Quality Control Strategy for Automated CBC: A Laboratory Point of View Deducted from an Internal Study Organised in an Emergency Laboratory

Setting up an own laboratory performance-based internal quality control plan - a model for complete blood count

Quality Control (QC) in Romania is regulated by the Order of the Minister of Health no. 1608/2022 that modifies the previous Order 1301/2007. The new version of the Order introduces a more scientific approach by requesting the laboratories to assess test performance and then elaborate an appropriate internal QC plan. The aim of this study was to demonstrate how to design a QC plan for complete blood count (CBC) in an Emergency Laboratory with continuous activity, in order to comply with the new Order 1608/2022. QC data obtained over a three-month period (April-June 2022) from the Sysmex XN-1000 instrument of the Emergency Laboratory of the County Emergency Clinical Hospital of Târgu Mureș were included. In order to establish an appropriate QC plan, two models were applied and the following parameters were calculated: the number of daily QC runs (N), the probability of false rejection (Pfr), the QC frequency (run size), and the required QC rules. White blood cells achieved high performance, while Hematocrit performance was poor. Different levels of performance were achieved for Platelets. We emphasize that, when all parameters are measured on the same instrument, QC frequency and Pfr should be adjusted in order to develop a QC plan that “fits” all the parameters of the CBC as a whole. In our Emergency Laboratory, the calculated QC plan for CBC is N=2, Pfr=0.03, multi-rule 1:3s/2:2s/R:4s, and a run size of 95 samples which is approximately the same as the number of CBCs performed during one 12-hour shift.

Hematological indices reference intervals for a healthy Arab population in Qatar: Effect of age, gender, and geographic location

ABSTRACT

Hematologic reference intervals vary with gender, age, ethnicity, and geographic area. Therefore, local or national laboratory reference ranges are essential to enhance the accuracy when diagnosing health conditions. Still, no comprehensive list of reference ranges tailored to the Arab population living in Qatar. Accordingly, this study aims at establishing a hematology reference guide for Arabs in Qatar.This is a retrospective study where 750 healthy volunteers (18-69 years) from 2015 to 2019 were included, analyzed by an automated hematology analyzer. Arab adults were divided into African (Egypt, Libya, Tunisia, Morocco) and Asian (Syria, Lebanon, Jordon, Palestine, Qatar). The Cell-Dyn and Sysmex were used for measuring hematological parameters.The mean +/- 2SD were established for all the study groups. Arab males had significantly higher Hb, Hct, red cell distribution width, absolute neutrophil count, lymphocytes, and monocyte counts than females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes, and eosinophils than African Arabs. Asian-Arab young (>18: < 40 years) males had significantly higher Hb and lymphocytes and lower monocytes than older males (>40 years). African-Arab young males had significantly higher lymphocytes and lower monocytes than older males. Asian-Arab young females had higher WBC and absolute neutrophil count than older Asian Arabs.The findings of this study will help in establishing specific reference intervals in the Arab world. The differences in hematology reference intervals considering age, gender, and geographical location highlight the importance of establishing blood reference intervals in each country considering the ethnic diversity of each country.