The Unexplored Territory of CBC: Increasing the Effective Utilization of CBC Histograms through the Creation and Testing of the Online Module “Visual CBC”

Abstract

Background: Despite being one of the most frequently ordered laboratory tests in clinical practice, the complete blood count (CBC) is underutilized by most physicians, particularly regarding graphical outputs, flag indicators, and many overlooked indices. Most doctors focus solely on basic parameters such as hemoglobin, RBC, WBC, and platelet counts, overlooking valuable diagnostic data embedded in other indices and graphical representations. Furthermore, many laboratories omit CBC graphs in routine reports, contributing to a limited understanding and usage of these features. Objective: This study developed and tested Visual CBC, an online educational module aimed at improving physicians’ proficiency in interpreting the complete spectrum of CBC data including graphical representations and underutilized indices—to enhance diagnostic accuracy and clinical decision-making Methods: A multi-centric, experimental study was conducted in teaching hospitals across Algeria. Initially, a needs assessment survey was distributed to 488 primary care physicians and interns to assess current practices in CBC interpretation. Subsequently, 63 participants completed a pre-test, underwent the Visual CBC module, and took a post-test to evaluate knowledge gains. Results: The needs assessment revealed that approximately 30% of respondents do not receive CBC graphs in their laboratory reports. Among those who do, nearly 60% reported never interpreting them, while only 3.2% consistently use these graphical elements in daily clinical practice. After completing the Visual CBC module, participants demonstrated significant improvement (P .0001 Overall z score = −6.90) in interpreting RBC and platelet graphs, as well as often-overlooked indices such as Mean Platelet Volume (MPV) and Red Cell Distribution Width – Standard Deviation (RDW-SD). Conclusion: There exists a global educational gap in the comprehensive interpretation of CBC results among physicians leading to misdiagnosing some cases and ordering unnecessary tests. The Visual CBC module effectively addresses this gap, highlighting the need for integrating graphical data into routine CBC reports and strengthening CBC interpretation training in medical education so it can cover the commonly neglected parts.