{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T22:16:29Z","timestamp":1771884989907,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,11]],"date-time":"2023-03-11T00:00:00Z","timestamp":1678492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Despite a lack of evidence, a bone marrow aspirate differential of 500 cells is commonly used in the clinical setting. We aimed to test the performance of 200-cell counts for daily hematological workup. In total, 660 consecutive samples were analyzed recording differentials at 200 and 500 cells. Additionally, immunophenotype results and preanalytical issues were also evaluated. Clinical and statistical differences between both cutoffs and both methods were checked. An independent control group of 122 patients was included. All comparisons between both cutoffs and both methods for all relevant types of cells did not show statistically significant differences. No significant diagnostic discrepancies were demonstrated in the contingency table analysis. This is a real-life study, and some limitations may be pointed out, such as a different sample sizes according to the type of cell in the immunophenotype analysis, the lack of standardization of some preanalytical events, and the relatively small sample size of the control group. The comparisons of differentials by morphology on 200 and 500 cells, as well as by morphology (both cutoffs) and by immunophenotype, are equivalent from the clinical and statistical point of view. The preanalytical issues play a critical role in the assessment of bone marrow aspirate samples.<\/jats:p>","DOI":"10.3390\/diagnostics13061071","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T02:31:55Z","timestamp":1678674715000},"page":"1071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cell Count Differentials by Cytomorphology and Next-Generation Flow Cytometry in Bone Marrow Aspirate: An Evidence-Based Approach"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8193-1402","authenticated-orcid":false,"given":"Rafael","family":"R\u00edos-Tamayo","sequence":"first","affiliation":[{"name":"Fundaci\u00f3n para la Investigaci\u00f3n Biom\u00e9dica del Hospital Universitario Puerta de Hierro-Majadahonda, Hematology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4817-0757","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain"},{"name":"Registro de C\u00e1ncer de Granada, Escuela Andaluza de Salud P\u00fablica (EASP), 18080 Granada, Spain"},{"name":"Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"G\u00f3mez-Rojas","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-9779","authenticated-orcid":false,"given":"Miguel","family":"Rodr\u00edguez-Barranco","sequence":"additional","affiliation":[{"name":"Registro de C\u00e1ncer de Granada, Escuela Andaluza de Salud P\u00fablica (EASP), 18080 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria P\u00e9rez","family":"Segura","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9986-915X","authenticated-orcid":false,"given":"Daniel","family":"Redondo-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Registro de C\u00e1ncer de Granada, Escuela Andaluza de Salud P\u00fablica (EASP), 18080 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9570-5542","authenticated-orcid":false,"given":"Gonzalo","family":"CARRE\u00d1O-TARRAGONA","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio Rodr\u00edguez","family":"Nicol\u00e1s","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain"},{"name":"Immunology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2247-3293","authenticated-orcid":false,"given":"Francisco","family":"Ruiz-Cabello","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain"},{"name":"Immunology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain"},{"name":"Immunology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Alonso","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n del 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la Investigaci\u00f3n Biom\u00e9dica del Hospital Universitario Puerta de Hierro-Majadahonda, Hematology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1136\/jcp.54.9.657","article-title":"Bone marrow aspiration","volume":"54","author":"Bain","year":"2001","journal-title":"J. Clin. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1046\/j.1365-2141.1996.d01-1786.x","article-title":"The bone marrow aspirate of healthy subjects","volume":"94","author":"Bain","year":"1996","journal-title":"Br. J. Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1007\/s00277-020-04255-4","article-title":"Reevaluation of reference values for bone marrow differential counts in 236 healthy bone marrow donors","volume":"99","author":"Parmentier","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_4","unstructured":"Jandl, J.H. (1996). Blood: Textbook of Hematology, Little Brown. [2nd ed.]."},{"key":"ref_5","unstructured":"Osorio, G. (1996). T\u00e9cnicas y Procedimientos de Laboratorio, Mediterr\u00e1neo."},{"key":"ref_6","unstructured":"Greer, J.P., Foerster, J., and Lukens, J.N. (2004). Wintrobe\u2019s Clinical Hematology, Lippincott Williams & Wilkins. [11th ed.]."},{"key":"ref_7","unstructured":"Woessner, S., and Florensa, L. (2006). La Citolog\u00eda \u00d3ptica en el Diagn\u00f3stico Hematol\u00f3gico, Acci\u00f3n M\u00e9dica. [5th ed.]."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1751-553X.2008.01100.x","article-title":"International Council for Standardization in Hematology. ICSH guidelines for the standardization of bone marrow specimens and reports","volume":"30","author":"Lee","year":"2008","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_9","unstructured":"Koottke-Marchant, K., and Davis, B.H. (2012). Laboratory Medicine Practice, Blackwell. [1st ed.]."},{"key":"ref_10","unstructured":"Kaushansky, K., Lichtman, M.A., and Prchal, J.T. (2016). Williams Hematology, McGraw-Hill Education. [9th ed.]."},{"key":"ref_11","unstructured":"Keohane, E.M., Smith, L.J., and Walenga, J.M. (2016). Rodak\u2019s Hematology, Clinical Principles and Applications, Elsevier. [5th ed.]."},{"key":"ref_12","unstructured":"Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., Thiele, J., and Vardiman, J.W. (2017). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, IARC. [4th ed.]."},{"key":"ref_13","unstructured":"Bain, B.J., Bates, I., Laffan, M.A., and Lewis, M. (2017). Dacie and Lewis Practical Haematology, Elsevier. [12th ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/ajcp\/aqy034","article-title":"Is a 500-Cell Count Necessary for Bone Marrow Differentials? A Proposed Analytical Method for Validating a Lower Cutoff","volume":"150","author":"Abdulrahman","year":"2018","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_15","first-page":"588","article-title":"Health impact assessment and the role of accredited clinical laboratory on ISO 15189:2007 International Standard","volume":"8","author":"Sainz","year":"2011","journal-title":"J. US-China Med. Sci."},{"key":"ref_16","unstructured":"R Core Team R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_17","unstructured":"Potapov, S., Model, F., Schuetzenmeister, A., Manuilova, E., Dufey, F., and Raymaekers, J. (2023, January 26). Package \u2018mcr\u2019. Available online: https:\/\/CRAN.R-project.org\/package=mcr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1159\/000509524","article-title":"Morphogo: An Automatic Bone Marrow Cell Classification System on Digital Images Analyzed by Artificial Intelligence","volume":"64","author":"Fu","year":"2020","journal-title":"Acta Cytol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1071\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:52:54Z","timestamp":1760122374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/6\/1071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,11]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["diagnostics13061071"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13061071","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,11]]}}}