Joseph

Anyone have any knowledge or experience with the Siemens/Sysmex instruments? I'm looking at the 1500 vs. the 2500. Daily volume is about 200 PT, PTT, Fib and D-dimers mixed. We will soon add Xa. We have been using Stago for 20 years. Thanks!

We use the plasma blank method. It's not too difficult. I found that a lot of the new techs we were getting were math challenged. I created an Excel worksheet where you simply plug in the data and the corrected HGB and the RBC indices are calculated for you. Yes, I verify the Excel calculations vs. manual calculations on a regular basis as required. The spreadsheet is password protected so the formulas can't be altered. You can print it too, if you want.

Unless your instrument can differentiate between hematopoietic cells and the "lining" cells and not count them, then you are actually counting nucleated cells and you should report that. I believe the Sysmex counts nucleated cells. Your apps person can tell you what it counts. You could report an "estimated WBC" by using the % neuts, lymphs, monos, eos, basos from your manual diff and calculating a WBC. It's only an estimate though. A cytospin prep doesn't have random distribution on a slide due to the centrifugal forces present.

Go the the Safety Lady's web site and register for her newsletter. I don't remember the address, Google it.

I have been vortexing CBC samples for many years. Try it. It doesn't cause fragmentation, won't lyse cells and won't cause any issues with the CBC. It does break up those platelet clumps caused by improper collections like short draws, hard sticks in the ER, etc. It doesn't break up the clumping from EDTA sensitivity. Try it. Compare the WBC and RBC before and after, make smears if you want to. It works!

I just saw the Blood Hound at the AACC. It does digital images of all the WBC's, RBC's and Plts on a CBC. Per the manufacturer, it is capabel of detecting and counting RBC inclusions, including malaria, in RBC's. It looked impressive and is pending FDA approval. Check out their website.

We report absolute and relative values on our automated diffs. The manual diff are reported in % only because that's the way it been done for years. Most docs like the % because they can remember the reference ranges and the relationship, ie: 70/30, 60/40. Our decision rules to perform a manual are based on the absolute values provided the cell populations are in typical positions. I personally don't believe that you should calculate absolute values for a manual diff based on only 100 counted cells. Jusy my "professional" opinion. I also find it interesting the most of our docs and nurses don't know how to calculate the ANC.

Well hold on there just a minute. Where do CAP Survey "true" specimens come from? Aren't they manufactured? I bet one of the reagent manufacturers make the CAP samples too. But because you purchase them from the CAP, they are ok to use for method comparisons. The CAP allows you to use QC samples for method comparisons in other areas, such as hematology. And these CAP inspectors, MT's just like us who are trying to interpret the same guidelines. It depends on the technologist doing the inspecting as to whether you are following the intent of the guideline. But I believe the intent is to compare the testing methods and determine their relationship to each other. The CAP says that the methods don't have to agree, you just have to know how they compare.

The cyto spin is not an even distrubution due to centrifigal effects. The larger cells are heavier, etc. I find if you spin slower and longer, these can be minimized. Too much albumin makes the lymphs look "blasty". Don't use too much just enough to help preserve morphology and act as a glue to help cells adhere to the slide.

We use the Akers rapid screen, it works fairly well. Some false positives and it has been improved and is easier to read.

We use the ESR stat plus also. 5 minutes and 25 ul of blood.

Everything you always wanted to know about mixing studies can be found at www.fristmafactor.com. Just do a search. Tons of good info there on coag. I will be happy to share my stuff with you. Joe

I set up two TEGs about 18 months ago. We have saved a bundle on blood products predominately for CABG surgeries. We operate them out of blood bank/hematology.