Required section · Section 4 of 5
Apply the workflow once
Apply the workflow in order. The K2EDTA tube is adequately filled and physically inspected: no visible clot is present. The analyzer has no error; it reports neutrophils 78% and an IG flag. The locally triggered 100-cell manual differential supplies segmented neutrophils 78% and bands 2%, so the local ANC is 11.8 × 10^9/L; analyzer IG and the IG flag are not added. The quality smear resolves the flag as rare bands with mature neutrophil morphology, mild toxic granulation/occasional Döhle bodies, heterogeneous lymphocytes, and no blasts or dysplasia. Document the result and follow the validated pathway; release only if all local criteria are met, otherwise repeat/review/escalate.
A prior CBC collected 2026-08-14 (two days before the current 2026-08-16 specimen) had ANC 5.6 × 10^9/L. That dated comparison supports a new or changing result over this interval; it does not identify etiology. Hemoglobin 13.8 g/dL and platelets 286 × 10^9/L are within this case’s local intervals. Record verified evidence, then release or escalate under local communication and referral policy. The defined urgency combinations—not this ANC alone—govern prompt escalation.
The supported conclusion is: increased circulating neutrophils above this local interval, with reactive-supportive morphology. Do not convert that conclusion into infection, drug effect, or exclusion of a myeloid process. Persistence, cytopenias, blasts, dysplasia, extreme counts, or other concerning features change the local routing decision.
Illustrative drawing — this picture was drawn rather than captured.
| Collection date | ANC × 10^9/L | Interpretive use |
|---|---|---|
| 2026-08-14 | 5.6 | Prior CBC; duration evidence |
| 2026-08-16 | 11.8 | Current specimen; above local teaching interval |
Ordering exercise
Place the actions in the one workflow before assigning an interpretation.
1. Release or escalate locally
Document the verified pattern and follow local communication or referral procedure.
2. Resolve on a quality smear
Use the local review rule to characterize morphology and resolve the IG flag: document findings and either release if criteria are met or repeat/review/escalate under the validated pathway.
3. Compare the dated prior CBC
Use prior results as evidence about duration.
4. Inspect specimen and analyzer context
Confirm timing and identity, physically inspect the tube for clot and adequate fill, then review analyzer errors, flags, and scatter information.
5. Calculate local ANC
Calculate local absolute counts from declared sources: segmented cells plus manual bands for this local ANC convention; do not add analyzer IG or an IG flag.
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