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PubMed2005

Proficiency testing of reticulocyte counting in Ontario.

The reticulocyte count reflects the erythropoietic activity of the bone marrow and is thus useful in both the approach to the diagnosis of anemia and in monitoring bone marrow response to therapy. Traditionally, reticulocyte quantitation relied upon microscopic techniques; recently automated reticulocyte quantitation has become widely available. External quality assessment (EQA) of reticulocyte quantitation has not been widely reported; this paper presents data from reticulocyte EQA surveys conducted in Ontario between November 2000 and October 2004. Samples with normal and increased reticulocyte levels were obtained from adult donors and analyzed within 48 hours. We found that despite improved accuracy and precision, automated reticulocyte counting techniques do not translate into markedly improved inter-laboratory accuracy and precision. Further, we found that both microscopic and automated techniques can effectively differentiate between patients with normal and those with increased reticulocyte counts. Finally, we ascertained that reference intervals submitted with the initial surveys revealed that laboratories could have made erroneous clinical interpretations of their normal or elevated reticulocyte counts. The reestablishment of reference intervals by participants resulted in a marked improvement of the reference intervals submitted on subsequent surveys.

Adult↗
PubMed1994

[Evaluation of the QBC-Autoread System in hematological screening in a hospital laboratory].

The QBC Autoread System is based on fully automatic, electro-optical linear measurements of the discrete layers of packed blood cells in a microhematocrite tube. The layering results from differing cell densities during high-speed centrifugation. The determination of hemoglobin, hematocrit, leucocytes, platelets and of the percentual share of granulocytes and lymphocytes/monocytes with the QBC Autoread System was evaluated concerning reliability and precision in comparison with the conventional analytical methods. We used a Coulter Counter System and the manual differentiation of the stained blood smears as reference methods. The evaluation of the first 400 blood samples showed a close correlation for all hematological parameters examined, but no significant deviation relative to the reference methods. Only 83 of totally 1000 (8.3%) examined venous blood samples could not be evaluated completely by the QBC Autoread System. For the analysis of very pathological cell populations, especially of hematological oncological diseases, the QBC System is not qualified. The extreme portability, the quick practicability and the good accordance with the conventional analytical methods make the QBC Autoread System a qualified screening method for practice and emergency laboratories.

Automation↗
PubMed2005

von Willebrand factor ristocetin cofactor (VWF:RCo) assay: implementation on an automated coagulometer (ACL).

BACKGROUND: VWF:RCo assay is the standard and widely used laboratory test for von Willebrand disease (VWD) diagnosis. It is hampered by high intra- and inter-assay imprecision and is time consuming. Automation may improve the assay performance and allow its routine application. OBJECTIVE: Automation of VWF:RCo on the ACL 7000 coagulometer (Instrumentation Laboratory, Milan, Italy) and its evaluation in VWD diagnosis. METHODS AND MATERIALS: Method performance determination: precision, detection limit (DL), interferences, dose-response curve. Method comparison: analysis of 105 plasma samples from normal subjects (50), VWD type 1 (24), VWD type 2 (24) and VWD type 3 (7) with ACL VWF:RCo and comparison with the reference aggregometric (AGM) method. RESULTS: ACL VWF:RCo: CVs around 10% vs. 19% of AGM method; DL: 0.08 U mL(-1); potential interferences from bilirubin, triglycerides and hemoglobin, avoided by suitable plasma dilution; high correlation with AGM VWF:RCo (Deming regression Y =-0.0277 + 1.0519X) either in normal or VWD plasmas. In VWD types 1 and 2, the VWF:RCo/VWF:Ag ratios are >0.6 or <0.6, respectively, when calculated with both AGM and ACL VWF:RCo values. CONCLUSIONS: The automated VWF:RCo on the ACL 7000 coagulometer shows precision improvement and high correlation with the reference AGM method. The test allows the diagnosis of both quantitative (VWD types 1 and 3) and qualitative (VWD type 2) forms of the disease. These results and the assay feasibility make it a suitable and reliable test for the routine diagnosis of VWD.

Automation↗
PubMedDate not supplied

Knowledge-based approaches to the maintenance of a large controlled medical terminology.

OBJECTIVE: Develop a knowledge-based representation for a controlled terminology of clinical information to facilitate creation, maintenance, and use of the terminology. DESIGN: The Medical Entities Dictionary (MED) is a semantic network, based on the Unified Medical Language System (UMLS), with a directed acyclic graph to represent multiple hierarchies. Terms from four hospital systems (laboratory, electrocardiography, medical records coding, and pharmacy) were added as nodes in the network. Additional knowledge about terms, added as semantic links, was used to assist in integration, harmonization, and automated classification of disparate terminologies. RESULTS: The MED contains 32,767 terms and is in active clinical use. Automated classification was successfully applied to terms for laboratory specimens, laboratory tests, and medications. One benefit of the approach has been the automated inclusion of medications into multiple pharmacologic and allergenic classes that were not present in the pharmacy system. Another benefit has been the reduction of maintenance efforts by 90%. CONCLUSION: The MED is a hybrid of terminology and knowledge. It provides domain coverage, synonymy, consistency of views, explicit relationships, and multiple classification while preventing redundancy, ambiguity (homonymy) and misclassification.

Computer Simulation↗
PubMed1985

Diurnal intraocular pressure. Correlation to automated perimetry.

Patients referred to a centralized glaucoma laboratory obtained intraocular pressure measurements every two hours from 5:00 am to 3:00 pm. Analysis revealed 400 eyes with visual field defects and 400 eyes without visual field defects as determined by Octopus perimetry of the central 20 degrees. The diurnal variation in intraocular pressure was 6.2 mmHg +/- 3.6 for those with visual field defects and 5.5 mmHg +/- 2.7 for those without visual field defects. There was no statistical significance in the mean diurnal variation between the two groups (P = 0.91). The highest intraocular pressure tended to occur at either 5:00 am to 7:00 am or 11:00 am to 1:00 pm in both groups. The lowest intraocular pressure tended to occur between 7:00 am to 9:00 am or 1:00 pm to 3:00 pm in both groups. No significant differences were noted in the distribution between the two groups with regard to the time of the highest or lowest intraocular pressure. In the group with visual field defects, 30% had an intraocular pressure of less than 23 mmHg and 23% had an intraocular pressure of greater than or equal to 23 mmHg at all five time periods.

Circadian Rhythm↗
PubMed1982

The cost of quality control procedures in the clinical laboratory.

The impact of quality control procedures on the workload and the cost of the clinical laboratory during the last decade is explored. Quality control procedures are shown to represent a relatively constant share of test procedures for acute care admissions. The effect of automation on quality control testing in the laboratory has been to reduce the workload units per quality control test and thus to reduce the relative share of total laboratory costs incurred by quality control. The need to assess changes in the cost of quality control testing against any change in quality of laboratory output is emphasized.

British Columbia↗
PubMed1987

Myelodysplastic syndrome: identification in the routine hematology laboratory.

The Coulter S+IV electronically generates an automated white blood cell differential which counts 10,000+ cells per sample, separating lymphocytes, mononuclear cells, and granulocytes. In patients with preleukemic or so-called myelodysplastic syndromes, the histograms are consistently abnormal. CBCs of five patients demonstrate the variable features of myelodysplasia involving abnormal monocytosis, neutropenia, thrombocytopenia, and macro-ovalocytic anemias. The histogram analysis of white blood cells is a rapid, economic way of alerting the hematologist to a possible diagnostic problem in the elderly patient population.

Adult↗
PubMed1987

[Microcomputer-based automation of the microbiological analysis of antibiotic activity].

Laboratory informative computer systems (LICS-10 and LICS-11) for microbiological assay of antibiotics were developed. The systems are based on the ISKRA-1256 computer. As compared to the routine method with the use of the well-known V. S. Dmitrieva's Tables the LICSs provide more than a 2-fold decrease in the working hours of the assay. The data on the specific software for the LICSs are presented and the algorithms for the calculations are described.

Algorithms↗
PubMed1990

Development of an automated procedure for fluorescent DNA sequencing.

We describe here the development of a procedure for complete automation of the dideoxynucleotide DNA sequencing chemistry using fluorescent dye-labeled oligonucleotide primers. This procedure combines rapid preparation of template DNA using a modification of the polymerase chain reaction, automation of the DNA sequencing reactions using a robotic laboratory workstation, and subsequent analysis of the fluorescent-labeled reaction products on a commercial automated fluorescent sequencer. Using this procedure, we were able to produce sufficient quantities of template DNA directly from bacterial colonies or bacteriophage plaques, perform the DNA sequencing reactions on these templates, and load the reaction products on the fluorescent DNA sequencer in a single work day. This scheme for automation of the fluorescent DNA sequencing method allows the fluorescent sequencer to be run at its full capacity every day and eliminates much of the labor required to obtain a high level of data output. Currently, we are able to perform and analyze 16 fluorescent-labeled reactions every day, with an average output of over 7000 bp per sequencer run.

Automation↗
PubMed2006

Use of various common isolation media to evaluate the new VITEK 2 colorimetric GN Card for identification of Burkholderia pseudomallei.

The use of automated systems in the modern microbiology laboratory is becoming commonplace as the pressure of cost containment impacts on staff resources. With increased international travel and threats of bioterrorism, recognition and accurate identification of organisms such as Burkholderia pseudomallei is important. In areas where this organism is endemic, identification is not usually problematic. This study evaluates the performance of the new VITEK 2 colorimetric GN card for the identification of this organism. A total of 103 previously identified clinical isolates were tested with the new card with isolates taken from MacConkey agar, Columbia horse blood agar, Columbia sheep blood agar, and Trypticase soy agar in order to determine identification performance and to see if there was any variability in results due to the agar. Columbia horse blood agar produced the highest rates of identification (81%), followed by Trypticase soy agar (78%), Columbia sheep blood agar (75%), and MacConkey agar (63%). There was considerable variability in some of the reactions obtained. Seven isolates failed to identify from any of the agars used. This study highlights issues with the identification of this organism with the new VITEK 2 GN card. Enhancements of the algorithm parameters for the GN card are warranted and are in progress. Laboratory personnel need to be aware of the current limitations with this GN card and the software (version 4.02 or older for the VITEK 2 60/XL and version 1.02 or older for VITEK 2 Compact) and rely on clinical history, a high index of suspicion, and basic microbiology tests to confirm the identification of this organism.

Agar↗
PubMed2006

Infrequent MODS TB culture cross-contamination in a high-burden resource-poor setting.

One obstacle to wider use of rapid liquid culture-based tuberculosis diagnostics such as the microscopic observation drug susceptibility (MODS) assay is concern about cross-contamination. We investigated the rate of laboratory cross-contamination in MODS, automated MBBacT, and Lowenstein-Jensen (LJ) cultures performed in parallel, through triangulation of microbiologic (reculturing stored samples), molecular (spoligotype/RFLP), and clinical epidemiologic data. At least 1 culture was positive for Mycobacterium tuberculosis for 362 (11%) of 3416 samples; 53 were regarded as potential cross-contamination suspects. Cross-contamination accounted for 17 false-positive cultures from 14 samples representing 0.41% (14/3416) and 0.17% (17/10248) of samples and cultures, respectively. Positive predictive values for MODS, MBBacT (bioMérieux, Durham, NC), and LJ were 99.1%, 98.7%, and 99.7%, and specificity was 99.9% for all 3. Low rates of cross-contamination are achievable in mycobacterial laboratories in resource-poor settings even when a large proportion of samples are infectious and highly sensitive liquid culture-based diagnostics such as MODS are used.

Cost of Illness↗
PubMed2005

Portable gas analyser Cosmed K4b2 compared to a laboratory based mass spectrometer system.

AIM: The purpose of this study was to systematically test the accuracy of an automated, portable, gas analysis system, the Cosmed K4b2 with a laboratory based mass spectrometer system, the Morgan EX670 across a number of gas and ventilation parameters. METHODS: Eight subjects (mean+/-SE) age, 23.7+/-1.1 y, height, 1.78+/-0.01 m, mass, 74.4+/-2.1 kg performed a V.O2max test and a submaximal exercise test at 150, 200, 250 and 300 Watts (W), on an SRM cycle ergometer. The Morgan EX670 system and the K4b2 were randomly connected in series, using the same breath for the calculation of gas and ventilatory parameters. RESULTS: The K4b2 system reads significantly higher than the Morgan EX 670 for both VO2 and V.CO2 at 250 (VO2/V.CO2: p<0.05, p<0.002), and 300 W (VO2/V.CO2: p<0.002, p<0.005). Unsystematic bias between the 2 analysers varies between 1% and 16% and systematic bias between 3% and 8%. CONCLUSION: There are some significant unsystematic and systematic differences between these 2 systems and laboratories should endeavour to utilise either one or the other piece of equipment to test their subjects.

Adult↗
PubMed1999

Evaluation of cation-exchange HPLC compared with isoelectric focusing for neonatal hemoglobinopathy screening.

BACKGROUND: Central Middlesex Hospital, in northwest London, has screened neonates for hemoglobinopathies, using the established manual technique of isoelectric focusing (IEF) since 1989. Recently, this laboratory has faced a large increase in the number of samples tested per year. This study compared the detection of hemoglobin abnormalities between the existing manual IEF method and that of automated cation-exchange HPLC to determine the reliability of HPLC and whether an automated system would save time in the laboratory. METHODS: Over a 15-month period, 25 750 blood samples, collected by heel prick onto filter paper, were tested using HPLC, and the results were compared with those obtained with IEF. RESULTS: HPLC and IEF each identified 568 patients with FAS, 151 with FAC, 49 with FAD-Punjab, 23 with FS, 3 with FC, 6 with FSC, 5 with FE, and 1 with FD. IEF detected 62 patients with FAE, whereas HPLC detected 63. This additional FAE was observed on repeat IEF. One additional heterozygote detected by HPLC was initially not observed by IEF, but was detected on repeat IEF. HPLC detected all but six cases of Hb Barts observed by IEF. One double heterozygote and four heterozygotes were detected by IEF, but not by HPLC. The detection of hemoglobin variants expressed at low concentrations was comparable for the two methods, and carryover was not observed in routine analysis on HPLC. CONCLUSIONS: HPLC is a sensitive, efficient, and time-saving alternative to IEF for the neonatal screening of common hemoglobinopathies.

Chromatography, High Pressure Liquid↗
PubMedDate not supplied

Establishment of a central laboratory serum tumor marker service on a consolidated immunodiagnostic platform: development of practice standards, service improvements, and operational efficiency.

BACKGROUND: Laboratory testing for serum tumor markers traditionally has been performed in low volume in most hospitals. Many markers are sent out to reference laboratories. Over the past decade, serum tumor marker testing in patient management has become more defined, resulting in increasing test volume and wider availability of assays on automated immunodiagnostic platforms. METHODS: A retrospective review of laboratory operations, test volumes, and budgets over a 10-year period. Results of utilization initiatives as part of a clinical practice management team also were reviewed. RESULTS: The volume of serum tumor marker requests in our institution increased 2.25-fold over an 8-year period. In contrast, total laboratory test volume increased only 1.3-fold. Implementation of an on-site tumor marker laboratory using a consolidated platform (Elecsys 2010) decreased the average unit cost per test from $12.36/test to $6.79/test. This was accomplished by a combination of insourcing and by consolidation of multiple semi-automated instruments. Total savings were $219,972 per year, including direct budget reductions and cost avoidance due to volume increases. Various institutional practice standards were implemented, and turnaround time was markedly reduced for selected tests. CONCLUSIONS: Testing for serum tumor markers is becoming more established in large hospital laboratories. Increasing test volumes and the availability of consolidated instrument platforms with a broad menu of tumor marker tests (such as the Elecsys 2010) facilitates consolidation and insourcing of many tumor marker assays. This permits the laboratory to reduce unit and overall cost, to leverage excess capacity on existing instrumentation, and to create an opportunity to add value to the service by reducing turnaround time and implementing practice standards.

Academic Medical Centers↗