Revista Brasileira de Hematologia e Hemoterapia Revista Brasileira de Hematologia e Hemoterapia
Rev Bras Hematol Hemoter 2017;39:306-17 DOI: 10.1016/j.bjhh.2017.06.007
Original article
Evaluation of criteria of manual blood smear review following automated complete blood counts in a large university hospital
Samuel Ricardo Comar, , Mariester Malvezzi, Ricardo Pasquini
Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
Recebido 24 Março 2017, Aceitaram 20 Junho 2017
Relacionado:
Rev Bras Hematol Hemoter 2017;39:295-6
Abstract
Background

There is great interest in reducing the number of automated complete blood counts requiring manual blood smear reviews without sacrificing the quality of patient care. This study was aimed at evaluating and establishing appropriate screening criteria for manual blood smear reviews to improve the performance in a hematology laboratory.

Method

A total of 1977 consecutive samples from the daily workload were used to evaluate four sets of screening criteria for manual blood smear reviews to identify samples with positive smear findings. Three sets of screening criteria were arbitrarily proposed in this study: Group 1 (narrow ranges), Group 2 (intermediate ranges), and Group 3 (wide limits) and one set (Group 4) was adapted from the International Society for Laboratory Hematology. All samples were run on Sysmex hematology analyzers and were investigated using manual blood smear reviews. Diagnostic accuracy and agreement were performed for each set of screening criteria, including an investigation of microscopic review rate and efficiency.

Results

The microscopic review rates for Groups 1, 2, 3 and 4 were 73.85%, 54.52%, 46.33% and 46.38%, respectively; the false-negative rates were 0.50%, 1.97%, 2.73% and 3.95%, respectively. The efficiency and negative predictive values of Group 3 were 73.04% and 4.91%, respectively.

Conclusions

Group 3 had the best relationship between safety (false-negative rate: ≤3%) and efficiency to estimate the limits of automation in performing complete blood counts. This study strengthens the importance of establishing screening criteria for manual blood smear reviews, which account for the different contexts in which hematological determinations are performed. Each laboratory should optimize the screening criteria for manual blood smear reviews in order to maximize their efficiency and safety.

Keywords
Manual blood smear review, Complete blood counts, Criteria for manual blood smear review, Positive smear findings
Rev Bras Hematol Hemoter 2017;39:306-17 DOI: 10.1016/j.bjhh.2017.06.007