Smear review criteria not meet

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

smear review criteria not meet

I read the article "Are the review criteria for automated complete blood counts of was not detected, the blood cell smear should be examined due to additional flags. Each laboratory must define the best criteria to achieve their performance . review meets the accreditation Review? Blood smear review, for the pur- pose of this article, is defined as a feasible, such a set of criteria may not be. Laboratory criteria triggering a morphologic blood smear not met, an ordered peripheral smear examination will not be performed unless.

Peripheral Smear Review | Dahl Chase Pathology Associates / Dahl Chase Diagnostic Services

The difference in the parameters causing false positivity for the ICGHR and our laboratory criteria can be explained by the fact that the threshold cutoffs for all the parameters were not the same for both sets of criteria [Table 5]. Hematology analyzers use suspect flags to notify the user that the automated differential WBC count may not be correct and requires review.

This indicated that the hematology analyzers used were guilty of over flagging, i. The same was the case with the present study where the suspect flags alone were responsible for Our laboratory criteria, however, showed that 7. This point again emphasizes the downside of having strict threshold cutoffs, as with our laboratory criteria, which of course have greater sensitivity but at the cost of a higher MRR. As the sensitivity of the suspect flags is adjusted by technicians of the hematology analyzer's manufacturer, Comar et al.

In the same line of thought, Kim et al. In the present study, however, as only one analyzer was used, the above aspect could not be reviewed.

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

The sensitivity using our laboratory criteria This may be in view of the high MRR The greatest modification made to the ICGHR criteria in the present study was regarding the delta check rules. Due to high software development costs, many clinical laboratories cannot implement the delta check rules in their electronic records or interfacing systems.

Conclusions In the present day and scene where the sophistication of the AHAs is only improving with the launch of every new analyzer, it is essential for clinical laboratories to consider methods for reducing the number of MSRs to improve their productivity and efficiency.

Although our laboratory criteria performed better with regard to sensitivity and negative predictive value, it came at the expense of a very high MRR which in turn may lead to decrease in laboratory productivity and increase in the turnaround time. Therefore, development of optimized criteria based on the ICGHR criteria followed by their validation will improve turnaround time and efficiency in our laboratory.

The results of all samples provided by the hematology analyzers and MBSR were recorded in a spreadsheet. Of the patients, performed a single complete blood count CBC during the sample collection period while underwent more than one CBC patients underwent two, 30 patients underwent three; 40 patients underwent four; 15 patients underwent five and one patient underwent six.

Both internal and external quality control procedures were followed to monitor performance of the hematology analyzers as well as reliability of the results.

The adjustments and settings on the analyzers were performed by the manufacturer's scientific and technical support staff. Manual blood smear review For each sample, a blood smear was prepared and stained using the Sysmex SPi automatic slide maker-stainer Sysmex Corporation, Kobe, Japan. In most cases, leukocytes were counted in each smear by one of six independent observers with extensive experience 10—30 years in MBSR. A count of or cells per sample on a single slide for only one of each observer was considered a suitable reference method to compare the findings.

smear review criteria not meet

Group 1 narrow cut-off limitsGroup 2 intermediary cut-off limitsGroup 3 wide cut-off limits and cut-off limits adapted from the ISLH Group 4. In the first three sets of SC established in this study, the selection of limits for each hematological parameter was performed arbitrarily and empirically. The performance indicators for the sets of SC were: This was based on the study by Novis et al. Nevertheless, the observers had no prior knowledge of the cut-off limits in each set of SC and the new PSF proposed in this study.

Table 1 Positive smear findings in microscopic analysis. The list of criteria for smear review is usually developed by individual laboratories with input from pathologist sclinicians, and the hematology supervisory staff, and may be updated periodically as deemed appropriate.

Although, clinical significance of the abnormal CBC and DIFF findings is the major determining factor in deciding which blood smears need review, several other factors may also influence such a decision. These factors may include patient population served, clinicians' concerns pertaining to specific patient populations, training and experience of blood smear examiners s and reviewer sworkload of the laboratory and the reviewer sinitial vs.

Published criteria [ 19 - 22 ] may be used by individual laboratories as a starting point in the process of developing their own set of criteria. Table 3 Open in a separate window Blood smear review by a qualified hematomorphologist can serve several functions that are considered essential to good patient care. Interpretation of blood smear findings along with CBC and other available laboratory data in the clinical context may provide a definite diagnosis or suggest a strategy for additional work-up of the case in an efficient and cost-effective manner.

Furthermore, blood smear review can serve as an excellent teaching resource for training of students, residents, fellows and newly hired staff, and for continuing education of the technical staff.

smear review criteria not meet

Blood smear review process encompasses every aspect of the blood smear scan and the blood smear examination described above, with one exception. The exception is that the reviewer may or may not choose to perform the actual cell DIFF. The circumstances, which will necessitate a cell DIFF by the reviewer include a if the review is being performed also for the purpose of QC for the DIFF or for assessing competency of the staff in performing manual DIFF and b if, in the judgement of the reviewer, the DIFF results reported by the blood smear examiner are either incomplete, inaccurate, or contain some unidentifiable cells reported as other cells with or without any comments.

A blood smear review by a physician often generates a written report with interpretation of the findings in the clinical context.

Blood smear reviewers often serve as consultants to clinicians and other laboratory professionals in explaining the abnormal findings and their clinical relevance, besides providing either a diagnosis whenever feasible or suggesting an appropriate strategy for an efficient and cost-effective additional work-up necessary for arriving at a diagnosis.

Int J Lab Hematol. Performance evaluation of the latest fully automated hematology analyzers in a large commercial laboratory setting: A 4-way, side-by-side study. Comparison of performance characteristics between first- and third-generation hematology systems.

Cellular morphologic analysis of peripheral blood. Diagnosis from the blood smear. N Engl J Med.

Why and how validate criteria by manual smear review to improve laboratory productivity?

A blood smear campaign. Hematol Oncol Clin North Am. Spurious counts and spurious results on hematology analyzers: Spurious rise in the automated platelet count because of bacteria. Effects of bacteria and yeast on WBC counting in three automated hematology counters.

Spurious automated platelet count enumeration of yeast forms as platelets by the Cell-DYN Am J Clin Pathol. Branda JA, Kratz A. Effects of yeast on automated cell counting. Using a vortex to disaggregate platelet clumping. Blood cell morphology grading guide.