Starting November 29th, 2022, Corewell Health West, Hematology Laboratories will begin reporting absolute counts for white blood cell (WBC) manual differentials, in addition to relative (percentage) counts. The WBC differential count determines the number of each type of white blood cell present in the blood. It can be expressed as a percentage or as an absolute value. Of these, the absolute value is much more important than the relative value, given that clinically relevant WBC elevations and declines are defined by their absolute numbers, not by their relative proportions, and there is potential for error if this conversion is performed outside the laboratory.
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Cell Count w/ Differential if indicated, Cerebrospinal Fluid [LAB2111025] and Cell Count with Differential, Cerebrospinal Fluid (Pediatric Oncology) [LAB212] currently result nucleated cell counts as a White Blood Cell (WBC) count.
Effective Tuesday, August 16, 2022, the WBC component will be removed and instead reported as a Total Nucleated Cell (TNC) Count for CSF.
Beginning Tuesday, January 4, 2022, Spectrum Health Laboratories will include an automated neutrophil (PMN) count on Cell Count with Differential, Body Fluid (LAB210) orders for peritoneal body fluids. This component will be displayed in Epic as an absolute PMN count, body fluid.
• The absolute PMN count in the peritoneal fluid is calculated by multiplying the total nucleated cell count by the percentage of PMNs in the differential.
• This calculation aids in the diagnosis of spontaneous bacterial peritonitis (SBP).
• The diagnosis of bacterial peritonitis is established by a positive peritoneal fluid bacterial culture and an elevated peritoneal fluid absolute PMN count (≥250 cells/uL).
• Epic will automatically calculate the absolute PMN count in peritoneal body fluids based on the manual differential data.
• This component ONLY calculates for Cell Count with Differentials (LAB210) on PERITONEAL BODY FLUIDS
Chemistry, Compliance & Safety, General Information, Hematology, Hemostasis/Coagulation, Microbiology, Referral/Sendouts
CSF Priorities on QNS Specimens
When a Cerebrospinal fluid (CSF) specimen arrives into the laboratory and is deemed Quantity Not Sufficient (QNS) for ordered testing, the ordering provider is contacted to identify testing priorities. Occasionally, the laboratory is unable to secure these priorities.
If the lab is unable to secure priorities from the ordering provider within an hour of collection, the following will occur:
1. We will move forward with the Cell count with differential, Culture, and Protein/Glucose
2. The rest of the ordered testing will hold until we can clarify the priorities
Laboratory is partnering with Epic Beaker to discover if a prioritization of orders, upon CSF order entry, is possible.
If you have questions or concerns, please use the “Contact Us” link above.
Effective February 24, 2021, Cerebrospinal Fluid (CSF) Xanthochromia results of “Present” will be considered a critical laboratory value.
This change was approved by the MEC and driven by a collaboration between neurology and laboratory departments to assist in expediting the diagnosis and management of patients with possible subarachnoid hemorrhage (SAH).
The Spectrum Health Regional Laboratory Hematology Department has updated rejection criteria for the orderables, Cell Count w/ Differential, Body Fluid and Cell Count, Body Fluid. Spectrum Health Hematology will no longer perform cell counts on specimens which are not from a sterile body cavity (e.g. wound drainage, abscess, pus, etc.). Unacceptable specimens submitted to the Hematology Department for cell counts will not be performed and the test will be credited.
For Hemoglobin A1c testing, Mayo Clinic Laboratory has switched to an Ion-Exchange High-Performance Liquid Chromatography (HPLC) method (Bio-RAD D100) which is the same method of A1c testing used at Spectrum Health Regional Laboratory. They no longer offer the alternative method, boronate affinity chromatography, for A1c testing.
When A1c cannot be determined due to interferences that affect the Bio-RAD 100 method, measurement of serum fructosamine is recommended (Mayo test FRUCT).
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.