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Biomedical subjects

M B O'Sullivan

Publications and source records attributed to M B O'Sullivan.

10 recordsLinked to original sources

Quality control of multichannel haematology analysers: critique of current methods and the need for performance goals.

Performance goals for internal quality control of multichannel haematology analysers have been developed by consensus in the Subcommittee on Quantitative Cellular Haematology of the National Committee of Clinical Laboratory Standards (NCCLS). Conventional methods of quality control (i.e. use of standards for machine calibration and control samples to detect drift) are not feasible for the automated complete blood-cell count because standards and generally accepted reference methods for cell enumeration are not currently available. In the absence of an ideal system, a host of different quality control strategies are utilized with fresh whole blood, stabilized blood preparations, commercial surrogate materials, and statistical functions of measurements on patient specimens. All have their theoretical strengths and weaknesses which, up to now, have been difficult to quantify and to compare experimentally between methods and between laboratories. Performance goals, or what have been judged by a consensus of experts to be achievable tolerance limits for the various sources of analytical variations, were determined for the following measurements: haemoglobin concentration, erythrocyte count, leukocyte count, platelet count, and mean cell volume. These performance goals can be used to compare the effectiveness of the various quality control strategies now used and to determine which strategy would perform best and be most cost-effective in a particular laboratory situation.

Automation

Changing technologies in the reference laboratory.

Changes in technology will have a profound impact on specialized reference laboratories. In their research and development efforts, reference laboratories will have to pursue the incorporation of the technologies of molecular and cell biology into clinical practice. Computers can be applied to the management of clinical laboratory data bases and to the organization of scientific and clinical knowledge for medical consultation. Because of the distance between the site of acquisition of referred specimens and the laboratory, research on analyte stability is needed. Computer networking will help to solve problems of inadequacy of clinical information, and bar code technology will address the problems of specimen identification. Finally, improved telecommunication will permit reference laboratories of the future to be true medical consultation centers rather than just technical analysis operations.

Clinical Laboratory Information Systems

Investigation of statistical decision rules for sequential hematologic laboratory tests.

A statistical data processing program for identifying patients who are likely to have abnormalities on various hematologic laboratory tests is described. The prediction of abnormal levels of serum vitamin B12, serum folate, transferrin saturation, and reticulocyte counts is based on a statistical analysis of the patient's age, sex, and routine blood cell measurements. The program was developed using data from normal-value studies and data from patients who had these laboratory abnormalities. The sensitivity and specificity of the program were evaluated in a controlled prospective study of about 5,000 ambulatory adult patients. The program's predictions also were compared with the laboratory tests requested by the patients' attending physicians. The program was most sensitive for predicting low serum vitamin B12 (74%) and low transferrin saturation (78%). In the prospective evaluation, the predictive values varied from 11% for predicting low serum folate to 65% for predicting low transferrin saturation.

Adult

The prediction of prothrombin time system performance using secondary standards.

A method for the comparison of prothrombin time systems using single large lots of lyophilized plasma in the College of American Pathologists Surveys is presented. Systematic biases for prothrombin time methods as well as for thromboplastins have been measured, and their use allows a very accurate (within 2.25%) prediction of the prothrombin time for the great number of prothrombin time systems presently being used in the United States.

Blood

Routine erythrocyte measurements in diagnosis of iron-deficiency anemia and thalassemia minor.

A study was made of the routine electronic measurements of erythrocyte size and hemoglobin concentration in blood samples from 122 patients with decreased transferrin saturation and 66 patients with elevated levels of hemoglobin A2 or F. The medical histories of these patients were reviewed to identify 52 cases of uncomplicated iron-deficiency anemia and 39 cases of uncomplicated thalassemia minor. Four decision functions were compared for separating these two disorders. The functions evaluated were: D.F'. = MCV--[5 X Hb]-RBC; ratio MCV/RBC; ratio MCH/RBC, and RBC. The rules performed better in the uncomplicated cases than in the routine laboratory defined cases. Only minor differences in the performances of the various decision functions were observed. None was sufficiently accurate for final diagnosis, but they should have value in screening patients and in determining which additional test should be considered.

Anemia, Hypochromic