Evaluation of criteria of manual blood smear review following automated complete blood counts in a large university hospital (original) (raw)
Related papers
Archives of Pathology & Laboratory Medicine, 2013
Context.—Each laboratory should have criteria for manual smear review that limit workload without affecting patient care. The International Consensus Group for Hematology Review established guidelines for action after automated blood cell analysis in 2005. Objective.—To compare the consensus group criteria with our laboratory criteria and optimize them for better efficiency. Design.—A total of 2114 first-time samples were collected consecutively from daily workload and were used to compare 2 criteria as well as establish the optimized criteria. Another set of 891 samples was used to validate the optimized criteria. All samples were run on either Sysmex XE-5000 or Coulter LH750 hematology analyzers and were investigated by manual smear review. The efficiency of each set of criteria was compared and optimized to obtain better efficiency, an acceptable review rate, and a low false-negative rate. Results.—From 2114 samples, 368 (17.40%) had positive smear results. Compared with that of ...
2019
Background: Microscopic assessment of a peripheral blood smear is an essential diagnostic tool in hematology laboratory. It can complement the numerical values on the automated Full Blood Count (FBC) to provide a definite diagnosis or to guide further investigation of a patient. The results of a significant proportion of specimens are flagged by the analyzers, and require confirmation by smear review. Thus, there is a need to validate the rules for smear review proposed by International Consensus Group for Hematology Review (ICGHR). Objective: To validate criteria for manual smear review following automated complete blood counts (CBC) using the rules proposed by the International Consensus Group for Hematology Review in St.Paul"s Hospital Millennium Medical College. Methods: A prospective cross-sectional study was conducted in St.Paul"s Hospital Millennium Medical College from September to November 2019. A total of 500 blood samples were collected from patients who are ref...
Revista Brasileira de Hematologia e Hemoterapia, 2014
rev bras hematol hemoter. 2 0 1 4;3 6(3):219-225 Revista Brasileira de Hematologia e Hemoterapia Brazilian Journal of Hematology and Hemotherapy w w w . r b h h . o r g a b s t r a c t Objective: to verify whether the review criteria for automated blood counts suggested by Methods: initially, the review criteria of the International Society for Laboratory Hematology were adapted due to limitations in the Institution's electronic hospital records and interfacing systems. The adapted review criteria were tested using 1977 samples. After this first assessment, an additional 180 inpatient samples were analyzed to evaluate the screening criteria of the review criteria in conjunction with positive smear findings established by the institution. The performance of the review criteria was verified by determining false positive, false negative, true positive and true negative rates, sensitivity, specificity, positive predictive value, negative predictive value, microscopic review rate and efficiency.
The rate of manual peripheral blood smear reviews in outpatients
Clinical Chemistry and Laboratory Medicine, 2000
Background: The International Consensus Group for Hematology Review recommends manual blood smears for new findings from automated complete blood cell (CBC) tests. However, in outpatients, the rate of peripheral manual blood smear reviews is uncertain, as is the effect of historical results on this rate. Methods: In a prospective cohort study of 687,955 members of a health maintenance organization, we extracted 39,759 consecutive automated CBC test results and determined the rate of manual peripheral smear reviews that were indicated using different triggering criteria, and historical results. Results: Individual triggering values increased from 10.7% to 19.5% when comparing our criteria to those of the consensus criteria. The proportion of CBC test results with at least one triggering value was 7.2% using our criteria, compared to 13.9% with the inclusion of a mean corpuscular volume-75 and a plus one immature granulocyte flag according to the consensus committee. Availability of historical data decreased our peripheral smear review rate to 2.6%. Conclusions: The peripheral smear review rate in outpatients using the consensus criteria was higher than with our less stringent criteria. If historical data are available and no clinical utility is demonstrated for the additional consensus criteria, an acceptable outpatient review rate might be as low as 2.6%.
International Journal of Laboratory Hematology, 2017
Background: The aims of this study were to compare the diagnostic accuracy of blood smear review criteria, by means of three different panel rules, those proposed by: the International Consensus Group for Hematology [41-ICGH rules], the Italian Survey [IS rules] and the Working Group on Hematology-SIBioC (WGH) consensus rules (WGH rules). Methods: This study is based on 2707 peripheral blood (PB) samples referred for routine hematological testing to the WGH-associated laboratories displaced all over the Italian territory. The PB samples were processed on seven different hematology ana
International Journal of Current Research and Review, 2020
Objectives: Automated hematology analyzer generates flags for white blood cells abnormalities, indicating associated manual peripheral blood film examination. This study was aimed at evaluation and correlation of abnormal cell flagging with manual blood film reviews to improve performance in a hematology laboratory. In this study, an automated slide maker SC-120 was used to study the performance of fully automated haematology analyzer Mindray BC-6800. Methods: Total 500 routine samples were obtained over a period of seven consecutive days, and run through analyzer which displayed flags for white blood cells. Thereby, results from flags were evaluated and correlated with smear findings through careful statistical analysis of the observed parameters. Results: Flags for white blood cells and Nucleated Red Blood Cells (NRBC) were generated by BC-6800 for 211 samples out of total 500 run samples, from which 46.45% patients were diagnosed with haematological disorder and 53.55% with solid neoplasms. Sensitivity, specificity and Youden's Index observed against total 500 samples were 100%, 99.31% and 0.99 respectively. Efficiencies for blasts, abnormal lymphocytes and atypical lymphocytes were 95.64%, 95.20% and 97.60% respectively, whereas sensitivity for blasts was 75.81%. Further, sensitivity and specificity of NRBC were 86.76% and 100% respectively. Youden's index observed for various flags was close to 1, indicating near to satisfactory performance of analyzer. Conclusion: The present study confirms that performance of an automated analyzer aligns with standard manual methodology. However, to avoid false-negative results by analyzer, peripheral smears should be examined manually.
Reducing unnecessary blood smear examinations: can Sysmex blood cell analysers help?
Medical Technology Sa, 2014
Background The microscopic assessment of a peripheral blood smear is an essential diagnostic tool. Many haematology laboratories currently assess smears microscopically for every full blood count request, many of which may however be assessed unnecessarily-an important consideration in resource-constrained settings. Modern blood cell analysers are increasing in sophistication and can flag abnormal specimens that may require microscopy. Objectives To evaluate the flagging efficiency of the Sysmex haematology analysers and to determine whether this potentially labour-saving technology could assist in safely reducing the number of unnecessary microscopic blood smear assessments. Methods A total of 427 full blood count specimens collected consecutively over a 24-hour period at NHLS Pelonomi and NHLS Kimberley, were evaluated microscopically and compared with the instruments' abilities to flag potential morphological abnormalities. Results The Sysmex blood cell analysers flagged 63.7% of specimens as "positive" and 36.3% as "negative". After microscopy, false positive flags were found to constitute 18.5% and false negative flags 5.4% of the total number of smears reviewed, giving a total of 23.9% incorrect assessments. No false negative flag was clinically critical. Conclusion False negative results occurring with the Sysmex instruments' flagging systems in our settings are relevant, although not critical. The potential time and monetary savings of a flagging-based smear review policy may weigh heavier than occasional false negatives. In the African milieu, where laboratories are faced with the challenges posed by staff-and other shortages, relying on instrumentation flagging to guide smear review policy should be considered.
INTRODUCTION Peripheral blood smear (PBS) examination is a part of the routine work of every laboratory. The manual examination of these images is tedious, time consuming and suffers from interobserver variation. This has motivated researchers to develop different algorithms and methods to automate PBS image analysis. The automated hematology analyzers give more accurate and <1% coefficient of variation for the RBC indices and hence have replaced the manual methods. Thus we can definitely conclude that the hematology analyzers definitely have a potential to replace peripheral blood smear examination. 1 The expertise needed to see the PBS is definitely far more than that needed to run the analyzers. Moreover there is intra and inter observer variation in morphological typing of anemia based on PBS examination. The additional PBS review performed by hematologist hardly ever provided unique information and provided incremental helpful information in only 4% of the cases. 2 Cell counting with these instruments is rapid, objective, statistically significant (8000 or more cells are counted) and not subject to the distributional bias of the manual count. Hence automated instruments increase accuracy, speed of analysis, minimizes levels of human manipulation for test entry, sampling, sample dilution and ABSTRACT Background: The aims and objectives of present study was to correlate typing of anemia based on RBC indices obtained from an automated analyzer with peripheral blood smear (PBS) examination and also to find out whether the number of PBS examination can be reduced with the help of automated hematology analyzer. Methods: A total of 2500 blood samples showing anemia as per WHO reference range were collected in central pathology lab of SVBP Hospital attached to L.L.R.M. Medical College, Meerut, Uttar Pradesh, India over a period of one year. Samples were reported by auto-analyzer and PBS examination simultaneously. Results: Out of total 2500 cases, there were 1623 females (64.9%) and 877 males (35.1%) with male: female ratio 0.54:1. By auto-analyzer and PBS examination, MCHC anemia (49.8%) was the commonest anemia followed by NCNC anemia (36.5%) and Macrocytic anemia (4.2%). Discordant typing of anemia between two methods was found in 284 (11.4%) cases only. These cases were diagnosed as normocytic normochromic (NCNC) anemia with raised RDW by autoanalyzer while as Dimorphic Anemia (DA) on PBS examination. Also morphological changes such as RBC inclusions, spherocytes, RBC fragments, schistocytes, nucleated RBCs were seen only on PBS examination. Conclusions: The Study concluded that even today PBS examination is very important and cannot be totally replaced by automated analyzer and both methods are complementary to each other.
Journal of Evolution of Medical and Dental Sciences, 2020
BACKGROUND nRBCs also referred to as normoblasts are seen in the peripheral blood films in variable numbers; both in physiological as well as pathologic states. Enumeration of these cells by modern day automated analysers remains a challenge. We wanted to assess the precision of the Beckman Coulter LH 755 & 780 haematology analysers TM in enumerating the nRBC count. METHODS This is a retrospective study conducted in the Clinical Laboratory and Haematology Division of Kasturba Hospital, Manipal over a 3-month period on the Beckman Coulter LH 755 & 780 haematology analysers TM (Beckman Coulter Inc., Miami, FL, USA) after obtaining requisite clearance from the Institutional Ethics Committee. A data of 47,332 random blood samples run on the analysers was collected. Both descriptive and analytical statistics were performed using the SPSS software version 22.0 TM (Chicago, IL, USA). The sensitivity, specificity and kappa agreement were calculated using the same. RESULTS A total of 797 cases from the 47,332 samples showed a "flag" for nRBCs. Two Twenty of these cases were confirmed microscopically to have had nRBCs in the peripheral smear (true positives). 137 cases had nRBCs in the smear but were not definitively evaluated by the instrument (false negatives). A vast majority of the cases (577) did not reveal any nRBC on microscopic examination despite a flag generated by the machine (false positives). Additionally, a sensitivity of 27.6% and specificity of 99.7% were also noted. The kappa agreement was 0.376 which showed a fair agreement between the two methods. CONCLUSIONS The automated haematology analysers Beckman Coulter LH 755 & 780 were found to be less sensitive in adequately enumerating the nucleated red blood cells. The number of false positives can be reduced by noting the 'cellular interference' flag. A manual review of such smears is necessary to confirm or refute such instrument messages.