Westgard Rules in Hematology

[RobinL]

I have been out of the lab for a number of years and am trying to understand some of the changes since I left, particularly in hematology.  Does anyone set up Westgard rules on hematology analyzers?  If so, could you explain how you do it and on whichever instrument you use?  When I was in the lab it was only used in Chemistry so this is new to me.

 

If you could provide information on how you handle QC in hematology these days, I would really appreciate being brought up to date.  When I was in the lab we ran 3 levels of liquid controls on each shift.  We would look at our L-J charts and determine if controls were in or out.  We also ran a patient blood throughout the day to assure instrument precsions.  Is this still being done? 

 

I may be going back into the lab and would really like to feel a little more current.  I hate to date myself, but my first automated hematology instrument was a Coulter S and we also  used a ZBI for platelets.  The newer instrument are really marvelous. Instrumentation has come a long way.

 

Thanks in advance to anyone willing to share their knowledge and expertise with this dinosaur.

 

Robin 

[nziegler]

We have no rules set up for our hematology qc.  I do look at the levy-jennings to identify shifts or trends, but generally speaking rules like 10x or 4,1s aren't very helpful.  In the world of hematology, being part of a qc pool is the most important tool (for Beckman users, it's IQAP).  Comparison of your values to the "pool" is much more important than package insert means.  Having multiple instruments is also helpful for comparison. We run a patient check once a day - i have 3 instruments, so at any given time, between IQAP reports and patient check numbers i can figure out which instrument is showing a problem.

Because our standards in NY require at least one level of control every 8 hours, +/- 15 minutes(!) we have taken to running one level of control every 6 hours - it is actually saving a lot of money (we were running 2 levels every 8 hours).  If there's ever a problem with the one level of control, they can run the other levels as a troubleshooting measure.

Hope that helps!

[SMILLER]

We use pretty much the same standard rules that we do for chemistry -- QC is OK if within 2 SDs of the mean.  Target means are set by running a new QC lot in parallel with the current lot.

 

As far as frequency: for coag and hema, in the US, I believe we are required to run at least 2 levels a day and one level every 8 hours.  We also do a mode-to-mode check every 8 hours to "QC" our open mode.

 

Peer review is another requirement for regulated tests, this is satisfied by comparing QC results to peer groups, as has ben mentioned.  Proficiency testing is another form of peer review.  We only use XB for troubleshooting.

 

Scott

[RobinL]

Thank you for taking the time to post this information.  It is really very helpful.

 

Robin