23 November 2017 (Thursday) - WTF is that !?

This piccie appeared on one of the Facebook groups I follow: “57 Year old Male, Walked into the Emergency Room and Expired 3 Hours later.....
Well, … I wonder what that is?

I *think* it is some form of histoplasmosis. But it is a new one to me. If I saw it I would know it’s not normal… I need to find out about this…

23 November 2017 (Thursday) - Infectious Anaemia (!)

This piccie appeared on one of the Facebook groups I follow: “What would you say about this blood smear?

Well, there’s lots of elliptocytes and no white cells. I was rather baffled by some of the other comments including one of “infectious anaemia”. I wonder what that is?

21 November 2017 (Tuesday) - XN

We’re getting the new Sysmex XN analysers in a little while. We had a training seminar today delivered by the nice man from Sysmex.
It was rather odd to have the presentation given by the chap who did it; for years Dean from Sysmex would have done that. He’s recently retired… I was going to send him a little message on Facebook – but he’s deleted me from his friends list.

I wonder what I did to offend?

20 November 2017 (Monday) - Change

Here’s something from the Lablogatory people. It looks at reacting to change. Over the years I’ve seen quite a bit of change in the workplace. Some for the better; most not.
Perhaps this article is intended more for the managers…  it made me think. I don’t like change as it has been my experience that it is rarely for the better. However on the rare instance when things are improved, I’m all for it.
Don’t have change for change’s sake. Consider what is being changed, and make sure it is a change worth having.

This ain’t rocket science. What *really* annoys me is the growth industry which is “stating the bleeding obvious” as exemplified by this article…

20 November 2017 (Monday) - The Oncologist Newsletter

The Oncologist Newsletter appeared in my in-box this morning:

Featured Article

Maria Vittoria Dieci et al.

Multiple risk factors for both venous thromboembolism (VTE) and early mortality in patients with lung cancer receiving systemic chemotherapy should guide best practice by better informing clinical evaluation and treatment decision‐making. The Khorana risk score is of value in assessing the risk of early all‐cause mortality along with other clinical parameters in patients with lung cancer receiving systemic therapy. Further study is needed to fully evaluate the validity of the risk score in predicting the risk of VTE in the modern era of lung cancer therapy.
CME Activities

Perceptions of Cancer Care and Clinical Trials in the Black Community: Implications for Care Coordination Between Oncology and Primary Care Teams

Reducing Uncertainty: Predictors of Stopping Chemotherapy Early and Shortened Survival Time in Platinum Resistant/Refractory Ovarian Cancer (PRROC) - the GCIG Symptom Benefit Study


Special Report
 from the 2017 ESMO Annual Meeting

At the European Society for Medical Oncology (ESMO) 2017 Congress, held September 8-12, 2017, in Madrid, Spain, the theme was "integrating science into oncology for a better patient outcome." In this ESMO 2017 Special Report, The Oncologist focuses on new research on the use of prognostic and predictive biomarkers in the individualized management of patients with colorectal cancer.
Clinical Trial Results

Lessons Learned

>The addition of the heat shock protein 27 (Hsp27)‐targeting antisense oligonucleotide, apatorsen, to a standard first‐line chemotherapy regimen did not result in improved survival in unselected patients with metastatic pancreatic cancer.

> Findings from this trial hint at the possible prognostic and predictive value of serum Hsp27 that may warrant further investigation.
Conference Perspectives: Lessons Learned
Evolving Standards in Colorectal Cancer:
Case-Based Insights from ESMO 2017
David P. Ryan, MD, explores new standards of care in advanced and metastatic colorectal cancer (mCRC).
0.5 AMA PRA Category 1 Credits™

20 November 2017 (Monday) - Transfusion Evidence Library Update

The nice people over at the Transfusion Evidence Library sent me their update today. Loads of stuff to pore through at tea breaks…

Top 10 new publications
Thrombopoietin mimetics for patients with myelodysplastic syndromes
Dodillet H, Kreuzer KA, et al., The Cochrane Database of Systematic Reviews 2017
Age of red cells for transfusion and outcomes in critically ill adults
Cooper DJ, McQuilten ZK, et al. The New England Journal of Medicine 2017
Plasma transfusions prior to lumbar punctures and epidural catheters for people with abnormal coagulation
Estcourt LJ, Desborough MJ, et alThe Cochrane Database of Systematic Reviews 2017
Questions about blood transfusion and blood donation (UK)?
A new national UK survey​ (responses from UK based residents onlyhas opened, giving everyone affected by blood transfusion and blood donation, personally or professionally, the chance to prioritise research questions on blood donation and blood transfusion. 
The survey is open to all healthcare professionals involved with blood transfusion and blood donation and your prioritisation of 50 potential research questions will be highly valuable to researchers. The top 10 questions will help inform future research in blood donation and blood transfusion.

Please complete the survey before 11th January 2018 to participate

17 November 2017 (Friday) - Hub and Spoke ?

The IBMS have taken to sending out a weekly summary email of what is going on over on their new forum.
So far I have made a point of staying away from it. Internet forums *always* end up in petty bickering and personal abuse. Always have; always will. It is human nature unfortunately.
However I shall look at the weekly summary of what’s going on. You never know what you are missing.

I’m most intrigued by this thread “What will be the impact of hub and spoke models on pathology?” Needless to say several opinions are being bandied about. The obvious impact will be centralisation of specialist work, formation of pathology networks, and the growth of the “factory lab”… or so we all thought ten years ago.
It seems this idea is now raising its head again.

All I can say is that I hope it waits until I’m retired. I’m happy where and how I’m now working. I do *not* want to go back to where I once was (both geographically and as a state of mind)

17 November 2017 (Friday) - Analyser Training

We’ve got new coagulation analysers which are going live next week. I had a formal training session on them today. They work very much like the old ones did, but I was trained on those on my first days in my new job and everything was big and new and scary then.
Today’s little session was really useful.

17 November 2017 (Friday) - Malaria Revisited

The other day we had the blood parasite NEQAS come in. There were malarial parasites in one film… They *weren’t* P. falciparum… I think.
I’m no expert on malaria. Well… compared to most of humanity I suppose I am, but when it comes to speciation I do struggle; particularly differentiating between P.vivax and P.ovale.

A colleague pointed me at this website. It’s not perfect, but it is a useful little guide.

16 November 2017 (Thursday) - aHUS

Here’s an interesting article. I came across it via the Facebook Hematology Interest Group. The article is about an unusual variation of haemolytic uraemic syndrome.
Interestingly the article on the Facebook page was from the American point of view… did you know that it costs $750 000 to treat such a patient each year?

Be grateful for the NHS!!!

15 November 2017 (Wednesday) - IBMS Newsletter

The IBMS Newsletter came out today. One or two items of note in there….

Featured news stories

Celebrating FAB Change Week 13-17 November - As part of Fab Change Week 2017, IBMS council members, including president-elect Alison Geddis (pictured), have launched our pledges to “promote the valuable contributions our members play in healthcare” and to “raise public awareness of biomedical science”.  Read more>>
Announcing our first Webinar - We are pleased to announce our first webinar which will be sponsored by Siemens and will take place on Wednesday 29th November. Further information will be made available and sent to members shortly. 
Joining the STEM Ambassador network - To ensure that our members who undertake public engagement are fully prepared and supported at their events promoting biomedical science, we shall be hosting STEM Ambassador training sessions in 2018. More details will be made available to members when ready. Read more>>
IBMS forums - Connect with fellow biomedical science professionals - Each week members will receive an update on the latest discussions in the forums, ranging from topical questions from The Biomedical Scientist magazine to ‘What are you reading now?’ So why not take part by logging into MyIBMS and follow the links to the forum. Login to MyIBMS>>
Exploration for use of Patient Group Directions by biomedical scientists  A UK-wide project is underway to explore the possibility of enabling biomedical scientists to use PGDs to supply or administer medicines. NHS England is leading the project and will be working closely with the IBMS and other key stakeholders to explore this proposal. More details>>

Biomedical Science Awards 2018 

Inspiring the biomedical workforce of the future

Advancing Healthcare Awards 2018 - Nominations are now open. There are 14 categories to enter, including the IBMS sponsored Inspiring the biomedical workforce of the futureaward. The aim is to showcase the essential contribution that biomedical scientists make to attracting and developing a workforce which displays the behaviours and values that are needed to deliver professional care. More details>>
NHS science award applications open - Supported by Professor Sue Hill, the 2018 Healthcare Science Awards celebrate and promote the importance of biomedical science staff working in laboratories across the NHS. More details>>

Members News

Showcasing the hard work and achievements of our members

IBMS members win Advancing Healthcare Award - Biomedical scientists were amongst the award winners at this year’s Advancing Healthcare Awards (AHA) for Northern Ireland. Read more>>
Showcasing biomedical science to local schools - IBMS members showcase biomedical science at the Aneurin Bevan University Health Board’s careers event for schoolchildren. More details>>
Biomedical Scientists impress at Welsh Skills event - IBMS members represented biomedical science at the Skills Cymru events in Llandudno and Cardiff.  More details>>
IBMS eStudents showcase their research at Keele University - Co-sponsored by the IBMS, the biomedical and Biochemistry event is held over two days for all final year students to demonstrate their research. Read more>>
Welcoming our 27th student affiliate society - We are pleased to announce the University of Portsmouth Biomedical Science Society to our student affiliate society and look forward to a successful working relationship with them. More details>>
Chester biomedical scientists welcome students at careers event - IBMS members meet with local students at The Countess of Chester Hospital NHS Foundation Trust event. Read more>>
IBMS North East region holds gala dinner and awards ceremony - Event held to relaunch the region and to celebrate the achievements of local members. More details>>
Call for member contributions

We love hearing about the amazing work of our members promoting biomedical science.

If you have a story to tell or an event that needs promoting contact us at website@ibms.org  

14 November 2017 (Tuesday) - Transfusion News email

The nice people at Transfusion News sent their email update today:

Potential Screening for Cytomegalovirus among Cord Blood Donors

November 9, 2017
Infection with cytomegalovirus (CMV) can cause severe complications for hematopoietic stem cell transplant patients. In addition to screening for maternal antibodies to CMV with FDA-approved assays, some cord blood banks also screen the actual cord blood sample for CMV nucleic acid before the stem cell transplantation. Researchers recently investigated screening procedures used for cord blood [Read More]

Rapid Transfusions after Combat Causalities Improves Chances of Survival

November 1, 2017
Since bleeding is a major cause of death in combat causalities and civilian trauma cases, researchers recently examined the association between prehospital transfusions and survival after combat causalities in Afghanistan from 2012 to 2015. Of the 502 combat causalities (98% male) which qualified for the study, 55 soldiers received prehospital transfusions while 447 soldiers received [Read More]

“Wholly Whole Blood!” with Mark Yazer

November 6, 2017 | BBGuy Podcast
“Whole blood? Seriously?” That is the reaction Dr. Mark Yazer gets when he talks about his current favorite blood product. He is on a mission to change your mind about this “old school” product! FREE Continuing Education Activity: Earn free AMA PRA Category 1 Credit or ASCLS P.A.C.E ®credits for listening to this episode. [Listen Now]

Interestingly the Blood Bank Guy is thinking about whole blood too...

13 November 2017 (Monday) - Vending Machines ?

This little snippet came from the BBC (via the British Blood Transfusion Society’s Facebook page): “Blood vending machines; what do you think?

The article was obviously written for the layman, but it makes a lot of sense. Given that the usual criteria are met for a given patient to be suitable for the electronic issue of blood (let’s face it, 90+% of patients are suitable) why not let the clinicians got to a blood vending device. The thing would obviously record who blood was allocated for, would issue suitable blood, and the lab staff could devote their time on the vanishingly small proportion of patients who can only have blood provided by time-consuming manual techniques.

10 November 2017 (Friday) - Transfusion Evidence Library

The nice people at the Transfusion Evidence Library sent me their update email today:

Click on any of the links below to view the article in the Transfusion Evidence Library database. Enjoy your update!

Clinical Commentaries

10 November 2017 (Friday) - Whole Blood Transfusion ?

One of the most frustrating parts of my job is the ever-changing recommendations and standard practices.
For example back in the day, one unit of fresh frozen plasma had to be given after every four units of blood. Had to be given (!) No excuses (!)
Nowadays you’d be shot for doing that with no other rationale.

Years ago we used to have whole blood for transfusion. We’d give a unit of blood; cells, plasma, platelets, the lot.
Then “component therapy” was seen as the way forward. It makes sense only to give the part of blood that is needed. I’ve not seen whole blood in a blood bank for twenty-five years (or more).

But now it seems there is a place for whole blood again…

10 November 2017 (Friday) - Oncologist email

The Oncologist” email appeared in my in-box this morning:

Academia-Pharma Intersect: Hematologic Malignancies

Tumor Lysis Syndrome in Chronic Lymphocytic Leukemia with Novel Targeted Agents

Bruce D. Cheson, Sari Heitner Enschede, Elisa Cerri, Monali Desai, Jalaja Potluri, Nicole Lamanna, Constantine Tam
Tumor lysis syndrome is an uncommon but potentially life-threatening complication associated with the treatment of some cancers. In this review, prevention strategies and management of patients with chronic lymphocytic leukemia who develop tumor lysis syndrome are described.

Breast Cancer

Incorporating Tumor Characteristics to the American Joint Committee on Cancer Breast Cancer Staging System

Mariana Chavez-MacGregor, Elizabeth A. Mittendorf, Christina A. Clarke, Daphne Y. Lichtensztajn, Kelly K. Hunt, Sharon H. Giordano
The American Joint Committee on Cancer (AJCC) breast cancer staging system provides important prognostic information. The recently published eighth edition incorporates biological markers and recommends the use of a complex prognostic stage. In this study, the relationship between stage, breast cancer subtype, grade, and outcome in a large population-based cohort is assessed, and a risk score system incorporating tumor characteristic to the AJCC anatomic staging system is evaluated.

Neoadjuvant Therapy with Weekly Nanoparticle Albumin-Bound Paclitaxel for Luminal Early Breast Cancer Patients: Results from the NABRAX Study (GEICAM/2011-02), a Multicenter, Non-Randomized, Phase II Trial, with a Companion Biomarker Analysis

Miguel Martín, José I. Chacón, Antonio Antón, Arrate Plazaola, Elena García-Martínez, Miguel A. Seguí, Pedro Sánchez-Rovira, José Palacios, Lourdes Calvo, Carmen Esteban, Enrique Espinosa, Agusti Barnadas, Norberto Batista, Angel Guerrero, Montserrat Muñoz, Estefania Romio, César Rodríguez-Martín, Rosalía Caballero, María I. Casas, Federico Rojo, Eva Carrasco, Silvia Antolín
The NABRAX study was designed to evaluate the antitumor activity and safety of single-agent weekly nab-paclitaxel as neoadjuvant treatment of estrogen receptor-positive/HER2-negative breast cancer patients. This article reports on the trial and efforts to define the role of this drug and biomarkers of activity in this particular subtype of breast cancer.

Adipose-Derived Fatty Acid-Binding Proteins Plasma Concentrations Are Increased in Breast Cancer Patients

Sandra Guaita-Esteruelas, Paula Saavedra-García, Alba Bosquet, Joan Borràs, Josefa Girona, Kepa Amiliano, Marta Rodríguez-Balada, Mercedes Heras, Luís Masana, Josep Gumà
Circulating FABP4 and FABP5 may be a biomarker for breast cancer. This article focuses on the association of FABP4 and FABP5 plasma levels with the presence of breast cancer.

Distinct Tertiary Lymphoid Structure Associations and Their Prognostic Relevance in HER2 Positive and Negative Breast Cancers

Xia Liu, Julia Y.S. Tsang, Thazin Hlaing, Jintao Hu, Yun-Bi Ni, Siu Ki Chan, Sai Yin Cheung, Gary M. Tse
Tumor infiltrating lymphocytes are associated with good clinical outcome in many types of cancer, including breast cancer. Tertiary lymphoid structures are associated with anti-tumor immune responses and prolonged patient survival. This study analyzed characteristics of tertiary lymphoid structures and their prognostic value related to different invasive breast cancer molecular subgroups.

Cancer Diagnostics and Molecular Pathology

Quality Assessment of Reporting Performance for EGFR Molecular Diagnosis in Non-Small Cell Lung Cancer

Yanxi Han, Rui Zhang, Guigao Lin, Kuo Zhang, Jiehong Xie, Jinming Li
Advancements in molecular diagnosis have revolutionized traditional diagnosis and therapeutic management of non-small cell lung cancer. This study focuses on the quality assessment of gene mutation reports, focusing on EGFR gene mutation testing and reporting performance of the NCCL.

Community Outreach

Predictors of Disruptions in Breast Cancer Care for Individuals with Schizophrenia

Kelly E. Irwin, Elyse R. Park, Jennifer A. Shin, Lauren E. Fields, Jamie M. Jacobs, Joseph A. Greer, John B. Taylor, Alphonse G. Taghian, Oliver Freudenreich, David P. Ryan, William F. Pirl
Disruptions in breast cancer are common for patients with schizophrenia and are associated with adverse outcomes. The aim of this study was to examine the proportion of patients with schizophrenia who received stage-appropriate breast cancer care, identify and categorize care processes that may interfere with receiving stage-appropriate care defined as care disruptions, and determine potentially modifiable predictors of care disruptions.

Geriatric Oncology

Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?

Tina Hsu, Matthew Loscalzo, Rupal Ramani, Stephen Forman, Leslie Popplewell, Karen Clark, Vani Katheria, Rex Strowbridge, Redmond Rinehart, Dan Smith, Keith Matthews, Jeff Dillehunt, Tao Feng, David Smith, Canlan Sun, Arti Hurria
Cancer-related therapy is increasingly administered in the outpatient setting, resulting in increased dependence on caregivers suggest to provide physical and emotional support to patients. This article describes differences in patient versus caregiver assessments of patient health, considering caregiver perceptions of the patient's health and abilities compared to that reported by the patient.

Global Health and Cancer

Disparities of Trastuzumab Use in Resource-Limited or Resource-Abundant Regions and Its Survival Benefit on HER2 Positive Breast Cancer: A Real-World Study from China

Jianbin Li, Shusen Wang, Yongsheng Wang, Xiaojia Wang, Haibo Wang, Jifeng Feng, Qingyuan Zhang, Tao Sun, Quchang Ouyang, Yongmei Yin, Yinhua Liu, Cuizhi Geng, Min Yan, Zefei Jiang
The study of disparities in trastuzumab use has been complicated by the lack of population-based cohorts. Real-world research is lacking. This study used real-world data from a multicenter study in China to explore disparities in trastuzumab use and to investigate the survival effects of trastuzumab on early stage and metastatic breast cancer.

Regulatory Issues: EMA

The European Medicines Agency Review of Carfilzomib for the Treatment of Adult Patients with Multiple Myeloma Who Have Received at Least One Prior Therapy

Kyriaki Tzogani, Jorge Camarero Jiménez, Isabel Garcia, Arantxa Sancho-López, Marc Martin, Alexandre Moreau, Pierre Demolis, Tomas Salmonson, Jonas Bergh, Edward Laane, Heinz Ludwig, Christian Gisselbrecht, Francesco Pignatti
This article summarizes the scientific review of the application leading to regulatory approval of carfilzomib in combination with lenalidomide and dexamethasone in the European Union.

Regulatory Issues: FDA

FDA Approval Summary: Pembrolizumab for Treatment of Metastatic Non-Small Cell Lung Cancer: First-Line Therapy and Beyond

Lee Pai-Scherf, Gideon M. Blumenthal, Hongshan Li, Sriram Subramaniam, Pallavi S. Mishra-Kalyani, Kun He, Hong Zhao, Jingyu Yu, Mark Paciga, Kirsten B. Goldberg, Amy E. McKee, Patricia Keegan, Richard Pazdur
This FDA approval summary provides an update on approval of pembrolizumab for treatment of patients with metastatic non-small cell lung cancer whose tumors express PD-L1 as determined by an FDA-approved test. The results of KEYNOTE-010 and KEYNOTE-024 trials are presented.

FDA Approval Summary: Daratumumab for Treatment of Multiple Myeloma After One Prior Therapy

Vishal Bhatnagar, Nicole J. Gormley, Lola Luo, Yuan Li Shen, Rajeshwari Sridhara, Sriram Subramaniam, Guoxiang Shen, Lian Ma, Stacy Shord, Kirsten B. Goldberg, Ann T. Farrell, Amy E. McKee, Richard Pazdur
Multiple myeloma is mostly an incurable disease. The FDA granted daratumumab accelerated approval as monotherapy for patients with multiple myeloma who have received at least three prior lines of therapy, including a proteasome inhibitor and an immunomodulatory agent, or who are double refractory to a proteasome and an immunomodulatory agent. This article describes the FDA review of the strength of evidence for this application and its clinical implications for the multiple myeloma population.


Soft Tissue Sarcomas of the Extremities: Surgical Margins Can Be Close as Long as the Resected Tumor Has No Ink on It

Kamran Harati, Ole Goertz, Andreas Pieper, Adrien Daigeler, Hamid Joneidi-Jafari, Hiltrud Niggemann, Ingo Stricker, Marcus Lehnhardt
Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal tumors, accounting for approximately 1% of all adult malignancies. About 60% of all STS arise in the extremities. This article reports on the clinical behavior of extremity STS and prognostic indicators of survival.

Symptom Management and Supportive Care

Antiemetic Corticosteroid Rotation from Dexamethasone to Methylprednisolone to Prevent Dexamethasone-Induced Hiccup in Cancer Patients Treated with Chemotherapy: A Randomized, Single-Blind, Crossover Phase III Trial

Se-Il Go, Dong-Hoe Koo, Seung Tae Kim, Haa-Na Song, Rock Bum Kim, Joung-Soon Jang, Sung Yong Oh, Kyung Hee Lee, Soon Il Lee, Seong-Geun Kim, Lee Chun Park, Sang-Cheol Lee, Byeong-Bae Park, Jun Ho Ji, Seong Yoon Yi, Yun-Gyoo Lee, Jina Yun, Eduardo Bruera, In Gyu Hwang, Jung Hun Kang
Dexamethasone is an established agent for the prevention of chemotherapy-induced nausea/vomiting; however, even a short course of dexamethasone can cause many adverse effects, such as insomnia, indigestion, weight gain, acne, and hiccupping. Although often regarded trivial, persistent hiccups can cause depression, insomnia, and malnutrition. The objective of this study was to determine whether the rotation of corticosteroids affects the incidence and intensity of dexamethasone-induced hiccup without compromising the antiemetic efficacy.

Development of Palliative Care in China: A Tale of Three Cities

Zhenyu Yin, Jinxiang Li, Ke Ma, Xiaohong Ning, Huiping Chen, Haiyan Fu, Haibo Zhang, Chun Wang, Eduardo Bruera, David Hui
Although the most populous country in the world, China has limited palliative care programs. This article presents examples of three palliative care programs in China and encourages the program development in other Chinese hospitals.

Advance Directives, Hospitalization, and Survival Among Advanced Cancer Patients with Delirium Presenting to the Emergency Department: A Prospective Study

Ahmed F. Elsayem, Eduardo Bruera, Alan Valentine, Carla L. Warneke Geri L. Wood, Sai-Ching J. Yeung, Valda D. Page, Julio Silvestre, Patricia A. Brock, Knox H. Todd
Delirium is a devastating condition for a patient with advanced cancer. Early diagnosis in the emergency department should improve management of this life-threatening condition. This article presents results of a prospective study of patients with advanced cancer who presented to the emergency department at MD Anderson Cancer Center and were assessed for delirium.

Letters to the Editor

Regarding “Survival Outcomes in Asymptomatic Patients with Normal Conventional Imaging but Raised Carcinoembryonic Antigen Levels in Colorectal Cancer Following Positron Emission Tomography-Computed Tomography Imaging”

Fergus Macbeth, Tom Treasure
This Letter to the Editor questions the benefits of a recently reported CT-PET scan screening policy in terms of improving survival in patients with colorectal cancer.

In Reply

Khurum Khan, David Cunningham, Katharine Aitken, Sheela Rao
This Letter to the Editor acknowledges the limitations of a cohort observational study compared with a randomized clinical trial and defends the results of a recent study.>

8 November 2017 (Wednesday) - Differential Counting

Here’s an interesting discussion in the Facebook Hematology Interest Group…

What is your lab's policy regarding manual diffs on leukopenic oncology patients? Do you read them all? Have a lower limit to read? Report automated?

Personally I’d be inclined to report the automated diff from the analyser *if* one is obtained. And if one isn’t then do a manual diff *if* you can get a reliable diff. But what constitutes a reliable diff. I’ve seen slides in which there wasn’t more than a dozen white cells in the entire film.

I suppose the bottom line is that if there are too few cells to count then the patient is neutropenic; that is what the clinician wants to know.
The discussion in the article was interesting.

Some people don’t report diffs on Wbc <1.0
Some people do differentials on films made on buffy coats

… Really ?