{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T18:43:21Z","timestamp":1794077001955,"version":"4.8.0"},"reference-count":22,"publisher":"Walter de Gruyter GmbH","issue":"10","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Harmonization in laboratory medicine is increasingly recognized as a fundamental requirement to ensure interchangeable laboratory information, avoid confusion among users, and ultimately improve patient safety. However, current evidence continues to highlight substantial gaps in harmonization across several dimensions of the total testing process, including test requesting strategies, analytical comparability among different methods and platforms, reporting units, reference intervals, and the clinical interpretation of results. The complete blood count (CBC) represents a paradigmatic example of the persistent lack of harmonization in laboratory medicine and of the potential clinical implications that may arise from it. The CBC is among the most widely requested and clinically impactful laboratory tests, being routinely used across nearly all areas of medical practice. However, recent papers published in highly influential medical journals, including\n                    <jats:italic>Nature<\/jats:italic>\n                    and\n                    <jats:italic>JAMA<\/jats:italic>\n                    , have highlighted two complementary but equally important issues. On the one hand, these studies emphasize the need for improved interpretative criteria, particularly through the adoption of personalized reference intervals that better reflect individual biological variability. On the other hand, they underline the substantial heterogeneity in the number and type of CBC parameters reported, which may generate uncertainty and confusion among clinicians regarding the clinical meaning and utility of the reported variables. Taken together, these observations highlight that harmonization should not be limited to analytical standardization alone but must also address the appropriateness of test requesting and the clinical interpretation of laboratory results. In this perspective, CBC may represent an ideal model for rethinking the role of laboratory medicine: moving from the simple generation of numerical results toward the delivery of actionable and clinically meaningful information. Achieving this goal requires stronger collaboration between laboratory professionals and clinicians, with the shared objective of aligning test requesting, reporting strategies, and interpretative criteria to the clinical question and the patient\u2019s context. Such an approach would represent a concrete step toward the implementation of Value-Based Laboratory Medicine, where the true value of laboratory testing is measured not by the volume of tests performed but by its ability to improve diagnostic accuracy, support clinical decision-making, and ultimately enhance patient outcomes.\n                  <\/jats:p>","DOI":"10.1515\/cclm-2026-0590","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:36:09Z","timestamp":1778585769000},"page":"2168-2172","source":"Crossref","is-referenced-by-count":3,"title":["The complete blood count: data or clinical information?"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-1711","authenticated-orcid":false,"given":"Mario","family":"Plebani","sequence":"first","affiliation":[{"name":"Department of Medicine-DIMED , University of Padova , Padova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Buttarello","sequence":"additional","affiliation":[{"name":"Laboratory Hematology, Synlab-Data Medica Clinical Laboratory , Padova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia Chiatamone","family":"Ranieri","sequence":"additional","affiliation":[{"name":"Clinical Pathology and Microbiology Unit, Department of Services , \u201cG. Mazzini\u201d Hospital, ASL of Teramo , Teramo , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Papa","sequence":"additional","affiliation":[{"name":"UOC Patologia Clinica, Ospedale Isola Tiberina Gemelli , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026082718023499286_j_cclm-2026-0590_ref_001","doi-asserted-by":"crossref","unstructured":"Plebani, M. Harmonization in laboratory medicine: the complete picture. Clin Chem Lab Med 2013;51:741\u201351. https:\/\/doi.org\/10.1515\/cclm-2013-0075.","DOI":"10.1515\/cclm-2013-0075"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_002","doi-asserted-by":"crossref","unstructured":"Lewis, SM. Standardization and harmonization of the blood count: the role of International Committee for Standardization in Haematology (ICSH). Eur J Haematol Suppl 1990;53:9\u201313. https:\/\/doi.org\/10.1111\/j.1600-0609.1990.tb01520.x.","DOI":"10.1111\/j.1600-0609.1990.tb01520.x"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_003","doi-asserted-by":"crossref","unstructured":"Buoro, S, Lippi, G. Harmonization of laboratory hematology: a long and winding journey. Clin Chem Lab Med 2018;56:1575\u20138. https:\/\/doi.org\/10.1515\/cclm-2018-0161.","DOI":"10.1515\/cclm-2018-0161"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_004","doi-asserted-by":"crossref","unstructured":"Obstfeld, AE, Davis, BH, Han, JY, Urrechaga, E. Report of the International Council for Standardization in Haematology working group for standardization of reticulocyte parameters. Int J Lab Hematol 2024;46:266\u201374. https:\/\/doi.org\/10.1111\/ijlh.14209.","DOI":"10.1111\/ijlh.14209"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_005","doi-asserted-by":"crossref","unstructured":"Buttarello, M, Plebani, M. Automated blood cell counts: state of the art. Am J Clin Pathol 2008;130:104\u201316. https:\/\/doi.org\/10.1309\/ek3c7ctdknvpxvtn.","DOI":"10.1309\/EK3C7CTDKNVPXVTN"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_006","doi-asserted-by":"crossref","unstructured":"Foy, BH, Petherbridge, R, Roth, MT, Zhang, C, De Souza, DC, Mow, C, et al.. Haematological setpoints are a stable and patient-specific deep phenotype. Nature 2025;637:430\u20138. https:\/\/doi.org\/10.1038\/s41586-024-08264-5.","DOI":"10.1038\/s41586-024-08264-5"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_007","doi-asserted-by":"crossref","unstructured":"Meex, SJR, Aakre, KM. Personalized ranges for blood-test results enable precision diagnostics. Nature 2025;637:279\u201380. https:\/\/doi.org\/10.1038\/d41586-024-03854-9.","DOI":"10.1038\/d41586-024-03854-9"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_008","unstructured":"Fraser, CG. Biological variation: from principles to practice. In: Biological variation. Washington DC: AACC Press; 2001."},{"key":"2026082718023499286_j_cclm-2026-0590_ref_009","doi-asserted-by":"crossref","unstructured":"Aarsand, AK, Co\u015fkun, A, Sandberg, S. Utilizing the stability of individual homeostatic setpoints over time\u00a0\u2013\u00a0a step forward on the path to personalized laboratory medicine. ClinChem 2025;71:925\u20137. https:\/\/doi.org\/10.1093\/clinchem\/hvaf022.","DOI":"10.1093\/clinchem\/hvaf022"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_010","doi-asserted-by":"crossref","unstructured":"Coskun, A, Lippi, G. The impact of physiological variations on personalized reference intervals and decision limits: an in-depth analysis. Clin Chem Lab Med 2024;62:2140\u20137. https:\/\/doi.org\/10.1515\/cclm-2024-0009.","DOI":"10.1515\/cclm-2024-0009"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_011","doi-asserted-by":"crossref","unstructured":"Demirelce, O, Inal, BB, Co\u015fkun, A. Personalized reference intervals versus indirectly estimated population-based reference intervals for hematology measurands. Int J Lab Hematol 2026;48:365\u201370. https:\/\/doi.org\/10.1111\/ijlh.70035.","DOI":"10.1111\/ijlh.70035"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_012","doi-asserted-by":"crossref","unstructured":"Plebani, M, Coskun, A. Promoting value-based laboratory medicine: moving towards an innovative model of clinical laboratory. Clin Chim Acta 2025;572:120269. https:\/\/doi.org\/10.1016\/j.cca.2025.120269.","DOI":"10.1016\/j.cca.2025.120269"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_013","doi-asserted-by":"crossref","unstructured":"Coskun, A, Plebani, M. Personalized reference intervals based on biological variation: a critical evaluation of strengths and limitations. Clin Chem Lab Med 2026;64:e143\u20135. https:\/\/doi.org\/10.1515\/cclm-2026-0263.","DOI":"10.1515\/cclm-2026-0263"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_014","doi-asserted-by":"crossref","unstructured":"Plebani, M. Advancing value-based laboratory medicine. Clin Chem Lab Med 2025;63:249\u201357. https:\/\/doi.org\/10.1515\/cclm-2024-0823.","DOI":"10.1515\/cclm-2024-0823"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_015","doi-asserted-by":"crossref","unstructured":"Go, LT, Go, LT, Gunaratne, MDSK, Abeykoon, JP. Variation in complete blood count reports among US hospitals. JAMA Netw Open 2025;8:e2514050. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.14050.","DOI":"10.1001\/jamanetworkopen.2025.14050"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_016","doi-asserted-by":"crossref","unstructured":"Burack, WR, Lichtman, MA. The complete blood count-time to assess what is impactful and what is distracting. JAMA Netw Open 2025;8:e2514055. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.14055.","DOI":"10.1001\/jamanetworkopen.2025.14055"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_017","doi-asserted-by":"crossref","unstructured":"Sandhaus, LM, Meyer, P. How useful are CBC and reticulocyte reports to clinicians? Am J Clin Pathol 2002;118:787\u201393. https:\/\/doi.org\/10.1309\/cqgg-hy0u-lrkl-glmp.","DOI":"10.1309\/CQGG-HY0U-LRKL-GLMP"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_018","doi-asserted-by":"crossref","unstructured":"Burack, WR, Lichtman, MA. The Complete Blood Count: increasing its precision and impact. Ann Intern Med 2023;176:404\u20135. https:\/\/doi.org\/10.7326\/m22-3071.","DOI":"10.7326\/M22-3071"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_019","doi-asserted-by":"crossref","unstructured":"Lichtman, MA, Burack, RW. The evolution of the complete blood count: have we gone too far? Haematologica 2026;111:1215\u201319. https:\/\/doi.org\/10.3324\/haematol.2025.300032.","DOI":"10.3324\/haematol.2025.300032"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_020","doi-asserted-by":"crossref","unstructured":"Crawford, JM, Shotorbani, K, Swanson, K. The role of the clinical laboratory in diagnostic stewardship and population health. J\u00a0Appl Lab Med 2025;10:140\u20137. https:\/\/doi.org\/10.1093\/jalm\/jfae113.","DOI":"10.1093\/jalm\/jfae113"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_021","doi-asserted-by":"crossref","unstructured":"Lucijanic, M, Krecak, I. The complete blood count: increasing its precision and impact. Ann Intern Med 2023;176:eL230164. https:\/\/doi.org\/10.7326\/L23-0164.","DOI":"10.7326\/L23-0164"},{"key":"2026082718023499286_j_cclm-2026-0590_ref_022","doi-asserted-by":"crossref","unstructured":"Trenti, T, Petrini, AM, Plebani, M. New reimbursement models to\u00a0promote better patient outcomes and overall value in laboratory\u00a0medicine and healthcare. Clin Chem Lab Med 2024;62:1795\u2013803. https:\/\/doi.org\/10.1515\/cclm-2024-0168.","DOI":"10.1515\/cclm-2024-0168"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-0590\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-0590\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:02:56Z","timestamp":1787853776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2026-0590\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,9,25]]}},"alternative-id":["10.1515\/cclm-2026-0590"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2026-0590","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"value":"1434-6621","type":"print"},{"value":"1437-4331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]}}}