Don’t perform a manual differential on a complete blood count (CBC) if a recent valid automated differential result remains unchanged.

Automated differentials consider thousands of cells, compared to a standard of 100 on a manual differential. On a properly validated modern instrument, auto-diffs are highly reliable. Manual differentials are laborious, time-consuming, and prone to variation. A

complete-blood-count with differential (CBC w/diff) is a common test, often ordered repeatedly on in-patients. In most cases, a repeated white blood cell differential within 24 hours does not add clinical value.

Sources:

Phelan MP, Nakashima MO, Good DM, Hustey FM, Procop GW. Impact of interventions to change CBC and differential ordering patterns in the emergency department. Am J Clin Pathol. 2019 Jan 7;151(2):194-197. doi: 10.1093/ajcp/aqy128. PMID: 30247523.

Shen JZ, Hill BC, Polhill SR, Evans P, Galloway DP, Johnson RB, et al. Optimization of laboratory ordering practices for complete blood count with differential. Am J Clin Pathol. 2019;151(3):306-15. doi: 10.1093/ajcp/aqy146. PMID: 30357374.

Starks RD, Merrill AE, Davis SR, Voss DR, Goldsmith PJ, Brown BS, et al. Use of middleware data to dissect and optimize hematology autoverification. J Pathol Inform. 2021;12:19. doi: 10.4103/jpi.jpi_89_20. PMID: 34221635.

Tran A, Hudoba M, Markin T, Roland K. Sustainable laboratory-driven method to decrease repeat, same-day WBC differentials at a tertiary care center. Am J Clin Pathol. 2022;157(4):561-5. doi: 10.1093/ajcp/aqab146. PMID: 34617986.