PubMed · 3341288
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A P Chitre, D S Velaskar. 1988. Make aggregometry more accurate.. https://doi.org/10.1093/ajcp%2F89.2.289a
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In the years 1984-1989 the Istituto Superiore di Sanità organized an EQAS for haematology (SVEQE) in Italy. A series of trials for haemocytometry, abnormal haemoglobins, HbA2, HbF, red cell G6PD and peripheral blood films, were carried out with the participation of 126 hospital laboratories, in different regions. SVEQE was an educative programme, aiming at promotion of quality assurance (QA) in laboratory haematology. At the same time an attempt was made to survey the analytical methods and instruments and to estimate the "state of the art" by the dispersion of all results. Participant laboratories were not scored for their performances. The operative protocol was harmonized to the guidelines established by WHO and ICSH; the trial specimens were prepared from normal or pathologic blood samples provided by blood banks or hospital departments. The trials for haemocytometry demonstrated a wide use of completely automated analyzers and in a steady state of performance during about five years. CVs, mainly for WBV and PLT, were somewhat higher than in other countries, where national QA systems have been established for a long time. Such discrepancies were not surprising in a pilot programme and were likely to be caused by inadequate internal quality control. The exercises for abnormal haemoglobins, HbA2, HbF and G6PD pointed out the need of using standardized methods according to the recommendations of ICSH. A large number of participating laboratories took part in the trial for blood cell morphology, being convinced of the educative function of this exercise; it is important to continue with systematic surveys, even including rare haematological disorders amongst the selected cases.
In this report we describe the two years (1991-1992) EQA programmes organized by the health committee of the Piedmont region (Italy). This programme was mandatory for all public and private laboratories. The parameters analysed were: PT and APTT (for coagulation); Hb, RBC, WBC, platelets and MCV (for haematology); glucose, urea, creatinine, total proteins, cholesterol, uric acid, triglycerides, AST, ALT, LDH, GGT, amylase, alkaline phosphatase, sodium, potassium, calcium, chloride, phosphorus and iron (for clinical chemistry). For haematology, the comparison between the first and the second year shows a significant decrease of imprecision, especially for platelets, WBC and MCV.
A pilot regional EQA scheme in haematology has been implemented in Emilia-Romagna. The distinctive features of this scheme are: a) inter-laboratory comparability of results on a local basis has been selected as main target of the whole scheme; b) fresh blood has been chosen as ideal control material; c) a fast and effective dispatching system of control material has been accomplished. This has been made possible by means of the hospital ambulances network and an express delivery service; d) the assessment of the analyzers calibration alignment in the whole region has been subdivided in two phases. The first one consists in aligning all analyzers of each province with the corresponding reference provincial center, the second one in aligning the analyzers of the eight reference centers in the region with each other; e) all laboratories taking part in the EQA scheme have been directly involved. Preparation of control material and comment sheet mailing to participants are carried out by eight provincial reference centers. Initial setting of the scheme targets, collegial survey of results and alteration of the scheme guidelines involve all participants in the scheme; f) a distinction between a short-term and a medium-term goal has been made. The short-term one is to improve the harmonization of results for comparability between different laboratories in the same area. The medium-term one is to set up educational programmes and consensus procedures for establishing operative protocols and for defining the allowable analytical errors, set on the basis of clinical requirements.