A normal total can still need a smear review

An adult outpatient EDTA specimen has a white blood cell count of 9.8 × 10^9/L, within this case reference interval of 4.0 to 11.0 × 10^9/L. The automated differential reports neutrophils 66%, lymphocytes 24%, monocytes 7%, eosinophils 2%, and basophils 1%. It also reports a first-time flag: Atypical lymph? Review.

An automated flag is a review trigger, not a diagnosis. Suggested consensus action criteria include a first-time atypical or variant lymphocyte flag, while each laboratory validates its own triggers and flag definitions. Review the peripheral smear when the trigger is met, then perform a manual differential when the automated differential is absent, unreliable, or contradicted by smear findings. The analyzer result and the smear answer related but different questions.

The manual result will describe morphology and reconcile percentages; it will not diagnose an infection or malignancy. Keep the specimen, method, and flag visible while you count so a calculated result stays connected to the release decision. Release a flagged automated differential only under your locally validated review procedure.