title: Process to evaluate hematological parameters that reflex to manual differential cell counts in a pediatric institution.
abstract: 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.
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA. jguarne@emory.edu
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Maria Ana
authors.initials: MA
authors.lastname: Atuan
authors.forename: Barbara
authors.initials: B
authors.lastname: Nix
authors.forename: Christopher
authors.initials: C
authors.lastname: Mishak
authors.forename: Connie
authors.initials: C
authors.lastname: Vejjajiva
authors.forename: Cheri
authors.initials: C
authors.lastname: Curtis
authors.forename: Sunita
authors.initials: S
authors.lastname: Park
authors.forename: Richard
authors.initials: R
authors.lastname: Mullins
mesh_terms: D000755:Anemia, Sickle Cell / Q000097:blood / Q000473:pathology; D020811:Biomedical Technology / Q000379:methods*; D001752:Blast Crisis / Q000097:blood / Q000473:pathology; D001772:Blood Cell Count / Q000379:methods*; D002648:Child; D004906:Erythrocyte Count / Q000379:methods; D004912:Erythrocytes / Q000473:pathology; D006776:Hospitals, Pediatric; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000473:pathology; D007958:Leukocyte Count / Q000379:methods; D018655:Lymphocyte Count; D009369:Neoplasms / Q000097:blood; D009195:Peroxidase / Q000097:blood
chemical_list: D009195:Peroxidase