Wikipedia:Featured article candidates/Complete blood count/archive1

Complete blood count

 * Nominator(s): Spicy (talk) 23:39, 6 August 2020 (UTC)

This article is about the complete blood count, one of the most commonly performed medical laboratory tests. Most people have had a CBC done at some point during their lives, but they probably have not learned about the vast amount of information that can be gleaned from examination of the blood, the technology that makes it possible, or the test's long and interesting history. This is my first FA nomination, and before being brought here it was reviewed by several WP:MED and FAC editors, including, , , , and. Working with these editors, I have done my best to ensure that the article is comprehensive, well-sourced, and easily understandable for a general audience. Thanks, Spicy (talk) 23:39, 6 August 2020 (UTC)

Review by Graham Beards
It's great to see another medical article at FAC, there have been too few of late. This is a placeholder, my review will follow later. Graham Beards (talk) 13:54, 7 August 2020 (UTC)

The nominator has done a superb job on this. I have made a few edits, but not so many as to warrant a recusal on my part. I first used a Coulter to complete a full blood count in September 1971 (and yes, I can remember the day of the week), so I feel qualified to offer an "expert" review. I will probably use British spellings, so please excuse me in advance. We have to remember that this article is about a set of laboratory tests and not an article on haematological diseases and disorders. Getting the right balance is important. Having said this, I think the article would benefit from more examples of counts and the interpretation. I have added one. Perhaps include one showing a white cells disorder with blast cells in the differential? And perhaps one indicating a recent haemorrhage?
 * That is a good idea, although I'm not sure if we have space for two more of these with the number of images already in the article. We do have a blood smear of CML and I can probably find an example diff of CML in one of my textbooks... will see what I can do. Spicy (talk) 17:25, 8 August 2020 (UTC)
 * Done — in "white blood cells" section. Spicy (talk) 18:34, 8 August 2020 (UTC)

Lead
More to come. Graham Beards (talk) 10:20, 8 August 2020 (UTC)
 * I am concerned about this sentence; " Anemia and thrombocytopenia can be diagnosed from abnormal results, which may indicate a need for urgent medical treatment, such as a blood transfusion." Particularly the part about needing a blood transfusion. We don't want to frighten our readers  who might think this means that because a FBC has been requested, a blood transfusion is on the cards. Most, 99.9%  I would guess, of FBCs are routine and non-urgent and many of these will be normal. Also, blood transfusions are rarely used to treat thrombocytopenia - platelets are given as a last resort.
 * Changed. I was uncomfortable with that sentence as well. It has been tweaked a lot over the past few months. I have changed it to a softer phrasing and removed the bit about transfusions, also added that results outside the reference range do not always require medical intervention. Spicy (talk) 17:22, 8 August 2020 (UTC)
 * In this sentence "The hematocrit may be performed manually if the automated results are questionable." I don't think readers will understand what we mean when we say that a result is "questionable". A manual HCT can only really check the automated HCT and not the other results and by "questionable" we really mean that it doesn't make sense in the light of the other results. Perhaps we can say "manual tests can be used to independently confirm abnormal results"?
 * Done, and I added a bit more about manual testing to the lead. Spicy (talk) 17:22, 8 August 2020 (UTC)
 * The Lead image is superb.
 * Thank you, I am proud to have shed my own blood for Wikipedia... Spicy (talk) 17:22, 8 August 2020 (UTC)

Purpose

 * This sentence concerns me: "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." I think we have a problem here in that the CBC does not give binary (positive or negative) results. With the CBC we work with numbers. I don't think any component of the count is reported as positive or negative. This means, at least to me, that "false positive" and "false negative" reports are not applicable. The results that are outside the normal range in healthy people can be explained by the normal distribution that is used to define the normal ranges. Usually two standard deviations either side of the mean are used to define this range, which covers 95.4% of the population. But, and a statistician will kindly correct me if I'm wrong, most normal distributions incorporate six standard deviations – three either side of mean, so as to included 4.6% of the population. Is this not why we sometimes see results that are out of range ( not "false positive") in healthy people? Graham Beards (talk) 18:42, 8 August 2020 (UTC)
 * "False positive" is the term used in the source, but I agree that it is a bit silly. I have rephrased this and added information about how the reference range is derived to that section. Spicy (talk) 19:02, 8 August 2020 (UTC)
 * That's much better and informative. And I apologise for the egg sucking lessons. This tends to happen at FAC. Graham Beards (talk) 19:13, 8 August 2020 (UTC)
 * I appreciate it, it's good to remember that what is obvious to us isn't always obvious to others. Spicy (talk) 19:16, 8 August 2020 (UTC)
 * I don't understand this sentence: "A 2011 study in the United States found that a CBC was performed on approximately 56% of adults presenting for an annual checkup, leading to an estimated loss of $33 million USD per year." Loss to whom? It's also best to avoid costs and prices in medical articles. Graham Beards (talk) 19:18, 8 August 2020 (UTC)
 * "Cost" would be better than "loss". But I have just removed this sentence per your concerns about MEDPRICE and the fact that the study is old; I thought it would be useful to have some idea of the scope of CBC screening and these were the most recent statistics I could find, but it is probably not necessary. Spicy (talk) 19:24, 8 August 2020 (UTC)

Procedure

 * I mentioned this problem in the Lead "The blood sample is typically tested on an automated analyzer, but manual techniques such as a blood smear examination or manual hematocrit test can be used to investigate abnormal or questionable results". We need to make it consistent now. Graham Beards (talk) 19:21, 8 August 2020 (UTC)
 * Done. Spicy (talk) 19:25, 8 August 2020 (UTC)
 * Here "A reagent chemical is added to the sample to destroy (lyse) the red cells." We need to stress that this is needed to measure the Hb and that the red cells are counted ( simultaneously in another channel).Graham Beards (talk) 19:28, 8 August 2020 (UTC)
 * Clarified this. Spicy (talk) 21:47, 8 August 2020 (UTC)
 * (I'll continue on Sunday)Graham Beards (talk) 19:31, 8 August 2020 (UTC)
 * In this sentence "Impedance-based cell counting operates on the Coulter principle, which states that when cells are suspended in a fluid carrying an electric current and passed through an aperture, they cause decreases in current because of their poor electrical conductivity." It sounds like the Coulter principle is on a par with physical laws such as Ohm's law. The problem is caused by the use of "states that". Is there a way around this?
 * Rephrased. Spicy (talk) 13:41, 9 August 2020 (UTC)
 * Is this true? "Basophils, which are difficult to distinguish from other white blood cells using conventional methods" I don't have a problem recognising them on a stained blood film.
 * Conventional automated methods is what is meant here.... I will rephrase. Spicy (talk) 09:01, 9 August 2020 (UTC)
 * I have just removed that clause, not sure we need to get into why exactly they are hard for analyzers to count, but that can be added if necessary. Spicy (talk) 09:13, 9 August 2020 (UTC)
 * This is not really true "White blood cells can be classified into three types (granulocytes, mononuclear cells and lymphocytes) based on measurements of cell volume by impedance or light scattering." This is not the basis of the classification, which is actually morphology and cell markers.
 * Yes, the classifications themselves are not just based on cell volume, but the peaks on the volume histogram correlate with these cell types and permit a differential count to be performed; how do you propose clarifying this? Just saying something along the lines of what I've said here? Spicy (talk) 09:26, 9 August 2020 (UTC)
 * Yes, or use "distinguished" instead of "classified". Graham Beards (talk) 09:32, 9 August 2020 (UTC)
 * Clarified. Spicy (talk) 16:32, 10 August 2020 (UTC)
 * Here, "laboratories are often required to participate in these programs to maintain accreditation", do we needed to link or explain "accreditation"?
 * Linked. Spicy (talk) 09:47, 9 August 2020 (UTC)

Red blood cells, hemoglobin, and hematocrit

 * We have two occurrences of "anaemia" back-to-back here: "Evaluation of red blood cell indices is helpful in determining the cause of anemia. Anemia with a low MCV ...".
 * Fixed. Spicy (talk) 09:18, 9 August 2020 (UTC)
 * Here (and please forgive the pedantry) "People with warm autoimmune hemolytic anemia may exhibit red cell agglutination that does not resolve on warming." It is not the people who exhibit; it's their blood sample.
 * Also fixed. Spicy (talk) 09:18, 9 August 2020 (UTC)

History

 * There's something missing here "Before automated cell counters"
 * This was previously phrased as "Prior to the invention of automated cell counters" but it was cut down for brevity - do you think the prevous wording was better? Spicy (talk) 09:20, 9 August 2020 (UTC)
 * Yes, it was better. Or how about "Before the introduction of"?
 * Done. Spicy (talk) 09:43, 9 August 2020 (UTC)

Other issues
Support The nominator has done a stupendous job. I am happy for my review to be "capped" as all my issues have been resolved by edits or discussion. Graham Beards (talk) 09:44, 9 August 2020 (UTC)
 * There are many duplicated links.
 * I have removed some. A few are intentional - I have linked MCV, MCH and MCHC again in the "red blood cells" section because they are important concepts for that section and the previous link is quite far away; same for red blood cell agglutination in the "limitations" section; and I duplinked basophils because it would be the only cell not linked in the list of cell types if it weren't duplinked. Spicy (talk) 09:38, 9 August 2020 (UTC)
 * In the figure the count does not "match" the smear which shows a lot of blasts. (Not a major problem)
 * Ugh, yeah, I noticed that... agree it is not a major problem but I will see if I can find a different picture of CML or a different example diff. I figured changing the blast percentage myself would be original research. Spicy (talk) 09:38, 9 August 2020 (UTC)
 * Do we need a little more detail on manual WBC, RBC and platelet counts? We seem to focus on the Hb.
 * I was thinking about this; I was hesitant to include it because I was not sure if it would verge on WP:NOTMANUAL territory, but it would be helpful IMO to discuss the different diluents used, different squares used for counting... I will add some material on this. I am working today so may not be able to address all of this until later. Spicy (talk) 09:38, 9 August 2020 (UTC)
 * I know from experience that manual counts are the norm in many parts of India.
 * Added. I have chosen to leave out the specifics about dilution factors, number of squares counted, etc. as this seems to vary a lot, e.g. one text recommends a 20x dilution for platelets, another 100x; both recommend 20x for WBC but the Unopette systems, for example, use a 100x dilution. Hopefully this is satisfactory. I haven't had to do a manual blood count since I was in school... Spicy (talk) 15:53, 10 August 2020 (UTC)

Ceoil
Placeholder for now. Am following this closely, with interest. As said on the talk, the nominator has done commendable work in producing an accessible page without compromising precision or technical accuracy. Am mostly c/eing as I go, comments here to follow. Ceoil (talk) 10:53, 9 August 2020 (UTC)
 * This is a very accesable page for non specialists, and goes out of its way to be understandable for slow folks such as myself, without compromising integrity. as such, having watched for months, and been editing on and off since then; support [on prose]. Ceoil  (talk) 21:51, 30 August 2020 (UTC)

Review by Jfdwolff
Many apologies for my delayed review of this important article. I am writing from the perspective of a clinician with a modest interest in diagnostic haematology. JFW &#124; T@lk  15:13, 11 August 2020 (UTC)
 * Done. General comments: I see UpToDate used in two sources. I am very unclear whether UpToDate is a good source for medical articles. Happy to help find alternatives.
 * Replaced one, trimmed the other; leukostasis is interesting but maybe not something the average reader needs to know about Spicy (talk) 17:24, 11 August 2020 (UTC)
 * Uptodate is MEDRS reliable; it is less preferred only because we cannot point to archived versions as their pages change. Jacob, we can’t use done templates at FAC as they cause a transclusion limit problem in archives.  I will go through when you are done and switch them to bolded done, before the page archives. Sandy Georgia  (Talk)  13:08, 18 August 2020 (UTC)


 * Done. Intro: from my European perspective, the words "medical examination" are only used in reference to physical examination, and blood tests are supplementary rather than integral. The same is repeated in the "Purpose" section.
 * Would "checkup" or something along those lines be better? Spicy (talk) 15:21, 11 August 2020 (UTC)
 * I have replaced it with "medical assessment" which is somewhat broader. "Checkup" would work but is also an Americanism... JFW &#124; T@lk  08:56, 18 August 2020 (UTC)
 * Purpose:
 * Done. Should this section actually be called "Indication"? I think both are reasonable.
 * I think "indication" might be a bit less clear than "purpose" to non-medical readers. MEDMOS recommends that this section be titled "Medical uses", which is a bit silly (what non-medical uses are there for a medical test?) Spicy (talk) 15:21, 11 August 2020 (UTC)
 * In the third paragraph, the routine use of CBC in medical emergencies could be sourced to the latest version the Surviving Sepsis Campaign or an emergency medicine text such as Rosen
 * Would you mind clarifying what you mean here − I assume you mean screening for sepsis in the ED? The 2016 SSC guidelines don't seem to mention the CBC (although I know it is a part of the SIRS criteria)... and Rosen's is a rather long book which mentions the CBC very, very often, so it's hard to know where exactly to look. Spicy (talk) 22:42, 11 August 2020 (UTC)
 * Really tricky and I acknowledge this, but I think we need to emphasise the point that CBCs are obtained as a semi-routine test in almost every conceivable form of acute illness, both in primary and secondary care. The difficulty is that it is mentioned too often but mostly in specific context. That is because irritatingly medical textbooks are still organised by diagnosis/group rather than by process. At the time when the CBC is drawn, there is often substantial diagnostic uncertainty! Unfortunately I have no access to textbooks at the moment, but I do think this is a really important point to make. Next week looks better for me. JFW &#124; T@lk  08:56, 18 August 2020 (UTC)
 * I agree completely but this is hard to source for exactly the reasons you say! I will see what I can find in the emergency medicine literature but I'm sure you know the territory better than me. Spicy (talk) 17:47, 18 August 2020 (UTC)
 * I've added a bit on this. I still haven't been able to find any sources that talk about the test's uses in general as opposed to in specific conditions, but I tried to phrase it in a way that gets the idea across that it's ordered for pretty much any reason someone might show up at the emergency department. Spicy (talk) 17:18, 21 August 2020 (UTC)
 * Done. Procedure: it might be worthwhile mentioning that blood may be drawn from indwelling lines (e.g. PICC, Hickman) or from temporary lines (CVC, arterial) as well. Not sure what the best source would be for this!
 * Hrm. Blood Cells: A Practical Guide mentions it can be drawn from a line, but doesn't mention that it can be arterial blood. I will look for a source for this. Spicy (talk) 22:42, 11 August 2020 (UTC)
 * Okay, I have looked around and haven't been able to find a source that goes into more detail. The problem I face now is how to phrase this appropriately. "Line" is jargon and I'm not up to speed with the proper terminology for different types of lines; the specific phrasing in the source is "It may sometimes be necessary to obtain blood from [...] indwelling cannulae in various sites" but "indwelling cannulae" is a mouthful for a non-technical reader. Is there a better term for this? Spicy (talk) 19:54, 13 August 2020 (UTC)
 * My main point is that not all CBCs are obtained by venepuncture. The arterial source is pretty niche so agree it could be skipped. Perhaps the "indwelling cannulae" problem can be handled by linking to Central venous catheter which has a list of different types of venous lines. Sounds like your source covers this. JFW &#124; T@lk  08:56, 18 August 2020 (UTC)
 * Would it be acceptable to just omit the part about venipuncture? I have done this. Spicy (talk) 17:32, 18 August 2020 (UTC)
 * Done. Included tests: under "platelets", I would suggest that they play a role in blood clotting but they interact closely with the humoral coagulation system and with the vessel wall. Currently the text implies that they are solely responsible.
 * Added (tried to keep it simple). Spicy (talk) 04:41, 12 August 2020 (UTC)
 * Done. Limitations: I don't think rouleaux are a "limitation" as such but they deserve mention as a non-specific marker of disease.
 * Mentioned this under the "Manual" section where red cell morphology is discussed. Spicy (talk) 17:32, 11 August 2020 (UTC)
 * Done. History: very comprehensive, nothing to add there!

Colin
I read through this and made a few tweaks and some suggestions on the talk page. Happy to support this for FA. My review is as a lay reader: I can't comment on the accuracy of the information and I didn't review the sources. I'll defer to Graham and Jfdwolff on those. -- Colin°Talk 16:21, 11 August 2020 (UTC)

SandyGeorgia
I would fully support this article for promotion, once Ceoil and Jfdwolff are satisfied, but leave it to the Coords to decide if I am too "involved". The article is written more than 90% by Spicy, who is to be commended for very fine medical work, but I figure as the second highest editor via edit count, because of my typical gazillion edits to fix the little MOS-y things-- I have added no significant content, and have followed the article since its GA pass. It was in great shape at the GA stage, but has vastly improved and expanded (for comprehensiveness) since then. Having Ceoil's layperson review— along with the master FA writers and specialists of WPMED (Colin, Cas, Graham, and Jfdwolff)— makes this a truly commendable accomplishment, in bringing back FA expertise to WPMED! Kudos to Spicy for this accomplishment in a content area that is helpful to everyone! Sandy Georgia (Talk)  16:52, 11 August 2020 (UTC)

Image review
you looked at the images here, on my talk, but some have changed. Might you have time to revisit? Best, Sandy Georgia (Talk)  13:17, 18 August 2020 (UTC)


 * I'm not sure that textual tables like File:Example_of_a_Complete_Blood_Count.jpg should be presented as images, per MOS:ACCIM. Nikkimaria (talk) 21:06, 18 August 2020 (UTC)
 * (but it's so perfect for the article!) Sandy Georgia  (Talk)  21:08, 18 August 2020 (UTC)
 * Thank you, RexxS! Sandy Georgia  (Talk)  22:55, 18 August 2020 (UTC)
 * I was worried that would be a problem. Here's an example of the first image expressed as a table: (I know this will have to be tweaked for accessibility). To save on space, is there a way to embed an image (such as File:Iron-deficiency_Anemia,_Peripheral_Blood_Smear_(4422704616).jpg) into the table? Preferably with a caption to explain how the CBC results relate to the blood smear? I looked at Help:Table but I didn't see anything that looks quite like what I want to do. Spicy (talk) 21:39, 18 August 2020 (UTC)
 * is right. I've replaced the image in question with a table that meets accessibility concerns. As a bonus, the small text inside the caption was too small, so I've taken the opportunity to make that as no smaller than MOS:FONTSIZE allows. It does take up a bit more room, but I can read the table now, which I couldn't do with the image. If you don't like it, please feel free to revert. --RexxS (talk) 22:10, 18 August 2020 (UTC)
 * Wow! Thank you - that looks much better than my attempt. Is there a way to include the image in the table without breaching the accessibility guidelines? Also, there is another similar image in the "White blood cells" section - but now that you have made a table for the first one I can probably just copy and paste that one and change the values. Thanks, Spicy (talk) 22:24, 18 August 2020 (UTC)
 * Erm, I'm not sure how including the image in the table would look. I wouldn't do it. Oh, wait - which image did you mean? It would be good if you can adapt it yourself for the White blood section, but it is rather more complex. Would you rather I did it for you so that you have another example for future reference? --RexxS (talk) 22:32, 18 August 2020 (UTC)
 * , this image was the one I was referring to. Honestly, I'm terrible with tables and wiki markup so it would probably be better if you did the second table; just wanted to avoid making more work for you if possible... Spicy (talk) 22:38, 18 August 2020 (UTC)
 * Okay, sorry I got distracted. I've replaced the multiple image with an image + table. I think it looks nicer with the table on the left, but it's easy to rejig to taste. Cheers --RexxS (talk) 00:40, 19 August 2020 (UTC)
 * Thanks so much, it looks fantastic... I ended up taking the image out of the table because it looks odd when the image and table are different sizes, but the rest is great. :) Spicy (talk) 01:31, 19 August 2020 (UTC)
 * I've now tweaked it to remove the extra code needed to place the table next to the image. I also changed the captions below to match the size and line-spacing of an image caption. That's a little more compact now. --RexxS (talk) 03:54, 19 August 2020 (UTC)
 * Brief comment Acronyms are currently introduced both without an "or" (eg. "complete blood count (CBC), also known as a full blood count (FBC)") or with an "or" (eg. "mean corpuscular hemoglobin, or MCH", "red blood cell distribution width, or RDW"). Suggest removing the ors to avoid the impression it might be two different items. CMD (talk) 02:16, 19 August 2020 (UTC)
 * Revised. Spicy (talk) 02:59, 19 August 2020 (UTC)

Tom (LT)
I reviewed this article for GA, where it was already stellar, and commend Spicy for his work. Thanks to other reviewers for your comments. I don't have much experience reviewing for GA, to me this article seems at FA standard (therefore I would support). There are two small comments here: --Tom (LT) (talk) 00:28, 23 August 2020 (UTC)
 * "Approximately 10–25% of samples require a manual blood smear review,[4] " stands out as a weird single instance of a citation for a fact in the lead.
 * Thanks for taking a look . This was discussed on the talk page: Iztwoz agrees with you, but according to Sandy it's expected for FAs to have citations for statistics in the lead. I'm not particularly attached to this one citation but I do think it could be helpful for verification. Spicy (talk) 02:46, 23 August 2020 (UTC)
 * Override me if consensus goes that way, no problem, but we used to always cite statistics in FA leads. Sandy Georgia (Talk)  02:49, 23 August 2020 (UTC)
 * Ok, happy to respect FA standards, however personally I feel the single citation does stand out weirdly, inviting other citations to be provided for consistency. I think it's an odd middle ground between no or all sentences cited. As I don't have much familiarity here however, so happy to leave this one.--Tom (LT) (talk) 22:59, 23 August 2020 (UTC)
 * I defer to Spicy; it is neither required nor not required. Sandy Georgia  (Talk)  23:28, 23 August 2020 (UTC)
 * "Regular CBCs are necessary for people taking some psychiatric drugs" suggest this is broadened to "drugs including some psychiatric drugs", as it's also used to monitor immunosuppressants such as azathioprine and mycophenolate
 * Indeed, it's used to monitor many things - this is mentioned in the paragraph above: "people... who are receiving treatments that can affect blood cell counts may have a regular CBC performed". The purpose of the subsequent paragraph is to give a very basic overview of some specific applications in medical specialties... psychiatry is mentioned because it's something that many laypeople might not see the connection to and clozapine in particular is a big deal (my lab for example has special protocols for reporting CBCs on clozapine patients). Respectfully, I think covering every application of the test would be outside the scope of the article, since it is so ubiquitous. Spicy (talk) 02:46, 23 August 2020 (UTC)
 * You make a good point; happy to let this one lie too.--Tom (LT) (talk) 22:59, 23 August 2020 (UTC)

Ergo Sum
I will leave my (non-medical-expert) thoughts on prose and style here.  Ergo Sum  23:22, 23 August 2020 (UTC) Those are all my comments. Though I was reading only for prose, once addressed, I should be happy to support.  Ergo Sum  23:52, 23 August 2020 (UTC)
 * In the lede sentence: "give information" strikes me as a tad inelegant. "Provides" or "supplies" information might do.
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * "real medical issue"...I am ignorant about whether this is a commonly encountered phrase in medicine, but the petulant in me asks what an unreal medical issue is. Perhaps dropping "real" or otherwise rephrase such as "a medical issue requiring intervention."
 * Dropped "real". Spicy (talk) 00:45, 24 August 2020 (UTC)
 * "high-frequency" can link to High frequency.
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * The link to Fluorescence should be moved to the first instance of "fluorescent".
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * "accuracy of these readings is questionable". I would clarify what this means/what the implication is. Does it mean that it's not a technique that is generally considered reliable?
 * Clarified. Spicy (talk) 01:00, 24 August 2020 (UTC)
 * The blood smear link should be moved to the first instance of the term.
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Possibly link microscope. Common, but nonetheless technical concept.
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Is the quality control section speaking only about automated analysis? If so, it should become a sub-section of Automated.
 * The first paragraph is about automated analysis. There are internal quality control methods for manual tests but they are not as standardized and the sources do not discuss them in much detail. External quality control procedures are used for both manual and automated tests - I'll see if I can find a source that explicitly says that. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Is the Main articles templates necessary under the various section headers? Those terms are already fairly frequently used and linked throughout the article.
 * I think it's helpful to have the link right there in case someone wants to read about the tests in more detail than is presented in the subsection. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Mean cell volume is duplinked.
 * Ditto for RBC indicex
 * I intentionally added duplicate links to these in the 'red blood cells' section because they are important concepts in that section and the previous links are far away. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Ditto for lung.
 * The second link is actually piped to "lung disease". Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Ditto for clotting.
 * Done. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * Ditto for platelets.
 * Sorry, would you mind pointing out this one - I can't find it. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * I can't seem to find it either. I must have read too quickly.  Ergo Sum  01:03, 24 August 2020 (UTC)
 * Thank you for taking the time to review this, I really appreciate it. Spicy (talk) 00:45, 24 August 2020 (UTC)
 * I'm satisfied with the prosaic changes made, and support the FAC. Nice work.  Ergo Sum  01:04, 24 August 2020 (UTC)

Coord note
I think we just need a source review? Adding it to the source review list. --Ealdgyth (talk) 15:44, 31 August 2020 (UTC)
 * I have posted a notice at Wikipedia talk:WikiProject Medicine asking for a source reviewer. --- C &amp; C ( Coffeeandcrumbs ) 04:29, 3 September 2020 (UTC)
 * See my response there. Sandy Georgia (Talk)  15:02, 3 September 2020 (UTC)
 * Just want to add that while many of the sources aren't available online, I can share PDF copies with reviewers if they need them for spot-checking. There are only a few sources that I don't have in PDF format. Spicy (talk) 02:13, 8 September 2020 (UTC)

Partial review by WhatamIdoing
I took a quick look at a few sources. I'm a little surprised to see websites like Lab Tests Online and Choosing Wisely being cited for content that could/should be available in textbooks. These aren't bad sources, but they aren't typical of MEDRS's ideal. Also, although I think citation formatting is a trivial problem that can be corrected at the end, it's a little odd that these refs are pointing to the archived copies when the original web pages are 'live'. If this is accidental, then perhaps there's a way to change that. WhatamIdoing (talk) 00:21, 4 September 2020 (UTC)
 * It is surprisingly difficult to find certain sorts of information in "gold standard" MEDRS sources, since they're written for healthcare practitioners and they tend to assume that the reader has some prior knowledge of, for example, basic situations in which a CBC might be useful. I have only used these sources for simple and uncontroversial information (e.g. very general applications of the test, alternate names, units). Spicy (talk) 01:11, 4 September 2020 (UTC)
 * I want to explicitly state that I don't insist that these sources be changed. Have you checked a nursing textbook?  I have had some success with that in the past.  WhatamIdoing (talk) 18:31, 5 September 2020 (UTC)
 * It took quite a bit of looking but I found this, which is decent. I've added this to augment the existing refs. Spicy (talk) 02:33, 6 September 2020 (UTC)
 * It looks like the problem was that |url-status=live was missing. I've fixed this. I never knew that parameter actually did anything... Spicy (talk) 01:11, 4 September 2020 (UTC)
 * The CS1 templates get changed every few months. This must have been one of the changes.  WhatamIdoing (talk) 18:31, 5 September 2020 (UTC)

Partial source review
I checked all sources and citations for WP:MEDRS-compliance and citation consistency. The article's sourcing complies with WP:MEDRS, using textbooks, secondary reviews, national or practice guidelines, and Historical articles (for the History section as appropriate). The (very) few instances that I questioned, where non-controversial content was sourced to websites or comparative studies (primary sources) were well explained on article talk. Page numbers or section headings are provided in short-form citations for lengthy journal articles and the many books used. I hope (knowing that the sourcing is up to snuff) that someone else will do the close paraphrasing, copyvio, source-to-text integrity spot checks typical for a first-time nominator. Regards, Sandy Georgia (Talk)  14:37, 8 September 2020 (UTC)
 * might you be willing to do the first-time nominator spotchecks for close paraphrasing and accurate representation of sources cited?  I am concerned that other reviewers may be intimidated by MEDRS, so I have checked all sources for compliance. I think you are comfortable with technical language and journal sourcing, and might be able to do this final piece. Regards, Sandy Georgia  (Talk)  14:40, 8 September 2020 (UTC)

Source spotcheck
As requested by SandyGeorgia. The procedure is to pick a random sample of references and check the statements against the source:
 * 12: I dunno. The source might be adequate by MEDRS standards but I am not sure if Don’t perform serial blood counts on clinically stable patients. Transfusion of red blood cells or platelets should be based on the first laboratory value of the day unless the patient is bleeding or otherwise unstable. refers to complete blood count.
 * Blood count is a synonym. See for example, . Spicy (talk) 22:21, 8 September 2020 (UTC)


 * 156: I take that the "blasts" language is supported by the other source? Source looks otherwise OK, it's linked from the original too.
 * Yes - from d'Onofrio et al (2014), p. 289: "The basic requirement for the diagnosis of acute leukaemia is the morphological recognition of blast cells in the bone marrow and peripheral blood"


 * 95: Can't access this one, does someone have a copy? Source looks good beyond this, though. eta: Got it, seems OK.
 * 83: Same as *95.
 * I only have a hard copy of this one but here's a quote of the relevant section: "Schistocyte (fragmented cell): Schistocytosis is a very serious pathologic condition... Schistocytes are characteristic of microangiopathic hemolytic anemias and their presence is a danger signal requiring immediate action by the physician"; "Sickle cell (drepanocyte): Sickle cells are the result of a genetic condition in which abnormal hemoglobin S (HbS) is present in a homozygous state in RBCs". (being homozygous for hemoglobin S means you have sickle cell disease) Spicy (talk) 22:21, 8 September 2020 (UTC)
 * Mmm, might want to mention that schistocytes are an emergency sign. Jo-Jo Eumerus (talk) 09:06, 9 September 2020 (UTC)
 * Hmm, I kind of wanted to avoid scaring our readers. Schistocytes are classically associated with MAHA but they can occur in other situations as well (see Bain et al (2017) p. 72 which lists, among other things, thalassemia, megaloblastic anemia, mechanical damage to red cells via heart valves, and severe burns as causes of schistocytosis). But I have added "requires urgent investigation..." Spicy (talk) 02:06, 10 September 2020 (UTC)


 * 89: The "clinically significant" is a bit implicit. Otherwise fine.
 * 18: OK source, I take it only has to "carry" the "shortness of breath" bit?
 * Yes, the other two refs are for the other two conditions. Spicy (talk) 22:21, 8 September 2020 (UTC)


 * 91: Same as *95, can't help but notice though that "Smock" does not appear in the Google preview.
 * Smock is the chapter author. I'll send you an email with this text & the others you requested (except for Turgeon (2016)) which I only have as a hard copy. Spicy (talk) 22:21, 8 September 2020 (UTC)
 * OK, found the chapter but it's hard to work with it when it has no page numbers (also, the entire book has over 7000 pages!?) Jo-Jo Eumerus (talk) 09:06, 9 September 2020 (UTC)
 * Yes, unfortunately it is not a very well formatted ebook so my choices were either to cite the chapter + section headings or to pay 500 dollars for a hard copy. I went with the former as advised by Sandy on the talk page... The relevant section should be on pages 184-5 of the PDF. Spicy (talk) 02:06, 10 September 2020 (UTC)


 * 31: Same as *95. eta: I see that the text in our article omits most mentions of reactive leukophilia.
 * Sorry, I am not sure what you mean by "reactive leukophilia". If you are referring to reactive leukocytosis/neutrophilia, this is mentioned in the white blood cell differential section but without using that specific terminology. Spicy (talk) 09:57, 9 September 2020 (UTC)


 * 56: Why is radiofrequency not mentioned? Source looks otherwise good.
 * Because that's how it's presented in the source: "Despite the number of hematology analyzers available from different manufacturers and their varying levels of sophistication and complexity, most rely on only two basic principles of operation: electronic impedance (resistance) and optical scatter." Radiofrequency is mentioned as "a modification sometimes used". The article does discuss radiofrequency further down. Spicy (talk)


 * 155: The source mentions some more conditions in addition to these listed in our page. Otherwise, seems OK.
 * Yes - there are a lot of conditions that can throw blood counts out of whack and I was trying to stick only to the "classic" conditions here. See for example Bain (2015) p. 236 "some of the causes of eosinophilia are shown in Tables 6.6, 6.7 and 6.8, the commonest being allergic diseases (particularly asthma, hay fever and eczema) and and, in some parts of the world, parasitic infection." The white blood cell differential article goes into a bit more detail, and could be expanded. Spicy (talk) 22:21, 8 September 2020 (UTC)


 * 198: Seems OK. Also the kind of claim that does not really need WP:MEDRS sourcing.
 * 83: Not sure why this appears twice...
 * Not sure what you mean by appearing twice Spicy (talk) 22:21, 8 September 2020 (UTC)
 * It means that for some reason I did get the number 83 twice when making a list of refs to check. Jo-Jo Eumerus (talk) 09:06, 9 September 2020 (UTC)


 * 123: Where does it say "Normal hemoglobin"? I take this is a MEDRS-compliant source.
 * Yes, it's a medical textbook from a major publisher. "normal hemoglobin" is from ref 122: "A high RBC and a low MCV despite a normal Hb are characteristic of thalassaemia trait" Spicy (talk) 22:21, 8 September 2020 (UTC)


 * 107: Same as *95.
 * See my comment regarding 91. Jo-Jo Eumerus (talk) 09:06, 9 September 2020 (UTC)
 * This was a bit tricky to source because it's sort of like a "lead section" for all the subsections... because of the whole no page numbers issue, I ended up citing the whole chapter, which I realize is not optimal. The information is in there - but not a very elegant way to source it. Looking at this again it looks like all the info is in the LTO source ; since this is rather basic and uncontroversial information I'll just swap Wintrobe's out for that. Spicy (talk) 07:53, 11 September 2020 (UTC)


 * 54: "Spectrophotometry" is only mentione in the references of the source.
 * Graham Beards added that one. But this is supported by ref 55: "Hb is an intensely colored protein, allowing its measurement by spectrophotometric techniques [...] The absorbance of the cyanmethemoglobin is measured in a spectrophotometer at 540 nm to determine Hb." I'll move both refs to the end of the paragraph to make this clearer. Spicy (talk) 22:21, 8 September 2020 (UTC)


 * 87: Same as *95.
 * Hard copy only but the relevant quote is "The differential count consists of identifying and counting a minimum of 100 WBCs. After the RBCs and platelets have been examined, the WBCs are classified and counted in the optimal counting area of the blood film under oil immersion ... Occasionally, the absolute number of cells of each type is of interest, although values are usually reported as percentages. To calculate the absolute value, multiply the percentage of each cell type, expressed as a decimal, by the total WBC count".
 * Seems OK then. Jo-Jo Eumerus (talk) 09:06, 9 September 2020 (UTC)


 * 149: A finely cut sentence but it seems to be reasonably source.
 * 8: I take the other sources contain the justification for leaving out the "perhaps" in "perhaps most common"?
 * Yes; from Keohane et al p. 244: "The CBC provides such valuable information about a patient’s health status that it is among the most frequently ordered laboratory tests".


 * 109: Same as *95.
 * added that one. I don't have access to it. Spicy (talk) 22:21, 8 September 2020 (UTC)
 * Yes, I have a copy of Blann, A; Ahmed, N (2014). Blood Science (1 ed.). Institute of Biomedical Science. What is the issue exactly? Graham Beards (talk) 09:45, 9 September 2020 (UTC)
 * Jo-Jo is doing the random spotcheck for source compliance and avoidance of copyvio customary for first-time nominators. If you could provide the text that backs up citation 109, Jo-Jo can review.  Regards, Sandy Georgia  (Talk)  02:58, 10 September 2020 (UTC)
 * The source is a Table which has the same values but in a different order and excluding the ESR. The salient texts regarding the Table read: "This case is symptomatic and has several cell abnormalities, so is anaemic." "The major cause of microcytic anaemia are insufficient iron reaching the bone marrow and haemoglobinopathy." Should we add that the Table has been adapted from the source? I included this when I added the original image that has been removed but the data are the same. Graham Beards (talk) 06:29, 10 September 2020 (UTC)
 * I would probably add a "Most likely" somewhere; to me "the major cause" implies "not the only one". Otherwise seems OK. Jo-Jo Eumerus (talk) 08:58, 10 September 2020 (UTC)
 * That was a typo - sorry. The source says "major causes" (plural) - it's most unlikely to be anything other than iron-deficiency or haemoglobinopathy

Otherwise it looks like all the sources are MEDRS compatible. Nothing out of the bits I checked jumped out as copyvio, plagiarism or close paraphrase - for the most part other than terminology and meaning there was no text-source similarity. Mostly a cosmetic comment so feel free to ignore, but if the Bibliography section isn't part of a Harv (sfn and friends) referencing system adding none to the individual citations might be a good idea. Jo-Jo Eumerus (talk) 18:58, 8 September 2020 (UTC)
 * Thanks, Jo-Jo! I'm sure Spicy will get right on these. Also, Earwig copyvio check looks fine.  Best regards, Sandy Georgia  (Talk)  20:12, 8 September 2020 (UTC)
 * Thanks so much for taking this on. I'll email you with copies of the sources you requested. Spicy (talk) 22:21, 8 September 2020 (UTC)
 * Email sent. Posted excerpts here for sources I only have in hard copy format. Spicy (talk) 23:23, 8 September 2020 (UTC)
 * Just following up here, is there further action/review forthcoming based on emailed sources? -- Laser brain  (talk)  13:44, 13 September 2020 (UTC)
 * Sorry, should have said earlier that no further action is needed. Jo-Jo Eumerus (talk) 13:50, 13 September 2020 (UTC)