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Process to Evaluate Hematological Parameters that Reflex to Manual Differential Cell Counts in a Pediatric Institution by Jeannette Guarner, Maria Ana Atuan, Barbara Nix, Christopher Mishak, Connie Vejjajiva, Cheri Curtis, Sunita Park, Richard Mullins

Background: Each institution sets specific parameters obtained by automated hematology analyzers to trigger manual counts. We designed a process to decrease the number of manual differential cell counts without impacting patient care.
Methods: We selected new criteria that prompt manual counts and studied the impact these changes had in 2 days of work and in samples of patients with newly diagnosed leukemia, sickle cell disease, and presence of left shift.
Results: By using fewer parameters and expanding our ranges we decreased the number of manual counts by 20 %. The parameters that prompted manual counts most frequently were the presence of blast flags and nucleated red blood cells, 2 parameters that were not changed. The parameters that accounted for a decrease in the number of manual counts were the white blood cell count and large unstained cells. Eight of 32 patients with newly diagnosed leukemia did not show blast flags; however, other parameters triggered manual counts. In 47 patients with sickle cell disease, nucleated red cells and red cell variability prompted manual review. Bands were observed in 18% of the specimens and 4 % would not have been counted manually with the new criteria, for the latter the mean band count was 2.6 %.
Conclusions: The process we followed to evaluate hematological parameters that reflex to manual differential cell counts increased efficiency without compromising patient care in our hospital system.

DOI: Clin. Lab. 2010;56:21-27