Bone marrow cytogenetics workup: Application of lean management system to determine if additional cell workup is helpful and necessary to analysis.
BACKGROUND
High workload volumes in a Cytogenetics laboratory can lead to long result turn-around times (TAT). This study aimed to improve laboratory efficiency by adopting Lean Management System initiatives to increase productivity through the elimination of wastes. This study examined if the prerequisite 20-cell analysis was sufficient for a conclusive result or if additional cell workup was necessary to ascertain the presence of a previous chromosome abnormality among cases on follow-up, or when a single abnormal cell was encountered during the analysis to determine the presence of a clone.


METHODS
The karyotype results of cases that had additional workup were retrieved from among 8040 bone marrow cases of various haematological disorders performed between June 2003 and June 2008.


RESULTS
Of 8040 cases analysed, 2915 cases (36.3%) had additional cell workup. Only 49 cases (1.7%) led to the establishment of a clone. The majority of these cases could have been resolved without the additional workup, especially if fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR)-based assays had been utilised.


CONCLUSIONS
This study shows that the additional workup procedure is redundant. The time saved by discontinuing the workup procedure can be used to analyse other cases, leading to increased laboratory efficiency and a faster TAT without compromise to patient care. The practice of additional workup over and above the 20- cell analysis should be dispensed with as little benefit was derived for the amount of additional manpower expended. FISH or PCR-based assays should be utilised to elucidate a case further.
Department of Pathology, Singapore General Hospital, Singapore. alvin.lim.s.t@sgh.com.sg
Alvin S T
AS
Lim
Ting Jie
TJ
Chen
Tse Hui
TH
Lim
Mary
M
Tan
Lai Ching
LC
Lau
Ping
P
Lim
Geok Yee
GY
Lee
Li Eng
LE
Loo
Fiona P S
FP
Liaw
Charles T H
CT
Chuah
Yeow Tee
YT
Goh
Sim Leng
SL
Tien
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow; D001854:Bone Marrow Cells; D003582:Cytogenetics; D004526:Efficiency; D017598:Efficiency, Organizational; D005260:Female; D006402:Hematologic Diseases / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000295:instrumentation / Q000379:methods; D007621:Karyotyping / Q000295:instrumentation / Q000379:methods; D008297:Male; D016133:Polymerase Chain Reaction