The issue of laboratory critical value (CV) reporting has gained importance in the recent times due to the national focus on patient safety. Critical value notification (CVN) has become an essential part of accreditation procedures for medical laboratories, including the universally accepted International Organization for Standardization (ISO) 15189: 2012. Our study aimedto analyze the critical value data in hematology and biochemistry sections of the laboratory, to compare the frequencies of critical values for different parameters and to suggest measures for improving the effectiveness and operational efficiency of the critical value notification process.Our study was a retrospective, cross-sectional, descriptive study done over a period of one year six months (January 2020 to June 2021). The parameters chosen for CVN included platelets, hemoglobin and International Normalized Ratio (INR) from hematology section and creatinine, glucose, sodium, potassium and calcium from the biochemistry section. A test result that was significantly outside the normal range and that required immediate communication was considered as a “critical value (CV)”. Both verbal (through telephone) and non-verbal [through short message service (SMS)] communication processes for CVN were implemented in our lab. We also followed the practice of CV “read-back” by the person who was informed over the phone. A total of 2199 critical values were reported. A maximum of 1224 (55.7%) critical values were recorded from the emergency department. CVs were highest from biochemistry (1898, 86.3%) section. Analyte most commonly notified was creatinine (1151, 52.3%). CVNs were maximum in the morning shifts (1378, 62.7%).Implementation of the critical alert short message service (SMS) send outs has greatly helped us in reducing the CV turn around time (TAT). Our study has successfully demonstrated the importance of both verbal and non-verbal communication processes for notification of CVs.
Background: With the advent of automation in hematology, both platelet indices and their histograms are available from the blood cell counters at no extra cost or time. The variations of histograms in various mechanisms of thrombocytopenias are explored in this study.Methods: Adults with thrombocytopenia determined with (name of the analyser)were categorized into four groups based on the mechanism of thrombocytopenia and variations in platelet histograms were studied in all groups. Data was collated and analysed using Microsoft Excel.Results: A total of 224 adults with thrombocytopenia were seen, most of them had hyperdestructive type (73.6%) followed by hypoproductive type (16.08%), abnormal pooling (6.3%) and EDTA induced thrombocytopenia (4.01%). The following variations in histogram were seen; Normal curve(8.03%), Curve not touching/reaching the baseline (43.75%), Broad based curve (10.71%), Bimodal curve (7.14%), Curve with short peak (25.9%) and Saw-tooth appearance of curve (4.47%) and correlated with the above mentioned mechanisms of thrombocytopenias using SPSS software version 20. Conclusion:An awareness regarding the variations in the platelet curve ensures a good correlation with its numerical parameters and also with the etiology of thrombocytopenias. With the era of automation taking over in most of the laboratories, it is imperative to have knowledge about these simple yet, often overlooked platelet histograms
Introduction: Thrombocytopenia (TCP) is defined as a platelet count below 1,50,000 per microliter. This fall can be attributed to increased destruction, decreased production in bone marrow and pooling of platelets. A good knowledge of the cause and clinical course of the underlying pathology as reflected by the platelet indices contributes to the better management of TCP. With the advent of automation in haematology, these indices are now available from the routinely used blood cell counters in the laboratory. Aim: To determine if studying the variation in platelet indices helps to identify the aetiology of TCP. Materials and Methods: The prospective study was conducted in the haematology wing of central diagnostics attached to a medical college in Bangalore, Karnataka, India over a period of three months from June 2019 to August 2019. A total of 598 cases of adult TCPs were encountered, out of which 505 cases met the inclusion criteria and were categorised into three groups, namely- Hyperdestructive (Group 1), Hypoproductive (Group 2) and Abnormal pooling (Group 3). Variation of platelet indices {Platelet count, Plateletcrit (PCT), Mean Platelet Volume (MPV), Platelet Distribution Width (PDW)} were studied not only between the groups but also with the severity of TCPs. Data was analysed using the software Statistical Package for Social Sciences (SPSS) program version 20 and tested for statistical significance using one-way Analysis of Variance (ANOVA) test. A p-value of <0.05 was considered as statistically significant. Results: Of the 505 cases a majority fell under Group 1- 420 cases (83%). A higher value of MPV (11.870±1.3) and PDW (15.63±3.4) were seen in Group 1 compared to Groups 2 and 3. There was also significant variation among the platelet indices (PCT, MPV, PDW) with the severity of TCPs. Conclusion: Platelet counts along with a good knowledge on interpretation of platelet parameters obtained by automated analysers play a pivotal role in determining the aetiology of TCPs, thereby, providing better initial patient management.
Umbilical lesions constitute a comparatively lesser percentage of the specimens received on a daily basis for histopathological examination. During embryological development, the umbilicus functions as a channel that allows flow of blood between the placenta and fetus. It also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present. Nevertheless a few lesions are encountered related to the same. Patients with umbilical disorders present with drainage, a mass, or both. Umbilical granuloma, omphalomesenteric remnants, urachal remnants, hernias are few lesions in the umbilical region. We present a case of an umbilical polyp in an infant, which clinically suspected to an umbilical granuloma. The idea behind presenting this case was that, not only are umbilical polyps rare lesions but also it is necessary to differentiate it from umbilical granuloma as the treatments may vary. The clinicians and reporting pathologists must be aware of this rare congenital lesion.
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