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VALIDASI HASIL
PEMERIKSAAN HEMATOLOGI

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Dr. Abas Suherli Sp.PK

6/24/10
PROSES LABORATORIUM
PRA - ANALITIK

QUALITY
ASSURANC
E
UNTUK MEMASTIKAN
HASIL YANG
DIKELUARKAN OLEH
LABORATORIUM ANALITIK
BENAR
QUALITY
TEST YG BENAR,
CONTRO
DIKERJAKAN
PADA SAMPEL L
UNTUK
YANG BENAR , MEMASTIKAN
HASIL DAN BAHWA TEST YANG
INTERPRETASI YG PASKA-ANALITIK DIKERJAKAN
BENAR DAN BERLANGSUNG
DIBERIKAN PADA DENGAN TEPAT DAN
ORANG YANG TELITI
BENAR PADA
WAKTU YG TEPAT
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Validation (Verification) Process

1. Validate the test result


2. Review QC results for the run
3. Review analyzer performance
4. Perform delta check
5. Compare related test results
6. New result may be similar to previously known
abnormal results
7. Specimen drawn from wrong patient or sample
integrity problems (eg. IV line)
8. A multitude of variables

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Actions

• Validate (verify) the result and report


• Repeat the analysis

• Dilute and re-run the sample

• Perform reflex test

For most labs, (chem, endo, immuno, etc)


• actions involve the same analyzer

• reflex testing is minimal (e.g. HIV)

Hematology is more complex

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What Makes Hematology Special?

1. What to do after automated CBC and differential


results have been produced
2. Verify and report
3. Repeat with or without dilution on the same or other
analyzer
4. Examine a smear
5. Visual differential count
6. Manual platelet count
7. Other follow up tests

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The International Consensus Group for Hematology
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Rules of Three for normal Hematology

Rule #1
Hgb X 3 = Hct +/-2

Rule #2
RBC x 3.3 = Hgb +/- 1.5

Rule #3
RBC x 9 = Hct +/3

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Definition of Positive Smear Findings:
Morphology

• RBC morphology: 2+/moderate or greater


• Platelet morphology: 2+/moderate or greater

• Platelet clumps: > rare or occasional

• Toxic granulation: 2+/moderate or greater

• Dohlebodies:2+/moderate or greater

• Vacuoles:2+/moderate or greater

• Any malarial parasite

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Definition of Positive Smear Findings:
Abnormal Cell Types

• Blast ≥1
• Metamyelocytes> 2

• Myelocytes/Promyelocytes≥1

• Atypical lymphocytes > 5

• NRBC ≥1

• Plasma cells ≥1 or more

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Rules Summary

•Rules separated into five main categories


WBC parameters
Platelet parameters
RBC/Hemoglobin parameters
Differential parameters (#)
Suspect codes/flags
•Neonates

•1st time samples

•Subsequent sample ( < 72 hrs. )

•Total of 41 consensus rules

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Some Consensus Rules - WBC

1. WBC >4 and <11 with WBC flags: slide review

1. WBC >11 and <50 with no WBC flags: verify

1. WBC >11 and <50 with WBC flags: slide review

1. WBC > 4 <11, first time, no WBC flags: verify

1. WBC <4, first time, no flags: slide review

1. WBC any, incomplete diff: slide review + count

1. WBC < 4, pass delta, same flag except blasts: verify


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Some Consensus Rules -Differential

1. Neut# < 1.0, first time = slide review

1. Neut# < 1.0, pass delta, no blast flag = verify

1. Mono # > 1.5, first time or fail delta = slide review

1. Mono # > 1.5, pass delta = verify

1. Flags : Immature granulocytes, or NRBC, or blasts,


or atypical lymphs: slide review

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Some Consensus Rules -Platelets

1. PLT <100 and first time: slide review


2. PLT >100 and <1000 with no PLT flags: verify
3. PLT any count and PLT clump flag: slide review
4. PLT >100 and other PLT flags, first time analysed:
slide review
5. PLT <100 and other PLT flags: slide review
6. PLT <10 any time: lab SOP, alternate count
7. PLT clump any count : check sample clot, slide review

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Some Consensus Rules -RBC

1. HGB < 7, first time = slide review


2. HGB > 7, no RBC flags = verify
3. MCV > 105, adult, first time, sample < 24 hrs old =
slide review
4. MCV < 75, pass delta = verify
5. RDW > 22, first time = slide review
6. RBC fragment flag = slide review
7. RBC dimorphic flag = slide review

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KASUS 1

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KASUS 1

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KASUS 2

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KASUS 3

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KOREKSI JUMLAH LEUKOSIT :

100 X Jumlah leukosit


100 + Jumlah eritrosit berinti

Cntoh :
Jumlah leukosit 60.000 /uL
Ditemukan 25 eritrosit berinti / 100 leukosit
Maka jumlah leukosit dikoreksi menjadi :

100
X 60.000 = 48.000
100 + 25

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KASUS 4

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KASUS 5

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KASUS 6

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KASUS 7

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KASUS 8

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TERIMAKASIH

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