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Posts posted by nziegler
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does anyone do any testing on amniotic fluid? we have some ob/gyn md's requesting (demanding is a better word) that we do: cell count, leukocyte esterase, glucose, and gram stain with culture. I don't understand why they want a leukocyte esterase (they want us to just use our urine dipstick) if we would be giving a cell count.
** does anyone do "leukocyte esterase" testing on amniotic fluid? if so, by what method and how did you validate?
** how different does amniotic fluid look when doing a cell count? are there any kinds of cells a general tech wouldn't be familiar with? (for example, I know there are lamellar bodies, but haven't been able to find a picture of they would look like under the scope.)
any experience you can share is appreciated!
Nicole z
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Sonia - i don't have any experience with the Horiba model, but i do have a CellaVision that pretty much does the same thing: you make and stain the slide and the instrument scans, takes pictures, and pre-classifies. I truly believe these systems have the potential to cut manual differential time in half, but you have to make sure you have all of the supporting pieces to ensure efficient workflow. My problems include (and things that you should check out before purchasing a system):
1. We make our smears by hand and then stain on an old HemaTek stainer. Slide quality is of utmost importance in order for something like EasyCell or Cellavision to work efficiently. The smears must be consistent, of the proper length, and stained well -- all qualities that we struggle with in a large lab with 30+ techs making slides. (Something like Beckman's slide-maker-stainer would resolve this problem)
2. Interfacing. Make sure your Information System (we use SoftLab) will be able to interface the results and merge them with your hematology analyzer results. This piece took us months to iron out and we still have two separate interfaces: one for the hemo results, and the other for our Cellavision results.
3. do the slides require a barcode in order to be recognized by the EasyCell - if so, do you have a system that will EASILY create these slide labels?
Hope that helps -
Nicole
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Thanks Scott. I am currently waiting for a replacement due to temperature errors from this one (this will be our 3rd replacement in just over a year). Once that comes in, i'm going to have techs start to log the errors they get along with sample demographics. I'm glad yours has been working well for you! Adding the tube too soon is not something i considered - interesting.
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For anyone running aspirin and P2Y12 on the VerifyNow: have you been having trouble with error codes using the P2Y12 test devices. All of our aspirins run just fine, but it seems as if every other plavix device gives an error. This is causing patients to be redrawn numerous times and is getting frustrating. (Some other background: we have had several analyzers over the past two years, so it's not the analyzer itself, and a bold reminder for everyone to tighten down the needle before running.)
Just wondering if someone else has seen the same problem.
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We use SoftLab and we do not do this. It is an all-or-nothing type of autovalidation. In the past, techs used to manually release the hgb, hct, and plts for ER and nursery patients if a differential needed to be done.
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kholshoe: to clarify your clarification (hopefully) - the PFA100 has two different test cartridges, COL/EPI is a generic screen of platelet function - it just tells you if the platelets are working or not; if it comes out abnormal, you have the option of running the COL/ADP - this one tells you whether the 'malfunction' is due to aspirin or some plt defect (vWD, glanzmanns, etc.) - if it comes out normal the first abnormal result was due to aspirin, if the ADP is still abnormal, you'd have to do a full plt aggregation study.
So it would really depend on what your intended use is - like Scott, we have both the PFA (which we use for general pre-surg screening) and the VerifyNow - which is used specifically for aspirin and plavix testing.
Mabel: the TEG and Rotem haven't been used too much outside of trauma, and (as far as i know) definitely not for monitoring plavix. I did hear one lecture on the possibilities of using it to screen for thrombophilia. I think in the future they'll definitely be used for more than just trauma and surgery cases.
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I have a Cellavision. It has the potential to be a really useful tool. If you really plan on getting one, there are a few MUST HAVES - and i cannot stress enough, MUST HAVE:
1. a slide-maker stainer - consistent slides and good stain is key to optimal use. i work in lab where there are 35 different techs making slides 35 different ways, and inconsistency is a problem. Stain precipitate from a dirty stainer is also a problem. Which brings down a minor rabbit trail:
1a. Cellavision does NOT have a brain. It does NOT learn how to classify cells better the more you use it. Personally, i am ok with this, but i came into the project after the techs had already been told that this would be possible. This is why stain junk is a problem - i've concluded it just looks for dark purple-ish anything and tries to classify.
2. An efficient way to create barcoded labels that can go through the staining process. (Pretty sure a slide-maker stainer would cover you on this). I don't even want to tell you what we go through to get the slides labeled. That said, a slide MUST have a barcode in order to be run. There is no way around it.
3. Middleware. I use SoftLab and currently don't have middleware. So in order to verify a diff from Cellavision involves careful manipulation of 2 separate interfaces. Let's just say the number of modified reports sky-rocketed when i put it into use and one shift all but refuses to use it.
There are some positives: the images are nice. And they can be magnified far beyond what you see in a scope. (which can also be bad if you have some "over-analyzers") You can also build a library of reference cells. So as you get patients with blasts, pros, myelos, plasma cells - you can add them to a reference library - so no more getting up and flipping through a reference book to try to find an image that matches yours. It does have the capability of remote viewing for pathologists - but costs $$$. It also has a competency software (but i haven't figured that out yet). It can do body fluids, but i haven't worked that up yet.
Negatives: only 1 image for red cell morphology. it is equivalent to 8 hpf, but if the image is taken in the wrong part of the slide (too far out, too far in) you have to slap it back on the scope. It also has a platelet module, but i haven't bothered to work it up. In my opinion platelet issues really need a good eyeball scanning of the slide on a scope.
Sorry if that was a bit rambling, but my facility has wasted a TON of money - because we bought far too many and did not have the supporting pieces to make workflow efficient.
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Yes, the Xa assay is wonderful! It's calibrated with a hybrid curve, so we can report both unfractionated and LMW. 99.9% of our testing is unfractionated for the inpatients. No more heparin response curves! So the only PTT's we run (for the most part) are ER, pre-surgical, and ambulator surgery. And it shouldn't even be used for pre-surg or ASU.
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Thanks Scott. I have no idea when the last true normal range study was done. The problem is that in the past, whenever we would switch lots, we would "validate" the normal range in use. This meant that all specimens saved already fell within our range, guaranteeing validation of the range. (i just took over about a year ago and am trying to do things the right way) I'm not sure when we switched from the SP to the SS reagent.
i do have message out to my technical rep to see how others are running and am waiting for feedback from other sites in my system.
Luckily, i don't have to worry about heparin response curves - we run the heparin assay!
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This question goes out to users of IL TOP 500 running PTT's using SynthaSil reagent:
What is your current normal range?
Ours is currently 21-36 seconds, but alot of our pre-admits are flagging high. I ran 40 pre-admit and ambulatory surgery patients as part of a new lot workup, but i'm getting 24-42 seconds - which seems kinda high. So i'm just wondering what some other places might be using before i continue my workup....
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your original question mentioned "reference ranges" - just to clarify, you don't need to validate reference ranges for patient results when a lot number switches. regulatory agencies prefer you create your own control ranges, but there is also an "out" for tests that are not performed frequently enough (or for tests in which it would be very expensive) to establish these ranges.
for any of my special coag testing, we use assayed controls, we use the manufacturer mean, but we do tighten the acceptable range to 2sd. as auntie-d mentioned, many published ranges are, indeed, 3sd - and (are you sitting down?) IL published ranges are a whopping FOUR sd!
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thanks for the input - i guess i was worried some of the more inexperienced techs would have trouble at 50x, but they can always switch to 100 if they think they see something unusual. those phrases are helpful, too, scott - exactly what i was looking for!
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i thought this was talked about once here, but i can't seem to find the thread. we are moving our differential policy to more closely reflect ISLH guidelines that recommend reviewing the slide over performing a full manual differential.
the problem is that i know i'll have to have a policy as to what constitutes a "review". my seasoned techs don't need a policy, but there are a number of techs that need everything spelled out. (plus those pesky regulatory agencies) namely - how many fields should be reviewed based on the WBC count under 100x.....
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i also use IL - right now my opinion is that it's a sales pitch to get you to use more stuff. all due to ISTH guidelines that there should be 2 sensitive methods in order to confirm a lupus anticoagulant. where i work, we do NO reflex testing ourselves - it is up to the physicians to order further testing once they get the results.
if you already automatically reflex to sending out positive dRVVT ratios, then it may be beneficial ($$) to bring that testing in-house. all depends on volume.
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interesting you're moving from beckman to sysmex. the dxh 800's are wonderful!
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thanks scott. we used the unopette years ago until they discontinuted it. we really only used it for our neonatal specimens when the nurses can't seem to collect a cbc that isn't clotted. it's becoming an issue again, so we're discussing bringing in leukocheck.
from what i remember, we set up a random patient check using a purple top that was already run on the analyzer as our qc. (but it has to be with every manual platelet, by whoever is performing the count. so someone draws the short straw for the 8 hour shift!)
thanks for reminding me about the qc - almost forgot. one more reason not to bring them back...
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anyone out there still do manual platelet counts? any experience using leukochek to do them?
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certain viral infections and parasites can cause eos to show up in csf
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whenever we get a unique patient, we make 4 slides and coverslip them and add them to our abnormal library along with all pertinent information. we use the rumke scale to grade technologist responses. new York state department of health also still puts out glass slides for proficiency testing, so I use those, too.
if a tech's results don't match, I go over the slide with them.
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you guys should thank your lucky stars you don't live in NYS - qc every 8 hours +/- 15 minutes! we were running 2 levels every 8 hours, but we're actually saving money running 1 level every 6 hours. one of the many nice things about the DxH800 is that there is no secondary mode to qc separately!
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thanks, scott. just out of curiosity, what is your volume like? how often do you have service calls?
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wondering how often you guys end up calibrating your hemo analyzers. i know minimum requirement is 6 months or after any major service. we end up calibrating every 3 months out of necessity. anyone able to go the full 6 months?
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Beckman has specific body fluid controls available. We run those.
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We only report up to 160 seconds, so we don't do any abnormal controls.
What does your facility do when you have platelet clumping?
in General Information
Posted
We request tandem samples for the redraw and use the blue only for the platelets. Of course, this requires education of dozens of processors so that we actually RECEIVE the extra blue top back to hematology.... but we're getting better!