Educational cost-effective intervention to reduce pathologist’s peripheral blood smears reviews with non-contributory findings: an academic institution experience

2021 ◽  
pp. jclinpath-2021-207905
Author(s):  
Trang K Lollie ◽  
Robyn Parks ◽  
Lissette Bakic ◽  
Alyssa Ziman ◽  
Sheeja Pullarkat
Keyword(s):  
Peripheral Blood ◽  
Complete Blood Count ◽  
Clinical Information ◽  
Cost Effective ◽  
Peripheral Blood Smear ◽  
Order System ◽  
Resource Utilisation ◽  
Differential Count ◽  
Laboratory Staff ◽  
Peripheral Blood Smears

Peripheral blood smear (PBS) review by a pathologist is a necessary and invaluable diagnostic tool. However, innovative highly sophisticated haematology analysers that flag peripheral blood abnormalities have decreased the need for a PBS review. Ordering practices including PBS reviews lumped as part of an ‘order set’ or with complete blood count (CBC) constituted most PBS requests at our institution. A retrospective review of all PBS review orders from 1 April 2016 to 31 January 2017 was performed to investigate the ordering practices at our institution. A total of 2864 PBS were ordered during the above study period. In many cases, the PBS report did not add any significant clinical information beyond that acquired by the CBC and differential count. These findings inspired policy changes within our institution for pathologist PBS reviews. Within the electronic order system, all PBS orders for inpatients were linked to a pop-up window with criteria for peripheral smear review and instructions on the approval policy. Outpatient orders required clinicians to request pathology approval. This implementation reduced total number of PBS orders by 42.5% with no adverse effect on patient management. Empowering pathologists and clinicians with guidelines on PBS review orders is a beneficial educational exercise of resource utilisation. Discussion with physicians regarding clinical indications reduces non-contributory PBS reviews, provides guidance to appropriate testing, and aptly allocates pathologist and laboratory staff time and resources.

scholarly journals Clinician-ordered peripheral blood smears have low reimbursement and variable clinical value: a three-institution study, with suggestions for operational efficiency

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Amy K. Beckman ◽  
Valerie L. Ng ◽  
David L. Jaye ◽  
Manila Gaddh ◽  
Sarah A. Williams ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Complete Blood Count ◽  
Clinical Value ◽  
Laboratory Staff ◽  
Clinical Scenarios ◽  
Blood Smears ◽  
Peripheral Blood Smears

Abstract Background Peripheral blood smears are performed to evaluate a variety of hematologic and non-hematologic disorders. At the authors’ institutions, clinician requests for pathologist-performed blood smear reviews have increased in recent years. Blood smears may contribute significantly to pathologists’ workloads, yet their clinical value is variable, and professional reimbursement rates are low. This study aimed to identify clinical scenarios in which smear review is likely to provide value beyond automated laboratory testing. Methods Blood smear review practices at three institutions were examined, and the indications for and interpretations of clinician-initiated smears were reviewed to determine the percentage of smears with potential added clinical value. A smear review was classified as having added clinical value if the pathologist’s interpretation included a morphologic abnormality that had the potential to impact patient management, and that could not be diagnosed by automated complete blood count with white blood cell differential or automated iron studies alone. Results Among 515 consecutive clinician-requested smears performed during the study timeframes, 23% yielded interpretations with potential added clinical value. When sorted by indication, 25, 19, and 13% of smear reviews requested for white blood cell abnormalities, red blood cell abnormalities, and platelet abnormalities, respectively, had findings with potential added clinical value. The proportion of smears with potential clinical value differed significantly across these three categories (p = 0.0375). Conclusions Smear review ordering practices across three institutions resulted in a minority of smears with potential added clinical value. The likelihood of value varied according to the indication for which the smear was requested. Given this, efforts to improve the utilization and efficiency of smear review are worthwhile. Solutions are discussed, including engaging laboratory staff, educating clinicians, and modifying technology systems.

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

2006 ◽  
Vol 130 (5) ◽  
pp. 596-601 ◽  
Author(s):  
David A. Novis ◽  
Molly Walsh ◽  
David Wilkinson ◽  
Mary St. Louis ◽  
Jonathon Ben-Ezra
Keyword(s):  
Peripheral Blood ◽  
Blood Count ◽  
Complete Blood Count ◽  
The United States ◽  
Differential Count ◽  
Cell Parameters ◽  
Blood Smears ◽  
Peripheral Blood Smears ◽  
Manual Review ◽  
Differential Counts

Abstract Context.—Automated laboratory hematology analyzers are capable of performing differential counts on peripheral blood smears with greater precision and more accurate detection of distributional and morphologic abnormalities than those performed by manual examinations of blood smears. Manual determinations of blood morphology and leukocyte differential counts are time-consuming, expensive, and may not always be necessary. The frequency with which hematology laboratory workers perform manual screens despite the availability of labor-saving features of automated analyzers is unknown. Objective.—To determine the normative rates with which manual peripheral blood smears were performed in clinical laboratories, to examine laboratory practices associated with higher or lower manual review rates, and to measure the effects of manual smear review on the efficiency of generating complete blood count (CBC) determinations. Design.—From each of 3 traditional shifts per day, participants were asked to select serially, 10 automated CBC specimens, and to indicate whether manual scans and/or reviews with complete differential counts were performed on blood smears prepared from those specimens. Sampling continued until a total of 60 peripheral smears were reviewed manually. For each specimen on which a manual review was performed, participants indicated the patient's age, hemoglobin value, white blood cell count, platelet count, and the primary reason why the manual review was performed. Participants also submitted data concerning their institutions' demographic profiles and their laboratories' staffing, work volume, and practices regarding CBC determinations. The rates of manual reviews and estimations of efficiency in performing CBC determinations were obtained from the data. Setting.—A total of 263 hospitals and independent laboratories, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program. Results.—There were 95 141 CBC determinations examined in this study; participants reviewed 15 423 (16.2%) peripheral blood smears manually. In the median institution (50th percentile), manual reviews of peripheral smears were performed on 26.7% of specimens. Manual differential count review rates were inversely associated with the magnitude of platelet counts that were required by laboratory policy to trigger smear reviews and with the efficiency of generating CBC reports. Lower manual differential count review rates were associated with laboratory policies that allowed manual reviews solely on the basis of abnormal automated red cell parameters and that precluded performing repeat manual reviews within designated time intervals. The manual scan rate elevated with increased number of hospital beds. In more than one third (35.7%) of the peripheral smears reviewed manually, participants claimed to have learned additional information beyond what was available on automated hematology analyzer printouts alone. Conclusion.—By adopting certain laboratory practices, it may be possible to reduce the rates of manual reviews of peripheral blood smears and increase the efficiency of generating CBC results.

scholarly journals Pathophysiology, Diagnosis and Treatment of Immune Thrombocytopenia

2017 ◽  
Vol 5 (1) ◽  
pp. 32-36
Author(s):  
Mihnea-Alexandru Găman ◽  
Amelia Maria Găman
Keyword(s):  
Peripheral Blood ◽  
Immune Thrombocytopenia ◽  
Blood Count ◽  
Complete Blood Count ◽  
Anabolic Steroids ◽  
Peripheral Blood Smear ◽  
Intravenous Immunoglobulins ◽  
First Line Therapy ◽  
Anti Cd20 ◽  
Immunosupressive Therapy

Immune thrombocytopenia (ITP) is an acquired disorder characterized by isolated thrombocytopenia with a peripheral blood count < 100.000/ mm3 in the absence of any obvious initiating or underlying causes, by antibody mediated destruction of platelets and suppression of megakaryocyte and platelet production on the basis of immune deregulation. ITP is idiopathic (primary) in 80% of cases and secondary to several associated disorders in 20% of cases. A diagnosis of exclusion, based on patient history, physical examination, complete blood count and examination of the peripheral blood smear, is used for ITP. The treatment of ITP is indicated in adult patients with platelet counts below 20.000-30.000/ mm3, with bleedings or risk for bleeding. First line therapy is represented by corticosteroids, intravenous immunoglobulins and intravenous anti-RhD. Second-line treatment is represented by: splenectomy, inhibition of the monocytic phagocytic system therapy, immunosupressive therapy, anabolic steroids, anti-CD20 therapy, and thrombopoietin receptor agonists.

scholarly journals An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

2018 ◽  
Vol 38 (6) ◽  
pp. 512-517
Author(s):  
Young-gon Kim ◽  
Jung Ah Kwon ◽  
Yeonsook Moon ◽  
Seong Jun Park ◽  
Sangwook Kim ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Blood Count ◽  
Blood Smear ◽  
Complete Blood Count ◽  
Peripheral Blood Smear ◽  
Draft Report

scholarly journals LEUKEMIA SEL BERAMBUT

2018 ◽  
Vol 19 (2) ◽  
pp. 132
Author(s):  
Reini Meilani Isbach ◽  
Agus Alim Abdullah ◽  
Mansyur Arif
Keyword(s):  
Peripheral Blood ◽  
Disease Onset ◽  
Peripheral Blood Smear ◽  
Cell Leukaemia ◽  
Definite Diagnosis ◽  
Hairy Cell ◽  
Blood Smears ◽  
Laboratory Results ◽  
Hairy Cells ◽  
Peripheral Blood Smears

Hairy cell leukaemia (HCL) is a neoplastic disorder of B lymphocytes originally described by Bouroncle et al. in 1958. HCL clinicalmanifestations varies, generally characterized by various degrees of splenomegaly, pancytopenia, or emphasis only on the two cell lines(bisitopenia), with the hairy cells in varying amounts in the peripheral blood smear and bone marrow. HCL is a very rare case, there areonly about 2% of all leukaemias more frequently in men than women (4:1) with the average age of disease onset between 50–55 years.The etiology of HCL is still not known. A case of HCL Leukaemia in a female patient, aged 55 years is reported which was a rare case.HCL diagnosis in this patient was based on the clinical manifestation (splenomegaly), and laboratory results (bisitopenia, neutropeniaand monositopenia) and about 80% hairy cells were found in peripheral blood smears. Definite diagnosis of HCL should be made by bonemarrow examination, immunophenotyping and cytogenesis.

scholarly journals Deep Optical Blood Analysis: COVID-19 Detection as a Case Study in Next Generation Blood Screening

2021 ◽  
Author(s):  
Colin L Cooke ◽  
Kanghyum Kim ◽  
Shiqi Xu ◽  
Amey Chaware ◽  
Xing Yao ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cell Morphology ◽  
Peripheral Blood ◽  
Peripheral Blood Smear ◽  
Cell Types ◽  
Multiple Instance Learning ◽  
Blood Analysis ◽  
Learning Approaches ◽  
Diagnostic Efficacy ◽  
Peripheral Blood Smears

A wide variety of diseases are commonly diagnosed via the visual examination of cell morphology within a peripheral blood smear. For certain diseases, such as COVID-19, morphological impact across the multitude of blood cell types is still poorly understood. In this paper, we present a multiple instance learning-based approach to aggregate high-resolution morphological information across many blood cells and cell types to automatically diagnose disease at a per-patient level. We integrated image and diagnostic information from across 236 patients to demonstrate not only that there is a significant link between blood and a patient's COVID-19 infection status, but also that novel machine learning approaches offer a powerful and scalable means to analyze peripheral blood smears. Our results both backup and enhance hematological findings relating blood cell morphology to COVID-19, and offer a high diagnostic efficacy; with a 79% accuracy and a ROC-AUC of 0.90.

scholarly journals Quick Leukocyte Nucleus Segmentation in Leukocyte Counting

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Yapin Wang ◽  
Yiping Cao
Keyword(s):  
Real Time ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Color Space ◽  
Peripheral Blood Smear ◽  
The Difference ◽  
Leukocyte Segmentation ◽  
Peripheral Blood Smears ◽  
Key Techniques ◽  
Nucleus Segmentation

The leukocyte nucleus quick segmentation is one of the key techniques in leukocyte real-time online scanning of human blood smear. We propose a quick leukocyte nucleus segmentation method based on the component difference in RGB color space. By analyzing the captured microscopic images of the peripheral blood smears from the autoscanning microscope, it is found that the difference values between B component and G component (B−G values) in the regions of the leukocyte nuclei and the platelets are much bigger than those in the other regions, even in the regions including the stains. So, the B−G values can segment the leukocyte nuclei and the platelets with an appropriate empirical threshold because the platelets are much smaller than the leukocyte nuclei, so the leukocyte nuclei can be segmented by size filtering. Also, only an 8 bit subtraction operation is performed for the B−G values, and it can improve the leukocyte nucleus segmentation speed significantly. Experimental results show that the proposed method performs well for the five types of leukocyte segmentation with a quick speed. It is very suitable for the real-time peripheral blood smear autoscanning test application. In addition, the five types of leukocytes can be counted accurately.

scholarly journals Flow Cytometric, Morphologic, and Laboratory Comparative Study in Patients With Leukocytosis and Cytopenia

2019 ◽  
Vol 153 (2) ◽  
pp. 266-273
Author(s):  
Estafani Rivas ◽  
Fred V Plapp ◽  
Wei Cui
Keyword(s):  
Flow Cytometry ◽  
Peripheral Blood ◽  
Screening Test ◽  
Hematologic Malignancy ◽  
Cost Effective ◽  
Effective Screening ◽  
Flow Cytometric ◽  
Blood Smears ◽  
History Of ◽  
Peripheral Blood Smears

Abstract Objectives We wanted to evaluate the effectiveness of flow cytometry immunophenotyping (FCI) as a screening test for patients with leukocytosis and cytopenia. Methods We identified 320 patients during August 2016 to December 2016 and evaluated FCI and morphology of peripheral blood smears (PBSs). Results The most common indications for FCI included history of hematologic malignancy (HHM, n = 126), leukocytosis (n = 80), and cytopenia (n = 53). Positive FCI rate was low with a range of 4.4% to 12.5% in patients with absolute neutrophilia regardless of HHM, if cases with circulating blasts were excluded. Patients with absolute lymphocytosis had a 93% positive FCI rate. Patients with HHM and pancytopenia showed a higher incidence of positive FCI findings than patients without HHM and with isolated cytopenia. PBS morphology correlated strongly with FCI (P = .0001). Conclusion PBS evaluation is an accurate and cost-effective screening test. FCI for patients with mature neutrophilia and isolated cytopenia has a very low yield.

scholarly journals Evaluation of EDTA induced pseudothrombocytopenia and the effect of alternative anticoagulants

2014 ◽  
Vol 4 (8) ◽  
pp. 626-629
Author(s):  
A Shrestha ◽  
S Karki
Keyword(s):  
Platelet Count ◽  
Peripheral Blood ◽  
Peripheral Blood Smear ◽  
Institute Of Medicine ◽  
Platelet Counts ◽  
Blood Smears ◽  
Low Platelet Count ◽  
The Mean ◽  
Correct Estimation ◽  
Peripheral Blood Smears

Background: Artifactual Thrombocytopenia is a condition in which there is falsely lowered platelet in patients who have thrombocytopenia but the absence of petechiae or echymoses. Pseudothrombocytopenia is also an artifactual thrombocytopenia caused by anticoagulant dependent agglutinins. The aim of this study was to compare the platelet count in pseudothrombocytopenia in EDTA anticoagulated samples and other alternative anticoagulants.Materials and methods: This study was performed in the department of hemotology hematology, Institute of medicine. All cases during study period were evaluated by EDTA-anticoagulated whole blood samples but criteria for selecting pseudothrombocytopenia patients was unexpectedly low platelet counts with clumping/aggregate on peripheral blood smear. Additional samples were collected in sodium citrate and heparin for examined.Results: A total of 50 patients aged between 18 to 90 years were found to have pseudothrombocytopenia. Platelet counts in samples anticoagulated with EDTA ranged from 20x109/l to 149x109/l and samples from same patients anticoagulated with citrate ranged from 41x109 /l to 312x109 /l and heparin showed platelet count ranging from 29x10 9 /l to 210x109 /l. The mean platelet count in EDTA- anticoagulated blood of individuals with pseudothrombocytopenia was 104x109/l whereas the mean platelet count in citrate and heparin-anticoagulated samples was 151x109/land123x109/l respectively. Platelet counts decreased dramatically in the EDTA samples in contrast to the samples anticoagulated with citrate or heparin post four hours of collection.Conclusion: Peripheral blood smears should be examined for platelet clumping/aggregates in cases with low platelet count not correlating with clinical presentation or in isolated thrombocytopenia flagged in hematology analyser. Alternative anticoagulants should be used for correct estimation of platelet count.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11498 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 626-629

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