Talk:Complete blood count/Archive 1

full blood count vs cbc

I was surprised to find this title. Where is "full blood count" used more than cbc? Is this european or british usage? I've never heard the term in the US. Alteripse 16:44, 23 Jun 2004 (UTC)

It's UK usage. Asking for a CBC would draw a blank in this part of the world. JFW | T@lk 00:39, 24 Jun 2004 (UTC) OK thanks. Alteripse 00:45, 24 Jun 2004 (UTC)

In our lab (in the UK) we use Coulter Gen S series cell counters (made in the US). When selecting the type of test the menu you are presented with offers "CBC only" and "CBC + Diff" as options. It seems that Coulters view is that CBC refers only to the WCC/RBC/PLT component of the test and not to the diff. I'm willing to trust them, after all, They did invent the rheostatic method of cell counting (ie. the coulter principle) --Povmcdov 16:30, 8 Jan 2005 (UTC)

Per wikipedia naming conventions, the more common name should be the title. CBC is far more common than FBC. Ace-o-aces 05:39, 8 May 2005 (UTC)

Article rating

I think that this article could easily reach "B" class for quality if it had more than one reference. WhatamIdoing (talk) 22:45, 25 November 2007 (UTC)

The existing reference doesn't work anymore. The www.missouricancer.com web site still exists, but has been rearranged and I can't find any pages on blood. MarcM1098 (talk) 07:17, 21 June 2008 (UTC)

Hemogram

"Hemogram" is redirected here. Can the definition of "hemogram" be added to this article (even if just to say it is identical to CBC, if that is the case)? Wakablogger2 (talk) 10:34, 21 July 2010 (UTC)

Diagram

i don't know how to edit this diagram, but it has a typo, saying hbg for hemoglobin rather ythan hgb.Toyokuni3 (talk) 02:48, 14 May 2013 (UTC)

I just uploaded a new one Major_Small (talk) 08:01, 16 July 2013 (UTC)

Infobox problems

"Schematics (also called "Fishbones") of shorthand for complete blood count commonly used by clinicians. The shorthand on the right is used more often in the US."

a) There is no shorthand on the right. (If 'shorthand' is just another word for 'schematic', then there is only one. Otherwise, I see no "shorthands" in the infobox.

b) The sentence is awkward at best: Schematics of shorthand...

c) Using two words for the same concept is not kind to readers.

Item: If I there is no objection, I will change the first sentence to:

Schematic commonly used by clinicians to represent complete blood count results (sometimes called "Fishbones"). The numeric results are placed in the positions indicated.

Item: If two diagrams are not provided, I will change the second sentence to:

The results are placed in different positions in different countries. Do not assume this is the format used for actual results you wish to interpret. — Preceding unsigned comment added by Joaquin (talk • contribs) 18:34, 18 October 2014 (UTC)

Need separate article on differential white blood cell count

IMHO there should be a separate article devoted just to the differential white blood cell count, rather than only including the information in the article about the CBC. Thomas.Hedden (talk) 17:16, 3 March 2015 (UTC)

Total white blood count

This is more for interest than anything else, but whereabouts do you request a CBC and only get a total white count (without diff)? T 12:16, 14 Apr 2004 (UTC)

In the Netherlands, where I gained most of my clinical experience, many hospitals do not routinely perform the diff. IMHO, this is folly, and in the UK (where I work now) a full/complete blood count is indeed full/complete, including the diff. In addition, microscopy is performed on samples when expressly requested (e.g. patient with fever, confusion and bruising - DD TTP. Schistocytes?) JFW | T@lk 14:27, 14 Apr 2004 (UTC)

It is a bit strange a differential isn't routinely done there. If it's done with a machine, the additional cost of running the sample through the diff channel (and the reagents needed for this) must be a small proportion of the total cost. Insignificant for the extra information obtained with a diff. T 10:06, 15 Apr 2004 (UTC)

On the east coast of the US, you can't assume you'll get a differential when you get a WBC, unless you specifically request it, and even then your request may not be honored. The lab has established criteria (one differential every three days max for hospitalized patients (unless otherwise ordered), or no differential if WBC not elevated unless requested. Doing fewer differentials saves not only on the reagents, but on technician time. It's not optimal but it's workable. - Nunh-huh 10:13, 15 Apr 2004 (UTC)

If it's done on an automated analyser it won't be any more work for the technicians, (the sample will spend longer on the machine, but this usually won't affect the amount of work) but i get your point. I've worked in a hospital and a 'community' (private) lab in NZ, (in two different provinces). Diffs get done on everything. In the hospital i worked in, retics and NRBCs were done on all paed samples (as they're put through the machine manually) even if the result is never seen. But i s'pose inefficiencies like this exist in every industry. T 10:55, 15 Apr 2004 (UTC)

In this instance at least, the feeling was that if a differential was given it could not be merely a machine differential: it was an indication that an actual and hopefully knowledgable human had actually looked at the peripheral smear, with all the possibilities for thereby discerning things a machine would not detect. - Nunh-huh 21:33, 15 Apr 2004 (UTC)

A machine differential will give a more precise, and nearly as accurate diff as a human; and in a 'normal' sample you'll get the results (#s of neuts/lymphs/monos/etc) you want. Where I am now, a blood film is done if the diff is abnormal enough to expect a change in morphology (e.g. WBCs > 15 x10⁹/L). The machine will also flag things like blasts, immature grans, atypical lymphs etc, and a film is done on these. T 22:33, 15 Apr 2004 (UTC)

In the UK haematology lab I work at the rough rule of thumb is that if a patient is ill we will do a diff, if they are injured then we will not by default. The main catagories of parients who do not get one are: pregant women, postnatal women, pre-op and post op patients. The reason it is done is money. the 5-10% of samples we put through "diff off" save the department £2000 per year. Not much really, but then this is the NHS. Microscopy is done on all paed samples, and retics are done on newborns. other patients get it when they are outside normal ranges and especially is the analyser flags up blasts etc. We do not use the analyser for retics as the reagent is quite expensive, and its cheaper to do one manually using a Merrett tube. --Povmcdov 16:44, 8 Jan 2005 (UTC)

haemoglobin measured on single cell?

"automated hematology analyzers also measure the amount of haemoglobin in our blood and within each red blood cell" I don't think the haemoglobin content is measured on each cell, but rather on the lysed content of a bunch of cells.

Request: normal range of counts in mammals

Could someone please provide a normal range of the above counts in the most important mammals (like human, mouse, cow, pig) and possible diseases, if out of range (maybe separated by "below" and "above"). THANKS. massa 09:41, 22 Nov 2004 (UTC)

The spectrum of diseases is probably quite similar, but I have no access to the veterinary reference ranges. Perhaps Google will help. JFW | T@lk 18:13, 22 Nov 2004 (UTC)

This is not as easy as it may seem. Reference values in humans vary according to age and sex, so I assume the same would be true of other mammals.

Glandular fever / infectious mononucleosis

I will be making a minor edit to the section regarding significance of results. It states that monocytes are raised in GF/IM. This is not the case, it is the lymphocytes that increase in number. I suspect the error was made because of the similarity between the terms monocyte and mononuclear lymphocyte. I am not a stste registed BMS, just a tech, but I do monospot tests most days. --Povmcdov 16:55, 8 Jan 2005 (UTC)

Thanks mate, your expertise is much welcomed. JFW | T@lk 19:59, 8 Jan 2005 (UTC)

More references needed

This article has had a "more references needed" tag on it since 2007. It is difficult to find sources for concepts like this because the concept is so ubiquitous that CBC is not described well anywhere online. I added a Mayo Clinic source which is below the level Wikipedia needs, and other clinics similarly have explanations which are too simplistic to be of much use here. I think this article should be sourced with a textbook, but I only have easy access to online resources and textbooks are not easily found online. Blue Rasberry (talk) 14:59, 29 July 2014 (UTC)

Bluerasberry well, 6 years later, I'm finally working on this. I'm planning to take the article to GA (it will take a while). Any input would be appreciated. SpicyMilkBoy (talk) 08:51, 3 January 2020 (UTC)

@SpicyMilkBoy: Best wishes! You know how to find WP:WikiProject Medicine, which is the best support for wiki development for health articles. This article gets 20k views a month which means it is among Wikipedia's 0.01% most popular articles. If you change this you change common knowledge in society. Looking ahead, this is also a concept which we need to translate. Prioritize accuracy but when possible, choose simple English because as a matter of public health education after GA or as good as we can get this it needs to go to Translation Task Force then into other languages. Blue Rasberry (talk) 12:25, 3 January 2020 (UTC)

Pre-GA checks

Thanks, SpicyMilkBoy, for offering to take this article to GA. First of all, it's worth checking it against B-class criteria - see Wikipedia:Content assessment/B-Class criteria, and making sure it can be classified as B-class, which you can do yourself. Obviously the next step would be to check against Wikipedia:Good article criteria.

A couple of technical points to note: The dates throughout the article are consistently "dmy", and that's fine. But the article contains a mixture of British English and American English spellings, such as "categorize" (en-us) and "litre" (en-gb). Maybe these are Canadian English; it might be worth asking someone like JenOttawa to comment whether that is the case. If not, you ought to decide on either en-us or en-gb, where it's much easier for others like me to help out, and go through the article regularising (or regularizing) the spellings to one or the other. Then put {{American English}} or {{British English}} near the top of the page to inform other editors that a choice has been made.

The references may come under scrutiny, so they should be consistent in style. I strongly recommend against using a mixture of CS1 and CS2 citation styles; it's best to pick one or the other and then regularise the others. You'll need to make sure author names are presented in the same style as well - most of the time we tend to use "Last name, Given name" or "Last name, Initial" (which using |first= and |last= will do for you).

This isn't my area of expertise, but I'm happy to do checks for you if you need me. Get through the above first and see how it goes. Cheers --RexxS (talk) 15:13, 4 January 2020 (UTC)

Thanks, RexxS. :) There's still a lot of work needed to bring it up to B-class, let alone GA, but I will keep working on it. For what it's worth, the combination of "-ize" and "litre" is Canadian English, but I haven't gone through the whole article yet to check for spelling consistency. And thanks for pointing out that one of the references was in CS2 style, I hadn't realized that; I've just changed it to CS1 to match the rest of them. I will probably deal with the reference formatting when I'm closer to being done, because I'll be adding a lot of references, and I find it easier to do the whole thing at once. Thanks again for your advice on this. SpicyMilkBoy (talk) 16:38, 4 January 2020 (UTC)

FYI - I started working on Milk allergy and Egg allergy as C-class and moved both to GA. My early steps including deleting weak material and checking existing refs for true support of content before adding content and refs. In my opinion, six paragraph lead is too long. All the history stuff could go in a History section, before Notes. David notMD (talk) 03:03, 1 February 2020 (UTC)

Thanks for the feedback, David notMD. One of the points brought up during the GA review for White blood cell differential was that the lead needed expansion. I may have gone overboard in trying to apply that advice here; I'll see what I can do to shorten it. I was never sure what to think about the WP:MEDMOS style of putting the history section at the end. Makes sense in some ways, but I like having that bit of context before getting into the details... I will work on this more when I have time. SpicyMilkBoy (talk) 03:49, 2 February 2020 (UTC)

GA Review

This review is transcluded from Talk:Complete blood count/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Tom (LT) (talk · contribs) 16:53, 29 May 2020 (UTC)

Hey @SpicyMilkBoy, well met. Thanks for your edits to this article, I'll review it according to the good article criteria. I edit in the medicine / anatomy space and you can see other nominations that I've reviewed on my talk page. I'll spend a few days familiarising myself with the article and post my review then.--Tom (LT) (talk) 16:53, 29 May 2020 (UTC)

Thanks Tom, I appreciate it. Looking forward to the GA review :) SpicyMilkBoy (talk) 16:54, 29 May 2020 (UTC)

Review

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	Done
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Done
	2c. it contains no original research.	No OR
	2d. it contains no copyright violations or plagiarism.	Done no copyvio on Earwig's
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.
	6b. media are relevant to the topic, and have suitable captions.
	7. Overall assessment.

Commentary

Comments below: --Tom (LT) (talk) 05:44, 1 June 2020 (UTC)

• A great article, really easy to read and very well phrased. I really commend you for this; I cannot imagine an article that has been written as well as this one, so kudos.
• Some domains (copyvio check, references check) pending
  • Addit: no problemso Earwig's. References all up to date and from reliable sources.
• I have passed the article, but here are just a few things that I think could be improved if you would like:
  • Suggest remove "routine" from "routine medical examination" as you already say it's commonly ordered and it's also ordered in other medical examinations.
    •  Done Spicy (talk) 01:09, 2 June 2020 (UTC)
  • Just being picky here: "The test may also be ordered if a healthcare provider suspects a person has a medical condition that affects blood cells, such as anemia, bleeding disorders, infection or cancer"
  • Suggest reword to "bleeding disorders due to platelets" (as other disorders won't show abnormalities) and "some cancers" as most solid tumours don't cause significant abnormalities of the blood count. Also, what would your thoughts be about adding "other inflammatory conditions" as these are another common cause
    •  Partly done Added "inflammatory conditions" and "some cancers". I'm not sure about "bleeding disorders due to platelets", because that implies that the clinician would know whether or not the bleeding is due to a platelet disorder prior to ordering a CBC, as opposed to using it to rule in/out platelet issues in someone with general symptoms of a bleeding disorder. Spicy (talk) 01:09, 2 June 2020 (UTC)
  • Use of 'CBC' - it's only used a few times in the article. I would recommend rewordint it to 'complete blood count' just to make the article more readable and remove an unnecessary acronym.
    •  Done I've reworded it in the body of the article but kept the acronym in the infobox and captions for brevity. Spicy (talk) 01:09, 2 June 2020 (UTC)
  • 'Automated' - "In the white blood cell channel, a reagent lyses the red cells so that white blood cells can be analyzed more easily". Suggest like other sections, add some other terms to explain what a reagent and lyses is. Such as "a substance added to the sample (a reagent) destroys (lyses) the red blood cells..."
    •  Done Reworded to "a reagent chemical is added to the sample to destroy (lyse) the red cells so that white blood cells can be analyzed more easily." Spicy (talk) 01:09, 2 June 2020 (UTC)
  • 'Included tests' - some parts mention the tests only, others mention tests + pathology. To make this standardised, I would probably add in the Hb section that low Hb is an indicator of anaemia; and haematocrit can be influenced by dilution, dehydration and anaemia (as the main causes in my mind, anyway)
    •  Doing... Will do this shortly. Spicy (talk) 01:09, 2 June 2020 (UTC)
  • 'Interpretation of results' - suggest link "blast cells"
    •  Done I remembered why I didn't do that originally: the article on blast cells is not good and does not discuss any of the hematological aspects. Those aspects are covered at lymphoblast and myeloblast, but it would be inappropriate to link "blast cells" in general to a specific type of blast. I guess the blast cell article explains that it's an immature cell, at least, so that's somewhat helpful. Spicy (talk) 01:09, 2 June 2020 (UTC)
  • 'Interpretation of results' - two columns in the table (RBC and WBC) have colons; the others don't.
    •  Done Spicy (talk) 01:09, 2 June 2020 (UTC)
  • "Schematics (also called "fishbones") of shorthand for complete blood count commonly used by clinicians". I am not sure if this is commonly used - I have never seen it used in my jurisdiction; needs a reliable source.
    •  Doing... yeah, I never liked that image or its caption, but it was originally the lead image for the article and I felt bad about getting rid of it. Will look for a source for the caption and if I can't find one, I'll use a different image. Spicy (talk) 01:09, 2 June 2020 (UTC)

Overall this is an excellent article and I want to compliment you again on writing something so readable. Would recommend you consider putting it up for featured article nomination (or ask an experienced editor for a brief review) because I feel it must be quite close. --Tom (LT) (talk) 00:25, 2 June 2020 (UTC)

Thank you so much for the review! I will address your comments shortly. Re. FA... I've been thinking about it, but IMO the article will require substantial work first, especially for the comprehensiveness aspect - there are a couple topics I haven't covered here, like the reticulocyte count (which I never really considered to be part of the CBC but many sources seem to), experimental/research parameters such as these, drawbacks of use as a general screening test... I figured it wasn't necessary to cover these minor topics at GA level but it's probably necessary for FA. I am also not good at all the nitpicky stuff about citation formatting, tables, dashes, commas and so on, so I would want an experienced FA writer to go through it with a fine toothed comb first. But I really appreciate your encouragement and I'll keep it in mind for the future :) Spicy (talk) 00:40, 2 June 2020 (UTC)

Tom (LT) I've responded to your comments. Thanks again :) Spicy (talk) 01:09, 2 June 2020 (UTC)

Article review

Here is a section for comments on the article in preparation for an eventual FAC. Let's start with what I'm most unsure about:

• Tables.
  • I know nothing about tables. I've added a table of reference values to the article, and set it to be hidden by default, because it is very long. I'm aware of MOS:DONTHIDE, but I don't know what to do with the table otherwise. The information is (IMO) highly relevant, but the unhidden table is extremely long and distracting.
  • Should the reference value table include conversions into imperial units? How should the two sets of values be displayed if so?
  • Should the reference value columns be sortable? I'm not quite sure how to do this - I attempted to do it but it interfered with the title heading and it resulted in the non-numerical columns being sortable alphabetically, which is silly.
  • I believe Sandy objected to the bolding in the "Quantitative abnormalities of blood cells" table, which I'll remove. That was a relic from the old article.
  • Does the "Quantitative abnormalities" table need references? While it is obvious and self-explanatory information ([cell]+[penia] = low number of [cell], [cell type]+[osis] = high number of [cell]), I am very hesitant about any sort of unsourced content... the only reason I haven't added sources so far is that it's sort of hard to source since, well, it's self explanatory and no one bothers to explain all of these terms in one place (would have to cite an entire textbook's glossary, probably). Spicy (talk) 00:55, 14 June 2020 (UTC)

Spicy, what do you think about this to deal with the hidden table? That is, reduce the overall number of images and move it to the right. I self-reverted, but you can reinstate if it works. SandyGeorgia (Talk) 01:05, 16 June 2020 (UTC)

On imperial units, we typically have to convert. Let's ask RexxS (Brit?). If you have to convert these units, the charts become unmanageable. SandyGeorgia (Talk) 01:06, 16 June 2020 (UTC)

RexxS may also know how to make the table sortable. SandyGeorgia (Talk) 01:07, 16 June 2020 (UTC)

(edit conflict) Thanks for the table magic :) I like what you've done with the reference range table but I don't like that it pushes the second table halfway into the history section. I suppose we could just get rid of the second table but I do think it's useful as a sort of index/navigational aid. If we end up having to drop the reference range table due to the conversion issue I suppose I could probably find an external link with the ranges. Or cut it down to WBC/HB/HCT/PLT only. Spicy (talk) 01:08, 16 June 2020 (UTC)

Is it possible to rearrange the sections to provide more space? SandyGeorgia (Talk) 01:30, 16 June 2020 (UTC)

Sure, could do something like this or this (shorter version) - although I'm not sure how that will look if I have to add the conversions. Spicy (talk) 01:38, 16 June 2020 (UTC)

I like it ... but let’s see what RexxS says. I will continue reviewing after he weighs in, Bst, SandyGeorgia (Talk) 02:12, 16 June 2020 (UTC)

Example of complete blood count reference ranges

Test	Units	Adult	Pediatric (4–7 years old)	Neonate (0–1 days old)
WBC	× 109/L	3.6–10.6	5.0–17.0	9.0–37.0
RBC	× 1012/L	M: 4.20–6.00 F: 3.80–5.20	4.00–5.20	4.10–6.10
HGB	g/L	M: 135–180 F: 120–150	102–152	165–215
HCT	L/L	M: 0.40–0.54 F: 0.35–0.49	0.36–0.46	0.48–0.68
MCV	fL	80–100	78–94	95–125
MCH	pg	26–34	23–31	30–42
MCHC	g/L	320–360	320–360	300–340
RDW	%	11.5–14.5	11.5–14.5	elevated
PLT	× 109/L	150–450	150–450	150–450
Neutrophils	× 109/L	1.7–7.5	1.5–11.0	3.7–30.0
Lymphocytes	× 109/L	1.0–3.2	1.5–11.1	1.6–14.1
Monocytes	× 109/L	0.1–1.3	0.1–1.9	0.1–4.4
Eosinophils	× 109/L	0.0–0.3	0.0–0.7	0.0–1.5
Basophils	× 109/L	0.0–0.2	0.0–0.3	0.0–0.7

References

@Spicy and SandyGeorgia: There are quite a few points you've raised. I'll try to bullet point them and give a demo of how I think it should be marked up.

• Tables should always have captions.
• No content in the article body should be collapsed by default.
• Headers should be marked up with their scope.
• I'm pretty certain you don't need conversions for these sort of medical units. SI units like 'per litre' are pretty much universal, and even us Brits and you Yanks with our penchant for imperial units are not going to measure blood counts as "per pint".
• Sorting is a bit of a dark art, so I've implemented it as far as it's possible in my demo for you to see.
• I have to say I'm not sure about the sorting because the units differ between tests, but if you want sorting, you can. Personally, I wouldn't bother.
• I don't think you can save any more space. Using 85% font-size is as far as you can go, and floating it off to the right minimises the whitespace. However, if you want to avoid it pushing down into the next section, then the most economical way is to is use {{clear}} at the very end of the current section, which will prevent it.

Does that answer your questions? Feel free to ping me back if I've missed anything or been unclear. Cheers --RexxS (talk) 13:53, 16 June 2020 (UTC)

Thanks, RexxS, works for me. So Spicy, I suggest going to your longer version using RexxS chart. Indifferent about sorting. SandyGeorgia (Talk) 14:33, 16 June 2020 (UTC)

Looks good—- ready to continue? SandyGeorgia (Talk) 19:34, 16 June 2020 (UTC)

Thanks for the help, RexxS! I got rid of the sorting, agree with you that the different units make it pointless... I thought that there might be some way to deal with that but I guess not. I'm ready to move on... Spicy (talk) 19:53, 16 June 2020 (UTC)

I've just removed the <small>...</small> tags as that font size reduction is now inside the table. I've also simplified the table by removing all of the sorting as it's not used. Hope that's okay. --RexxS (talk) 20:18, 16 June 2020 (UTC)

Now that's settled, I'll dig back in later today, SandyGeorgia (Talk) 20:20, 16 June 2020 (UTC)

SG review

Spicy, I will work mostly with inline commentary. It's not necessary to answer me on each one; you can address my queries and remove the inline commentary, or not address them too if they are off. At any rate, just remove the inlines when you are satisfied. SandyGeorgia (Talk) 02:10, 17 June 2020 (UTC)

• I suggest a TOC limit of 3 rather than 2 ... it does not result in a TOC that is too dense, and provides a better overview of what is to come. SandyGeorgia (Talk) 02:49, 17 June 2020 (UTC)
  •  Done Spicy (talk) 04:47, 17 June 2020 (UTC)

Should anything from Venipuncture#Additives_and_order_of_draw be added here? Unsure myself ... SandyGeorgia (Talk) 14:06, 17 June 2020 (UTC)

The lead says:

• The analyzer counts red and white blood cells and platelets by flow cytometry, isolating single cells and measuring characteristics like light scattering and electrical impedance to distinguish between different types of cells and collect information about their size and structure. Hemoglobin is measured by spectrophotometry, and the red blood cell indices are calculated from the red blood cell count, average cell volume, and hemoglobin.

This includes four terms possibly unknown to layreaders, like me :) Is it necessary to give the layreader so much technical information in the lead? One has to click out to understand many of the terms. What if flow cytometry, light scattering, electrical impedance and spectrophotometry are introduced instead in the body of the article, with brief definitions (eg spectrophotometry – quantitative analysis of molecules depending on how much light is absorbed by colored compounds), with the lead being much simpler? For example:

• The analyzer counts red and white blood cells and platelets, isolating single cells and measuring characteristics to distinguish between different types of cells and collect information about their size and structure. Hemoglobin is measured, and the red blood cell indices are calculated from the red blood cell count, average cell volume, and hemoglobin.

I suggest that gives most readers enough, and then the body can go into each of those terms, adding a brief definition after each one, so that the reader is not forced to click out multiple times in the lead to understand the topic.

For example, white blood cell differential is briefly explained in the lead, and so is hematocrit. If you rework some of this, then these sentences will also need some rejigging:

• Spectrophotometric methods for measuring hemoglobin were developed in the 1920s, and Maxwell Wintrobe introduced the Wintrobe hematocrit method in 1929, which in turn enabled him to define the red blood cell indices. Automation of the complete blood count began with the invention of the Coulter counter by brothers Wallace and Joseph A. Coulter in the 1950s. This device used electrical impedance measurements to count blood cells and measure their sizes, a technology that remains in use in many automated analyzers.

If "spectrophotometric" can be changed to a simpler word or eliminated (?). The sentence using impedance etc could be something like:

• This device used technology that remains in use in many automated analyzers.

Doing this, along with showing the level 3 TOC, then allows layreaders to get to the portion of the article they are most interested in, and helps them bypass some of the more technical aspects with higher-level vocabulary. SandyGeorgia (Talk) 14:29, 17 June 2020 (UTC)

This sentence raises passive voice concerns, and can probably be re-worded to avoid that:

• When transfusions are needed, it is recommended that the test only be performed once per day if the person's condition is stable, because excessive blood draws can deplete hemoglobin and platelets, leading to unnecessary transfusions.

"It is recommended" raises the question, by whom? Could it be reworded to something like ...

• When transfusions are needed, the test is typically only performed once per day if the person's condition is stable, because excessive blood draws can deplete hemoglobin and platelets, leading to unnecessary transfusions.

Or if this is always true, leave off typically entirely? SandyGeorgia (Talk) 14:42, 17 June 2020 (UTC)

• CDC and USPSTF on complete blood count: it might be better to add the primary source to the secondary source used, in case such info changes. For example, with a google search, I found this, so the secondary source isn't completely correct. I am unsure where to find the actual CDC recommendation, and could not locate one. The USPSTF is notorious for making it hard to find information ... I did find several reviews that said they recommend against CBC screening, but cannot locate the actual info (and many many sources were incorrectly the USPSTF screening guidelines on PSA for a very long time ... ), so it would be good to get more direct info on this. SandyGeorgia (Talk) 15:15, 17 June 2020 (UTC)

• The sample is then transported to a medical laboratory to be tested.

But sometimes the sample is taken at the medical laboratory that will do the testing, so doesn't always need to be "transported" ... reword that part ? SandyGeorgia (Talk) 15:17, 17 June 2020 (UTC)

See here for information on DupLinks; Ian always checks Duplinks before promoting. You can argue the case that some are needed. MOS:DUPLINK is only a guideline, and I was liberal about ignoring it when I was FAC Coordinator, because there are times when extra links benefit our readers (I was more of a stickler for MOS:OVERLINK in general and link on first occurrence). But since Ian does pay close attention to duplinks, be prepared to defend any extra links as necessary for the layreader. SandyGeorgia (Talk) 18:42, 17 June 2020 (UTC)

If "red blood cell agglutination" is an antibody-mediated condition, why does it not have an article? In this sentence, we call it a condition:

• An elevated MCHC can also be a false result from conditions like red blood cell agglutination (which causes a false decrease in the red blood cell count, elevating the MCHC) …

but only link to the general term, Agglutination (biology). Another sentence:

• Another antibody-mediated condition that can affect complete blood count results is red blood cell agglutination.

seems to indicate it is a specific diagnosable condition. If so, per WP:RED, we should have red blood cell agglutination (that is, if that is the name of a recognized condition). SandyGeorgia (Talk) 18:39, 17 June 2020 (UTC)

WP:RED for bone marrow disorder ? Are there many different types ? Should it have its own article? SandyGeorgia (Talk) 18:46, 17 June 2020 (UTC)

I'm done for now. Spicy this is VERY fine work, and almost ready for FAC. Ping me when you've worked through all of this, ignore as needed (I'm not tied to anything), but don't head to FAC until I can write walls of text to you about your next steps and how to handle FAC … basically, we need someone not familiar with medical jargon to go through it next, and I have several recommendations-- and I want to tell you a lot of things to avoid doing wrong at FAC.  :) Best (unwatching for now, so ping when ready). SandyGeorgia (Talk) 19:09, 17 June 2020 (UTC)

Comments from Cas Liber whose ears were burning

• The Medical uses section needs mention of circumstances where CBC is monitored routinely due to a drug. In my profession, people on clozapine need 4-weekly screening indefinitely due to risk of agranulocytosis for starters. There are others. Will think of others. Cas Liber (talk · contribs) 21:51, 27 June 2020 (UTC)

Thanks for taking a look at the article! This is mentioned briefly - people who are receiving treatments that can affect blood cell counts, such as chemotherapy, may have the test performed regularly to monitor their health - but it would probably be good to give a few more specifics and state why it is important to monitor blood counts in people on chemo or taking clozapine, etc. I will work on this. For that section I have found it hard to strike a balance between information that is overly general to the point of being useless and info that is too specific for a general encyclopedia. Most sources are either geared at patients or at medical professionals in a specific specialty. Neither are great for Wikipedia's purposes. Spicy (talk) 22:01, 27 June 2020 (UTC)

There are many, many others Cas. The CBC is used by most subdisciplines. I think it would be beyond the scope of this article to attempt to list them all. In the UK, the CBC is often performed daily on hospital patients because it is so useful. An explanation of the interpretation of abnormal results would probably be best linked to other articles such as hemoglobinopathy for example.Graham Beards (talk) 22:39, 27 June 2020 (UTC)

I agree there are many examples but some are more important than others (I guess I am looking at this a little as a doctor but we have an article with 6469 words of prose and the Medical uses section (i.e. what we actually use the test for) is miniscule. I don't think we need to be exhaustive but there are some pretty obvious/important examples. e.g. CBC is critical in clozapine, be we do it routinely in some other psych drugs (carbamazepine (looking at white cells), valproate (looking at platelets) every few months but is not such a big of a deal. Also, regular CBCs are critical in some areas, e.g. (sometimes) daily post surgery to monitor for blood loss. "Some cancers" is too vague - it's critical in leukemias and lymphomas, but also a normocytic normochromic anaemia is a sign something weird is going on. Anyway - this section needs to be expanded. I'd say specific mention to blood cancers, clozapine, polycythaemia (tricky as mentioned elsewhere). There may be others. Need to think. Cas Liber (talk · contribs) 21:27, 28 June 2020 (UTC)

Yes, I agree that there are organizational issues. WP:MEDMOS suggests separating the "medical uses" section from the "interpretation" section, so that is what I've done here, using the "medical uses" section as a basic overview of situations in which the test might be ordered, while discussing the implication of the results in the interpretation section and on a very simple level in the section on the individual tests. I never thought this was optimal, but I don't know how else to handle it. It may be better to put some of that up front.

And I agree there should be more detailed discussion of circumstances in which it is useful. Since the test is so ubiquitous it is hard to find a medium between the level of detail appropriate for a patient pamphlet and the level of detail appropriate for a medical textbook. To try to find reasonably detailed sources from a general perspective I did searches like "indications for complete blood count", "complete blood count in primary care", and I found nothing especially useful - but thinking on it my approach was probably too general and it may be better to search for sources specific to certain populations, e.g. surgery, pregnancy, oncology, infectious diseases, assessment of anemia/cytopenias, and integrate that with the more general ideas. I will work on this (I'm busy this week so may take me a while). I've also found stuff like "normocytic normochromic anaemia is a sign something weird is going on" difficult to source... it is very true, but the sources don't ever explicitly say it... but maybe I am just looking in the wrong places. Spicy (talk) 23:08, 28 June 2020 (UTC)

Casliber, I've expanded the medical uses (now Purpose) section with information about specific uses in medical specialties. Let me know if there are any glaring omissions. Some information on anemia/polycythemia has been added to the red blood cell (etc.) section as well... I plan to add a separate paragraph about use in hematology/heme-onc to "Purpose" but I will have to think about how to structure it so it's not redundant to the information in the "Included tests" section. Spicy (talk) 18:58, 3 July 2020 (UTC)

That is better yes. Cas Liber (talk · contribs) 20:50, 3 July 2020 (UTC)

• Also, some of the article is repetititive and material could be better organised (after reading the rest of the article), I will think about how to do it, and list specific issues below. Cas Liber (talk · contribs) 21:21, 28 June 2020 (UTC)

Specifically - overlap between interpretation, reference ranges and medical uses, and the (rbc) indices and the three sections above it. Cas Liber (talk · contribs) 21:33, 28 June 2020 (UTC)

Re. the RBCs, I wonder if it would be a good idea to consolidate the hemoglobin/hematocrit/RBC count/indices into one section and transfer the stuff about the mechanics of the tests into the "Procedure" section. This would also make it easier to explain how these parameters relate to each other physiologically and numerically. Spicy (talk) 23:08, 28 June 2020 (UTC)

I posted a draft of the combined section in my sandbox - User:Spicy/sandbox - and while doing so I was thinking that it might be best to address the interpretation in the sections on the individual tests, rather than having a stand-alone interpretation section, so I've done that as well. Let me know what you think. Spicy (talk) 00:50, 29 June 2020 (UTC)

Sandbox now contains a proposed rewrite of the tests section to integrate the interpretation and remove the procedural details, plus notes on areas that need expansion. I am thinking that the first paragraph of the interpretation section can be moved to the medical uses section and that section can be done away with completely. Let me know what you think of this. Spicy (talk) 12:29, 29 June 2020 (UTC)

@Spicy: the sandbox looks better, and rejigging the interpretation as above sounds good too. Cas Liber (talk · contribs) 13:51, 29 June 2020 (UTC)

Any info from (say) the WHO on availability and issues with CBC in remote underdeloped areas and what folks do when they don't have access to one (or whatever)? Cas Liber (talk · contribs) 21:25, 28 June 2020 (UTC)

Very briefly addressed under "manual testing" - deserves more for FA, will work on it. There's some stuff on this in Dacie and Lewis - apparently some places still use the hemoglobin colour scale described in the History section. Will look into sources from WHO and similar. Spicy (talk) 23:08, 28 June 2020 (UTC)

This might be worth watching to gain some insight on manual methods. I used to do this in the 1970s! [1]. Graham Beards (talk) 13:09, 29 June 2020 (UTC)

Very interesting! That was long before my time. They still make us do manual blood counts in school, but we got to use these instead of glass pipettes. :) Spicy (talk) 18:58, 3 July 2020 (UTC)

Responses

Thanks so much for your thorough review. I've addressed some of the inline comments and removed them, and I'm working on some others. I'll respond to some of the comments here if I think they could use further discussion or just for the purpose of organizing my thoughts...

• HATE the word "various" - yeah, I was trying to rephrase that and came up blank... same with that long sentence in the "Medical uses" section. Could never figure out a good way to phrase it. Will think harder on it.
• can you switch "mean" here to "average" for the "average" reader who may not know what "mean" is? - mean cell volume is the actual name of the test, but I think your suggestion is OK for the lead;  Done
• Unsure if that should say "sex" or "gender" ??? - I believe it should be sex - someone's gender identity wouldn't really affect the physiologic factors that lead to different reference ranges for lab tests. Unless they're on transgender HRT, possibly, but there's very little research on how that actually affects reference ranges. (see [2])
• Anything on other countries? -  Doing... not that I could find with a quick look, will look further into it; I initially tried to track down the CDC source cited in that paper but had trouble. Can probably find it with more searching.
  • They sure loved to do CBCs in Venezuela when I lived there - they really like to do CBCs in Canada too, it's why I have a job :P There is a disconnect between the guidelines and what is actually done in practice - the source says, About 70% of primary care clinicians would order a screening CBC for a 55-year-old woman, but I was hoping to find a stronger statement than that... I tried to look for statistics on how often CBCs are ordered and came up with nothing, just general statements that it is common. I will look further, may have to look for studies on laboratory tests in general instead of just CBCs.
• Re. the section on quality control, AFAIK those are requirements for accreditation in the US/UK/Canada and any lab found not to be doing that would have their license yanked quickly, but I should probably find sources that explicitly say that... will look. Not sure about the situation with other countries, but it looks like there are good sources for that [3] - will have to read up on it. Thanks for pointing out the globalization issue, definitely an oversight.
  • Belated reply - I have attempted to add more international perspectives the sections on quality control and criticism of screening... let me know how it looks... for screening I am still lacking sources from outside of the Anglosphere, and I'm not sure where to look for those. Do you have any ideas? Spicy (talk) 16:53, 24 July 2020 (UTC)
    • I do not know ... check with Casliber, Australia, and Graham Beards, UK, and google around for some other countries? Or make an inquiry at wt:med? SandyGeorgia (Talk) 17:34, 24 July 2020 (UTC)
      • OK, I have asked WT:MED and used my best google-fu (even tried using Google Translate to find foreign language search terms), and come up with nothing. Unless someone else has better Google skills I think this is the best I can do for now. Spicy (talk) 16:54, 1 August 2020 (UTC)

I might not get around to addressing the more substantial issues for a couple of days - I'm working night shift right now and feel sort of brain-dead. But I will deal with them in time. Feel free to continue reviewing. Spicy (talk) 04:47, 17 June 2020 (UTC)

• A few responses to above, will work on your new suggestions more later:
  • Red blood cell agglutination is not a disease in itself but a symptom/finding - it's usually caused by cold agglutinin disease or other forms of autoimmune hemolytic anemia. So "phenomenon" might be better than "condition". Agree it should have a stand-alone article, and it shouldn't be too hard to write a quick stub on it.
    • I was about to write the article when I found out it already exists at Red cell agglutination. Hooray. Article needs some improvement though. Spicy (talk) 21:16, 25 June 2020 (UTC)
      • Actually there are two articles on it. See Autoagglutination. Sheesh... Spicy (talk) 22:13, 25 June 2020 (UTC)
  • Yes, bone marrow disorder should be a broad concept article. I think a link to Bone marrow#Disease might be more helpful to readers than a redlink, though.
• Should anything from Venipuncture#Additives_and_order_of_draw be added here? - meh, the article says that it is usually collected in EDTA which is the most important part.

Thank you for your kind comments and for doing such a thorough review of the article, I appreciate it a lot! Spicy (talk) 20:27, 17 June 2020 (UTC)

• I've implemented most of your suggestions for simplifying the lead. I chose to still mention light scattering and electrical impedance in the history section, since IMO both concepts are important for understanding how the test works and how it evolved. Let me know if this is OK. Spicy (talk) 04:00, 19 June 2020 (UTC)
  • Spicy, if you are done for now, I will lay out on my talk page some suggested next steps: let me know. (I see there are still six inline queries.) SandyGeorgia (Talk) 18:36, 20 June 2020 (UTC)
    • I'm very far from being done... just haven't had the time to focus on the article over the past few days... I'll let you know when I'm ready :) Spicy (talk) 18:43, 20 June 2020 (UTC)
      • You've probably realized this but I tend to work on things slowly and in fits and starts (it took me about a month and a half from starting to work on this article to nominating it for GA, for example). I just don't want you to think I'm ignoring your review. I will have some time off work in about two weeks so I should be able to make more progress then. Spicy (talk) 15:57, 21 June 2020 (UTC)

The "Included tests" section has acquired some lunch food! SandyGeorgia (Talk) 18:52, 6 July 2020 (UTC)

• • Yep... I will either move the hematocrit image to the "Manual" section after I expand it a bit, or get rid of it. Spicy (talk) 19:19, 6 July 2020 (UTC)
• User:Evad37/duplinks-alt is a dup link checker that will be run at FAC. I am lax on enforcing one link only with highly technical terms, but there are quite a few dup links here that might need review. SandyGeorgia (Talk) 18:59, 6 July 2020 (UTC)
  • Will fix these when I'm closer to being done - I find it really hard to keep track of duplicate links when the article is still going through structural changes. Spicy (talk) 19:19, 6 July 2020 (UTC)
    • Yes ... best approach ... just wanted to make sure you knew to do that at the end, Best, SandyGeorgia (Talk) 20:07, 6 July 2020 (UTC)

Wow, this article has really progressed ... exciting! Spicy, are you getting close yet? Let me know when I should read through again, and then Graham, Cas and I can give you some advice about how to approach FAC. SandyGeorgia (Talk) 21:14, 12 July 2020 (UTC)

There is still a lot of work to be done, but I'm getting there... I do have one important question, which I probably should have brought up earlier. My copy of ref 4., Wintrobe's Clinical Hematology (14 ed.), is a PDF ebook. The ebook, annoyingly, doesn't have page numbers, so I have just been citing the pages of the PDF. Is this permitted? I looked for advice on what to do with books without page numbers and it seems the general advice is to use |loc= with a chapter/section title but this would require changing the citation format of the article. The other alternative, I suppose, would be to buy a print copy of the book so I can actually see the page numbers... Spicy (talk) 00:03, 15 July 2020 (UTC)

Ack, I see the problem. Because you are using rp, you can't add loc. So ... it seems you can either buy the book, or switch the format. I can save you some money by saying that I hate the way rps disrupt the flow of the article :) I'd prefer you switched the format. I shuddered at the idea when I had to add the page nos at dementia with Lewy bodies, but once I got going, it wasn't that bad. I do think it will make the article more readable to get the page nos out of the text. SandyGeorgia (Talk) 00:10, 15 July 2020 (UTC)

Aww, I like rp... but you're right that it can get ugly when you have a few of them in a row. I'm not looking forward to redoing a couple hundred citations but I guess it's preferable to spending 500 dollars. Going by what you've done at Dementia with Lewy bodies, should the the sfn look something like this (the last bit being the section title)? Also, if I include chapters for one book, do I have to add them to all the book sources for consistency, or is it fine to just cite the page numbers for the others? Spicy (talk) 00:41, 15 July 2020 (UTC)

References

There are places in the article where the citations plus page number strings are causing weird line wrap issues, leaving large blank spaces. If you're willing to do the work to convert, I think the result could be worth it. My understanding is that it is perfectly fine to mix page numbers for some with section headings for others, as I did with DLB. But I think the format would be, sec. "Advantage and sources of error with automated hematology" ... at least I encountered that somewhere in one of the Manual of style discussions. That is see how I used sec. in DLB. SandyGeorgia (Talk) 01:15, 15 July 2020 (UTC)

Thanks for the guidance... I will get started on it tomorrow or the day after. Spicy (talk) 01:43, 15 July 2020 (UTC)

OK, done all the books. Feel free to check my work. For the journal articles, how long do they have to be before I have to cite page numbers/sections? I was thinking 10 pages would be a good rule of thumb. Spicy (talk) 22:47, 17 July 2020 (UTC)

I took it case-by-case ...there's 10 pages of dense, highly technical text versus 10 pages where 1 is the abstract, 3 are citations and 2 are COI disclaimers. I say if there are five or less pages of fairly digestible prose, no need to cite pages, otherwise, better to do so. It's possible no one will complain at FAC either way, and that I got more scrutiny because of being former FAC delegate ... just look carefully at whether one can easily verify text, and be prepared to break out more page numbers if someone complains. SandyGeorgia (Talk) 01:25, 18 July 2020 (UTC)

OK... done. That was fun... now time to write. Spicy (talk) 00:35, 19 July 2020 (UTC)

To my eye, at least, it looks much better ;) SandyGeorgia (Talk) 01:04, 19 July 2020 (UTC)

OK... there are still a few things that I want to expand on, and I still have to clean up the dup links (will try to do this tonight), but I think it may be time to have some non-medical people take a look at the article. My work on the article has stalled a bit and I think some outside input would be helpful - also I'm concerned that it might be too dense/textbook-like in places, and of course it needs some copyediting... let me know if you think it's time. Spicy (talk) 16:54, 1 August 2020 (UTC)

ipad typing from car on way to cabin, pardon Siri’s typos, you can say at fac that you searched for global Information and found nothing else, i will re-read entire article tomorrow, type up more fac advice for you, and ping in some others. Meanwhile, it would be really good for you to go get your feet wet at FAC or FAR by reviewing some articles ... make your face known :). More when I get to cabin, six-hour drive, For now maybe Ceoil will glance in to tell us if there is too much jargon, prose is too dense, or any other broad issues ... SandyGeorgia (Talk) 17:03, 1 August 2020 (UTC)

Thanks again for your help. I reviewed a couple while ago... just easy ones, though... I don't feel like I have much to contribute to the average FAC review since I am not a particularly good copyeditor and don't know anything about, for example, sports or military history. But I'll keep an eye out... Spicy (talk) 17:12, 1 August 2020 (UTC)

Re the png above; have read about a 3rd, and its is admirably free of excessive jargon and very well written and accessible, presumably without compromising precision. Ceoil (talk) 21:23, 1 August 2020 (UTC)

Hi. Can we define the methods used for manual tests. Its mentioned several times, but not quiet tied down as to what it entails. The article is a fascinating read, bty. Ceoil (talk) 02:13, 2 August 2020 (UTC)

Thank you... that is good to know. This is a topic I am passionate about, as you can probably tell, and I was worried that it would be too long-winded and tedious for someone who is not as enthusiastic about the subject. There is no strict definition of what manual testing is, other than that it is something that is not performed by a hematology analyzer. The different types of manual tests are explained in the manual subsection of the procedure section... the sort of manual testing that is actually done depends on the needs of the laboratory. In first world countries the vast majority of testing is done on an analyzer, with manual differentials/blood smear reviews being done if there are serious abnormalities on the CBC or analyzer flags. Manual hematocrit testing is sometimes done to confirm the analyzer results, as is mentioned in passing (this apparently varies based on the analyzer and the patient population - I have to do them almost every day working in a hospital with a large population of heme-onc patients but I have heard of people who never have to do them at all (but that is all original research and I doubt that could be sourced)). I've included some information about the sorts of tests that may be available in different settings in the final paragraph of the "manual testing" section. Would you mind pointing out specific examples that are unclear? Just having trouble seeing this as I've spent forever staring at the article... Spicy (talk) 02:28, 2 August 2020 (UTC)

Great, thank you for explaining. I'm being perhaps very picky as I think the page is high potential, very engaging and a commendable achievement. I mostly done wrt gripes; all my ahem, "concerns" were met in almost real time; will keep the article watchlisted; best wishes with it. Ceoil (talk) 22:02, 2 August 2020 (UTC)

Thanks... I don't mind pickiness... want to make sure every possible issue is addressed before I put it up for further scrutiny. Not trying to impose, but curious if you have looked at the "History" section yet? It's the weakest IMO in terms of prose... Spicy (talk) 22:15, 2 August 2020 (UTC)

PS, Spicy, just looked at your FAC reviews, which were EXCELLENT, and gave the coords and the nominator info needed. SandyGeorgia (Talk) 23:39, 1 August 2020 (UTC)

SG review 2

• Is it possible to come up with a more descriptive section heading for ”Other” ? More tomorrow, SandyGeorgia (Talk)
  • I could add the NRBC stuff to the white blood cell differential section and have the reticulocyte count and "other parameters" as their own 2nd level sections, but that seems a bit weird/undue to me as they aren't really as important as the other tests. The "other" section is not really a coherent group but I'm not sure how else to handle it... Spicy (talk) 23:30, 1 August 2020 (UTC)
    • Not to worry then, SandyGeorgia (Talk) 23:35, 1 August 2020 (UTC)
• Inconsistent citation style on authors ...

• Fatemi, SH; Clayton, PJ (17 March 2016).
• Fleming KA, Naidoo M, Wilson M, Flanigan J, Horton S, Kuti M, et al ... SandyGeorgia (Talk) 23:19, 1 August 2020 (UTC)

• OK, I tried to fix this but I have no idea why the names are like that on the Fleming book - the citation format is the same as all the other books as far as I can tell. I thought it might have something to do with the displayauthors or chapter parameters but I don't think that's the case as other sources with those parameters display correctly. ??? Spicy (talk) 01:13, 2 August 2020 (UTC)

• I will look tomorrow on real computer, but I have encountered similar before ... when I can’t make citation templates behave, I just manually write that one citation ... Citation consistency is about making them render the same, regardless of method used .., SandyGeorgia (Talk) 01:58, 2 August 2020 (UTC)

I had another non-medical FA writer look at it (besides dear Ceoil) and they find the writing competent and the article FAC ready. I will read in the morning from real computer, type up for you some more FAC strategy stuff, but I think you are pretty much there. It is up to you whether you want to inquire at wt:med if anyone wants a final glance before you launch at fac. SandyGeorgia (Talk) 23:24, 1 August 2020 (UTC)

Many thanks to you and to the other unnamed FA writer :) I still have a bit of work to do (I think there are a couple of other problems with the citations... missing periods, some books missing editions and stuff) and I think I will check in with WT:MED before I take the plunge... want to make sure every possible issue is dealt with. Spicy (talk) 23:30, 1 August 2020 (UTC)

Another citation consistency thing, I just changed one, but not sure which you want ... sometimes you have a period after author before date on short citation, other times no period, eg:

• Greer, JP (2008). p. 4. (no period)
• Bain, BJ. (2015). pp. 29–30. (period)

I prefer them without the period, because that's how your long-form citations are written. SandyGeorgia (Talk) 20:16, 2 August 2020 (UTC)

The word enabled used twice in the one paragraph of the lead ... change one of them ... allowed ??? SandyGeorgia (Talk) 20:45, 2 August 2020 (UTC)

• After the baby is born, a complete blood count may be done to investigate jaundice or to count the number of immature cells in the white blood cell differential, which can be an indicator of sepsis.

These are both done on the baby? Or the first on baby, second on mother? If both on baby, perhaps change sentence to ... In newborns, a complete ... SandyGeorgia (Talk) 20:49, 2 August 2020 (UTC)

That's all for me! Good luck, SandyGeorgia (Talk) 21:03, 2 August 2020 (UTC)

We are now calling malaria a parasite when it is an infectious disease caused by mosquitos?? SandyGeorgia (Talk) 00:32, 3 August 2020 (UTC)

Whoops, brain fart. Fixed. Spicy (talk) 00:35, 3 August 2020 (UTC)

Well, I guess it was my brain fart: https://www.bbc.com/news/world-africa-53676702 SandyGeorgia (Talk) 23:47, 6 August 2020 (UTC)

No, you were correct... "malaria parasites" is okay, but just "malaria" is not. The latter is lab slang. The dangers of writing while sleep deprived... Spicy (talk) 23:51, 6 August 2020 (UTC)

Spicy, I think it is still correct to include the commons cats in EL: [4] SandyGeorgia (Talk) 15:01, 11 September 2020 (UTC)

There are only 8 files in the commons category; 2 of them are already used in the article and most of them are just printouts of CBC results. So not that helpful IMO c:Category:Blood films is better but it would be a bit weird just to link to that one since blood film examination is only an occasional part of the CBC. Spicy (talk) 18:56, 12 September 2020 (UTC)

ah ha, I had not checked, SandyGeorgia (Talk) 20:59, 12 September 2020 (UTC)

Query

• Red blood cells carry hemoglobin throughout the body—to the tissues, where it delivers oxygen, and to the lungs, where it releases carbon dioxide and is oxygenated again.

was changed to:

• Red blood cells carry hemoglobin to the tissues where they deliver oxygen, and to the lungs, where they release carbon dioxide and are oxygenated again.

I am not entirely comfortable with this as it makes it sound like the red blood cells, rather than specifically the hemoglobin, are what is transporting oxygen and CO2. Thoughts? Spicy (talk) 16:52, 3 August 2020 (UTC)

I think it is more accurate to say that the RBCs transport the gases, which are bound to their haemoglobin. How about:

Red blood cells deliver oxygen from the lungs to the tissues and on their return carry carbon dioxide back to the lungs where it is exhaled. These functions are mediated by the cells' hemoglobin. This might help. Graham Beards (talk) 20:16, 3 August 2020 (UTC)

Excellent... done. I forgot to ask... when you have a moment, would you mind adding a page number for Blann and Ahmed (2014)? Thanks, Spicy (talk) 22:55, 3 August 2020 (UTC)

Of course. I'll add it later today. Graham Beards (talk) 06:40, 4 August 2020 (UTC)

1%

In healthy people, up to 11% of CBC results may fall outside of the normal range, but these results require medical intervention less than 1% of the time.

This could be interpreted as

• 1000 people get a CBC
• 110 people have an abnormal result
• 10 need medical intervention (1% of the group tested)

or

• 1000 people get a CBC
• 110 people have an abnormal result
• 1 needs medical intervention (1% of the group with abnormal results)

Also, if by "healthy people", the (unnamed) source is actually talking about healthy, non-pregnant adults, then it would be better to be specific. WhatamIdoing (talk) 19:01, 25 July 2020 (UTC)

Thanks - I just removed this sentence as the source isn't too clear about these things either. Spicy (talk) 21:49, 25 July 2020 (UTC)

But i thought it useful nonetheless ... what if you switched it to .., In healthy people, up to 11% of CBC results may fall outside of the normal range, but these results rarely result in medical intervention. SandyGeorgia (Talk) 17:06, 1 August 2020 (UTC)

Refs

There is just one ref in the lead. Seems out of place.--Iztwoz (talk) 07:38, 6 August 2020 (UTC)

I thought I read something, somewhere, saying that statistics in the lead need to be supported by refs. Although I can't find it in WP:LEADCITE now. Spicy (talk) 07:40, 6 August 2020 (UTC)

I would put it back, it is not out of place, it is citing hard data, which is good practice in the lead ... the rest of the lead does not need citation, and there is nothing odd about this one citation. And you are correct, that is mentioned somewhere, although I can’t find it now. SandyGeorgia (Talk) 10:28, 6 August 2020 (UTC)

Here, data and statistics should be cited, Wikipedia:When to cite. It is an essay, but most experienced FA folk will expect it ... the essay was mostly written by the former FA director ... you could also leave it out and see if anyone complains, as you mentioned in edit summary. I think it falls under surprising, as the number is higher than a layperson realizes. SandyGeorgia (Talk) 10:34, 6 August 2020 (UTC)

Query in Automated

In first para - "A process called hydrodynamic focusing is used to isolate individual cells so that their properties can be measured. The diluted sample is injected into a stream of low-pressure fluid, which causes the cells in the sample to line up in single file through laminar flow.[42][43] This method of analyzing single cells suspended in a fluid stream is known as flow cytometry."

The process is stated to be hydrodynamic focusing - lining up cells in laminar flow - then last sentence states that this method is known as flow cytometry - the page on hydrodynamic focusing states that it is used to provide more accurate results than flow cytometry ? would suggest leaving out the last sentence. --Iztwoz (talk) 15:02, 6 August 2020 (UTC)

Perhaps it might be better with an earlier mention of flow cytometry, "In flow cytometry a process called hydrodynamic..... or some such; as somebody like myself with no knowledge of this might find it more useful. I find the attached note 3 to cause confusion - could find no particular reference in papers, to flow cytometry's specific use for cell surface marker identification.?--Iztwoz (talk) 18:16, 6 August 2020 (UTC)

Yes the way that was written was ambiguous, I've edited it to clarify. Re. your second point, per the source:

Although any measurement made on a cell or other object in a flowing stream is strictly speaking flow cytometry, by convention the term is now most frequently applied to those analyzers that perform optical and fluorescence measurements on cells that have been reacted with antibodies to various antigen markers on their cell surface.

If you search for "flow cytometry test" you will see that the term is often used this way, e.g. [5][6][7]. I think it is important to make this distinction. Imagine for example someone is reading this article because they're being evaluated for a blood disorder, and they've had both a CBC and flow cytometry immunophenotyping ordered... it may confuse them to read that automated CBC methods are based on flow cytometry, without qualification, when they have heard "flow cytometry" referred to as a separate test. Spicy (talk) 19:31, 6 August 2020 (UTC)

Thanks --Iztwoz (talk) 12:56, 7 August 2020 (UTC)

Query in Purpose

I find the last paragraph to be a bit clumsy. Since newer recommendations are against 'wholescale screening' and are mentioned later is the first part of the para needed.? Also the last part which covers cost - the study was in 2011 but the data was from 2009 (possibly not the costing) and with newer technologies and point of care testing now available is that info now needed or relevant? I think there are also refs to when the CBC is called for one says before surgery, seems that has now been changed to only for major surgery.? --Iztwoz (talk) 12:56, 7 August 2020 (UTC)

I trimmed a bit of it, but I don't think When the prevalence of disease in a population is low, as in when the complete blood count is done as part of a routine medical examination, abnormal results may be more likely to be false positives than to represent a real medical issue. should be removed, as that concept is not obvious to the average reader. The study is old, but it was the most recent one I could find that gives statistics about how often CBCs are ordered for screening, which I think is useful to know... regarding surgery, there is a discrepancy between the best practices and what is actually done... e.g. Lewandrowski et al. (2016) "It is estimated that 18 billion dollars is spent annually on preoperative testing in the United States. The CBC and routine coagulation testing are among the most frequently ordered preoperative tests. The majority of patients undergoing outpatient surgery, even those with no indication for testing, receive some preoperative laboratory testing". Would like to see what other people watching this page think about this though, I did find that section difficult to write. Spicy (talk) 15:12, 7 August 2020 (UTC)

It is just that first sentence that to me is not an easy read - could it not just read that the CBC is liable, likely, to give false positives.... I can understand the rest of the paragraph just query its currrent usefulness in terms of validity.--Iztwoz (talk) 18:14, 8 August 2020 (UTC)

This has been reprhased and I dropped the stuff from the old study. Spicy (talk) 20:41, 8 August 2020 (UTC)

Coulter counter

The text mentions Wallace and his brother as the inventors - from Wiki pages and search it was only Wallace who was the actual inventor and he was awarded the patent - his brother built the units from what I've read. --Iztwoz (talk) 18:03, 8 August 2020 (UTC)

I've changed "invented" to "developed" where appropriate... the sources [8][9], also [10] which isn't cited, state that Joseph had some role in the development of the counter, e.g. Joseph R. Coulter, Jr., after his Army service, joined his brother Wallace in a small basement laboratory and helped solve many difficulties while incorporating the Coulter Principle into a practical automated instrument; After their purchase of a Chicago house in April 1947, he and his brother, Joseph R. Coulter, Jr., began experimenting in their basement with Moldavan's suggestion for photo‐electrically counting blood cells flowing through a capillary tube. Although it was Wallace who came up with the principle and obtained the patent, as the text explains. Spicy (talk) 20:40, 8 August 2020 (UTC)

Blood

This might sound stupid, but is there another word we could from time to time for blood, which appears 390 times in the article, sometimes 3 times in a sentence. By another word I mean variation like "drawing the bloodfluid into the syringe...." or something. Ceoil (talk) 20:48, 8 August 2020 (UTC)

That's a tricky one. "Sample" might work from time to time, as in "drawing the sample into the syringe". Graham Beards (talk) 21:19, 8 August 2020 (UTC)

I was in the process of getting rid of some of these, but I edit conflicted with you. I'll try again. "Sample" works most of the time... "fluid" is bad in this context because there is such a thing as a fluid cell count. Spicy (talk) 21:23, 8 August 2020 (UTC)

Thanks. Similarly, am replacing some of the instances of "Complete blood count" with "The tests"....hope this is ok. Ceoil (talk) 22:23, 8 August 2020 (UTC)

Review

• "Because pregnancy causes many changes in the blood and is associated with serious hematologic conditions like HELLP syndrome,[19] and because anemia during pregnancy can result in poorer outcomes for the mother and her baby, the complete blood count is a routine part of prenatal care.[20]"

• We have two long explanations before we get to the point: the complete blood count is a routine part of prenatal care. I think we should simply state this up-front. Then explain why this is so.
• "pregnancy causes many changes in the blood" this is rather vague and not in itself a need for medical tests.
• "[pregnancy] is associated with serious hematologic conditions like HELLP syndrome". Firstly "hematologic" is not a word many readers will know. There may be a case for introducing it to readers in this article (btw Hematologic disease doesn't mention HELLP syndrome) but it is only used once otherwise (for Hematologic malignancy which itself redirects to Tumors of the hematopoietic and lymphoid tissues). So I wonder whether "serious blood-related disorders" would be better. It is a bit silly to use the word "associated with" for a prenancy-related disease. Of course it is associated.

Can this be improved? -- Colin°^Talk 21:09, 10 August 2020 (UTC)

Spicy, meet Colin: you and your article will be glad to make his acquaintance, as he goes all in on prose clarity :) PS: Colin, one of your edits has me confused between British and Canadian spelling .. hematology v. haematology ... I don't speak British, much less Canadian (which this article is) ! SandyGeorgia (Talk) 21:14, 10 August 2020 (UTC)

Thank you - I've rephrased this according to your advice. I believe "hematocrit" is the Canadian spelling... at least, I am Canadian and that's how I've always seen it spelled. We use the American spellings for such things as far as I'm aware, e.g. hematology, leukocyte, anemia as opposed to haematology, leucocyte, anaemia... Spicy (talk) 21:27, 10 August 2020 (UTC)

Hi Spicy. As always when I review someone else's expert work of labour, feel free to correct my mistakes and revert anything you don't think improved things. I am experimenting with the Visual Editor, and that may introduce some weirdness. I don't know how the hematology v. haematology thing crept in, other than my browser puts a big red wavy line under your wrong spelling and I probably accidentally clicked something to make it fix it. -- Colin°^Talk 21:30, 10 August 2020 (UTC)

• "Acute leukemia and lymphoma may present with abnormal cells on the smear". "may present with" is medical jargon. The next sentence uses "may raise suspicion for" and there are probably several options for changing this. What are we saying here? That the very first clue of those diseases might be an abnormal smear? Or is it actually diagnostic? Or just a ref flag for investigation? -- Colin°^Talk 21:37, 10 August 2020 (UTC)
  • It can be all three. It is not unheard of for someone to have a CBC drawn for a minor issue only for it to be full of abnormal cells; the number of blasts on the blood smear is one of the diagnostic criteria for acute myeloid leukemia in the WHO classification, but sometimes people can have circulating blasts in non-leukemic disorders, if they're on chemo or receiving G-CSF, or rarely in extreme cases of physiologic stress; and circulating lymphoma cells, which are bad news, can be difficult to tell apart from reactive lymphocytes which often just mean the person has a cold or something. Would it be better to say something vague like abnormal cells "may suggest" these disorders, or "can occur" in these disorders? I'm not sure if you're saying the next sentence should be changed as well. Spicy (talk) 02:13, 11 August 2020 (UTC)
    • I'm not suggesting to change the other sentence, just noting that it avoided the "may present with". We don't have to list all three if the example is just a "may be this". How about "Abnormal cells found on the smear might be the first sign of acute leukemia and lymphoma". -- Colin°^Talk 12:19, 11 August 2020 (UTC)
      • I think that might be a little strong (probably there are other signs that led a CBC to be ordered, even if it's just something vague like feeling tired); I will change it to "might indicate". 14:54, 11 August 2020 (UTC)
• "When the prevalence of disease in a population is low, as in when the complete blood count is performed as part of a routine medical examination, results outside the reference range may be more likely to reflect normal variation than to represent a real medical issue" It took me a while to understand what you were trying to say here. I think you are trying to say that performing a CBC on otherwise healthy adults (such as a routine medical checkup) may produce an "outside the reference range" result that is more likely to be for the "5% of healthy adults" than to indicate a problem. Firstly, are we absolutely sure the "95% of healthy people" claim is correct, rather than just "95% of random people". Because to claim the folk in your sample are all "healthy" is a big claim. And is this true of all the figures in the CBC? For example, anaemia is pretty common, and our wiki article claims the CBC is diagnostic. So perhaps it is more complex and some aspects of a CBC being outside of reference range may be simply normal variation whereas other aspects are very much diagnostic of disease? -- Colin°^Talk 21:58, 10 August 2020 (UTC)
  • I changed this on Graham Beards' advice; he explained the concept well here. [11] But this is a difficult concept to address... Yes, you are correct that "healthy people" is an oversimplification; people with overt disease are excluded from the populations used to derive reference intervals, but it's possible for subclinical disease to be present. And anemia is diagnosed from the CBC - but the question is, does a hemoglobin result that dips below the reference range necessarily indicate a real pathology? If someone's hemoglobin is 70 g/L, sure, they're anemic. But if someone's (let's say it's a woman's) hemoglobin is 118 g/L one week, and the next week it is 122, are they anemic? Even when the same sample is rerun 30 seconds apart on the same analyzer there can be a difference of 1-2 g/L, which is enough to kick someone out of the reference interval, and blood counts fluctuate quite a bit over time. The problem is we have to stick to what the sources say and they do not really spell this out. I would appreciate any advice on how to phrase this better. Spicy (talk) 00:39, 11 August 2020 (UTC)
    • Okay, I looked around and there is this from Keohane et al (2015), p. 245, which is similar to what I was saying above:

Several strategies can help in determining the significance of the results. First, if the results are very far from the reference interval, it is more likely that they are truly outside the interval and represent a pathologic process. Second, if two or more diagnostically related parameters are slightly or moderately outside the interval in the same direction (both high or both low), this suggests that the results are clinically significant and associated with some pathologic process. Because some healthy individuals always have results slightly outside the reference interval, the best comparison for their results is not the reference interval but their own results from a prior time when they were known to be healthy.

Do you think something along these lines would be helpful to include in that section? Spicy (talk) 01:10, 11 August 2020 (UTC)

Yes that sounds useful. Also Graham's text and your comment about "people with overt disease are excluded" mean I think "in 95% of healthy people" is wrong. How about "in 95% of apparently healthy people"? Or maybe someone else can suggest something. -- Colin°^Talk 12:19, 11 August 2020 (UTC)

Will rework this later today. Spicy (talk) 14:54, 11 August 2020 (UTC)

I have revised this. Spicy (talk) 17:02, 11 August 2020 (UTC)

• Do we have any stats on how many CBC's are requested? E.g. per some country, or per thousand people in developed countries, or for some size of hospital, etc.
  • I agree this would be very useful to include but I haven't been able to find anything. I found one paper that stated that 56% of US adults had a CBC ordered at an annual checkup, but the data was from 2009, so it's unclear if it's still relevant. Spicy (talk) 14:54, 11 August 2020 (UTC)
• The article hints at times about manual or more primitive techniques/equipment used when the automatic machines are not available. Can we indicate where or which countries have or don't have such equipment? Either with stats or giving examples. Are these machines generally within the reach of developed nations budgets or are some of them silly money?
  • I will look - I don't think the current sources say this explicitly. I know Graham Beards has said that blood counts are often done manually in India and there may be some sources for this. They're expensive to buy new (>$100k), see this for example (obviously not a usable source for the article though); you can find used models on Ebay for a few thousand dollars, but they need a constant supply of proprietary reagents, which aren't cheap either and are presumably hard to get to rural India or wherever. Spicy (talk) 14:54, 11 August 2020 (UTC)
• In the history, is it possible to indicate some idea of labour productivity improvement? For example, how many CBCs could a person do manually in a day, vs how many they could do on a machine?
  • Hmm, I know one of the sources said the Hemalog D could do 60 tests an hour IIRC, but I don't think it compared it to manual testing, other than to say that it was better. I'll look again. Spicy (talk) 14:54, 11 August 2020 (UTC)
• We say most machines take less than a minute. Can we give an end-to-end time, from the point someone in a hospital says "We need a complete blood count ASAP", through drawing the blood and taking it to the lab, to the results being presented? For example, can this be done in a few minutes? Does it ever need to be that quick? And if just requested routinely, how long does it take? I don't know if this is available or varies too much from one place to another. -- Colin°^Talk 13:21, 11 August 2020 (UTC)
  • I can look but I am not sure there are sources for this. It does vary a lot. The CBC is one of the fastest routine laboratory tests because a) the actual testing only takes <1 minute and b) it does not require any pre-test preparation (i.e. centrifuging the blood, which is required for chemistry panels, coagulation testing and blood typing). The limiting factor is how long it takes to get to the laboratory, which depends on where the laboratory is, where the blood is being drawn, and whether or not the person in the specimen processing department is on break or busy with something else... Spicy (talk) 14:54, 11 August 2020 (UTC)
    • This varies so much. In the UK, a sample from a GP's surgery can take a day from the time of the venepuncture to the reciept of the report. In UK hosptals we have turn-around-time targets, which are often 30 minutes from the time the sample arrives at the laboratory. Even this depends in which department, ward or outpatient clinic the sample is sent from. Graham Beards (talk) 17:24, 11 August 2020 (UTC)

Spicy after all our fixing and juggling, we now have MOS:SANDWICH in White blood cells section ... at least on my iPad, have not yet looked at computer ... you may have to go back to right alignment of the images, one over the other. It may also be possible to trim the caption on the table ... I could give it a try, you revert if I mess up?? SandyGeorgia (Talk) 11:50, 19 August 2020 (UTC)

• I noticed that... it looks ok on my home computer, but bad on my work computer. You can trim the caption... I should be sleeping now but I'll take a look tomorrow. Spicy (talk) 11:57, 19 August 2020 (UTC)
  • I messed with it but there is still considerable sandwiching here ... and I checked other computers. Will leave it to you, Best, SandyGeorgia (Talk) 13:31, 19 August 2020 (UTC)
    • With the default setting for image sizes of 220px, I've jigged the article to reduce the sandwiching to 'acceptable' levels on all screen widths from 800px to 3840px. I've unintentionally split the large third paragraph in the White blood cells section to move the image down. I've also floated the "Sample CBC in chronic myeloid leukemia" table to the left margin because it doesn't render well on narrow mobile phone screens if it's on the right margin (the mobile software knows how to deal with right-floated images, but not other elements). If I change my default image size to 400px (the largest option offered), it's more-or-less impossible to avoid sandwiching problems. This isn't the only article with that problem, but I done the best I can. I've also added a few {{clear}} templates to ensure the following heading aligns with the left margin where we have left-floated images. The only other place where you might want to look is the Procedure / Automated section where the line length is sandwiched down to around four words at certain window widths (using default image sizes). I don't find it too bad, but others might not like it. --RexxS (talk) 19:38, 19 August 2020 (UTC)
      • Thanks, RexxS-- it's good on all three devices here. I thought about a paragraph break, but couldn't figure out where! SandyGeorgia (Talk) 21:20, 19 August 2020 (UTC)

Links between short and full citations

Hi, does anyone object to adding {{harvnb}} to the in-line references like I started to add in this edit? The main advantage is that is provides a link between the short and full citations making it easier for readers to find the later. It also has the added benefit of insuring that the short references are formatted in a consistent way. Boghog (talk) 05:27, 6 September 2020 (UTC)

It is Spicy's choice, but I will express my concerns. First, there is an ongoing FAC, and altering citation style during a FAC is inconsiderate. (That's an understatement, intentionally.) Second, there is nothing wrong with the current citations. Third, there is no requirement for HARVNBs either at FAC or anywhere else. Fourth, some editors (like me) absolutely hate HARVNBs; they are offputting to new editors, and hard to maintain. Fifth, your edits breach CITEVAR during an ongoing FAC which is not very considerate, especially since this FAC already had consistent citations and was over every major hurdle and well on its way to being featured. And finally, with an ongoing FAC, you should have asked Spicy before making the change; 1e is a significant matter at FAC. As you may have noticed, the FAC has already gained a considerable number of supports from experienced FA writers, and not one of them asked for Harvnbs, because every reviewer knows they are not required, and despised by some.

Now, I have expressed my concerns, and perhaps Spicy welcomes Harvnbs and I shouldn't have opened my mouth, but I believe it is important to understand the basics. A source review does not mean alter citations to a personal style that is neither required nor desired by all editors. Please don't do this to other articles. SandyGeorgia (Talk) 05:39, 6 September 2020 (UTC)

Boghog: I can see the benefits of this referencing style, but I agree with Sandy that it is not a great idea to change the citation format during a FA since this particular citation format is not a FA requirement whereas article stability is. I think it would be better to restore it to the status quo for now; we can revisit this after the FAC is finished, when there will be more time to discuss the potential benefits and drawbacks since there will be no deadline. Spicy (talk) 06:57, 6 September 2020 (UTC)

Thanks, Boghog; after the FAC closes would be a good time to discuss with Spicy about changing the citation style. For now, we need to get through the source-to-text integrity check, which is most important! Regards, SandyGeorgia (Talk) 07:08, 6 September 2020 (UTC)

(edit conflict) I have reverted. Just for the record, I also hate {{harvnb}} templates and this is the very first time I had added them to any artcle and I have no plans to add to any other article. However if one uses short references, harvnb templates make a lot of sense, especially for a FAC, since it ensures a consistent format. This change would have increased, not decreased stability. Now we are in a situation have having to worry about whether all the un-templated short refs are consistently formatted which is a real pain. Hence I will make no further edits to this article. Boghog (talk) 07:16, 6 September 2020 (UTC)

FAC reviewers are pretty accustomed to checking for that kind on consistency, and yet many of them miss the frequent Harvref errors (unless they have a script to detect them installed, and oddly, few do). SandyGeorgia (Talk) 06:25, 8 September 2020 (UTC)

I was willing to install and maintain these ref links myself. All it takes is one conscientious editor to fix any {{harvnb}} errors that arise. It is not necessary for all editors to fix all problems. Hence you are inventing a hypothetical problem that in practice does not exist. Template like {{harvnb}} generate error messages highlighted in red that are much easier to catch than inconsistent formatting in unformatted citations. Finally, and most importantly, these links make it easier for readers to find the original sources. I really do get that you do not like harvnb templates and neither do I. But if shortened citations are used, harvnb (or an equivalent) provide an important navigational aid. Boghog (talk) 17:30, 8 September 2020 (UTC)

One {{harvnb}} error message that is not prominently displayed are non functional links, but at the moment there are no links. So this is no worse than what we currently have. Boghog (talk) 17:41, 8 September 2020 (UTC)

I appreciate that you are a knowledgeable and conscientous editor who would not have left a mess behind, and am sorry if my concerns here caused a kerfuffle. I think the broader ("you are inventing a hypothetical problem", etc.) issues, concerns, pros and cons with the different citation styles are probably better discussed over at WT:MED.

On this article, I was concerned about the effect on an ongoing FAC, as the article was pretty much ready to go, but waiting for a source review; if a source reviewer had chanced to finally engage just as part of the article was converted, that could have set up a complication. It sounds like Spicy may decide in the longer run to opt for Harvrefs, but consulting with a nominator first (during a FAC) is just good etiquette, to help avoid problems. If Spicy wants it, it could still be done during the FAC, but it would optimally be done in one step (perhaps using sandbox) so that reviewers don't chance upon a half-done conversion after Spicy has waited so long to entice a source-to-text integrity review to FAC.

My broader concerns for the general discussion over at WT:MED are three-fold: a) that we not leave the impression that medical editors must learn a whole new citations style (harvrefs) if they want to correctly start adding page numbers for WP:V; b) that we not create more articles that are harder for newcomers to edit at a time when we REALLY NEED to recruit new medical editors, by adding a citation style that is not intuitive and hard to figure out, at the same time that c) we already have a confusing situation for new and student editors with the cite ref tool installed in the edit window creating dreadful citations compared to the Diberri/Boghog citation template filler, and causing CITEVAR issues. Buruli ulcer is using Harvrefs, so the good news is we have examples of all types, but the bad news is ... how to make the overall situation less confusing to new and student editors at the same time as we would be hopefully transitioning to a better understanding of the need to sometimes add page numbers and sections for WP:V. (Just kidding, but I sometimes wonder if the editors who invented sfn and harvrefs did it intentionally to keep new editors out of "their" articles, by creating something so confusing that others won't touch it!) Another concern I have is that we have created such a false impression throughout Wikipedia of MEDRS, that it becomes hard to attract reviewers. Best regards, SandyGeorgia (Talk) 17:48, 8 September 2020 (UTC)

Source notes

Spicy, I am starting the source review myself, since no one else has. I will get as far as I can, and maybe with some of the work done, others will pitch in. I'll add summaries to the FAC, but for here:

• I am adding PMIDs for easy verification of reviews and because some citations have PMIDs, while others are missing them. (Perhaps another editor would have reviewed the sources sooner if they had all had PMIDs, since that makes it easy to scan for reviews.)
• American Association for Clinical Chemistry (18 December 2019). "Complete Blood Count (CBC)". Lab Tests Online. Archived from the original on 21 September 2019. Retrieved 5 January 2020.

• The citation has a date of 18 December 2019, but the source has later dates of changes made (August 2020). A December version can't be archived in September, so we need to be sure which page date you are using. Need to get these dates in sync, and probably should be using the latest version. SandyGeorgia (Talk) 04:33, 8 September 2020 (UTC)

• American Association for Clinical Chemistry (1 May 2019). "WBC Differential". Lab Tests Online. Archived from the original on 14 April 2019. Retrieved 1 January 2020.

• Similar. The citation date is 1 May 2019, but the dates in the source are last reviewed on October 14, 2015, last modified on July 29, 2020. A source can't be archived in April, and should we be using the July 2020 version? SandyGeorgia (Talk) 04:38, 8 September 2020 (UTC)

• Fixed these. Spicy (talk) 04:56, 8 September 2020 (UTC)

• Gersten, T (29 January 2019). Same situation, the URL says it was updated in 2020 ...

• Fixed the date. The most recent archive on archive.org is from July 2020 while the page was updated in August... I am not sure how to force archive.org to archive a site on demand (that's why the archive dates for the other sources were out of sync before but thankfully the archives had updated since then). I will try to figure out how to do this. Spicy (talk) 04:56, 8 September 2020 (UTC)

• I don't know either ... sorry :( SandyGeorgia (Talk) 05:23, 8 September 2020 (UTC)

• I found out how to force it to update... but it just gives me an error page when I try to view the snapshot. [12] I think we might have to live with the archive link for this page being slightly out of date, at least until their bots crawl the page again. The page is still live, and the information this is used for (units of the test) hasn't changed between the two versions. Spicy (talk) 05:13, 9 September 2020 (UTC)

• Nevermind, it's working now... fixed. Spicy (talk) 05:31, 9 September 2020 (UTC)

• Consistency in page numbers:

• Walls, R et al. (2017). pp. 1497−8.

but

• Walls, R et al. (2017). pp. 1486−88. ... should be 1486–8 for consistency with rest ??

I think you usually use only the last digit on most of the others ... check all for consistency. SandyGeorgia (Talk) 04:40, 8 September 2020 (UTC)

Fixed these - will scan for others. Spicy (talk) 04:56, 8 September 2020 (UTC)

• Sentence case vs. title case: books are usually written in title case in citations, but when different journal articles have different customs, and we need to standardize/be consistent within articles, we have to reduce journal article titles to sentence case. For this reason, if you use the Diberri citation filler to generate citations,] you'll get a nicely consistent sentence case title on journal articles even when the journal uses title case. For example, see https://synapse.koreamed.org/articles/1091038 but see what you get when you plug the PMID in here. Since you didn't use the Diberri citation filler, your only alternative now is to go back and reduce all journal article titles to sentence case for consistency (which Diberri would have done for you :) As of now, you have sentence case on most, but title case on a few. SandyGeorgia (Talk) 04:54, 8 September 2020 (UTC)

• Another note related to sentence vs. title case/journals vs. articles: some editors, where you have Complete_blood_count#Bibliography separate them into Complete_blood_count#Book sources and Complete_blood_count#Journal sources so the difference doesn't look so weird ... personal choice ... and works fine if you later decide to switch to Harvnbs per the above discussion. SandyGeorgia (Talk) 06:22, 8 September 2020 (UTC)

• See https://eutils.ncbi.nlm.nih.gov/entrez/eutils/esummary.fcgi?db=pubmed&id=21191263 Search for PubType, it returns BOTH Historical article, and Comment, but PMID 21191263 has it listed only as a Comment (which is akin to an opinion piece). You've used it for history, and I believe the XML record for the PMID is more correct (that is, it is a Historical article), but clarification might be asked for. SandyGeorgia (Talk) 05:02, 8 September 2020 (UTC)
• Lewis, SM (1981). "Automated differential leucocyte counting: Present status and future trends". Blut. 43 (1): 1–6. doi:10.1007/BF00319925. ISSN 0006-5242. PMID 7260399. Not a review, but not used for health statement, rather about a machine characteristic in History section: "These instruments would scan a stained blood smear to find cell nuclei, then take a higher resolution snapshot of the cell to analyze it through densitometry."
  • FWIW I am quite sure this source is a review... it's an overview of the automated diff methods that existed at the time that summarizes numerous primary and secondary sources. I have found that Pubmed's classification system isn't always accurate, and I imagine it's worse for older sources... I remember on Chagas there was a review paper (from Annual Reviews no less!) that it didn't recognize as one. Spicy (talk) 05:24, 8 September 2020 (UTC)
    • Yep, that happens with PubMed ... I am typing this without having looked at the actual articles, so no problem. SandyGeorgia (Talk) 05:30, 8 September 2020 (UTC)
• Mansberg, HP; Saunders, AM; Groner, W (1974). "The Hemalog D white cell differential system". Journal of Histochemistry & Cytochemistry. 22 (7): 711–24. doi:10.1177/22.7.711. ISSN 0022-1554. PMID 4137312. Categorized as a comparative study, primary source, but only used to back up another citation for a historical date. SandyGeorgia (Talk) 05:12, 8 September 2020 (UTC)
  • Yes, that one isn't there to verify anything, I just put it there in case someone might be interested in reading the original paper. I can remove it if that's an issue. Spicy (talk) 05:16, 8 September 2020 (UTC)
    • Absolutely not a problem ... just noting everything here so people can see I've checked them :)
• Tefferi, A; Hanson, CA; Inwards, DJ (2005). "How to interpret and pursue an abnormal complete blood cell count in adults". Mayo Clinic Proceedings. 80 (7): 923–936. doi:10.4065/80.7.923. ISSN 0025-6196. PMID 16212155.

• Pubmed categorizes this as a commentary/letter, but you are only using it to cite an alternate name, so no problem. Is it possible though to cite that to one of the other sources, or is there a reason you prefer this source? SandyGeorgia (Talk) 05:21, 8 September 2020 (UTC)

• Hmm, I could probably find another source for that but I think this one is kind of nice for verification purposes since it's right there in the title... Spicy (talk) 05:28, 8 September 2020 (UTC)

• Then I think it's OK, because it's kind of like citing "the sky is blue". You can argue that one. SandyGeorgia (Talk) 05:30, 8 September 2020 (UTC)

• Dewan, https://eutils.ncbi.nlm.nih.gov/entrez/eutils/esummary.fcgi?db=pubmed&id=28241909 is not a review, but it is only used to cite "so that blood loss can be monitored". Uncontroversial ??? SandyGeorgia (Talk) 05:30, 8 September 2020 (UTC)
  • Uncontroversial/common knowledge IMO, and from the introductory mini-review part of the article; I had to resort to this at the time because as I mentioned at the FAC, the best sources tend to assume the reader has that common knowledge already ... however, WAID gave me the advice to look at nursing textbooks for this sort of thing, and I found [13] which mentions it can be used to monitor for blood loss (although not specifically after surgery). I'll add this to back that source up. Spicy (talk) 05:39, 8 September 2020 (UTC)
• Graham, MD (2003). "The Coulter principle: foundation of an industry". Journal of the Association for Laboratory Automation. 8 (6): 72–81. doi:10.1016/S1535-5535(03)00023-6. ISSN 1535-5535.

is not Pubmed-indexed, although his other paper

• Graham, MD (2013). "The Coulter principle: Imaginary origins". Cytometry Part A. 83 (12): 1057–1061. doi:10.1002/cyto.a.22398. ISSN 1552-4922. PMC 4237176. PMID 24151220.

is. Quality of the non-indexed journal and article? I see it is citing nothing controversial, or only backing up other cites, so probably fine. SandyGeorgia (Talk) 05:34, 8 September 2020 (UTC)

• The article is highly cited [14], and as you noted, the author has published on the subject of Coulter counters in a Pubmed indexed journal. He's also been published in historical journals [15] and while I'm not too clear on how to evaluate the reliability of historical journals I presume that being indexed by JSTOR means it's not crap. I think he qualifies as a subject matter expert. Also, the paper is mainly used for historical material; where it is used to support material about the operation of hematology analyzers, it's cited alongside textbooks. Spicy (talk) 07:27, 8 September 2020 (UTC)

• Agree, thanks! SandyGeorgia (Talk) 14:23, 8 September 2020 (UTC)

• and laboratories are often required to participate in these programs to maintain accreditation.[105] is not sourced to a review, but this kind of medical text is not required to be sourced to a review. Source looks fine for text it is citing. SandyGeorgia (Talk) 05:43, 8 September 2020 (UTC)
• red blood cells contain a cell nucleus, which is usually absent in the mature cells that circulate in the bloodstream.[173] Constantino B.; Cogionis, B (2000). "Nucleated RBCs—significance in the peripheral blood film". Laboratory Medicine. doi:10.1309/D70F-HCC1-XX1T-4ETE. Source is not Pubmed-indexed ... quality of source? SandyGeorgia (Talk) 05:47, 8 September 2020 (UTC)
  • Graham Beards added this one, so pinging him. (It's also a bit old, although that's not a problem IMO because this is very basic physiology that hasn't changed in the past 100 years, but I figured someone might bring that up at FAC). This is common knowledge and could easily be sourced to any textbook so can be easily replaced if the source is sub-par. Spicy (talk) 05:49, 8 September 2020 (UTC)
    • This is published by American Society for Clinical Pathology, the full article is available as a PDF. This is basic stuff, but you can source it to Alvin and Lazarus (Eds), Concise Guide to Hematology, page 313, if you prefer a book.Graham Beards (talk) 06:44, 8 September 2020 (UTC)
      • (For anyone who doesn't know, the American Society for Clinical Pathology is the major professional organization for pathologists and medical laboratory technologists in the US). Personally I think the source is fine. Spicy (talk) 07:07, 8 September 2020 (UTC)
        • Agreed, thanks! SandyGeorgia (Talk) 14:24, 8 September 2020 (UTC)
• (termed cell population data)[175] source is not a review, a review is not needed to cite this text, not a problem. SandyGeorgia (Talk) 05:48, 8 September 2020 (UTC)
• for example, nucleic acids, which are found in higher concentrations in immature cells[69], Source is a comparative study, uncontroversial? SandyGeorgia (Talk) 05:51, 8 September 2020 (UTC)
  • The part of the paper this is taken from is basically background information summarizing the principles of operation of a particular sort of analyzer (sourced to the manufacturer's whitepaper). Presumably this is true or else the analyzer wouldn't work ;) I'm not sure this is "common knowledge", per se, but pretty much every hematology textbook notes that immature cells contain more nucleic acids than immature cells, which is particularly notable because it makes them appear more blue-ish (basophilic) on the blood smear (e.g. Keohane et al (2015), "As cells mature, certain morphologic characteristics of maturation allow specific lineages to be recognized. General characteristics of maturation include ... decreased basophilia in cytoplasm"; "[Metamyelocyte] cytoplasm contains very little residual ribonucleic acid (RNA) and therefore little or no basophilia.... Neutrophil bands make up 9% to 32% of nucleated marrow cells and 0% to 5% of the nucleated peripheral blood cells. All evidence of RNA (cytoplasmic basophilia) is absent..." I think it's a good enough source for what it's supporting, although your opinion may differ.... Spicy (talk) 07:00, 8 September 2020 (UTC)
    • I think it fine (just need to cover all bases for source review, and indicate that I checked and inquired about all of them, and that all uses are appropriate). SandyGeorgia (Talk) 14:26, 8 September 2020 (UTC)
• One book publisher is F. A. Davis Company, but several others are F.A. Davis ... name change or inconsistency? SandyGeorgia (Talk) 05:55, 8 September 2020 (UTC)

• See the Worldcat link in the userbox at my user page: I looked these up and adjusted them to F. A. Davis Company, now consistent. SandyGeorgia (Talk) 14:32, 8 September 2020 (UTC)

Going back to bed (woke up in a bother about lack of source reviews at FAC), checked all sources for type, I'll summarize to the FAC after this section is finished. All other sources check out as reviews, practice or national guidelines, textbooks, or historical papers (appropriate to History section) except as noted above; all have page numbers or sections as needed, consistent citation style with short-form citations used for page numbers. Will summarize tomorrow, and maybe with that much done, someone else will step up to do the source-to-text integrity/copyvio check. Best, SandyGeorgia (Talk) 06:01, 8 September 2020 (UTC)

• Oops, one more. I could be wrong on this, not sure where to check, but et al literally means "and others", so I think when there are only two authors, you should just list the two of them in the short-form citation, because one of them et al is literally means at least three ... for example, I think:

• Chabot-Richards, DS et al. (2015). p. 10.

is supposed to be

• Chabot-Richards, DS; George, TI (2015). p. 10.

I could be totally wrong on that, so don't go changing it on my account, but maybe do some poking around. I have only ever used the Diberri format, which was a) list all authors if there are five or less; b) if there are more than five authors, truncate to three plus et al. This guy seems to agree with me ... don't use unless there are more than two authors, and truncate with six or more. SO, maybe that's why I never see et al used in short citations when there are only two authors, rather both are listed. Best, SandyGeorgia (Talk) 06:12, 8 September 2020 (UTC)

See User_talk:Ealdgyth#et_al SandyGeorgia (Talk) 14:58, 8 September 2020 (UTC)

"Personally I'm not sure why you'd want to do that, but you can." I've changed it... Spicy (talk) 06:17, 9 September 2020 (UTC)

Better for two reasons at least. Seems to be standard (per the grammar link above and notice that if you decide to convert to Harvrefs, they will also list three), but more importantly, within topics, one frequently finds the same prominent lead authors, so this avoids confusion. In the 90s, almost every Tourette paper was some combination of the Yale authors, Leckman, Cohen, Scahill ... so listing three helps make sure there is no confusion. Best, SandyGeorgia (Talk) 13:24, 9 September 2020 (UTC)

Edit notice

Spicy, I just now remembered to set up the FA editnotice for this page (that is, whenever anyone edits, they will see the editnotice) at Template:Editnotices/Page/Complete blood count. The only sample spelling I added was colour; are there others that should be added? To see how it actually displays, edit the article ... SandyGeorgia (Talk) 19:29, 9 October 2020 (UTC)

Thanks :) I think it's the combination of "colour" and "-ize" endings that tends to trip people up... Spicy (talk) 19:35, 9 October 2020 (UTC)

If I ever kick the bucket, someone should take over maintaining them ... they are all listed in the last entry on the Userbox on my Userpage. SandyGeorgia (Talk) 19:37, 9 October 2020 (UTC)

SandyGeorgia I was just trying to add an example for "-ize" (analyze) but it appears I don't have the proper rights to edit editnotices. Would you mind adding it? Thanks, Spicy (talk) 11:29, 18 November 2020 (UTC)

Done ... maybe Barkeep49 will extend templateeditor rights to you, Bst, SandyGeorgia (Talk)

I mean I'm tempted to be passive aggressive and say I'd be happy to help spicy right over here. However, I will instead act responsibly and go ahead and grant the permission. Best, Barkeep49 (talk) 17:40, 18 November 2020 (UTC)

You really should have worked that leverage! Thx, SandyGeorgia (Talk) 17:49, 18 November 2020 (UTC)

That was a little unexpected, but thanks :) not sure how often this will come in handy, maybe I will need to write another FA to make sure this gets put to good use. Spicy (talk) 18:16, 18 November 2020 (UTC)

Since you are probably considerably younger than I am, you can take over maintaining all of them when I'm gone :0 SandyGeorgia (Talk) 18:22, 18 November 2020 (UTC)

"Haemogram" listed at Redirects for discussion

A discussion is taking place to address the redirect Haemogram. The discussion will occur at Wikipedia:Redirects for discussion/Log/2021 January 6#Haemogram until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Hildeoc (talk) 20:25, 6 January 2021 (UTC)