Automated peripheral blood leukocyte differential counts (LDCs) are widely accepted in routine practice. However, many laboratories still reflexively perform manual LDCs based solely on abnormal automated results or instrument "flags," before any manual triage step. We describe our transition to a procedure that uses manual methods to validate, rather than to replace, automated LDCs (an approach recommended early in the development of automated methods, but still not used in many clinical laboratories). Manual microscopic scans were performed in lieu of manual LDCs. Each scan that revealed cell types not quantifiable by the instrument triggered a manual LDC. However, if the manual scan simply confirmed the cell types seen on automated LDC, then the automated result was released, even if clinically significant quantitative abnormalities were present. This policy reduced manual LDCs by more than 70% and was validated by a manual retrospective audit. Patient care and laboratory operations can be optimized by using manual microscopic examination as a validation procedure rather than as a reflexive substitute for automated methods. There is no clinical rationale for reflex performance of manual LDCs based solely on instrument warnings.
This study evaluated the ability of the Coulter STKS Hematology Analyzer (Coulter, Hialeah, FL) to detect and classify acute leukemias involving the peripheral blood. One hundred ten acute leukemias cases with circulating blasts were studied: 72 acute myeloid leukemias were divided into "high WBC count (> 11.0 x 10(9)/L)" (28 AML, 22 ALL) and "normal/low WBC count (< or = 11.0 x 10(9)/L)" (44 AML, 16 (ALL) categories. Most cases in the high WBC count group elicited the blast suspect flag. The remaining cases of AML and ALL in both the high WBC and normal/low WBC count group were detected by the blast flag, other suspect flags, and/or definitive flags. Only one case of AML-M6 was initially missed using these flag combinations; a subsequent analysis elicited the blast flag. The blast populations in the high WBC count group were localized into characteristic myeloblast or lymphoblast regions of the scatterplot in 82.1% of AML and 63.6% of ALL cases, respectively. However, the remaining cases had indeterminate or aberrant scatterplot patterns, such that an accurate leukemia classification was not possible. The scatterplot pattern also was not helpful in differentiating AML FAB subclasses. The authors conclude that using a combination of appropriate suspect and definitive flags to trigger checking criteria and microscopic review, the Coulter STKS Hematology Analyzer will be successful in detecting virtually all cases of acute leukemia involving the peripheral blood. Although the scatterplots may give useful information, the patterns obtained are not sufficiently distinctive to aid in classifying acute leukemias.
Automated peripheral blood leukocyte differential counts (LDCs) are widely accepted in routine practice. However, many laboratories still reflexively perform manual LDCs based solely on abnormal automated results or instrument "flags," before any manual triage step. We describe our transition to a procedure that uses manual methods to validate, rather than to replace, automated LDCs (an approach recommended early in the development of automated methods, but still not used in many clinical laboratories). Manual microscopic scans were performed in lieu of manual LDCs. Each scan that revealed cell types not quantifiable by the instrument triggered a manual LDC. However, if the manual scan simply confirmed the cell types seen on automated LDC, then the automated result was released, even if clinically significant quantitative abnormalities were present. This policy reduced manual LDCs by more than 70% and was validated by a manual retrospective audit. Patient care and laboratory operations can be optimized by using manual microscopic examination as a validation procedure rather than as a reflexive substitute for automated methods. There is no clinical rationale for reflex performance of manual LDCs based solely on instrument warnings.
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