Is a 500-Cell Count Necessary for Bone Marrow Differentials?: A Proposed Analytical Method for Validating a Lower Cutoff

Objectives By convention, 500 cells are counted for bone marrow aspirate differentials. Evidence supporting such a cutoff is lacking. We hypothesized that 300-cell counts could be sufficient. Methods Cell count results from 165 cases, for which values were recorded at 300 and 500 cells, were analyzed. We tested for statistical differences and changes in diagnostic classification between the two cutoffs. Results Three hundred cell counts did not produce diagnostically different results, particularly for myeloblasts and plasma cells, where cell percentages are critical for disease classification. Method comparison analysis did not reach statistical significance for any cell type when comparing the two methods. Bias plots showed narrow, even spread about the mean bias. Contingency table analysis yielded no significant diagnostic discrepancies. Conclusions Performing differential counts on 300 cells would produce clinically and statistically similar results to 500 cells. Reducing the cell number counted has potential cost/labor reductions without affecting quality of care.