Standardization of haematology critical results management in adults: an International Council for Standardization in Haematology, ICSH, survey and recommendations

Abstract

Introduction: These recommendations are intended to develop a consensus in the previously published papers as to which parameters and what values should be considered critical. A practical guide on the standardization of critical results management in haematology laboratories would be beneficial as part of good laboratory and clinical practice and for use by laboratory-accrediting agencies. Methods: A working group with members from Europe, America, Australasia and Asia was formed by International Council for Standardization in Haematology. A pattern of practice survey of 21 questions was distributed in 2014, and the data were collected electronically by Survey Monkey. The mode, or most commonly occurring value, was selected as the threshold for the upper and lower alert limits for critical results reporting. Results: A total of 666 laboratories submitted data to this study and, of these, 499 submitted complete responses. Full blood count critical results alert thresholds, morphology findings that trigger critical result notification, critical results alert list, notification process and maintenance of critical results management protocol are described. This international survey provided a snapshot of the current practice worldwide and has identified the existence of considerable heterogeneity of critical results management. Conclusion: The recommendations in this study represent a consensus of good laboratory practice. They are intended to encourage the implementation of a standardized critical results management protocol in the laboratory.

Abnormal scattergrams and cell population data generated by fully automated hematological analyzers: New tools for screening malaria infection?

“…In conclusion, the peculiar abnormalities observed in both the WDF‐ and the WNR‐scattergrams of the Sysmex XN‐module may raise a concrete suspicion of Malaria infection, especially in blood samples containing Plasmodium parasites at the gametocyte stage and irrespective of the species. This alert should then be followed by microscopic revision of peripheral blood smear and urgent notification to clinical physician of microbiology confirmation of Malaria diagnosis …”

“…In the 5 blood samples in which the RET count could be performed in our study, no apparent pseudoreticulocytosis, RET-scattergram abnormalities, or abnormal RET/IRF ratio could be observed, thus highlighting the possible limits of using this criteria in samples with parasite indices <3.2%.In conclusion, the peculiar abnormalities observed in both the WDF-and the WNR-scattergrams of the Sysmex XN-module may raise a concrete suspicion of Malaria infection, especially in blood samples containing Plasmodium parasites at the gametocyte stage and irrespective of the species. This alert should then be followed by microscopic revision of peripheral blood smear and urgent notification to clinical physician of microbiology confirmation of Malaria diagnosis 21.…”

Pre‐ and postanalytical errors in haematology

“…45 It is essential that each labora- with critical blood film findings of acute leukaemia (with more than 20% blast cells), acute promyelocytic leukaemia, thrombotic microangiopathic anaemia, parasites and bacteria. 46…”

“…It is essential that each laboratory agrees a critical results action list with requesting physicians and establishes clear lines of communication and responsibility for critical results reporting. Recommendations from the International Council for Standardization in Haematology (ICSH) have summarised consensus critical limits for Hb, WBC and platelet counts, together with critical blood film findings of acute leukaemia (with more than 20% blast cells), acute promyelocytic leukaemia, thrombotic micro‐angiopathic anaemia, parasites and bacteria …”

Critical values in hematology of 862 institutions in China

“…A critical (or panic) laboratory value is a laboratory test result so extremely abnormal that it represents a life‐threatening condition for which some corrective actions should be taken promptly; this concept was originally defined by Lundberg in 1972 and has been used worldwide . It is widely known that critical value reporting is a determinant of patient outcome . It remains the responsibility of each laboratory to establish critical value lists for the results that must be reported when they fall outside of defined limit, and laboratories are responsible for the notification of critical results to clinicians immediately so that clinical interventions can be made in an appropriate time frame…”