Comar Samuel Ricardo, Malvezzi Mariester, Pasquini Ricardo
Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
Rev Bras Hematol Hemoter. 2017 Oct-Dec;39(4):306-317. doi: 10.1016/j.bjhh.2017.06.007. Epub 2017 Jul 31.
There is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory.
A total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency.
The microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively.
Group 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.
在不牺牲患者护理质量的前提下，减少需要人工复查血涂片的自动全血细胞计数数量备受关注。本研究旨在评估并建立适用于人工血涂片复查的筛查标准，以提高血液学实验室的工作效能。
共选取1977份来自日常工作量的连续样本，用于评估四套人工血涂片复查的筛查标准，以识别涂片结果呈阳性的样本。本研究任意提出了三套筛查标准：第1组（窄范围）、第2组（中等范围）和第3组（宽范围），另一套（第4组）改编自国际血液学检验学会。所有样本均在Sysmex血液分析仪上进行检测，并通过人工血涂片复查进行研究。对每套筛查标准进行诊断准确性和一致性评估，包括显微镜复查率和效率调查。
第1、2、3和4组的显微镜复查率分别为73.85%、54.52%、46.33%和46.38%；假阴性率分别为0.50%、1.97%、2.73%和3.95%。第3组的效率和阴性预测值分别为73.04%和4.91%。
第3组在安全性（假阴性率：≤3%）和全血细胞计数自动化限度评估效率之间具有最佳关系。本研究强化了建立人工血涂片复查筛查标准的重要性，这考虑到了进行血液学检测的不同背景。每个实验室都应优化人工血涂片复查的筛查标准，以实现效率和安全性的最大化。
