Talk:White blood cell differential

fantastic article

Fantastic article. As a hcp the first thing i looked for was a summary table showing the different causes for various shifts during leukocytosis. Any chance that could be added? Happy to help with a graphic. Ian Furst (talk) 22:34, 4 August 2019 (UTC)

Thanks for your comments here and at WikiProject Medicine, I'm flattered. :) Could you clarify what you mean by 'various shifts during leukocytosis' - do you mean i.e. leukocytosis due to neutrophilia vs. lymphocytosis vs. eosinophilia etc.? Thanks, SpicyMilkBoy (talk) 22:38, 4 August 2019 (UTC)

All well deserved. No, I mean the differential diagnosis. What is seen in acute infection, chronic infection, parasitic infection, TB, pregnancy, etc... Ian Furst (talk) 12:45, 5 August 2019 (UTC)

I see. :) I think that's a great idea, but I'm not sure how to integrate it into the article. Thoughts? SpicyMilkBoy (talk) 13:44, 5 August 2019 (UTC)

Consider reworking the headings to match the medical manual of style. Within that is Interpretation of results. Ian Furst (talk) 14:42, 5 August 2019 (UTC)

Thanks - I'd looked at the MOS, but I had a lot of trouble sticking to it since the article covers two testing methods with totally different history, procedures, and mechanisms. You're a lot more experienced with this stuff than I am, so would you be able to give any advice on rearranging the article to fit the MOS? SpicyMilkBoy (talk) 17:13, 5 August 2019 (UTC)

Happy to offer suggestions but you've already made the article look great, so please take anything I say with a grain of salt. there is no way I could have made the article better. Will look tonight. Ian Furst (talk) 17:23, 5 August 2019 (UTC)

Ian Furst I created a table and placed it in White blood cell differential#Interpretation - let me know what you think. SpicyMilkBoy (talk) 12:47, 11 August 2019 (UTC)

Btw, do I need to cite the information in the table if it's just summarizing what's already in the article? SpicyMilkBoy (talk) 18:36, 11 August 2019 (UTC)

Sorry for the slow response. Was at Wikimania, but also travelling before hand. Normally for a table like that I'd put one or two references in the header row, just so someone knows where to go for more info. Ideally, open source and online. Btw, exactly what I would be looking for. thank you very much. Ian Furst (talk) 19:14, 19 August 2019 (UTC)

Russian interwiki

Please add an interwiki link to the Russian page ru:Лейкоцитарная формула. --CopperKettle 10:51, 19 September 2019 (UTC)

Done. I added a link to Ukranian wiki as well. Thanks. SpicyMilkBoy (talk) 11:01, 19 September 2019 (UTC)

GA Review

This review is transcluded from Talk:White blood cell differential/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: SilkTork (talk · contribs) 10:32, 15 November 2019 (UTC)

I'll start reading over the next few days and then begin to make comments. I am normally a slow reviewer - if that is likely to be a problem, please let me know as soon as possible. I tend to directly do copy-editing and minor improvements as I'm reading the article rather than list them here; if there is a lot of copy-editing to be done I may suggest getting a copy-editor (on the basis that a fresh set of eyes is helpful). Anything more significant than minor improvements I will raise here. I see the reviewer's role as collaborative and collegiate, so I welcome discussion regarding interpretation of the criteria. SilkTork (talk)

Thank you so much for reviewing my article. Please feel free to take your time. I'm open to requesting a copyedit if necessary. :) SpicyMilkBoy (talk) 10:45, 15 November 2019 (UTC)

Tick box

GA review – see WP:WIAGA for criteria

1. Is it reasonably well written?

   A. Prose is clear and concise, without copyvios, or spelling and grammar errors:

   B. MoS compliance for lead, layout, words to watch, fiction, and lists:

2. Is it factually accurate and verifiable?

   A. Has an appropriate reference section:

   B. Citation to reliable sources where necessary:

   C. No original research:

3. Is it broad in its coverage?

   A. Major aspects:

   B. Focused:

4. Is it neutral?

   Fair representation without bias:

5. Is it stable?

   No edit wars, etc:

6. Does it contain images to illustrate the topic?

   A. Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:

   B. Images are provided if possible and are relevant to the topic, and have suitable captions:

Comments on GA criteria

Pass

• Has an appropriate reference section. SilkTork (talk) 14:09, 15 November 2019 (UTC)
• Article is stable - it was created by and almost exclusively edited by one editor, the GA nominator SpicyMilkBoy. SilkTork (talk) 14:12, 15 November 2019 (UTC)
• Images are all free to use and appropriately tagged (I had to pause at File:Mononucléose infectieuse-7.JPG as that was the first time I've come upon an Apache licensed image, and I had to read up on it!) SilkTork (talk) 18:24, 15 November 2019 (UTC)
• Article is well sourced to appropriate texts. SilkTork (talk) 08:37, 16 November 2019 (UTC)
• "Neutral", "Copyvio" and "Original research". All statements that I checked are supported by the source with no evidence of bias or original research. And statements are in own words with no evidence of plagiarism. SilkTork (talk) 08:37, 16 November 2019 (UTC)
• "Focus". Article is balanced and informative without going into excessive detail. SilkTork (talk) 08:39, 16 November 2019 (UTC)
• Images are relevant and informative. Two captions are a little long, but not excessively so, and the caption content is helpful. SilkTork (talk) 08:42, 16 November 2019 (UTC)
• "Major aspects". Slightly dubious sub-section has been removed. From a quick dip into the subject the major aspects have been covered. I did consider that there is no mention of taking the blood samples, but the subject is about testing the blood sample not drawing the sample. There is no in depth discussion of interpretation of results with the health implications, but the factual essentials are present in the White blood cell types section, which seems appropriate for GA level, though might need expanding for FA. My pause now is that after encouraging the name change, I am wondering if the current title is really describing what that section is about, as it describes both the blood cells and the interpretation of the findings. SilkTork (talk) 08:58, 16 November 2019 (UTC)

I'm OK with the title, as we do have a separate Clinical significance section. SilkTork (talk) 09:09, 16 November 2019 (UTC)

I've changed the title to "White blood cell types and test interpretation". I can definitely add some information on blood collection and sample requirements; I initially left that out because as you said, it's not directly relevant and I thought it might be a bit how-to-ish, but it would be nice to have. I am curious why you say that There is no in depth discussion of interpretation of results with the health implications. I felt that I went into a lot of detail about that in the "Clinical significance" section. One issue with this subject is that there are very few definitive health implications from WBC differential results. In most cases an abnormality can suggest a certain condition, but it is not diagnostic of it. For example, a high neutrophil count is suggestive of a bacterial infection but can also be caused by many other things, so it's necessary to interpret the differential results in light of the patient's symptoms and other test results. A full discussion of these factors seems to me like it would be beyond the scope of the article, even for FA. In your opinion, what would that part of the article look like if this was a FA? SpicyMilkBoy (talk) 09:19, 16 November 2019 (UTC)

"I am curious why you say that There is no in depth discussion of interpretation of results with the health implications." Yes, sorry, I wrote that before noticing the "Clinical significance" section, and when I did I meant to mention that I was satisfied with that when I came back to leave my second comment, but I think I got distracted and left an abbreviated comment instead. SilkTork (talk) 21:18, 17 November 2019 (UTC)

Ah, no problem. I'm still a little unsure about the format of the white blood cell types/clinical significance section: it seems illogical to have the summary of the clinical significance section (the increase/decrease columns of the table) before the full explanation. I considered removing those table sections entirely, but I added those because of a recommendation on the talk page from a healthcare provider who found it useful (although, I'm not sure people should really be using Wikipedia for medical advice...) This is probably not relevant for the GA review but I just thought I'd bring it up in case you have any ideas. SpicyMilkBoy (talk) 23:03, 17 November 2019 (UTC)

• Prose is clear and readable. SilkTork (talk) 15:54, 18 November 2019 (UTC)

Query

• Major aspects: "Reference ranges". This subsection has very little detail, and the reader is simply referred to a diagram. I am unsure if a reading machine would be able to assist a blind reader in making sense of the diagram, and generally we prefer illustrations to support the text rather than replace it. It is possible to explain the reference ranges in a little more detail? SilkTork (talk) 15:11, 15 November 2019 (UTC)

Thank you for bringing up the accessibility aspect; I'm embarrassed to say I didn't think about that at all. I can definitely add a table with a basic list of reference ranges. I intended for the reference range section to not contain much prose because the "Interpretation"/"White blood cell types" section already describes the meaning of increases and decreases in each white blood cell type, but maybe it would be better to have that information in the same section. Curious to hear your thoughts on this.

Thanks again for your very thorough feedback, SilkTork. SpicyMilkBoy (talk) 16:14, 15 November 2019 (UTC)

• I've started looking at the images, but I've been held up by the lead image (File:US Navy 030905-N-5956C-001 Medical Laboratory Technician Erin Rotter, takes manual differentials of blood samples.jpg) for a long time now. Can you give me a rationale for its use as the lead image in line with MOS:LEADIMAGE. I'm not seeing it as a defining image, though I understand why you've put it there, and it's not going to be a deal breaker if you can't provide an appropriate rationale yet insist on keeping it. But when I put "White blood cell differential" into Google images, I don't get images of scientists looking into microscopes, I get images like this: [1] and this [2]. Though perhaps those images are more suited to the White blood cell article. I really think I should move on and look at the other images, but before I do I thought I'd raise it with you. SilkTork (talk) 18:14, 15 November 2019 (UTC)

I thought a picture of a human might be nice for the lead of a rather technical article - I understand your concerns though and I actually had the same concerns myself. I will replace it with something more appropriate when I have time (editing at work right now) - probably a blood smear photo with a range of white blood cells. SpicyMilkBoy (talk) 18:34, 15 November 2019 (UTC)

Replaced the lead image. SpicyMilkBoy (talk) 18:58, 15 November 2019 (UTC)

• I've been unsure of the layout of what is now termed the White blood cell types section since first reading the article, and I think it's because it's actually a definition list section, and so should be laid out as per MOS:DLIST, though a table is also a possibility. Indeed, I'm wondering if we actually need that section to be in two parts, and if the definition list could be combined with the existing table to perhaps create a larger table, including the images. SilkTork (talk) 18:46, 15 November 2019 (UTC)

Thanks, I had no idea what the MOS guidelines were for that so I just winged it. I will play around with DLIST and tables in my sandbox and try to figure out something that works. At this point I'm thinking of a table with columns for image/cell name/basic description/reference range, with the more detailed medical information in a separate "interpretation" or "clinical significance" section. There might be a better way to do it though. Would appreciate your thoughts on this. SpicyMilkBoy (talk) 20:55, 15 November 2019 (UTC)

I've set up a few examples in User:SpicyMilkBoy/sandbox. Example 1 is the table I described above. Example 2 is a DLIST without reference ranges. Example 3 is the existing summary table plus reference ranges. SpicyMilkBoy (talk) 22:21, 15 November 2019 (UTC)

How about combining the info as in Example 4? SilkTork (talk) 03:45, 16 November 2019 (UTC)

I've done this and put the rest of the information in a DLIST. Also added some more information to the "Medical uses" section to help readers understand the following content. I'm still slightly unsure of this formatting style. It seems like it might be confusing to readers to have the summary of the clinical significance before the prose explanation. However, if you think it's good then I'm good with keeping it. I'm writing for other people, after all, not myself. :) SpicyMilkBoy (talk) 08:49, 16 November 2019 (UTC)

I'm not entirely convinced myself that the order is perfect, and we could spend some time discussing it, and others could come along and suggest a different order. My feeling at the moment is that the History section seems more logical and helpful as the first main body section. And, yes, the Blood cell types and Clinical significance sections feel more appropriate toward the end. Though an introductory Medical uses still feels more useful before the differential variations. I am not certain on this, and it won't impact the GA either way, but I'm thinking of a layout something like:

• History
• Medical uses
• Differential
  • Manual
  • Automated
• White blood cell types (though perhaps better as a sub of Medical uses)
• Clinical significance

Though I am not advocating it - just putting it down as a thought. SilkTork (talk) 09:10, 16 November 2019 (UTC)

I've never been happy with the layout of this article either. I arranged it the way I did because I assumed that people searching for "White blood cell differential" probably want to know what the test is and what the results mean more than when it was invented and by whom. Also, the MEDMOS guidelines always put history sections last. But I agree that it seems a little illogical and disjointed. I will play with the order some more today. SpicyMilkBoy (talk) 09:23, 16 November 2019 (UTC)

Here's one option. Thoughts? SpicyMilkBoy (talk) 10:14, 16 November 2019 (UTC)

Yes, I like that. What do you think of having the auto and manual differentials under one header, say Differential methods, and then the Auto and Manual sub-sections? SilkTork (talk) 13:20, 16 November 2019 (UTC)

At this stage (the review is almost complete) you need to be thinking of getting some of that history into the lead, per WP:Lead. As a general rule there should be nothing said in the lead which is not explained more fully in the main body, and nothing significant in the main body which is not summarised in the lead. Think of the Lead as a short introductory stand alone article, and the main body as a larger more detailed article. Essentially, you are writing two articles. I've given an example here: [3]. SilkTork (talk) 13:20, 16 November 2019 (UTC)

I'll work on this today. Thanks a lot for the example. I've added a header for the differential sections as well. SpicyMilkBoy (talk) 13:23, 16 November 2019 (UTC)

Sorry, I've been busy today but I'll get to this tomorrow. SpicyMilkBoy (talk) 20:21, 16 November 2019 (UTC)

Done. Still not sure how to cover the "clinical significance" section in the lead. I will think about it more today. SpicyMilkBoy (talk) 10:53, 17 November 2019 (UTC)

Fail

General comments

I am not a medical expert so I will be coming at this from the perspective of a common reader (though I have some experience of reviewing medical articles, such as Vagina and Clitoris); as such I will likely be asking some questions. The first one is: What does "Interpretation" mean in the context of this article? It is used as a section header and is not self-explanatory. The section contains details on the "five normal white blood cell types" mentioned in the lead, plus four other cells. From a layman's point of view it would make more sense to call this section "Blood cell types" as that appears to be what it is about. SilkTork (talk) 14:22, 15 November 2019 (UTC)

Interpretation refers to what the test results mean. I added that heading per WP:MEDMOS#Medical tests, but since I've already taken some liberties with WP:MEDMOS in this article I'm not that concerned about sticking to it. I agree that "White blood cell types" would be more understandable to a layperson, so I've changed it. SpicyMilkBoy (talk) 16:07, 15 November 2019 (UTC)

• Why is "laboratory test" used when the link goes to blood test? SilkTork (talk) 14:25, 15 November 2019 (UTC)

That sentence originally said "blood test", but I changed it to avoid repetition... A white blood cell differential is a blood test that provides information about the types and amounts of white blood cells in a person's blood. doesn't sound very good. (Note, it's necessary to say "in a person's blood" because there are tests for white blood cells in, for example, bone marrow and body fluids as well). I've changed it to [[medical laboratory]] test instead. SpicyMilkBoy (talk) 16:07, 15 November 2019 (UTC)

• Is there a difference between ""medical laboratory scientist" and "medical laboratory technologist". I note that there was a recent discussion to merge these two terms, which you completed. If there isn't a difference, purely for consistency on Wikipedia, and to avoid reader confusion, would it be acceptable to use the same name as the Wikipedia article? This is not a GA requirement so you can go with whatever you like. Just a general comment. SilkTork (talk) 14:36, 15 November 2019 (UTC)

No, they're the same thing - the terminology for this job is a mess. "Technologist" is just my personal preference. I've changed it to "scientist" for consistency. SpicyMilkBoy (talk) 16:07, 15 November 2019 (UTC)

• Not sure here, but as regards "electrical current" - isn't it an electric current that goes along an electrical network (or circuit)? SilkTork (talk) 14:45, 15 November 2019 (UTC)

Changed. SpicyMilkBoy (talk) 16:07, 15 November 2019 (UTC)

• Re: "ink droplets are deflected based on electrostatic charge" is it "Electric charge" or "Electrostatic discharge"? The link goes to Electric charge. SilkTork (talk) 14:55, 15 November 2019 (UTC)

Electrostatic charge was the term used in the sources. I will do some reading later and double check where it should link to. SpicyMilkBoy (talk) 16:07, 15 November 2019 (UTC)

Electrostatic discharge seems to refer to the release of electrostatic charge, not the charge itself. I've changed the target to Static electricity, which discusses electrostatic charge in more detail than the Electric charge article. SpicyMilkBoy (talk) 11:51, 17 November 2019 (UTC)

Wait, we actually have an article on the specific technique that was used - electrostatic deflection. I'll link to that instead. SpicyMilkBoy (talk) 11:58, 17 November 2019 (UTC)

• I see that by WP:MEDMOS#Medical tests the Types or variations of tests come first, then the Medical uses, and that is what you have done. Though when reading the article as a layperson, it seems to me both more logical and more helpful to follow your own intuition as you have it in the Lead, and to put the medical use first. What are your thoughts? As you have followed the layout advice it's not a GA issue as the MoS Layout guideline is to "order sections based on the precedent of similar articles", but it seems to make more sense to me to explain the purpose before explaining the variant methods of doing the test. I also wonder why you explain the automated procedure prior to the manual, given that the manual predates the automated. I also wondered if some of the history could be extracted from the two differential method sections to create an introductory history section that could even be combined with the Medical uses section to help explain it to the reader, and for some of this history to find its way into the lead as currently there is a lot of interesting and useful history in the main body which is not present in the lead, such as "The first microscopic observations of blood cells were published by Antonie van Leeuwenhoek in 1675. Using a microscope of his own design, van Leeuwenhoek discovered that blood consisted of 'small red globules, driven through a crystalline humidity of water'", and "The first automated hematology analyzer, the Coulter counter, was invented in the early 1950s by Wallace H. Coulter and Joseph A. Coulter." SilkTork (talk) 19:18, 15 November 2019 (UTC)

About the layout, I originally had the medical usage section first for the reasons you stated, but I found that the length of the white blood cell section made the article look lopsided. That should no longer be a problem, though, if that section is rearranged like you suggested. An introductory history section is a good idea and I'm considering scrapping the separate history sections entirely and just combining them into one.

Automated before manual - I did this because in the lab, the automated differential would be run first and the manual differential performed if indicated by the analyzer results. But you're right that that wouldn't make sense to a layperson, and if I'm going to combine the history sections and put it in chronological order it would make sense for the tests to be in chronological order as well. SpicyMilkBoy (talk) 20:55, 15 November 2019 (UTC)

I've rearranged the article; I'll work on improving the medical uses and lead section now. I should let you know that I've had a really hard time trying to work out how to include the information about the different types of white blood cells & their clinical significance in the lead. I ended up just leaving it out and justifying it to myself by saying it was too much detail for the lead, but realistically, given that it makes up a large part of the article, it should be included in the lead somehow. I would really appreciate your guidance on this. SpicyMilkBoy (talk) 21:10, 15 November 2019 (UTC)

Just seen this. I'll give it some thought, and post an example. SilkTork (talk) 13:28, 16 November 2019 (UTC)

I've given it some thought and see your difficulty, both in terms of condensing that information for the lead, and in the presentation of it in the body. When first going through the article there were no alarm bells in my head regarding that information not being in the lead, and looking at it more closely now I think that's because the information is already summarised in the first paragraph of the lead: "The test, which is usually ordered as part of a complete blood count (CBC), measures the amounts of the five normal white blood cell types – neutrophils, lymphocytes, monocytes, eosinophils and basophils – as well as abnormal cell types if they are present. These results are reported as percentages and absolute values. Changes in the amounts of white blood cells can aid in the diagnosis of many health conditions, including viral, bacterial, and parasitic infections and blood disorders such as leukemia." It is, admittedly, a very brief summary, but my feeling is that it is adequate given the nature of the material. My instinct and experience is telling me that the article has now met the GA criteria and should be listed as a Good Article. However, I agree with you that there are aspects of the "White blood cell types and result interpretation" section which are still troubling, and that perhaps the table and the sub-section, "Clinical significance", could be merged. I shall hold off listing while we discuss that matter, and my feeling that the section is essentially summarised in the first paragraph of the lead. SilkTork (talk) 16:24, 18 November 2019 (UTC)

Thank you for your thoughts on the lead. I agree with you about the summary being adequate. I was just unsure because of your earlier comments that the lead should summarize every major section of the article. SpicyMilkBoy (talk) 17:33, 18 November 2019 (UTC)

"Adult reference range" - there are two columns in the table which list these Reference ranges which are sourced to Rodak's Hematology: Clinical Principles and Applications. I've not really paid much attention to these columns. But what purpose do they serve? You indicate that the ranges may vary, and that they are for "example purposes only". What is the reader supposed to gain from these examples? And why is there a second column marked "(x 109/L)"? SilkTork (talk) 16:24, 18 November 2019 (UTC)

I felt it would be very confusing to discuss the significance of cell counts being outside the normal range without actually telling readers what the normal range is. Reference ranges are tricky, because for almost all tests, the ranges are calculated by each individual laboratory based on their own analyzers and population demographics¹, and while they are usually *roughly* the same between different labs, they can fluctuate a bit. (Here are some examples from random labs to demonstrate this. [4] [5] ) I liked the image that's now been removed (for good reasons) because it was based on ranges from multiple sources. There has been some discussion on WikiProject Medicine about this, and I agree with the person who suggested that if we report this info, it should come from textbooks, as the ranges there should be more general. Most hematology textbooks contain a table of example reference ranges for educational/informative purposes. My intentions in putting this information in the article were the same.

I've edited the headings for the % and x10^9/L columns to clarify what they mean. The % column is the reference range for each cell type as a percentage of the total WBC count. The x10^9/L column is the reference range for the absolute values (i.e. percentage x total WBC count). It is necessary to have two separate columns for this because it is possible for the percentage to be normal and the absolute value to be abnormal, or vice versa: e.g. a WBC count of 4.0 x 10^9 with 80% neutrophils would result in a normal absolute neutrophil count, while the same percentage of neutrophils at a WBC count of 11.0 x 10^9 would result in an elevated absolute value. SpicyMilkBoy (talk) 17:33, 18 November 2019 (UTC)

1: Totally irrelevant, but just an interesting note. Hospitals are full of sick people, so where would labs find healthy people to calculate reference ranges from? They usually draw the lab staff. I've donated lots of my blood for science. :)

"Increase" and "Decrease" - these columns deal with the count results, and Increase would be more of the cells than "normal" while Decrease would be fewer? I also assume that the Adult reference range would be the percentage of those cells found in a "normal" sample. Could this be made clearer, and a few words put into the lead - "These results are reported as percentages and absolute values which are compared against sample readings or "reference ranges" which are held by the testing laboratory." Could Increase be termed "Increase (higher count than average/normal)" and Decrease as "Decrease (lower count than average/normal)"? Selecting average or normal or whatever term might be more appropriate.SilkTork (talk) 16:24, 18 November 2019 (UTC)

Yes, that's correct. I have changed the headings and edited the lead as you suggested. SpicyMilkBoy (talk) 17:33, 18 November 2019 (UTC)

• "special staining should be used to confirm the lineage" is an instruction - can the wording be "special staining is generally used to confirm the lineage"? SilkTork (talk) 22:57, 18 November 2019 (UTC)

Done. SpicyMilkBoy (talk) 23:06, 18 November 2019 (UTC)

Pass

• I am listing this as a Good Article. This is an informative, detailed, well sourced and clearly written general article on the subject, and meets GA criteria. The "White blood cell types and result interpretation" section and "Clinical significance" sub-section can be questioned and developed further, but that would be part of normal ongoing development of an article. I don't feel the information there is too excessive, though thought could be given to presenting it all in a different manner. Not that the current method is inadequate or inappropriate, just that there may be a better way, as yet unseen. All in all a very decent article, and SpicyMilkBoy is a very accommodating and pleasant editor to work with - the sort that represents Wikipedia at its best. I wish you well for future Good Articles and possible Featured Articles. SilkTork (talk) 23:56, 18 November 2019 (UTC)

Thank you so much for this comprehensive review. I learned so much from you and I hope to apply what I've learned to other articles in the future. :) SpicyMilkBoy (talk) 23:59, 18 November 2019 (UTC)