nziegler

I've heard about them, and we think we may have seen them, but not reported. Curious what people would report them as. I would think that reporting "rare green crystals of death" might be a little disconcerting to the physician!

We've seen this once. If we're lucky enough to realize that's the problem, we would saline replace to allow the cells to get re-acquainted with the proper osmolality. (The MCV on our particular patient was 134, so it was a bit obvious)

You must be able to retrieve original instrument data for at least 2 years.  For something like a small Clinitek, the result tape is the only thing you would have to prove what the instrument originally gave - as results can be modified once they cross the interface. Most bigger analyzers have a way to store patient data electronically.

A cytospin is a centrifuge.
Scott

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.

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.

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.

We are going to the ILHS recommendations for lymphocytosis instead.  >5.0 (adult) or >7.0 (<12 yrs old)

It seems like those guys at Coulter 30 years ago had too much time on their hands...
Scott

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.

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)

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)

Forever ago we used a calculation.  You would spin the sample down, then run the lipemic plasma for hgb measurement.
Then calculate:  True hgb = original hgb - ((plasma hgb x (1 - hct as a decimal))
I have no idea where this calculation came from, but it did always the plasma replacement method.  In my opinion, doing any kind of calculation is just silly when you can just replace the problematic plasma with diluent/saline. Using plasma replacement, you don't have to recalculate any of the indices, either.
Nicole
 

When I started with the DDHS500 line a few years back I had a horrible time with controls. That 30 day claim is junk - and I thought they were going to work on changing that wording in the package insert. I could only get 3 days out of mine. They did seem to work out the issue I was having, though.  I believe it was a combination reagent stability AND qc stability.  (We ended up switching to BioRad controls simply because in NYS I have to have a "negative" control, and IL doesn't make one that low yet.)  But in all the years of using IL, that is the ONLY problem I've had. The TOP analyzers are rock stars! (and I just got my new 550's in!)
The best thing to do is document EVERYTHING. I had a log at the instrument where I had the techs write down every time they changed reagent or made up new qc and why (empty vs. qc trouble). And then I would print the Levy-Jennings and send them in.
Do you submit monthly to the AccuTrak? If everyone else is running high, that is in your favor.

i have a DM96 Cellavision and Soft.  Hemo instruments are DxH800.  We have to manipulate 2 separate interfaces in order to get the cellavision results into the CBCWD order.  it's really crappy because we have to make sure to clear the diff pad before going into the cellavision interface to post those results.
if you want more details, let me know....

very well written! I'm going to save this for lab week.  the public only hears when bad things happen with the lab, and most nurses seem to think our job is to compromise samples so they have to be redrawn. they don't realize that we do know patients by name, bad results have an effect on us, and we often wonder how patients are doing.

yes, SMILLER!  it's true! the kit is VERY easy to use - all liquid ready-to-use reagents. I don't remember if the controls are liquid or not. It will be a great test to quickly rule out HIT, but I'm pretty sure in order to diagnose you will still need to send a confirmation to a reference lab. Our friends at the FDA have made them change it to a qualitative pos/neg instead of reporting actual values. This is why it will take until 1st quarter of 2017 before it becomes widely available in the US - they need to reprint all the package inserts to reflect that change.
Start saving correlation samples!

It would be surprising if that were actually true. But I live in NYS, so even if JC gets rid of it, NYS never will!
Regarding Fib cal verification - we use the TOP500, but I'm pretty sure there is wording in the regulation that states if it is a clotting based test (versus chromogenic), you don't need to do the cal ver.  Just like you don't have to do it for PT or PTT...

Yeah.  What we would love here is for our administration to approve our capital requests that we have been putting in for the last 4 or 5 years.
By the time we get new analyzers, they will be obsolete!
 
Scott

ooh. you're going to love them!  their HIT assay is coming very close to FDA approval. I helped them with some testing for reproducibility and precision a few months ago and am doing another round in the fall.  I'm REALLY hoping it's approved first quarter of next year.  I spend $70k a year sending those out!
FYI, they're also working on anti-Xa calibrators for the new oral drugs but once again the FDA is giving them a hard time. the reason: the DRUG COMPANY says they don't need to be monitored.  *smh*

You will love the TOPs! I have never known an analyser so reliable They seem to never break down - when they do it can be pretty fun to sort it though.

we got rid of any kind of delta checks for PT/INR years ago. our logic was that it is not improbable for the results to vary one week to the next (even one day to the next) depending on the dose, the time, and what the person ate that day. we were easily repeating about half our samples due to the delta check. (we have also gotten rid of that policy - repeating delta's)

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.

Won't let me put the link here, but go to www.mayomedicallaboratories.com and search for "plavix" and you will see a hot topic about it that has a lot of info.

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.