colleenbennett

We just recently had out Joint Commission inspection. The new QC guidelines are: 2 levels of commercial QC every 24 hours This is for both primary and secondary modes. This went into effect in the first part of July. We were using a patient control for the secondary mode but we were informed by the inspector that we needed to perform the secondary mode QC with our commercial cell controls. We are using the Coulter 5C controls and are running all 3 levels once per day.

We coverslip all of our slides that we intend on keeping long term.

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There are several sources that state that the counting of RBCs has little diagnostic value in serous fluids. The big exception being in peritoneal lavage specimens in order to confirm intra-abdominal bleeding. Does everyone still perform RBC counts on serous fluids? I am hoping to discontinue the use of exact counts and replace it with a range. I have sources to back it up but would like to see if there are other laboratories that have discontinued providing the RBC count. References: Rodak B, Fristsma G, Doig K: Hematology Clinical Principles and Applications, 3rd Ed. Saunders, St. Louis, 2007. Strasinger SK, DiLorenzo MS, Urinalysis and Body Fluids, 4th ed. F.A. Davis, Philadelphia, 2001. Kjeldsberg C, Knight J, Body Fluids, 3rd Ed. ASCP Press, Chicago, 1993. Walters J, Analysis of Body Fluids Self-Study Course #116, CACMLE, Denver, 2004. Thank you, Colleen

I am studying for the specialist exam in Hematology and was wondering if there was anyone who had taken the test. If so does anyone have any advice on what material would be the most helpful?

We perform Lamellar Body Counts on our LH780. We validated the test by buying samples from ARUP who also does LBCs on the LH780. We then ran each of those samples twice to verify we were getting consistent results. We figured out the SD and CV for our statistical analysis. We did a total of 20 samples. Hope this helps.

SMILLER, We did not have an issue at all with the inspector and our practice of only running QC once daily in the secondary mode. This might not have been addressed specifically and as you pointed out different inspectors often focus on different points. Ours focused more on the fact that we were not performing linearity as a calibration validation. Thank you for bringing up this requirement as we will certainly be looking into it and possibly changing our practices soon as it would be an easy fix.

We use an LH 780 so I'm not entirely sure about the 750 but our machine automatically corrects the RBC values if the WBC value is > 140. We have noticed that the hgb values given by the LH were consistent with those obtained from our blood gas analyzer whose method is not affected by high WBCs. Before getting the 780 we would correct for the RBC parameters on any WBC value >100. We would then run the Hgb on our blood gas analyzer because the large number of WBCs would not interfere with the Hgb on that methodology. We performed a spun HCT and together with the corrected RBC and Hgb we could calculate all the other RBC parameters.

We run the 5C controls on our BC LH 780 and HMX once a day. We then meet the control requirement for the rest of the day by setting up patient controls (an a.m. and p.m. control). Each control is run every two hours for a total of twelve hours. Once daily we run one of the patient controls in both the primary and secondary mode to ensure that the two modes are in agreement. We also run one of the patient controls on both analyzers to check that our analyzers are in agreement. We just had a Joint Commission inspection in July and they agreed that our patient QC protocol met their requirements.

I'm curious if anyone uses the Lytic reagent from the Coulter analyzers for lysing red cells in grossly bloody urine specimens. I have always used Acetic Acid and had no issues but have been approached about the possibility of using the Lyse from the instrument. I cannot find any data supporting its use and am concerned about the what other cellular elements might be destroyed. Thank you, Colleen

We have had recent positive malaria smears and needed to give a % parasitemia to the physicians. The literature states to determine the average number of RBCs/ oil immersion field. Then do the following calculation. Total number of parasites in 100 fields ------------------------------------- = % parasitemia Number of RBCs/field x 100 fields Can this be accomplished by doing a count similar to a retic count using the Miller Occular? Just wondering how everyone else determined % parasitemia.