of some CBC indices differs in populations with, for example, a high prevalence of benign (ethnic) neutropenia or thalassemia trait compared with other populations. Whereas modern blood cell analyzers count reticulocytes they do not include this important count in a ‘standard’ CBC report. In this article, we review the history of blood cell counting, the clinical utility of some parameters as well as the logic and information processing costs of their use in clinical practice. We conclude that the CBC as currently reported is an unnecessarily complex yet incomplete test, and suggest that blood analyzers be reprogramed to offer physicians a Short CBC with 11 clinically relevant parameters i.e. red cell count, reticulocyte count, hemoglobin, mean corpuscular volume, red blood cell distribution width, platelet count, and five absolute leukocyte differential counts.