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EWEVANS

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About EWEVANS

  • Birthday 06/09/1966

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  1. Our facility offers 4 different UA tests - A UA (micro if indicated), UAT (microscopic done regardless of dipstick results), and then UACSI and UATCSI - that offer a culture if indicated. Our microscopic review rate (we have an IRIS iQ system) and our mircoscopic rate is about 66%. We reflex the microscopic for any of the following from the dipstick: non-clear urines, > 0.03 hgb, > trace protein, positive leukocytes esterase and positive nitrites. For urine culture we only reflex if we see 10 WBC/hpf on the microscopic - Leukocytes esterase and positive nitrites will trigger a microscopic exam, but only the presence of 10 or more WBCs/hpf triggers a culture. That has resulted in a huge decrease in negative cultures. Hope this helps - Evan
  2. Yes, and I understand what you are saying. We don't have a large number of body fluid counts (about 1/day) and we seem to get them in batches, none for a few days, then 3-4 in one day, and not all of them are run through our analyzer (CSF, extremely low cell counts below linearity, so small a specimen volume, etc.) It doesn't seem cost effective to buy a commercial control when it is easy to look at the cytospin (which we would make on the specimen anyway) and confirm that the cell count appears to match. Besides, we very rarely see high enough RBC counts on body fluids that would compare to a peripheral blood cell count. If we do they are a usually clotted, so a cell count cannot be assessed, or b, if they are that high they are run on our Sysmex and the lower control level if adequate. What we do is a simple, cost effective procedural control that suits our test volume and type of specimen seen. If we saw a higher volume of specimens that had a significant cell counts, I would re-think our control method.
  3. We use a procedural control on all body fluids. We make a cytospin slide on all specimens (regardless of count) and compare that slide to the number of cells counted (either via instrumentation or hemacytometer). We look to see if the count 'matches' what we see on the slide, i.e. if the RBC count was 10,000 and the WBC was 100, we should see 1000 RBC for every WBC (or so). If you look at the slide and you see more WBCs then RBCs, we require the count to be repeated. We notate this internal QC check on each report in our LIS. We've never had any CAP issues regarding this policy.
  4. We have gotten our back order in, and recievd a couple of bottles that we 'loaned' to others in the area, so I would hope this issue could be closed for now. Of course - we talked to our peditricians and got them to agree that we will no longer perfomr a Clinitest routinely on children < 2 (Since Illinois performs the genetic testing as part of the required PKU workup). We will only run a Clinitest if the physician specifically asks for it, so I'm sure our supply will now last until they expire.
  5. You are most welcome. That does seem to be the issue sometimes, we jump on new tests but are reluctant to discard old tests even if they are out-dated until we are forced to look at the issue due to a reagent shortage.
  6. Below is the latest CAP verbiage: URN.30650 Reducing Substances Phase II There is a documented policy indicating when pediatric specimens should be tested for reducing substances other than glucose. NOTE: Such a policy should be based on consultation with the pediatric clinical staff. The policy should include instructions for dealing with those urines tested and found to be negative with glucose-specific tapes or strips. There is no requirement for routine performance of reducing substance testing in adult urines. To me it only states that a policy must be in place. I also found an article that talks about reducing substance in urine: http://www.annclinlabsci.org/content/36/4/447.full It talks about that the need for testing reducing substances only if the physician specifies it (which is an issue without clinitest tablets), as most states are screening for galatosemia as part of PKU testing. What I think is funny is that our supplier (Cardinal health) gave us a couple of possible substitutes for Clinitest tablet - both of them glucose sticks, not really an equal substitute. We are planning to ask our pediatricians if we can only test if requested and not on all patients < 3 years old (our current policy). Hopefully that will reduce our needs enough to last until Bayer has the clinitest tablets available again. I understand it's not they are no longer going to manufacture them, but they moved the facility and have had some supply issues. Thank you -
  7. Just wondering how many people repeat every critical (or alert) value they produce. I know it is been considered good lab practice in the past, but is it neccessary - how often does the repeat not match the origianl? I know there is no CAP requirement. I just wanted to see what others are doing/thinking. Thank you - Evan Evans MT (ascp) Core Lab Supervisor Memorial Hospital Bellevilel, IL 62226 eevans@memhosp.com
  8. Per CAP you can just alternate between each analyzer each time you have a survey - if you have 3 analyzers and you get a survey 3 times a year you can do a different analyzer for each survey. However, if you have fewer surveys then analyzers you can have an issue, as I feel that each analyzer should have PT specimens run on it at least once each year. For analyzers that I run equally - I purchase the extra survey results and run on both - probably a little overkill, but it give another layer of trending against a larger peer-group then some QC materials will get you.
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