Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Current Status and Proposal of a Guideline for Manual Slide Review of Automated Complete Blood Cell Count and White Blood Cell Dfferential

  • Woo, Hee-Yeon (Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Sang-Yong (Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Hyo-Soon (Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-Jae (Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Hee-Jin (Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Young-Kyung (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Chae, Seok-Lae (Department of Laboratory Medicine, Dongguk University) ;
  • Chang, Yoon-Hwan (Department of Laboratory Medicine, Korea Cancer Center Hospital) ;
  • Choi, Jong-Rak (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Han, Kyung-Ja (Department of Laboratory Medicine, The Catholic University of Korea) ;
  • Cho, Sung-Ran (Department of Laboratory Medicine, Ajou University School of Medicine) ;
  • Kwon, Kye-Chul (Department of Laboratory Medicine, Chungnam National University College of Medicine)
  • Received : 2010.04.30
  • Accepted : 2010.09.15
  • Published : 2010.12.01
⟨ Previous Next ⟩

Abstract

Background : Manual slide review (MSR) is usually triggered by the results of automated hematolgy analyzers, but each laboaratory has different ciriteria for MSR. This study was carried out to investigate the current status of MSR criteria of automated complete blood cell count (CBC) and white blood cell (WBC) differential results and to propose a basic guideline for MSR. Methods : Total 111 laboratories were surveyed regarding MSR using questionnaires. The questionnaire asked: kinds of automated hematology analyzers used and the presence of criteria triggering MSR in seven categories: 1) CBC results, 2) 5 differential WBC counts, 3) 3 differential WBC counts, 4) automated reticulocyte counts, 5) delta check, 6) instrument flags (or messages), 7) clinical information (wards or diseases). Based on the survey results, we determined basic and extended criteria for MSR. With these criteria, we consulted nine hematology experts to get a consensus. Results : All 111 laboratories had their own MSR criteria. Among 111 laboratories, 98 (88.3%) used more than three criteria for MSR including CBC results and 5-part WBC differential count results and 95 (85.6%) had criteria of flags triggering MSR. For MSR criteria with numeric values, the 10th, 50th, and 90th percentiles of upper and lower threshold values were obtained. The basic guideline for MSR was made. Conclusions : We proposed a basic guideline for MSR. This guideline would be helpful to hematology laboratories for their daily operation and providing more rapid and accurate CBC and WBC differential results.

배경 : 수기도말검토(manual slide review)는 일반적으로 자동혈구분석기의 결과에 근거하여 이루어지나 검사실마다 수기도말검토 기준이 다르다. 본 연구는 전혈구계산과 백혈구감별계산 결과에 따른 수기도말검토 기준의 국내 현황을 조사하고 기본적인 수기도말검토 기준을 제안하기 위하여 시행되었다. 방법 : 총 111개의 검사실을 대상으로 수기도말검토 관련 설문조사를 시행하였다. 설문 내용은 보유 자동혈구분석기 현황 및 다음과 같은 7가지 수기도말검토 기준 유무에 대한 문항으로 구성되었다: 1) 전혈구계산 결과, 2) 5분획 백혈구감별계산 결과, 3) 3분획 백혈구감별계산 결과, 4) 자동 망상적혈구 수, 5) 델타 검사(delta check), 6) 장비의 flag (또는 message), 7) 임상 정보(병동 또는 질병). 설문조사 결과를 바탕으로 수기도말 검토에 대한 기본 기준과 확장 기준을 정하였으며, 이를 9명의 전문가에게 검토 의뢰하여 합의안을 마련하였다. 결과 : 조사된 111개 검사실 모두 자체 수기도말검토 기준을 가지고 있었다. 111개 검사실 중 98개 검사실(88.3%)에서 전혈구계산 결과와 5분획 백혈구감별계산 결과를 포함한 3가지 이상의 기준을 사용하고 있었으며, 95개 검사실(85.6%)에서는 flag에 따른 기준을 사용하고 있었다. 수기도말검토 수치 기준의 경우 상한값과 하한값의 10th, 50th, 90th percentile 값을 구하였다. 수기도말검토 기본 기준을 선정하였다. 결론 : 저자들은 수기도말검토를 위한 기본 기준을 제안하였다. 이 기준은 각 진단혈액 검사실에서 보다 신속하고 정확한 전혈구계산과 백혈구감별계산 결과를 제공하는 데 유용할 것이다.

Keywords

Acknowledgement

Supported by : KSLM

References

  1. Kang SH, Kim HK, Ham CK, Lee DS, Cho HI. Comparison of four hematology analyzers, CELL-DYN Sapphire, ADVIA 120, Coulter LH 750, and Sysmex XE-2100, in terms of clinical usefulness. Int J Lab Hematol 2008;30:480-6.
  2. Stroop DM, Triplett RC, Perrotta G, Roberts LP, Schramm RC, Comer K, et al. Comparison of the Abbott Cell Dyn 3000-SL and the Coulter-STKS hematology analyzers. Ann Clin Lab Sci 1994;24:250-8.
  3. Bentley SA, Johnson A, Bishop CA. A parallel evaluation of four automated hematology analyzers. Am J Clin Pathol 1993;100:626-32.
  4. Thalhammer-Scherrer R, Knöbl P, Korninger L, Schwarzinger I. Automated five-part white blood cell differential counts. Efficiency of software-generated white blood cell suspect flags of the hematology analyzers Sysmex SE-9000, Sysmex NE-8000, and Coulter STKS. Arch Pathol Lab Med 1997;121:573-7.
  5. Buttarello M and Plebani M. Automated blood cell counts: state of the art. Am J Clin Pathol 2008;130:104-16. https://doi.org/10.1309/EK3C7CTDKNVPXVTN
  6. Bain BJ. Diagnosis from the blood smear. N Engl J Med 2005;353:498-507. https://doi.org/10.1056/NEJMra043442
  7. Clinical and Laboratory Standards Institute. Reference leukocyte (WBC) differential count (proportional) and evaluation of instrumental methods: approved standard. CLSI document H20-A2. 2nd ed. Wayne, PA: Clinical and laboratory standards institute, 2007:1-63.
  8. Novis DA, Walsh M, Wilkinson D, St Louis M, Ben-Ezra J. Laboratory productivity and the rate of manual peripheral blood smear review: a College of American Pathologists Q-Probes study of 95,141 complete blood count determinations performed in 263 institutions. Arch Pathol Lab Med 2006;130:596-601.
  9. Barnes PW, McFadden SL, Machin SJ, Simson E. International consensus group for hematology. The international consensus group for hematology review: suggested criteria for action following automated CBC and WBC differential analysis. Lab Hematol 2005;11:83-90. https://doi.org/10.1532/LH96.05019
  10. Lantis KL, Harris RJ, Davis G, Renner N, Finn WG. Elimination of instrument-driven reflex manual differential leukocyte counts. Optimization of manual blood smear review criteria in a high-volume automated hematology laboratory. Am J Clin Pathol 2003;119:656-62. https://doi.org/10.1309/VH1KMV8WB7GB7R14
  11. Hyun BH, Gulati GL, Ashton JK. Differential leukocyte count: manual or automated, what should it be? Yonsei Med J 1991;32:283-91.
  12. Swaim WR. Laboratory and clinical evaluation of white blood cell differential counts. Comparison of the Coulter VCS, Technicon H-1, and 800-cell manual method. Am J Clin Pathol 1991;95:381-8.
  13. Gulati G, Behling E, Kocher W, Schwarting R. An evaluation of the performance of Sysmex XE-2100 in enumerating nucleated red cells in peripheral blood. Arch Pathol Lab Med 2007;131:1077-83.
  14. Lee YK, Kang HJ, Kim YM, Won CY, Cho HC. Evaluation of the ABX Pentra DX 120 for the detection of immature cells in peripheral blood. J Lab Med Qual Assur 2008;30:249-58. (이영경, 강희정, 김영민, 원철연, 조현찬. 말초혈액의미성숙세포진단에있어자동혈구분석기 ABX Pentra DX 120의유용성평가. 임상검사와정도관리 2008;30:249-58.)
  15. Ruzicka K, Veitl M, Thalhammer-Scherrer R, Schwarzinger I. The new hematology analyzer Sysmex XE-2100: performance evaluation of a novel white blood cell differential technology. Arch Pathol Lab Med 2001;125:391-6.
  16. Peterson P, Blomberg DJ, Rabinovitch A, Cornbleet PJ. Physician review of the peripheral blood smear: when and why. An opinion. Lab Hematol 2001;7:175-9.