High sensitivity flow cytometry testing for paroxysmal nocturnal hemoglobinuria (PNH) is a test done on patient’s peripheral blood to screen for the presence or absence of PNH clones and/or to follow PNH clonal populations. The lower limit of detection of a PNH clone for the Spectrum Health laboratory has been validated as 0.01% (1:10,000) for red cells, 0.01% (1:10,000) for granulocytes and 0.1% for monocytes (1:1000).
The results from PNH flow cytometry testing can guide the clinical team in classifying a patient’s disease appropriately, analyzing the risk of disease progression, and choosing appropriate testing to monitor response to treatment. Therefore, the PNH flow cytometry test result will now include a pathologist’s interpretation based on the new recommendations given in Updated ICCS/ESCCA Consensus Guidelines for the Clinical Utility of Testing for GPI-Anchor Deficient Clones in Paroxysmal Nocturnal Hemoglobinuria (PNH) and other Bone Marrow Disorders (Accepted article by Dezern and Borowitz, doi: 10.1002/cyto.b.21608).
The Spectrum Health Flow Cytometry Laboratory is pleased to announce that it has attained status as a Children’s Oncology Group (COG) approved laboratory for minimal residual disease (MRD) testing for patients with B lymphoblastic leukemia (B-ALL). This is a reflection of the expertise and dedication of the entire flow cytometry team to accomplish this 3-year project. It also highlights the strong support and collaboration between the laboratory and pediatric hematology oncology team.
As of 1/1/2017, the Flow Cytometry Laboratory at Spectrum Health Advanced Technology Laboratories will no longer accept specimens on hold. The orderable “Cell Hold by Flow Cytometry“ has been queued for inactivation. If a sample is received on hold after 1/1/2017, the ordering provider will be contacted for clarification, and appropriate testing will be performed based on the type of sample received.
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.
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.
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.