Clinical Pathology Laboratories (CPL) is committed to providing effective, appropriate, and timely patient care by ensuring that our testing reflects medical standards and current guidance. In an audit of our hematology processes, we identified a quality improvement opportunity concerning ordering, timeliness, and resource utilization for the complete blood count (CBC) Unit Code 1007, CBC WITH MANUAL DIFFERENTIAL and Unit Code 1001, MANUAL DIFFERENTIAL. These Unit Codes require a manual WBC differential on a CBC, even if not indicated for qualitative or quantitative abnormalities identified by analyzer expert systems or department procedures. WBC differentials performed by automated instrumentation at CPL offer higher precision, superior turnaround time, and improved clinical sensitivity in distinguishing normal from abnormal samples when compared to manual testing.
Effective July 10, 2023, Unit Code 1007, CBC WITH MANUAL DIFFERENTIAL and Unit Code 1001, MANUAL DIFFERENTIAL will be designated as CBC W/AUTO DIFF RFLX SMEAR REVIEW and AUTO DIFF REFLEX SMEAR REVIEW, respectively. The hematology lab will perform and report an automated WBC differential, unless automated flagging or procedure determine that a manual differential is required. When the data identifies an abnormality requiring a smear review, a manual differential will be performed and any morphologic abnormalities will be reported. If the findings meet laboratory-established criteria for pathologist review, the slide will be reviewed by a hematopathologist who will report significant findings, provide interpretation, and recommend further studies as appropriate. This change will improve timely reporting of essential and complete hematology data. The laboratory welcomes clinician requests for smear reviews to address clinical or analytic concerns. For more information, please contact your local CPL office and/or account representative.
|CBC WITH MANUAL DIFFERENTIAL
|CBC W/AUTO DIFF RFLX SMEAR REVIEW
|AUTO DIFF REFLEX SMEAR REVIEW
- Pierre RV. Peripheral blood film review. Clin Lab Med. 2002; 22(1):279-297.
- M. E. Kurt-Mangold et al. Clinical Utility of Ordered Pathology Blood Smear Reviews - an Overused Resource? Clin. Lab. 2018; 64.
- B. Bain Diagnosis from Blood Smear N Engl J Med 2005; 353:498-507