Home >> Tag Archives: Q&A — (page 3)

Tag Archives: Q&A —

Q&A column, 7/17

July 2017—A laboratory is considering the implementation of a laboratory test for the diagnosis of Zika virus infection. This test is currently labeled as a test under the issuance of an Emergency Use Authorization. What specific regulations regarding the use of this test, quality control, and proficiency testing apply when performing this test on patient specimens?

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Q&A column, 6/17

June 2017—Our analyzer reported nucleated red blood cells of six, with no cellular interference flag. The technologist missed that the automated NRBC was six. When he performed the manual differential, he noted more than five NRBCs and performed a corrected count and certified it. Is it acceptable to report out the automated white blood cell value as well as the corrected WBC?

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Q&A column, 5/17

May 2017—Is there any medical reason why a physician would ask the lab to run a complete blood count on cord blood? Does CAP checklist requirement HEM.23050 treat automated and manual differentials equally? That is, does the recommendation to report absolute counts apply also to manual differentials or only to automated differentials? What is the next step in resolving platelet clumping when it occurs in a citrate tube also?

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Q&A column, 4/17

April 2017—Our laboratory receives requests for breast predictive marker testing (estrogen receptor, progesterone receptor, HER2, Ki-67) on biopsies of bone metastases. Is it appropriate to perform this testing on decalcified tissue? Is there a regulatory speed limit—whether a per day or a per hour “at the microscope” workload limit—on surgical pathology slide interpretations, similar to workload limits for cytology screening?

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Q&A column, 3/17

March 2017—Our hospital system is implementing Sysmex instruments with a focus on the accuracy of the absolute white blood cell values—use of the absolute neutrophil count and immature granulocytes with the WBC as markers for septicemia. I then became aware that the hospital purchased the St. John Sepsis v14 protocol, which lists 10 percent bands as one of the markers for septicemia. The Rumke for 10 percent is 4–16. Using bands is not consistent with reducing manual differentials and is not an accurate parameter to use. Are there other protocols using WBC/ANC?

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Q&A column, 2/17

February 2017—I have an oncology patient with a diagnosis of immune thrombocytopenia. The patient’s sample has been drawn in sodium citrate, EDTA K2, sodium heparin, and warm saline replacements, and a true platelet count cannot be obtained. Platelets clump in all tubes, and multiple platelet clumps are observed under the microscope. The patient doesn’t have thrombocytopenia. What else can I do?

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Q&A column, 1/17

January 2017—I have a technologist who is a recent graduate from a medical technology school. She has her BA but the school she attended did not offer an internship program. We are offering her one year of on-the-job training so she will be able to sit for her ASCP certification exam after completing the one year of training.

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Q&A column, 12/16

Q. Are there guidelines on microsatellite instability analysis by immunohistochemistry on colorectal adenocarcinomas? Specifically, should immunohistochemical stains for the mismatch repair enzymes be performed on all colorectal adenocarcinomas regardless of the clinical or pathological findings? A medical group recently requested these studies on all colorectal adenocarcinomas.

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Q&A column, 11/16

November 2016—As originally described, there are technically five Gleason patterns: 1, 2, 3, 4, 5. However, since patterns 1 and 2 are never used, there are no Gleason scores 1 + 1 = 2, 1 + 2 = 3, 2 + 1 = 3, 2 + 2 = 4, 2 + 3 = 5, and 3 + 2 = 5. Why is this? Isn’t this an alteration of Gleason’s original classification concept? Furthermore, there are cases in which a biopsy may contain a few glands that are diagnostic of carcinoma but insufficient to assign an accurate Gleason score. Would it simply be best to make a descriptive comment to that effect?

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Q&A column, 10/16

October 2016—What are the guidelines for proper handling and processing of blood specimens collected in serum separator tubes? Are there regulations guiding the practice of taking additional blood samples from a patient even though there are no orders for the blood samples? These “just in case” specimens are sent to our laboratory by the emergency department when a port or catheter is placed in the patient. The ED’s reasoning is that it prevents a patient from being stuck twice if there is an order for blood tests later. Our lab has to either store the samples or process them (centrifuge or separate RBCs from serum) so they are ready in case an order is entered later. Should this practice be banned? Should we refuse to accept these samples?

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