Guarner Jeannette, Atuan Maria Ana, Nix Barbara, Mishak Christopher, Vejjajiva Connie, Curtis Cheri, Park Sunita, Mullins Richard
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA.
Clin Lab. 2010;56(1-2):21-7.
Each institution sets specific parameters obtained by automated hematology analyzers to trigger manual counts. We designed a process to decrease the number of manual differential cell counts without impacting patient care.
We selected new criteria that prompt manual counts and studied the impact these changes had in 2 days of work and in samples of patients with newly diagnosed leukemia, sickle cell disease, and presence of left shift.
By using fewer parameters and expanding our ranges we decreased the number of manual counts by 20%. The parameters that prompted manual counts most frequently were the presence of blast flags and nucleated red blood cells, 2 parameters that were not changed. The parameters that accounted for a decrease in the number of manual counts were the white blood cell count and large unstained cells. Eight of 32 patients with newly diagnosed leukemia did not show blast flags; however, other parameters triggered manual counts. In 47 patients with sickle cell disease, nucleated red cells and red cell variability prompted manual review. Bands were observed in 18% of the specimens and 4% would not have been counted manually with the new criteria, for the latter the mean band count was 2.6%.
The process we followed to evaluate hematological parameters that reflex to manual differential cell counts increased efficiency without compromising patient care in our hospital system.
每个机构都设定了通过自动血液分析仪获得的特定参数来触发手工计数。我们设计了一个流程，以减少手工细胞分类计数的数量，同时不影响患者护理。
我们选择了提示手工计数的新标准，并研究了这些变化在两天的工作以及新诊断的白血病、镰状细胞病和核左移患者样本中的影响。
通过使用更少的参数并扩大范围，我们将手工计数的数量减少了20%。最常提示手工计数的参数是原始细胞标记和有核红细胞的存在，这两个参数未改变。导致手工计数数量减少的参数是白细胞计数和大型未染色细胞。32例新诊断白血病患者中有8例未显示原始细胞标记；然而，其他参数触发了手工计数。在47例镰状细胞病患者中，有核红细胞和红细胞变异性促使进行手工复查。18%的标本中观察到杆状核细胞，按照新标准，4%的标本不会进行手工计数，后者的平均杆状核细胞计数为2.6%。
我们所采用的评估与手工细胞分类计数相关的血液学参数的流程提高了效率，同时在我们的医院系统中不影响患者护理。
