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Hematology

Hematology, Microbiology

Malaria Testing Update

Effective June 1, 2016, Malaria testing will be updated. Recommended first line testing for suspected malaria is called Malaria Rapid Screen which is a combination of a rapid BinaxNow test in Hematology and a blood smear review in Microbiology. The BinaxNow test has a reported sensitivity of 97.7% and specificity of 94.2% for detection of P. falciparum species if a patient has a parasitemia level of over 5000 parasites/uL; sensitivity is lower for other malaria species. The BinaxNow test is not reported to cross react with babesia species. BinaxNow testing will be available for all shifts in Hematology at the Spectrum Health Regional Laboratory. The specimen requirements are unchanged from previous malaria testing. Previous test “Malaria Smear for Protozoa” will be discontinued. Continue Reading

Hematology

Complete Blood Count (CBC) with Differential

As of March 17, 2016, immature granulocyte percentage up to 5% will now be reported on CBC with automated differential, without requiring a manual differential to be performed, if all other parameters allow verification. This is a change from our previous rule requiring manual differential at 3% immature granulocytes. This change should improve turnaround time, especially for patients in the Emergency Department setting. Some providers find the immature granulocyte percentage useful as a part of their algorithm in patients with possible sepsis. Immature granulocytes include cell types metamyelocytes, myelocytes and promyelocytes.

Any questions concerning immature granulocyte percentage in CBC with diff should be directed to Dr. Jennifer Stumph, Director of Hematology.

Hematology

Peripheral Blood Smear Reminder

As of January 12, 2016, pathologist review of peripheral blood smear ordered without accompanying CBC with differential will reflex to adding on a CBC and/or differential in the laboratory. Blood specimens that do not have a slide prepared need to be less than 6 hours old for a pathologist review to be added on.

This is due to the fact that older blood does not smear well and morphology is compromised, especially red cell morphology. This allows for a complete documentation of the patient’s CBC and differential findings in the electronic medical record and standardizes our process among the regional hospitals.

Any questions concerning Peripheral Blood Smear reflexes should be directed to Dr. Jennifer Stumph, Director of Hematology.

Hematology, Test Utilization

Pathologist Review – Reason for Review

Pathologist review of peripheral blood smear (#8367) will have an additional required field to complete upon ordering. We are striving to improve our test utilization, inter-provider communication, and accurate and timely result reporting. Providers will see a choice of the top 10 to 15 reasons for review, including such reasons as “anemia evaluation” and “look for blasts”. An option for “other, see comment” is available for any free text comments to the pathologist.

This change is anticipated to begin for all electronic ordering of this test on February 4, 2016

Any questions concerning these changes may be directed to Dr. Jennifer Stumph, Director of Hematology.