Use of Patient Samples for Quality Control in Hemogram
An Experience from a Tertiary Care Centre in Southern India
Keywords:
Hemogram, Patient sample, Quality control, Levey – Jennings chart
Abstract
Background: Quality control (QC) is an integral part of hematology practice. Various commercial controls are available and routinely used. A complementary method is to use patient sample in various ways especially in a resource limited setup. Methods: This study was performed in a tertiary care hospital in southern India with 12 laboratories, four using hematology cell counters and eight other smaller side-labs performing Hemoglobin (Hb) estimation by Sahli's or Drabkin's method. The QC tests performed using patient samples were: a. Daily - Average of numbers (AON) of RBC indices of 250-270 samples. These were compared with Levey-Jennings (LJ) charts of commercial controls b. Weekly - Replicate Test (RT) using a single sample for various levels of Hb, WBC and platelet counts; Duplicate Test (DT) using 10 samples; Correlation Check (CC) of 10 samples and Weekly AON c. Monthly - Deviation Index (DI) using one sample for inter-method/ instrument comparability among participating labs. Result: In daily AON, the graphs of RBC indices did not show significant difference with LJ charts of commercial controls. The co-efficient of variation in RT for various levels of Hb, WBC and platelet counts were in the acceptable range. The precision was higher for Hb and least for low platelet counts. In DT, an occasional random error was detected. In CC, monocytosis flag did not correlate with peripheral smear findings 66.6% times. The DI using z-score showed satisfactory performance among various labs. Conclusion: Use of patients' blood sample was helpful for internal QC and inter-method/ instrument comparability.References
1. Greer JP, Arber DA, Paraskevas F. Examination of the Blood and Bone Marrow. In: Greer JP, Arber DA, et.al.editors. Wintrobe’s Clinical Hematology. Philadelphia: 2013.pp.1-45.
2. Cembrowski GS, Lunetzky ES, Patrick CC and Wilson MK. An optimized quality control procedure for hematology analyzers with the use of retained patient specimens. Am J ClinPathol. 1988 Feb;89(2):203-10
3. Lewis, Shirley Mitchell & World Health Organization. Health Laboratory Technology and Blood Safety Unit. (1998). Quality assurance in haematology / by S.M. Lewis. Geneva: World Health Organization. http://www.who.int/iris/handle/10665/60141
4. West M, Corrons JV. Quality Assurance. In: Bain BJ, Bates I, Laffan MA, Lewis SM, editors. Dacie and Lewis Practical Hematology. Edinburgh: Elsevier; 2011.pp.592-8.
5. Buttarello M. Quality specification in haematology: the automated blood cell count. ClinChimActa. 2004; 346:45-54.
6. Hu X, Li Y, Xu L, Wu J, Huang Y, Song Y, et al. Study on the accuracy of automated hematology analyzers in Shanghai. Southeast Asian J Trop Med Public Health. 2002; 33:1-5.
7. Cembrowski GS, Smith B and Tung D. Rationale for using insensitive quality control rules for today’s hematology analyzers. Int J Lab Hematol. 2010; 32:606–15.
8. Briggs C, Longair I, Kumar P, Singh D and Machin SJ. Performance evaluation of the Sysmex haematology XN modular system. J Clin Pathol. 2012; 65:1024-30.
9. Saxena R, Kucheria K, Tyagi S and Sazawal S. Quality Control. In Saxena R, Pati HP, editors. Laboratory Techniques in Hematology. New Delhi: Jaypee; 2008. Pp384-92.
10. Briggs CJ, Linssen J, Longair I and MachinSJ. Improved flagging rates on the Sysmex XE-5000 compared with the XE-2100 reduce the number of manual film reviews and increase laboratory productivity. Am J ClinPathol. 2011; 136:309-16.
11. Hill VL, Simpson VZ, Higgins JM, Hu Z, Stevens RA, Metcalf JA, et al. Evaluation of the performance of the SYSMEX XT-2000i Hematology Analyzer with the whole bloods stored at room temperature. Lab Med. 2009; 40:709-18.
12. Fernandes B and Hamaguchi Y. Automated enumeration of immature granulocytes. Am J ClinPathol. 2007; 128:454-63.
13. Singh T. Automation in Cell Counts, Hemoglobin Separation, Immunophenotyping and Coagulation. In: Atlas and Text of Hematology. Avichal, 2014.Pp.53-61.
14. Min WK, Ko DH, Cho EJ, Jeong TD, Lee W, Chun S, et al. A novel quantitative evaluation method for quality control results. ClinChimActa. 2015; 451:175-9.
15. Park SH, Park CJ, Kim MJ, Choi MO, Han MY, Cho YU, et al. Development and validation of effective real-time and periodic inter instrument comparison method for automatic hematology analyzers. Am J ClinPathol. 2014; 142:777-87.
2. Cembrowski GS, Lunetzky ES, Patrick CC and Wilson MK. An optimized quality control procedure for hematology analyzers with the use of retained patient specimens. Am J ClinPathol. 1988 Feb;89(2):203-10
3. Lewis, Shirley Mitchell & World Health Organization. Health Laboratory Technology and Blood Safety Unit. (1998). Quality assurance in haematology / by S.M. Lewis. Geneva: World Health Organization. http://www.who.int/iris/handle/10665/60141
4. West M, Corrons JV. Quality Assurance. In: Bain BJ, Bates I, Laffan MA, Lewis SM, editors. Dacie and Lewis Practical Hematology. Edinburgh: Elsevier; 2011.pp.592-8.
5. Buttarello M. Quality specification in haematology: the automated blood cell count. ClinChimActa. 2004; 346:45-54.
6. Hu X, Li Y, Xu L, Wu J, Huang Y, Song Y, et al. Study on the accuracy of automated hematology analyzers in Shanghai. Southeast Asian J Trop Med Public Health. 2002; 33:1-5.
7. Cembrowski GS, Smith B and Tung D. Rationale for using insensitive quality control rules for today’s hematology analyzers. Int J Lab Hematol. 2010; 32:606–15.
8. Briggs C, Longair I, Kumar P, Singh D and Machin SJ. Performance evaluation of the Sysmex haematology XN modular system. J Clin Pathol. 2012; 65:1024-30.
9. Saxena R, Kucheria K, Tyagi S and Sazawal S. Quality Control. In Saxena R, Pati HP, editors. Laboratory Techniques in Hematology. New Delhi: Jaypee; 2008. Pp384-92.
10. Briggs CJ, Linssen J, Longair I and MachinSJ. Improved flagging rates on the Sysmex XE-5000 compared with the XE-2100 reduce the number of manual film reviews and increase laboratory productivity. Am J ClinPathol. 2011; 136:309-16.
11. Hill VL, Simpson VZ, Higgins JM, Hu Z, Stevens RA, Metcalf JA, et al. Evaluation of the performance of the SYSMEX XT-2000i Hematology Analyzer with the whole bloods stored at room temperature. Lab Med. 2009; 40:709-18.
12. Fernandes B and Hamaguchi Y. Automated enumeration of immature granulocytes. Am J ClinPathol. 2007; 128:454-63.
13. Singh T. Automation in Cell Counts, Hemoglobin Separation, Immunophenotyping and Coagulation. In: Atlas and Text of Hematology. Avichal, 2014.Pp.53-61.
14. Min WK, Ko DH, Cho EJ, Jeong TD, Lee W, Chun S, et al. A novel quantitative evaluation method for quality control results. ClinChimActa. 2015; 451:175-9.
15. Park SH, Park CJ, Kim MJ, Choi MO, Han MY, Cho YU, et al. Development and validation of effective real-time and periodic inter instrument comparison method for automatic hematology analyzers. Am J ClinPathol. 2014; 142:777-87.
Published
2019-06-24
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