nziegler

We have an actual form the techs need to fill out that includes the criteria set by our hematopathologist. I've (hopefully) attached it here.... SMEAR REQUEST FORM.docx

I agree with Scott - even in hyper-regulated NYS there is no requirement for differential "QC", just stain quality as already mentioned. (But we do have to start doing UA microscopic QC ... ) Nicole

Scott - we switched to BioRad DDimer QC. Mainly because in NYS we have to have a control above and below any "cutoff" values and IL does not have one. Stability was an added bonus.

IL's liquid reagents are excellent! I just switched to the liquid Readiplastin about 4 months ago and have not had any problems. Same goes for their heparin Xa reagent. I've been using that for over 5 years and it is the most stable reagent I've seen. It is rare that I have to re-calibrate prior to the 6 month or new lot requirement. They had trouble with their liquid DDimer reagent a while back, but I haven't had any issues since they were resolved.

that spreadsheet looks great! I'm definitely going to give it a try. the only thing I see that I don't like is that it seems to use the manual count as the "reference" method to do the math... with today's technology, I would consider the automated count more accurate than manual (obviously excluding leukemic/dysplastic scenarios)

do NOT let my NICU know that!!

It's super easy to use, just like anything on the TOP. Liquid reagents, no reconstitution. the controls are lyophilized, though. I don't remember much about on-board stability, but the package insert is available on their website. I believe we plan on offering the test on-demand and then putting the reagent back in the fridge after each patient. Each set of reagents give you roughly 24 tests, and there's 2 sets per box. I can't wait to get it - just for improved TAT. Currently physicians have to wait 2-5 days to get the result from Quest.

i have the midas III stainer and the same problem. MarketLab sells these labels that magically dissolve in water when you clean the vessels: product 9744 "soluble MSDS reagent label" it's a roll of 250. I hate the amount of maintenance on the Midas - I used to have Hemateks. but I got it for free, so I can't really complain

Curious to know how you're doing them - the unopette was discontinued years ago. We do not perform them (despite doctor's best efforts to demand them).

Beckman makes specific body fluid controls that get run in body fluid mode, and you should be running those if you are reporting body fluids from the DxH. As Scott mentioned, the linearity isn't very useful for most of our fluids (we can usually report the TNC, but need to perform a manual RBC). I'd like to move them to our Iris.

By performing the saline replacement, there are no calculations necessary. All parameters can be used as reported by the instrument. The WBC, RBC, and platelet counts can be checked against the original to make sure you didn't over or under-replace too much plasma. Our lab used to have a policy allowing for both methods. We discovered we were getting the exact same results with the saline replacement and got rid of the messy math.

we just renewed our contract with Beckman and replaced three overworked DxH's with brand new ones. our setup is all three connected in a line with the SMS at the end (and by the end of the year connected to the Power Express). Honestly, the only other system I would even consider switching to (based on comments read on numerous other forums) is the Sysmex XN. You have a tough choice there. If your facility is anything like mine, the finance department will make the final call. You'll have a choice of creating a connected line with both Sysmex and Beckman. Scott mentioned the connection doesn't work well for his lab - and I find that true for the other labs in our health system. For my lab, it works great. The SMS has pros and cons. LOTS of maintenance. We run a Wright-Giemsa stain, and the lines that handle the stain-buffer mix have developed what I have diagnosed as "coronary artery disease". That mix gets swampy and gross and clogs things up. They finally made a modification that makes flushing with methanol easier, but it is time consuming (45 minutes). BUT the slides are awesome! In my opinion, if you're looking for a system with a slidemaker stainer, I would lean toward Sysmex.

I always have 2 stainers in operation - Beckmans SMS, and then a benchtop backup. The question has come up regarding whether or not these need to be correlated on a 6 month basis. Because I live in NYS, and while there currently is no regulation stating we need to do cross-over studies or correlation when we switch lot numbers or manufacturers of toilet paper, I'm sure it's coming. So - does anyone else out there with more than 1 stainer perform 6 month correlations between them? We are documenting stain quality on a daily basis.

Gastroccult: QC is built into the card, just like Hemoccult, so external QC should not be required. Hansel stain: we also make smears with high eosinophil counts and the techs must indicate on the log that the nucleus stained blue and the granules stained pink/orange Giemsa: we also judge quality as our QC, the techs check off that they checked stain quality and there is a statement at the bottom of the log indicating what "quality" means PFA-100: as per the manufacturer, you must identify "normal donors" from your staff to be used as a monthly control HIT: can't help you there. We will be using IL's reagent which has commercial controls available

I bought "Blood Cell Morphology Grading Guide" by Gene Gulati - an excellent reference for bench techs. One of anything seen in an entire slide is not significant. All references give a percentage of cells with the specific morphological feature as a guide for grading. I always tell people, you shouldn't have to look for morphology, it should jump out at you. (with the exception of malaria/babesia - they can be sneaky)