The International Consensus Group for Hematology Review: Suggested Criteria for Action Following Automated CBC and WBC Differential Analysis

Clinical Hematology, Department of Laboratories, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Laboratory Hematology 02/2005; 11(2):83-90. DOI: 10.1532/LH96.05019
Source: PubMed


In the half century since the first use of automated analyzers, manual techniques, especially microscopic examination of a stained blood film, have complemented analyzer results to provide a comprehensive hematology report on a patient's blood sample. Over the years, as the capabilities and performance of automated analyzers have improved, the respective roles of the automated analyzer and the complementary procedures have changed. Manual action (most commonly smear review) following automated analyzer results is usually triggered by determining whether the results trigger one of a series of criteria for review of results. There is little uniformity among different laboratories on criteria for action. Recognizing the long-standing need for generally accepted guidelines ("rules") which could be applied to criteria for review of CBC and differential results from automated hematology analyzers, Dr. Berend Houwen invited 20 experts to a meeting in the Spring of 2002 to discuss the issues and determine the most appropriate criteria. At this meeting, 83 rules were developed by consensus agreement. These rules were then tested in 15 laboratories on a total of 13,298 blood samples. After a detailed analysis of the data, the rules were refined and consolidated to produce 41 rules that are presented here. They include rules for first-time samples as well as delta rules for repeat samples within 72 hours from a patient. It is hoped that these rules will be useful to a large number of hematology laboratories worldwide. To facilitate validating these rules in individual laboratories before implementation in routine operation for patient samples, a suggested protocol is attached to this paper.

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    • "Early studies evaluating the Technicon H-1E haematology analyser described cytogram abnormalities associated with specific morphological white blood cell changes [14,15]. In human patients, criteria for action following automated complete blood cell counts (CBCs) and white blood cell (WBC) differential analysis are more standardised and advanced than in veterinary medicine [16,17]. A large human multicentre study reviewing more than 90,000 CBCs from 263 institutions showed that manual reviews were performed in 16.2% of cases, including 6.5% manual blood film scans and 9.7% manual differential counts [11]. "
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    ABSTRACT: Background Modern automated haematology instruments are capable of performing leukocyte differentials faster, cheaper and with a higher precision than the traditional 100-cell manual differential count. Thus, in human laboratories, criteria are defined for performing a manual review of the blood smear resulting in a marked reduction of manual differential counts. While common in human laboratories, this approach to reducing the number of manual differentials in veterinary laboratories is still not commonly performed. Thus, our aim was to determine the rate and causes of manual leukocyte differentials in a university clinical pathology laboratory using the automated laser-based haematology analyser ADVIA 120. Overall, 14,953 complete blood cell counts from dogs, cats and horses were reviewed. Manual leukocyte differentials were requested if abnormal ADVIA peroxidase and baso cytograms were detected (i.e. suspicion of left shift or atypical lymphocytes/blasts, inappropriate separation of cell populations). Results In 21% of canine, 32% of feline and 20% of equine samples, a manual differential was requested. Indistinct separation of the cell population was present in 10% to 15% of the cases. Depending on the species, atypical lymphocytes were suspected in 2% to 12%, left shift in 13% to 25% and suspicion of blasts was present in less than 0.4% of the cases. Conclusions The obtained results are comparable to those published for human medicine and the rate of manual differentiation could be markedly reduced in veterinary laboratories if microscopic examination was used as a validation procedure rather than as a reflexive substitute for automated differentiation.
    Full-text · Article · Jun 2014 · BMC Veterinary Research
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    • "The majority of analyzers, however, are relatively ineffective in the proper recognition of abnormal cells [3], and therefore the instruments give "flag" messages when such cells are present in the blood. For this reason, manual WBC differential count by microscopy remains the current gold standard [4, 5]. "
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    ABSTRACT: Background We evaluated the efficacy of white blood cell (WBC) differential counts in severely leukopenic samples by the Hematoflow method and by automated hematology analyzers and compared the results with manual counts. Methods EDTA-anticoagulated blood samples (175 samples) with WBC counts of 40-990/µL were selected. Hematoflow differential counts were performed in duplicates employing flow cytometry using the CytoDiff reagent and analysis software. Differential counts were also performed using the DxH 800 (Beckman Coulter) and XE-2100 (Sysmex) automated hematology analyzers. The sum of the manual counts by a hematology technician and a resident were used as the manual counts. Results The total analysis time and hands-on time required by the Hematoflow method were shorter than those required by manual counting. Hematoflow counts were reproducible, showed a good correlation with automated analyzers, and also showed strong correlation with manual counts (r > 0.8) in neutrophils, lymphocytes, and monocytes. None of the cases containing less than 4% blasts as analyzed by the Hematoflow method had blasts in the manual counts, but 8 cases of 21 cases (38.1%) with over 4% blasts by Hematoflow had blasts in manual counts. Conclusion Hematoflow counts of severely leukopenic samples were reproducible and showed a good correlation with manual counts in terms of neutrophil, lymphocyte, and monocyte counts. The Hematoflow method also detected the presence of blasts. Manual slide review is recommended when over 4% blasts are found by Hematoflow.
    Full-text · Article · Jun 2014 · Blood Research
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    • "Les alarmes concernant les blastes et les lymphocytes atypiques sont importantes car ce sont des types de cellules anormales (Barnes et al., 2005), normalement absentes du sang périphérique (Buttarello & Plebani, 2008). Des globules blancs immatures tels que les blastes sont des indicateurs de leucémie (Wang & Dick, 2005). "
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    ABSTRACT: Sensibilité, spécificité et efficacité de l'analyseur UniCel® DxH 800™ pour la détection de blastes et de lymphocytes atypiques. Guido Vranken, Nathalie Henry et Niki Claes Les performances du système d'alarmes et l'efficacité clinique d'un analyseur d'hématologie sont des critères importants qui jouent un rôle décisif dans l'évaluation de ces dispositifs. L'efficacité clinique d'un analyseur d'hématologie est déter-minée en examinant si les spécimens pourvus d'alarmes montrent des anomalies lors d'une étude d'un frottis de sang périphérique. La différenciation manuelle d'un frottis sanguin est considérée comme la méthode de référence (Koepke et al., 2007) et est, dans la majorité des études, réalisée par deux morphologistes sur, soit 200, soit 400 cellules. Les critères d'anomalie sont définis par le Conseil international de standardisation en hématologie (ICSH) 1 . Dans ce rapport, nous nous concentrons sur l'efficacité clinique de l'analyseur UniCel ® DxH 800™ pour la détection de blastes et de lymphocytes atypiques. Les alarmes concernant les blastes et les lymphocytes atypiques sont importantes car ce sont des types de cellules anormales (Barnes et al., 2005), normalement absentes du sang périphérique (Buttarello & Plebani, 2008). Des globules blancs immatures tels que les blastes sont des indicateurs de leucémie (Wang & Dick, 2005). Des lymphocytes atypiques sont associés à des maladies virales telles que le VEB, le CMV, le virus 6 de l'herpès humain et à des infections parasitaires telles que la malaria, la toxoplasmose et la babésiose (Cunha, 2004). Trois articles récents ont donné des données suffisantes pour calculer la sensibilité, la spécificité et l'efficacité globales relatives aux blastes et seuls deux articles ont donné des données suffisantes pour estimer ces paramètres relatifs aux lymphocytes atypiques sur l'analyseur Coulter DxH 800.
    Full-text · Article · Oct 2013
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