Complete blood count: what is really important and what bothers the doctor (and scares the patient)

The idea behind the JAMA Network Open article is simple and bold: there is too much unnecessary stuff in the OAC form today. It clutters up the electronic chart, creates “false alarms” for patients, and distracts doctors from what really influences the decision.

Background

Why bother with the “regular” OAK/SVS?
Complete Blood Count (CBC) is the most common lab test in hospitals and outpatient practices. It is ordered “at the entrance”, in dynamics, at discharge - a total of hundreds of millions of reports per year. Any little thing in how this report looks scales across the entire system: it affects the doctor’s time, decision-making, and patient anxiety.

What's in the report - and why so much of it
Historically, the CBC is a "core" of three blocks:

• Red blood cells and hemoglobin (RBC, Hgb, Hct and derivatives MCV/MCH/MCHC, RDW),
• Leukocytes (WBC) with differential - in relative (%) and/or absolute values,
• Platelets (PLT) and their indices (eg MPV).

Modern hematology analyzers automatically calculate dozens of derivative and "extended" metrics (immature granulocytes, NRBC, reticulocytes, etc.). Technically, it is "cheap" to output them into the report - that is where the "zoo" of lines comes from, not all of which really change clinical decisions in general medicine.

Why Format Diversity Is a Problem, Not Just an Aesthetic

• Cognitive load and "flags". Redundant and ambiguous fields increase the number of "stars" outside the references, creating false reasons for action and consultation.
• Time in the EHR. The doctor spends minutes scrolling, comparing abbreviations and references, which at the department level turns into hours.
• Patient portals. With the introduction of the “instant results” policy, the patient often sees the report before the doctor. The plethora of indicators and “flags” increases anxiety and the flow of “is this dangerous?” messages.
• Interoperability. Different hospitals, different LIS/EMR and analyzer vendors = different sets of fields and designations. This prevents data from being compared between institutions and interferes with clinical logic (for example, some show only percentages of the leukocyte formula without absolutes, while others do the opposite).

Where does this variability come from?

• Legacy of devices. Vendors bring out the full set supported by a specific model; LIS often "mirrors" everything that came.
• Order templates and "defaults". When CBC is included in standard "packages", all available fields are pulled into the report.
• Lack of a unified display standard. There are measurement and coding standards (LOINC, etc.), but there is no national consensus on what exactly to show in the statement in routine scenarios.

Why it's not about "cutting everything for everyone", but about focus
The idea of "focused CBC" is to separate the core, which influences decisions in general practice (Hb, Hct, RBC indices, PLT, WBC with absolute differential), from supplements that are needed in a niche (hematology, oncology, intensive care) or according to indications. These are:

• will reduce noise and false flags in general medicine,
• will speed up the review of extracts and interhospital exchange,
• If necessary, it will allow you to open advanced options in one click.

Where it’s Subtle: The Risks of Oversimplification

• In some clinical situations, "secondary" fields (e.g. NRBC, IG, MPV) are useful. Therefore, it is better not to delete them permanently, but to hide them by default with the possibility of showing them on click or by triggers (suspected sepsis, cytopenias, etc.).
• Pediatrics and hematology use different references and kits - they will require a separate profile.

What to expect from this type of research

• Map of real variability by country: how many fields are in reports where basic things “drop out” (for example, differential absolutes), where, on the contrary, there is an overload.
• Agenda for clinics and IT: redesign of CBC templates in EHR/LIS, unification of abbreviations, “profiles” for scenarios (medical examination, admission, hospital, hematology).
• Effect metrics: fewer “false” requests to the portal, fewer repeat tests “just in case”, less time spent reviewing the extract - without loss of diagnostic sensitivity.

The result of the CBC context
is a tool with enormous utility and… with accumulated “visual technical debt”. The focus is not “cutting for the sake of cutting”, but bringing the report to the clinical task: a short core for most scenarios, expansion - according to indications; uniform designations; priority of absolute values where it reduces interpretation errors. This is a classic case when the report design is also part of evidence-based medicine.

What exactly did they do?

The Mayo Clinic team downloaded sets of CBC metrics that actually appear in medical records from the Epic Care Everywhere interhospital exchange and compared them between academic and regular hospitals for 2020-2023. This isn't about "norms" or devices - it's about what the doctor and patient see in the report.

Key figures

• The analysis included 139 hospitals from 102 cities in 43 states; the median number of items in the report was 21 (range 12-24). There was little difference between academic and regular hospitals.
• Every fifth hospital showed <20 values; 12% - maximum 24.
• A significant proportion of institutions did not display some of the usual lines at all:
  • % of the leukocyte formula - absent in 9%;
  • mean platelet volume (MPV) - 21%.
    However, absolute NRBC (nucleated red blood cells) and immature granulocytes appeared in the reports of 26% and 58% of hospitals, respectively - although the clinical value of their routine display is debatable.

Why is this important?

The authors remind us: CBC is one of the most common tests in the US (hundreds of millions per year). Doctors already spend a lot of time analyzing EHRs, and with “instant results” for patients (a requirement of the 21st Century Cures Act), the flow of portal messages has increased - often before the doctor has looked at the analysis. Extra or duplicate lines in the report → more clicks, more anxiety, more burnout.

What the experts suggest

In an invited commentary, hematologists W. R. Barak and M. A. Lichtman call for dividing the CBC into a “core” and “extras” — keeping the metrics that really influence decisions and removing the “distractions.” This is an extension of their previous concept of “focused CBC,” with several pre-defined profiles for different tasks (health checkup, acute care, hematology). The idea is simple: fewer columns, more value.

What does this mean in practice?

• For clinics and LIS/EMR. There is a "quick" field for improvement: CBC templates by indications, hiding secondary or derived metrics by default, a single set of designations. This will reduce "visual garbage" and time for viewing results.
• For doctors. Start from the clinical question: during a routine examination - "narrow" CBC; in acute inflammation - include differentiation; in hematology - expand consciously. Fewer fields - fewer false "flags".
• For patients. Do not panic because of incomprehensible lines and "asterisks" in the portal. The list of fields depends on the hospital and does not always reflect the need for your case. Discuss the results with your doctor.

Limitations of the study

This is a cross-section of one sharing ecosystem (Epic Care Everywhere): local reports may have differed from the “interhospital” view; the work did not assess outcomes (whether “cutting” would impact diagnostics/errors) or address discrepancies in reference intervals. But the signal of reporting overload is strong and replicable at the country level.

And what next?

The authors write directly about the great potential for simplification and standardization of CBC: fewer fields, clear profiles for the task, unified display logic. This can reduce noise in the EHR, save time, reduce patient anxiety, and support doctors in conditions of overload. The next step is to pilot reports redesign and evaluate the impact on clinical decisions and communication with patients.

Source:

• Go LT et al. “Variation in Complete Blood Count Reports Across US Hospitals,” JAMA Network Open, June 5, 2025 (open access, PMCID: PMC12142446).
• Burack WR, Lichtman MA “The Complete Blood Count-Time to Assess What Is Impactful and What Is Distracting,” JAMA Network Open, June 2, 2025 (invited commentary). doi:10.1001/jamanetworkopen.2025.14055