{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:32:01Z","timestamp":1794047521872,"version":"4.8.0"},"reference-count":26,"publisher":"Ferrata Storti Foundation (Haematologica)","issue":"4","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["haematol"],"abstract":"<jats:p>The complete blood count (CBC) began its evolution at the end of the 19th century with the development of the hemacytometer to count blood cells. Soon thereafter, the hematocrit, a method to determine the packed red cell volume, was described in Sweden. Subsequently, the mean volume and hemoglobin content of red cells were added. Stains that distinguished individual leukocyte types permitted differential white cell counts: the product of the total white cell count and the fraction of each white cell type. A reliable means to count platelets rounded out the manual CBC. In 1954, Wallace Coulter introduced the Model A electronic particle counter. Modifications and advancements evolved into the Model S, a rapid, accurate, electronic method to determine the standard variables in the CBC and an array of additional measurements. Electronic particle counting has undergone numerous further developments including the application of florescence technology, such that approximately 30 variables can be measured as part of a CBC. This evolution has led to a chaotic situation; a recent study showed that the CBC ranged from 12 to over 24 variables when measured in either a community or academic hospital hematology laboratory. Out-of-range values, frequent and often trivial, have to be reconciled for patient and physician. Redundant and very low value variables have accrued in the CBC. We propose a major change in the CBC depending on the reason for its measurement. These recommendations markedly decrease the variables measured and make the results more impactful, which will enhance the physician\u2019s focus on the use of this key laboratory test to the benefit of the patient\u2019s care.<\/jats:p>","DOI":"10.3324\/haematol.2025.300032","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T09:12:26Z","timestamp":1764839546000},"page":"1215-1219","source":"Crossref","is-referenced-by-count":2,"title":["The evolution of the complete blood count: have we gone too far?"],"prefix":"10.3324","volume":"111","author":[{"given":"Marshall A.","family":"Lichtman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard W.","family":"Burack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1856","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"87476","doi-asserted-by":"crossref","unstructured":"Verso ML. The evolution of blood-counting technologies. Med Hist. 1964; 8(2):149-158.","DOI":"10.1017\/S0025727300029392"},{"key":"87477","unstructured":"Ehrlich P. Methodologische Beitr\u00e4ge zur Physiologie und Pathologie der verschiedenen Formen der Leukocyten [Methodological contributions on the physiology and pathology of the different forms of leukocytes]. Z Klin Med. 1879; 1:553-560."},{"key":"87478","doi-asserted-by":"crossref","unstructured":"Lichtman MA. Reflections on the reticulocyte count: the importance of the \u201ccomplete\u201d blood count. The Hematologist. 2021; 18(6)","DOI":"10.1182\/hem.V18.6.2021612"},{"key":"87479","unstructured":"Blix MG. Presentation to the Society of Physicians. 1885."},{"key":"87480","doi-asserted-by":"crossref","unstructured":"Hedin SG. Der H\u00e4matokrit, ein neuer Apparat zur Untersuchung des Blutes. [The Hematocrit, a new apparatus for the examination of the blood.]. Skandin Arch f Physiol. 1891; 2:134-140.","DOI":"10.1111\/j.1748-1716.1891.tb00578.x"},{"key":"87481","doi-asserted-by":"crossref","unstructured":"Hedin SG. Untersuchungen mit dem H\u00e4mtocrit. [Investigations with the Hematocrit.]. Arch f Physiol. 1891; 2:134-140.","DOI":"10.1111\/j.1748-1716.1891.tb00583.x"},{"key":"87482","unstructured":"Wintrobe MM. A simple and accurate hematocrit. J Lab Clin Med. 1929; 15:287-289."},{"key":"87483","doi-asserted-by":"crossref","unstructured":"Wintrobe MM. Macroscopic examination of the blood: discussion of its value and description of the use of a single instrument for the determination of sedimentation rate, volume of packed red cells, leukocytes and platelets, and of icterus index. Am J Med Sci. 1933; 185(1):58-71.","DOI":"10.1097\/00000441-193301000-00007"},{"key":"87484","doi-asserted-by":"crossref","unstructured":"Wintrobe MM. The volume and hemoglobin content of the red blood corpuscles. Am J Med. Sci. 1929; 177:513-523.","DOI":"10.1097\/00000441-192904000-00006"},{"key":"87485","doi-asserted-by":"crossref","unstructured":"Wintrobe MM. Anemia: classification and treatment on the basis of differences in the average volume and hemoglobin content of the red corpuscles. Arch Intern Med. 1934; 54(2):256-258.","DOI":"10.1001\/archinte.1934.00160140099006"},{"key":"87486","doi-asserted-by":"crossref","unstructured":"Haden RL. Clinical significance of volume and hemoglobin content of the red blood cell. Arch Intern Med (Chic). 1932; 49:1032-1057.","DOI":"10.1001\/archinte.1932.00150130155013"},{"key":"87487","doi-asserted-by":"crossref","unstructured":"Zijlstra W.G. Standardisation of haemoglobinometry: history and new challenges. Comp Haematol Int. 1997; 7(3):125-132.","DOI":"10.1007\/BF02652590"},{"key":"87488","doi-asserted-by":"crossref","unstructured":"Brecher G, Schneiderman M, Cronkite EP. The reproducibility and constancy of the platelet count. Am J Clin Pathol. 1953; 23(1):15-26.","DOI":"10.1093\/ajcp\/23.1.15"},{"key":"87489","doi-asserted-by":"crossref","unstructured":"Graham MD. The Coulter principle: imaginary origins. Cytometry A. 2013; 83:1057-1061.","DOI":"10.1002\/cyto.a.22398"},{"key":"87490","doi-asserted-by":"crossref","unstructured":"Simson E. Wallace Coulter\u2019s life and his impact on the world. Int J Lab Hematol. 2013; 35(3):230-236.","DOI":"10.1111\/ijlh.12069"},{"key":"87491","unstructured":"Graham MD. The Coulter Principle: for the good of humankind 2020. 2025."},{"key":"87492","doi-asserted-by":"crossref","unstructured":"Graham MD. The Coulter Principle: a history. Cytometry. 2022; 101(1):8-11.","DOI":"10.1002\/cyto.a.24505"},{"key":"87493","unstructured":"Coulter WH. High-speed automatic blood cell counter and cell size analyzer. Proc Natl Electr Conf. 1957; 12(3):1034-1042."},{"key":"87494","doi-asserted-by":"crossref","unstructured":"Vembadi A, Menachery A, Qasaimeh MA. Cell cytometry: review and perspective on biotechnological advances. Front Bioeng Biotechnol. 2019; 7:147.","DOI":"10.3389\/fbioe.2019.00147"},{"key":"87495","doi-asserted-by":"crossref","unstructured":"Burack WR, Lichtman MA. The complete blood count: increasing its precision and impact. Ann Intern Med. 2023; 176(3):404-405.","DOI":"10.7326\/M22-3071"},{"key":"87496","doi-asserted-by":"crossref","unstructured":"Burack WR, Go RS, Lichtman MA. The complete blood count: new and more effective uses. The Hematologist. 2024; 21(4)","DOI":"10.1182\/hem.V21.4.202442"},{"key":"87497","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(6):e2514050.","DOI":"10.1001\/jamanetworkopen.2025.14050"},{"key":"87498","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(6):e2514055.","DOI":"10.1001\/jamanetworkopen.2025.14055"},{"key":"87499","doi-asserted-by":"crossref","unstructured":"St Sauver JL, Warner DO, Yawn BP. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013; 88(1):56-67.","DOI":"10.1016\/j.mayocp.2012.08.020"},{"key":"87500","doi-asserted-by":"crossref","unstructured":"Ahmed MM, Ghauri SK, Javaeed A. Trends of utilization of complete blood count parameters for patient management among doctors in Azad Kashmir. Pak J Med Sci. 2020; 36(5):999-1004.","DOI":"10.12669\/pjms.36.5.1885"},{"key":"87501","doi-asserted-by":"crossref","unstructured":"Sandhaus LM, Meyer P. How useful are CBC and reticulocyte reports to clinicians?. 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