Validation of the International Consensus Group Criteria for Slide Review Following Automated Complete Blood Count at Jimma Medical Center, Ethiopia

Background

The international consensus group suggested criteria for action following automated complete blood count and white blood cell differential analysis. These criteria were set based on data from laboratories of developed countries. It is highly important to validate the criteria in developing countries where infectious diseases are still rampant that can affect blood cell count and morphology. Thus, this study aimed to validate the consensus group criteria for slide review at Jimma Medical Center, Ethiopia from November 1, 2020 to February 30, 2021.

Methods

The study comprised a total of 1685 patient samples from the daily laboratory workload of CBC analysis. The samples were collected in K2-EDTA tubes (Becton Dickinson) and analyzed using Coulter DxH 800 and Sysmex XT-1880 hematology analyzers. A slide review was done on two Wright-stained slides for each sample. All statistical analyses were performed using SPSS version 20 software.

Results

There were 39.8% positive findings, the majority of which were related to red blood cells. The false negative and false positive rates for Sysmex and Coulter analyzer were 2.4% vs 4.8%; and 4.6% vs 4.7%, respectively. The false negative rate was unacceptably higher when we used physicians' triggered slide review, which was 17.3% and 17.9% for Sysmex and Coulter analyzers, respectively.

Conclusion

Generally, the consensus group rules are suitable to use in our setting. However, we might still need to modify the rules, particularly to reduce the review rates. It is also necessary to confirm the rules with case mixes proportionally derived from the source population.

From XE-2100 to XN-9000, from SIS Standard to GFHC recommendations for slide review: potential impact on review rate and turnaround time

In 2014, we moved from XE-2100 with Standard SIS rules to XN-9000 with GFHC recommendations for slide review. The aim of our study was to evaluate the potential impact of the new Sysmex^® automation with implementation of GFHC rules on our review rate, turnaround time (TAT), workload and on CD34+ stem cells enumeration. We conducted a retrospective observational study from September 2013 through August 2014, in CHU Dinant Godinne UCL Namur. With the GFHC recommendations and the new Sysmex^® automation, we significantly reduced our review rate by nearly 30% considering all units (35.8% vs 25.9%), and up to 73% when excluding oncology haematology department (17.5% vs 4.7%). We also noticed significantly shorter TAT for CBC measurement (median for routine samples: 76.4 vs 56.8 minutes, p < 0.0001; urgent samples: 18.9 vs 15.2 minutes, p = 0.023), slide review (median: 54.9 vs 36.4 minutes, p < 0.0001) and CD34+ enumeration performed on peripheral blood samples (p < 0.001) and on apheresis samples (p = 0.026). In conclusion, GFHC recommendations implemented on the new Sysmex^® XN-9000 resulted in a significant reduction in review rate and in TAT. This is particularly of interest for the clinicians with subsequent potential faster patient management.

The role of cytological follow-up after radical vaginal trachelectomy for early-stage cervical cancer

OBJECTIVES

To identify whether recurrences were picked up by cytology alone after radical vaginal trachelectomy and to determine the false-positive rate of abnormal cytology.

METHODS

Retrospective collection of patients from the cancer registry since radical vaginal trachelectomy was first performed in Bristol in 1999. All cytology results were collated and re-reviewed by a senior consultant cellular pathologist at the cytopathology centre in Southmead Hospital, Bristol. Cytology results and pathology and survival data are discussed, and any downgrading or upgrading of reports is reviewed.

RESULTS

Eighteen women were identified and 80 isthmic cytology samples were reviewed. Only one recurrence has occurred. Lower uterine segment sampling was apparent in 25 samples and other endometrial cells in 21 samples: thus 58% showed endometrial cell sampling. Odd metaplastic cells from the newly formed transformation zone were found in 25 samples (31%). Fifteen (19%) showed significant inflammation, two with actinomyces. After cytology review, seven of 80 reports were changed: two between negative and inadequate, two borderline changes in endocervical cells and one mild dyskaryosis were downgraded to negative, and two cases reported as ?glandular neoplasia were changed to squamous cell carcinoma and negative, respectively.

CONCLUSIONS

Cytology reporting may be challenging after trachelectomy. Cytology in our series did not add to the diagnosis of recurrence in the one case in which it occurred. We propose a pragmatic follow-up regime, and discuss the importance of the centralization of cytology reporting in these patients.