[Information from the clinical chemical laboratory. Hematologic laboratory].
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Clinical Laboratory Techniques↗
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[Effect of body position on laboratory hematological indices].
The influence which the position of the body (recumbent, sitting or erect) exerts on the hematologic laboratory indices was studied in 32 clinically healthy persons from both sexes, 19 to 48 years of age. Blood was taken by venepuncture in each of three positions. The analyses were carried out by a hematologic analyzer "H 1 Technicon". The differences of the results were processed by the pair analysis. The values of hemoglobin, hematocrit, erythrocytes, leucocytes and platelets increase with the change of the body position from recumbent to sitting and to erect and the differences are statistically significant. The changes are due to a reversible hemoconcentration and redistribution of the blood. The analysis of the differential count revealed that the greatest increase is of the neutrophils which is probably due to the mobilization of the pool of neutrophils which are nearest to the vascular wall, the process being parallel to the process of hemoconcentration.
Adult↗
[Reference values for hematologic laboratory tests and hematologic disorders in the aged].
The establishment of reference values in the complete blood count and lymphocyte subsets for the aged is necessary for diagnosis and therapy since the number of the aged is increasing rapidly in recent years. However, it is problematical to define the healthy aged because of physiological changes with aging, compared with the healthy adults. Red blood cell count, hemoglobin concentration(Hb) and hematocrit for the healthy aged showed the tendency of moderate decreasing with aging. These phenomena become more obvious by dividing the healthy aged into three groups, 65-74 years, 75-84 years and over 85 years. The mean corpuscular volume(MCV) for the healthy aged showed the tendency of increasing with aging, while mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration for the healthy aged showed no tendency with aging. No changes for the healthy aged were observed in the leukocyte differential, white blood cell count and platelet count with aging. Results of lymphocyte subsets(CD3, CD4, CD8, CD19 and CD4/CD8 ratio) for the healthy aged are not coincident among reporters at present because the healthy aged population is different and the determination of lymphocyte subsets is not standardized. It is important to diagnose as anemia below Hb 11.0 g/dL between 65 and 74 years, Hb 10.0 g/dL over 75 years using Hb level with high accuracy. Most of hematologic disorders in the aged are the secondary anemia based on malignant tumor. In the aged between MCV 95 and 120 fL or over MCV 120 fL, myelodysplastic syndrome or vitamin B12 deficiency is considered, respectively. In the future, more vertical study in the aged population is needed to establish the reference values for the aged.
Adult↗
Hematology laboratory standardization: a plan for harmonization in Asia.
Hematology laboratory is generally required in the hospital. At the macroscale, hematology laboratories have served a large number of population. In Asia, more than 3,000 million people are potentially to use the hematology laboratory service, particularly the complete blood count. Since 1970s, automated technology has been introduced to Asia and as years passed by, technology diversity is increasing. However, there are considerable number of hematology laboratories that have no automated machine. They are still relied on manual technology which is still variable in spectrophotometer for hemoglobin determination, centrifuge for hematocrit and diluting pipet for cell counting. In particular, blood smear preparation and interpretation are very difficult to control for standardization from person to person and laboratory to laboratory. Different methodology and a large population in the huge geographical area in Asia, the agreement of standard criteria is greatly important. This report has shown strategy and action plan to reach the goal of hematology laboratory standardization in Asia.
Asia↗
Streamline your automated hematology laboratory. Roundtable discussion.
How three hematology laboratories improved efficiency by automating the preanalytical process, reorganizing lab workspace, using data management systems to identify which samples need further verification, and setting strict criteria limiting the need for nonautomated processes.
Academic Medical Centers↗
A comparison of the effectiveness of malignancy detection in body fluid examination by the cytopathology and hematology laboratories.
BACKGROUND: Body fluid specimens in many institutions are submitted for cytologic examination as well as for examination in a clinical microscopy or hematology laboratory. The cytology laboratory is generally seen as the standard for detection of malignancy, whereas the clinical microscopy laboratory is often depended on predominantly for cell counting and categorization. METHODS: To analyze the effectiveness of the hematology laboratory at detecting malignant fluids, this study retrospectively analyzed reports on 397 body fluid specimens (cerebrospinal, pericardial, peritoneal, and pleural) that were concurrently submitted over a 12-month period to both the cytopathology laboratory and the hematology laboratory. RESULTS: Thirty-seven (9.3%) of the cases were diagnosed as malignant by at least one of the two examinations. The cytopathology examination reported 27 (73%) of the 37 malignant cases as malignant and 30 (81.1%) as at least atypical (27 malignant and 3 inconclusive), and the hematology examination reported 34 (91.9%) as malignant and 36 (97.3%) as at least atypical. A concordant malignant diagnosis was given by both laboratories in 24 (64.9%) of the 37 cases. CONCLUSIONS: These results show that examination of specimens by the hematology laboratory can provide a highly sensitive diagnostic evaluation in addition to its more customary role of providing timely cell counts.
Ascitic Fluid↗
[The hematological laboratory of clinical practice].
The spectrum of analyses of a hematological laboratory comprises the counts of erythrocytes, leukocytes and platelets, the determinations of the hemoglobin concentration and of the hematocrit, the calculation of the red cell indices and the microscopic examination of the blood film. The determination of white blood cells, platelets, hematocrit and MCV as well as staining of the blood film should be performed within two hours after blood sampling. The hemoglobin concentration, red-cell count and MCH value remain constant for five days, provided that the blood samples is stored at 4 degrees C. The recognition of morphologically 'minor' pathological findings is important in view of the possible clinical significance that they might have. In the case of thrombotic-thrombocytopenic purpura, for instance, it is very important that the fragmentocytes are recognized and recorded. The grading of pathological findings by use of +, ++, is based on strict limits of ranges. Quality control and quality assurance are integral parts of the daily laboratory performance; moreover, the importance of external quality control in morphological hematology is stressed as being a challenge to the hematological laboratory technologist.
Blood Cell Count↗
Workload, space, and personnel of hematology laboratories in teaching hospitals.
The resources needed to operate a hematology laboratory are known only as rough approximations. To gather more information about these resources, a 13-page questionnaire was completed by 50 pathology departments, of which, 34 departments provided adequate information about their hematology sections to permit data analysis. This study reports results for resource and work load factors and significant regression analyses among these factors for the whole hematology section and the subsections of coagulation, special hematology, and bone marrow examination. These data provide a basis for evaluating the current needs of hematology laboratories and for making projections for the future.
Hematology↗
Automation in the hematology laboratory.
In the routine laboratory for hematology conflicting results may be obtained for the red blood cell parameters with the Coulter Counter Model S. These parameters2) are: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). When the values of the MCHC are above 36 g/dl something must be wrong with the blood sample of the patient. One of the reasons can be agglutination e.g. by cold agglutinins. The blood sample should be reanalysed before and after heating for 1 hour at 37 degrees C. If the values change: cold agglutinins are present; if no change occurs paraproteins, or other disturbing factors, such as bilirubin or high leucocyte levels, will be found. MCH values may also be high in some cases e.g. if the red blood cells are coated with antibodies (Coombs test positive) or after ingestion of medicines like Azathioprine. These examples show that it is possible in some cases to correlate immunological findings with the red blood cell parameters. In addition to the results with the Coulter Counter Model S, some observations on the Hemalog (Technicon) are also presented.
Blood Cell Count↗
[Revisited univariate delta check method for hematologic laboratories (I)--Usefulness for detection of specimen mix-up in patients with hematologic disorders].
We evaluated the delta check method for hematologic laboratories to detect specimen mix-up. We selected 271 patients with hematologic disorders and two types of investigation were conducted. The first investigation comprised statistical analysis, while the second involved evaluation of the procedure. From parameters of white blood cell, red blood cell, hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration (MCHC), and platelets, MCV was considered to represent the best single marker to detect artificial mix-up. About 98% of MCV delta values from one patient were within 3 fl. Conversely, 40% of MCV delta values in artificial mixups exceed 10 fl. No correlations between time interval and MCV delta values were detected. However, some cases were observed in which MCV delta values changed markedly over a short period of time even though the samples originated from one patient. In conclusion, we recommend investigation for specimen mix-up in cases where MCV delta values exceed 4 fl.
Clinical Laboratory Techniques↗
Computerized hematology: operation of a high-volume hematology laboratory.
Operation of automated hematology testing, on-line to a laboratory-dedicated computer, is described. The computer stores, retrieves and monitors the results of two Model S Sr. Coulter Counters, three Technicon platelet counters, one Electra 600-D, and six leukocyte differential consoles, which are interphased to the computer. All other hematology tests are batch-entered via the keyboard of cathode-ray tubes. The computer generates specimen labels, worksheets, and lists of incomplete tests, monitors all on-line instruments, and performs all the calculations used in the procedures of quality control. Results are available instantaneously on cathod-ray tubes strategically located in patient-related areas throughout the institution. These can be obtained as all of the results for a given day or as cumulative summaries or histogram-type plots of results for a given day.
Autoanalysis↗
An automated hematology laboratory with computer-controlled robotics.
A highly automated hematology laboratory environment is described that has conveyance systems to move bar-coded specimens from one station ("workcell") to another, robotic handling devices to load and unload hematology analyzers, and a hematology workstation. Computer systems monitor the process and equipment, track the specimen, manage inventory, and interpret patient results. When a specimen arrives at the laboratory, the bar-code determines which workcell the specimen should go to for testing. Each specimen is handled individually and in real-time. Hematology specimens are routed to a workcell of Coulter STKS analyzers where complete blood counts with five-part leukocyte differentials are performed under full robotic control. The entire process is managed by a real-time Windows-based process control system that interacts with a networked laboratory information system. The hematology workstation is being evaluated for interpretive results reporting and to determine follow-up testing.
Clinical Laboratory Information Systems↗
Quality control methods in a routine hematology laboratory.
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Hematology↗
The Häma-COM laboratory data management system (LDS): tailor-made computerization of the individual working procedures arising in a hematology laboratory with a high throughput of pathologic samples.
A laboratory data management system (Häma-COM) is presented that is individually adaptable to the different working procedures arising in a hematology laboratory. The Häma-COM can be easily integrated into a hospital and/or another laboratory computer system, providing the facilities of total electronic data transfer between the referring institutions and the laboratory. The system is based on a network of personal computers running Novell Network software and coordinates two hematology analyzers (NE-8000, R-1000) and several microscopic work stations. The entire information provided by the hematology analyzers including scatterplots and histograms is captured by the system, whereby automated results are validated and worklists for further sample workup are created. Corrections of and/or additions to automated analysis results might be directly entered into the system from the respective microscopic working places. The Häma-COM system minimizes the administrative workload without interfering with the individual laboratory organization.
Blood Cell Count↗
Plan and process for hematology laboratory standard in Thailand.
In Thailand, there are around 2,000 clinical laboratories in private and government hospitals, By the end of year 2004, all of these laboratories are required to use the same or comparable standard nationwide. Many laboratories are in the process of starting ISO/IEC Guide 25 for the fulfillment of laboratory accreditation. To run the standard system of hematology laboratories in Thailand, we have considered three main aspects: standard in process, method selection and academic interpretation. Because of the wide spectrum of blood diseases in Thailand: thalassemia, iron deficiency anemia and G6PD deficiency hemolytic disease, the analysis and interpretation of laboratory results using different technology are of great importance. National plan has thus set up in two direction, one for standard process and another for academic approach.
Accreditation↗
The ADVIA 2120 hematology system: flow cytometry-based analysis of blood and body fluids in the routine hematology laboratory.
The ADVIA 2120 Hematology System was recently released by Bayer HealthCare, Diagnostics Division, as a bench-top analyzer designed for medium- to large-volume laboratories. This flow cytometry-based system uses light scatter, differential white blood cell (WBC) lysis, and myeloperoxidase and oxazine 750 staining to provide a complete blood cell count, a WBC differential, and a reticulocyte count. A cyanide-free method is used to measure hemoglobin colorimetrically. The system is automation ready; in addition to its capability for analyzing peripheral blood specimens, the analyzer is also equipped to analyze cerebrospinal fluid samples. In this article we explain the underlying technology of the ADVIA 2120, provide linearity ranges, method-specific reference ranges, and stability data, and describe novel parameters and applications that are unique to the methodology used by this instrument. Finally, we discuss research applications and future directions, such as the use of this hematology analyzer in the determination of fetal lung maturity.
Blood Cell Count↗
Robotics in the hematology laboratory. An evaluation of the productivity of the Sysmex HS-330.
The productivity of a robotic hematology system (Sysmex HS-330) was compared with that of existing automated, semi-automated, and manual systems (Coulter Counter-Model STKS; Sysmex R-1000 reticulocyte counter. Geometric Data Miniprep slide maker, respectively) in the clinical hematology laboratory of a large hospital. On average, for a batch of 50 samples, the HS-330 performed a blood count with a 5-part differential, a reticulocyte count, and prepare a blood smear 23 minutes faster than could trained technologists using existing equipment. An estimated 1.8 medical technologists could be assigned to other tasks; however, because of the equipment's high cost, in a laboratory processing 1,000 samples per day, 4.6 years would be needed before any actual cost savings were experienced.
Efficiency↗
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↗