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Here are the top 10 needs in today's hematology laboratory, according to Dr. Jolanta E. Kunicka. This section is a continuation of our February "Focus On: Hematology."
Participant:
Jolanta E. Kunicka, PhD, director, Scientific Marketing, Sysmex America Inc.
1. "Counting immature cells is one challenge. Laboratorians want to count cells as accurately as possible, but often immature cells are not present in peripheral blood in huge quantities. So the challenge is to develop automated technology to get to low levels of counting, for example down to just one, two or three cells per µL.
2. To assess the functionality of immature cells. For example, there is a lot of discussion about hematopoietic stem cells. Functional tests are performed on these cells but are not completely automated. So I think the automation of functional tests is a challenge. It would be extremely important to be able to get not only the cell counts, but also a measure of the viability of stem cells.
3. To expand the white cell differential to include more cell types. When there is an abnormality in the sample, for example blood from a patient with leukemia, there may be immature cells present that an automated cell counter can't fully classify. Some additional information can come from the manual differential, but even the manual diff does not provide all the information that physicians need. For example, blasts found in peripheral blood can be from one of many different lineages. Fluorescent flow cytometry using combinations of monoclonal antibodies helps determine the cell linage. However, this testing is not yet fully automated. The challenge is to automate the extended differential to include more abnormal and immature cells.
4. To understand the mechanisms associated with abnormal cell counts. This is what makes the analysis of immature platelets important. When a patient has thrombocytopenia, understanding the underlying pathophysiological mechanism may be important in selecting treatment. Automated tests that shed light on whether platelet production is increased or whether peripheral consumption is increased would be helpful to physicians. It is important to give physicians actionable information as part of routine testing.
5. To automate analysis of bone marrow aspirate. Pathologists may need to examine bone marrow because analysis of peripheral blood does not always give enough information about cellular pathology. But automated instruments in hematology do not routinely provide bone marrow analysis. When this sample limitation is overcome, we will have greater productivity and more time to dedicate to providing result interpretation to primary care physicians.
6. To automate cell counts and differentials in body fluids. Cellular abnormalities in body fluids usually require microscopic analysis for complete assessment. This can be very time consuming and requires a high level of proficiency with visual cell classification. Automated analyzers are expanding the capability of providing cell counts and classification so that more results can be released automatically.
7. To auto verify results and go paperless. Hematology review requires that laboratorians understand many and very complex verification rules. This stems not only from the fact that their hematology analyzers generate 17 or more parameters, but also from the relationships between various hematology results. It is not sufficient to have on-board rules. The hematology laboratorian needs a rule-based system that can provide auto verification specifically in different clinical cases. It is of value to provide support for laboratorians writing rule sets that harmonize and drive improvements in workflow and quality.
8. To incorporate hematology systems into the workflow of the whole clinical laboratory. In some laboratories, Hematology may be a separate lab staffed by specialists. However, the reality of many laboratories is to have a core lab with cross trained technologists. Without expanded parameters and rule-based decision systems, technologists still have to do a lot of manual work and microscopy.
9. The Automation of manual tests. With the limited availability of medical technologists, we still have tests that require manual processing. These tests can be time consuming, tedious and subject to variability. The automation of those tests performed manually today will free skilled staff, enabling them to focus more on abnormal samples, while reducing test variability and improving productivity and efficiency in the lab.
10. To provide physicians with information that could be used to determine treatment. There has been a tremendous increase over the last 5 - 10 years in the amount of information provided to physicians by clinical laboratories. Hematology reports contain results on mature and immature cells that reflect both cell production and functionality. Attending physicians may have disparate levels of understanding the interpretation of these results and their application to patient care. Pathologists and laboratorians bring a special expertise to the table. The great need is to provide interpretation of these results to clinicians, and enable data mining so that physicians can make appropriate and timely use of the laboratory information in clinical decision making."
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