Evaluation and optimization of the extended information process unit (E-IPU) validation module integrating the sysmex flag systems and the recommendations of the French-speaking cellular hematology group (GFHC)

Abstract

The French-Speaking Cellular Haematology Group (GFHC) recently published criteria for microscopic analysis of a blood smears when a hemogram is requested. In order to evaluate and improve these recommendations using an XN (Sysmex) analyzer, we assessed 31,836 samples categorized into two sub-groups of patients either receiving or not receiving care in the clinical hematology/oncology departments of two university hospitals. By combining the manufacturer’s recommendations and the GFHC recommendations, 21.3% of samples had a positive review flag in phase 1 of our study (17,991 samples). In phase 2 (13,845 samples), increasing the immature granulocytes (IG) percentage from 5–10% as a review trigger threshold, and ignoring slides with isolated flags ‘PLT HIGH’ (thrombocytosis) or ‘MCV LOW’ (microcytosis) or ‘Blast/Abn Lymph and Atypical Lymph’ (blast cells/abnormal lymphocytes and atypical lymphocytes) (in the absence of abnormal cells on a previous blood smear within 72 h), enabled us to significantly reduce the number of slides reviewed from 21.3–15.0% (p < 0.0001), without loss of clinical value. This decrease occurred in both sub-groups (hematology 48.7–38.0%, non-hematology 18.3–11.7%, p < 0.0001). In conclusion, the application of the GFHC criteria adapted to XN analyzers has enabled us to optimize the hematology laboratory processes, and thus reduce the production costs and the turnaround time of hemogram results.

Keywords:

• Analytical techniques
• automated blood counts
• decision support systems
• evidence-based laboratory medicine
• hematology
• hematologic diseases
• laboratory management
• laboratory routines and automation
• laboratory standardization
• management
• medical biochemistry
• microscopy

Acknowledgements

The authors thank Dr Françoise Schillinger (French Blood Agency Bourgogne Franche Comté, Molecular haematology-immunology-biology laboratory, Besançon, France) for the communication of data and results concerning the monocytosis care, as well as the technical teams of the hematology laboratories of CHU Caen and CHU UCL Namur for the handling of samples and the collection of the evaluation results, Gabi Bauer, Susanne Prinz and Jean-Pierre Pérol (Sysmex Europe) are also thanked for setting up validation rules in the validation module and support in its use.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.