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Choosing wisely during the COVID-19 pandemic: optimising outpatient cancer care while conserving resources with a new algorithm to report automated ANC results
  1. Maly Fenelus,
  2. Tamiqua Graham,
  3. Ryan Golden,
  4. Jessica L Bautista,
  5. Rachel J So,
  6. Nora Plante,
  7. Ellinor I B Peerschke
  1. Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York city, New York, USA
  1. Correspondence to Dr Maly Fenelus, Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; fenelusm{at}

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In the face of the COVID-19 pandemic, efficient outpatient management is paramount to minimise wait times and reduce exposure to respiratory illnesses, particularly in patients with cancer receiving chemotherapy. The complete blood cell count (CBC) with white cell count (WCC) differential (CBC-D) is an essential laboratory test used to screen cancer patients prior to chemotherapy. Patients receiving cytotoxic chemotherapy are at risk for developing neutropenia; the absolute neutrophil count (ANC) can be used to determine if a patient is neutropenic.1 Neutropenia is generally defined as an ANC <1.5×109/L–2.0×109/L, with severe neutropenia defined as <0.5 x 109/L.2

WCC differential analysis is performed by automated haematology platforms in the clinical laboratory. These platforms have been found to provide accurate and precise ANC results.3 However, automated results often require manual review if the analysis is associated with instrument flags that indicate the potential for inaccurate results. Review and confirmation of flagged results by laboratory technologists is time consuming and increases test result turnaround time (TAT), thereby prolongs onset of chemotherapy.4–7 Given that chemotherapy administration requires an adequate ANC, we examined the reliability of the automated ANC in the presence of instrument flags in outpatients with solid tumour and haematological malignancies. We aimed to confirm if discrete ordering of a ‘CBC with ANC only’ test could be used to replace the traditional CBC with full WCC differential (CBC-D) and shorten patient …

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  • Handling editor Mary Frances McMullin.

  • Contributors MF and EIBP designed the research, analysed data and wrote the paper. TG, RG, RJS and MF performed research. RJS, NP and JLB analysed data.

  • Funding This study was funded in part by National Cancer Institute (Cancer Center Support, grant P30 CA008748).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.