Hematology Programs

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BLOOD CELL IDENTIFICATION

Five graded photomicrographs, two digital images for manual differentials and two digital image educational challenges per testing event.

Refer to the Blood Cell Photomicrographs result code list on the form and code a single answer for the cell(s) or cellular features(s) indicated by an arrow or circle in each photomicrograph without regard to results obtained from any of the Hematology blood specimens.  All photomicrographs are derived from the same blood smear and should be associated only with the CBC data provided at the top of the photomicrographs sheet.


Choose your answers from either the General Identification or Detailed Identification lists at the bottom of the page.  Many laboratories do not identify abnormal cell(s) or cellular feature(s).  DO NOT attempt to identify structures beyond what you would routinely report from your laboratory.  If your laboratory does not perform detailed identifications blood cells or cellular features, be sure and choose the best response from the General Identification list.  If your laboratory performs detailed differentials or identifications, then you may use codes from either the General or Detailed Identification lists. Do not report code 610 (would refer) for all 5 fields.  If a photomicrograph demonstrates features which would be referred to another laboratory for identification, report code 610 (would refer) for that photo.

If you do not perform microscopic analysis of peripheral blood smears, leave all result fields blank and submit request to cancel program.  


Do not use abnormalities in the provided clinical data as sole justification for reporting abnormal result codes.  The photomicrograph must clearly represent an abnormal condition in order for a response of abnormal to be considered correct.  Using an abnormal code for normal cells or cellular features will be flagged as incorrect.  When a single cell is indicated for identification, do not use general descriptors such as Poikilocytosis unless asked to describe an overall condition in the instructions.  Use either the general abnormal code; e.g, 615 Abnormal RBC, would refer, or a specific code such as 641 Target Cell (codocyte) as appropriate.  Under no circumstances should you ever send any proficiency testing sample to another laboratory for testing.  Per CMS requirement, this emphatically includes samples that you would normally send out for confirmation or follow up identification.  This is to be followed REGARDLESS of your laboratory policy on such follow up testing.  CMS will immediately revoke the license of any laboratory found to be referring proficiency testing samples, even if they are following their laboratory procedures for confirmation.  Equally, CMS requires that you not perform testing on any sample that you suspect may be a proficiency testing sample received from another laboratory.  You also must report laboratories you suspect of such activity.  Severe penalties will apply to laboratories that perform proficiency testing for other laboratories or sites as well.


Note:  the same result codes may be used more than once per event.


Manual Differential – 2 digital images for manual, whole slide WBC differentials provided online only.  Supplemental testing only; not for CMS reporting.  You will perform a general review of the slide then you will be guided through a 25 cell differential.  

Please be sure to enter a result for each differential parameter, even if the results are 0%.  Please use the basic differential groupings as taken from CLSI Standard H20‐A2.


Examples


Hemoglobin C Crystals

Normal


Educational Challenge

The educational challenges are optional ungraded samples representing more difficult cells or features. No credit or flagging is given. The results will merely be summarized and expert commentary provided to assist the laboratory in the assessment of more complex cell identification. Digital slide images are only available online at our website http://www.aab‐pts.org as a link to your online reporting form.  The digital slide images require access to a computer with access to the AAB-PTS website via the internet. Additionally, it requires Internet Explorer version 11.0 or later (limited support for IE 9 and 10), FireFox 4.0 or later, Safari 3 or the latest Google Chrome version.


Examples


Rouleaux

Blasts


ERYTHROCYTE SEDIMENTATION RATE


Two specimens per testing event

Allow the samples to stand at room temperature for 20 minutes prior to use. Gently invert the vial until packed cells have been re-suspended and continue mixing for 30 seconds. Avoid foaming and do not vortex. Follow the manufacturer’s directions for filling the sample tubes.


These specimens are for manual and automated methods. Round all results to whole numbers to fit the reporting format provided. Code the method used by entering the appropriate numeric code from the list on the reporting forms.

Micro-ESR methods use tubes with 1.0 mm internal diameters. Westergren methods use tubes with approximate 30 cm length and 2.5 mm internal diameter. Wintrobe methods use tubes with approximate 10 cm length and 2.5 mm or larger internal diameters. Check the manufacturer’s package insert to verify the type of method to report. If the sample is diluted with saline prior to analysis, choose a diluted method for reporting results.  PolyMedco Sedimat method is not compatible with elevated sedimentation rate samples provided in this program.  See ESR-Rapid below.


ERYTHROCYTE SEDIMENTATION RATE-RAPID


Two specimens per testing event

These specimens are for rapid ESR test systems only, compatible with Pro Sed Auto 5, Polymedco SediMat 10 and 15.  All other methods should be enrolled in the Erythrocyte Sedimentation Rate program.

Instructions and method codes are included on the reporting form.


CENTRIFUGAL HEMATOLOGY

5 whole blood specimens per testing event for the following analytes:


Granulocytes

Hemoglobin

Lymph/Monos

Hematocrit

Leukocytes

Platelets


Please test as soon as possible after receipt of the specimens, within 4 calendar days if possible.

These specimens are only compatible with the Quantitative Buffy Coat (QBC) series of instruments, except the QBC HemaScan. Participants using older models in this series of instruments (which do not generate hemoglobin results) may report hemoglobin results on these specimens using the methods listed in the hemoglobin method code list on the reporting form. Specimen preparation instructions are included below and on the reporting form. Method Codes are listed on the reporting form.  You must report these codes to have your results graded according to the tube and/or instrument used.


GENERAL INSTRUCTIONS TO PARTICIPANTS

1)  This module contains centrifugal hematology specimens which are whole blood specimens for QBC Hematology methodologies.  These specimens are extremely sensitive to stress such as exposure to temperature extremes, being left at room temperature or unusual agitation.  Upon arrival, the specimens should be neither warm nor frozen.  Examine specimens for severe hemolysis which may be caused by extreme temperatures or rough handling.  Please refrigerate specimens immediately upon receipt in your laboratory and until testing can be performed.  For optimum results run specimens as soon as possible after receipt.


2)  Mixing:  Mix one vial at a time and immediately prepare the QBC tube.  Completely re-suspend sediment before testing by rolling vial between the palms of the hands for 30-45 seconds.

Do not use a mechanical mixer or rotator.


3)  Sampling:  Gently invert the vial 5-10 times just prior to sampling.  Choose the QBC tube type that is used most frequently:






4)  IMPORTANT:  Selecting the correct assay mode is necessary for the appropriate evaluation of your results.                  


Do NOT use the Proficiency Testing Mode.




CAUTION: POTENTIAL BIOHAZARDOUS MATERIAL

Human blood components were not used in the manufacture of QBC Control.  However, this product contains blood components from a non-human source and may transmit infectious disease. Follow the same precautions used for patient samples when handling or disposing of vials.



HEMATOLOGY w/DIFF A, 3-part, 3 mL


5 whole blood specimens per testing event for the following analytes:


Erythrocytes (RBC)

Hemoglobin

Lymphocyte

Neutrophils/Granulocytes

Hematocrit

Leukocytes (WBC)

Md/Mid/Mixed/Mono/Other

Platelets


These specimens are compatible with the following instruments:

Abbott Cell-Dyn 1200, 1400, 1600, 1700, 2000, 1800 series, Emerald and 2-part diff

Coulter Ac• J series, MD series, S Plus series, ST series, and T series (excluding Ac•T-5 & -8), Onyx and Nova impedance only

DANAM/Infolab all 2-part diff models, DC/Excell, DC18/Excell 16/I-1600 & 1800

Diatron Abacus

Drew D3 and Evolution

HORIBA ABX all 3-part non-8-900 diff instruments, 9018, 9020, 9120, Argors/Helios series, Micros, Micros Stx/Stel/Stex and Spirit

Medonic CA620/530, M-Series and all 3-part diff instruments

Mindray BC-3200


The specimens must reach room temperature (15‐30°C) before being re-suspended.  To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions.  Place the vials on a mechanical mixer or gently invert manually for 5 minutes.


This program is intended for instruments with a 3-part differential therefore only total granulocytes are reported. Do not separately report eosinophils and basophils with this program. Participants with 2-part diff instruments must report one part on the “Lymphocytes” line and the remaining part on the “Granulocytes” line, regardless of more inclusive terms on their instruments (such as “MO+GR”). 2-Part differential instrument users must not use the second line designated “MD/MID/ Mixed/Mono/Other” in the differential section of their forms.


HEMATOLOGY w/DIFF B, 5-part, 3 mL


Five whole blood specimens per testing event for the following analytes:


Basophils

Erythrocytes (RBC)

Hemoglobin

Lymphocytes

Neutrophils

Eosinophils

Hematocrit

Leukocytes (WBC)

Monocytes

Platelets


These specimens are compatible with the following instruments:


Abbott Cell-Dyn 3000, 3200, 3500, 3700, 4000, Sapphire, Ruby, Emerald 22

DANAM Excell 22 and Excell 2280; Diatron Abacus 5


The specimens must reach room temperature (15‐30°C) before being re-suspended.  To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions.  Place the vials on a mechanical mixer or gently invert manually for 5 minutes.


HEMATOLOGY w/DIFF C, 5-part, 3 mL


Five whole blood specimens per testing event for the following analytes:

Basophils

Erythrocytes (RBC)

Hemoglobin

Lymphocytes

Neutrophils

Eosinophils

Hematocrit

Leukocytes (WBC)

Monocytes

Platelets


These specimens are compatible with the following instruments:

Coulter DXH800, Gen-S, HMX, LH500, LH750/755/780, MAXM and STKS (the VCS series). Mindray BC-5800


The specimens must reach room temperature (15-30°C) before being re-suspended. To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions. Place the vials on a mechanical mixer or gently invert manually for 5 minutes.


HEMATOLOGY w/DIFF D, 3-part, 3 mL


Five whole blood specimens per testing event for the following analytes:

Erythrocytes (RBC)

Hemoglobin

Lymphocyte

Neutrophils/Granulocytes

Hematocrit

Leukocytes (WBC)

Md/Mid/Mixed/Mono/Other

Platelets


These specimens are compatible with the following instruments:

Sysmex E series, F-800, K series (includes the KX-21 and KX-21N), poocHi-100i. XP-300 and Royco Cell Counters


The specimens must reach room temperature (15‐30°C) before being re-suspended.  To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions.  Place the vials on a mechanical mixer or gently invert manually for 5 minutes.


This program is intended for instruments with a 3-part differential therefore only total granulocytes are reported. Do not separately report eosinophils and basophils with this program.


Participants with 2-part diff instruments must report one part on the “Lymphocytes” line and the remaining part on the “Granulocytes” line, regardless of more inclusive terms on their instruments (such as “MO+GR”).  2-Part differential instrument users must not use the second line designated “MD/MID/ Mixed/Mono /Other” in the differential section of their forms.


HEMATOLOGY w/DIFF E, 5-part, 3 mL


Five whole blood specimens per testing event for the following analytes:

Basophils

Erythrocytes (RBC)

Hemoglobin

Lymphocytes

Neutrophils

Eosinophils

Hematocrit

Leukocytes (WBC)

Monocytes

Platelets


These specimens are compatible with the following instruments:

Sysmex SF-3000, XE-2100, XE-5000, XN-1000 and XS-800i/-1000i, and XT series.  Mindray BC-6800


Allow vial to stand at room temperature for 20 minutes before mixing.  Hold the vial horizontally between the palms of the hands.  Briskly roll the vial back and forth for 60 seconds, then gently invert 10 times.  Continue to mix in this manner until the cells are completely and uniformly suspended (i.e., no cell button is observed on the bottom of the vial).  Do not shake the vial or use a mechanical mixer.


Sample from the vial using the same aspiration mode as a majority of your patient specimens, however, you must identify the specific system used and utilize the following instrument system specific instructions to obtain results.  


XE-2100/XE-2100D/L, XE-5000, XE-HST, XE-Alpha, XT-4000i, and XT-2000i/XT-1800i:

Note: For the Sysmex XE-2100, XE-5000, and XT-Series analyzers, specimens must be analyzed in the QC program to obtain white blood cell (WBC) differential data. Read and follow the specimen handling instructions before analyzing the specimens. Perform analysis of all specimens using the aspiration mode that the majority of your patient specimens are processed in: either closed vial (primary) or open vial (secondary) mode.


MANUAL OPEN MODE FOR SYSMEX XE OR XT:

  1. Click the "Controller" button on the Menu window. The X-Series Controller Menu will be displayed.
  2. Double-click the "Setting" button in the X-Series Controller Menu.
  3. Click the "Sampler Stop Conditions" tab.
  4. The current sampler stop conditions will be displayed on the Sampler Stop Conditions screen.
  5. If a check mark is present in the box next to "Unregistered QC Sample", click on the box to remove the check mark.
  6. Click "OK."
  7. Click "Menu" to return to Main Screen.
  8. Run samples in Manual Open Mode as usual, reading the barcode with the handheld barcode reader.
  9. When sample analysis has been completed, go into Explorer and print the results to the graphic printer (GP).
  1. Record the results on the form provided.
  2. When all data has been recorded, follow steps 1 thru 4. In the "Sampler Stop Condition" screen, click on the box next to "Unregistered QC Sample" to place the check mark back in the box.
  3. Click "OK."
  4. Click "Menu" to return to Main Screen.


MANUAL MODE FOR SYSMEX XN-SERIES:

 Note: The XN-Series should be tested using the QC mode to obtain the WBC differential data 

1.     Click on the "Analyzer Setting" icon on the Main Menu.

2.     Select "Sampler Analysis Stop."

3.     If a check mark is present in the box next to "Unregistered QC Sample," then click on the box to remove the check mark.

4.     Click "Apply." then click “OK” to exit the Analyzer Settings screen.

5.     Access the “Manual Analysis” entry screen.  To manually enter a proficiency testing number into the "Sample No." field using the keyboard, uncheck the “Read ID” box then  type the prefix QC- before the proficiency testing ID number (example: QC-11110805)

6.     Click "OK" to return to the Main Menu.

7.     Run samples in the Manual Open Mode as usual

Note: A “Control is not entered” error will display due to the fact that this particular “control” is not set up in a QC file. Touch “Accept” to clear the error. This will not affect your results.

8.     When sample analysis has been completed, go into Explorer and output the validated results to the GP. Record the results on the form provided.

Note: If the QC result is not validated in Explorer, click on the specimens and click on the “Validate” icon.

9.     When all data has been recorded, follow steps 1 and 2 to access Sampler Analysis Stop. Click on the box next to “Unregistered QC Sample” to place the check mark back in the box

10.  Click “Apply”

11.  Click “OK” to return to the Main Menu


MANUAL OPEN MODE FOR SYSMEX XS-SERIES WITHOUT AUTOLOADER

  1. With "Ready LED" green, click "Manual" or the F2 function key on the keyboard.
  2. Enter the proficiency testing barcoded number into the "Sample No." field, using:

Note: Confirm Caps Lock on the keyboard is OFF.

OR

  1. Click "OK", or press "Enter" on the keyboard.

NOTE: A control entry error will display in the Error List dialog box due to the fact that this particular product is not set up in a QC file. Click on "Accept" and "Close." This will not affect your results.

  1. Open the Sampler Cover.
  2. Select the appropriate sample tube adaptor, and place it in the sample position area of the XS-1000i with the red mark facing up. Turn the adapter clockwise until there is a click (turn about 45°) to secure it.
  3. Place the well mixed (10 times by inversion) proficiency testing sample vial into the XS sample adaptor.
  4. Press the white "Start" button on the right above the sample position area.
  5. A dialog box will display when sample measurement has completed.
  6. When sample analysis has been completed, click on "Explorer", deselect "Last 20", highlight the proficiency testing samples, and print the results to the graphic printer (GP). Record the results on the form provided.
  7. Click "Menu" to return to the Main Menu.


HEMATOLOGY w/DIFF G, 5-part, 3 mL


Five whole blood specimens per testing event for the following analytes:


Basophils

Erythrocytes (RBC)

Hemoglobin

Lymphocytes

Neutrophils

Eosinophils

Hematocrit

Leukocytes (WBC)

Monocytes

Platelets


These specimens are compatible with the following instruments:

HORIBA ABX Pentra 6OC+ series, 80, 120

Coulter Ac•T-5 and Ac•T-8  


Allow vial to stand at room temperature for 20 minutes before mixing.  Hold the vial horizontally between the palms of the hands.  Briskly roll the vial back and forth for 60 seconds, then gently invert 10 times.  Continue to mix in this manner until the cells are completely and uniformly suspended (i.e., no cell button is observed on the bottom of the vial).  Do not shake the vial or use a mechanical mixer.


Primary Mode Sampling (Closed vial mode) – Place premixed vial in sample rack and test.


Secondary Mode Sampling (Open vial mode) – Allow the vial to rest undisturbed about 15 seconds for dispersion of small air bubbles.  Immediately prior to use, gently invert vial 10 times.


NOTE: Per manufacturer’s instructions, specimens MUST be analyzed in QC mode to obtain an accurate WBC differential.



HEMOGLOBIN & HEMATOCRIT, WAIVED, 3 mL


2 challenges per testing event

Whole blood samples for waived testing of hemoglobin and hematocrit only.

The specimens must reach room temperature (15‐30°C) before being re-suspended.  To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions.  Place the vials on a mechanical mixer or gently invert manually for 5 minutes.


Abbott i‐STAT users

As per manufacturer recommendations, use the Proficiency Test Path. See Technical Bulletin 17‐Mar‐11.

Should consider reporting in the i-Stat specific chemistry program.


HEMOGLOBIN & HEMATOCRIT, 5-VIAL, 3 mL


5 challenges per testing event

Whole blood samples for testing of hemoglobin and hematocrit only.


The specimens must reach room temperature (15‐30°C) before being re-suspended.  To re-suspend contents, roll the vials between the palms of the hands for 20 seconds in upright, then inverted positions.  Place the vials on a mechanical mixer or gently invert manually for 5 minutes.

Abbott i‐STAT users

As per manufacturer recommendations, use the Proficiency Test Path. See Technical Bulletin 17‐Mar‐11.

Should consider reporting in the i-Stat specific chemistry program.


RETICULOCYTE COUNT, AUTOMATED


Two specimens per testing event, 1.0 mL

Specimens are compatible with the following instruments:

Abbott Cell-Dyn 3200, 3500, 3700, 4000, Ruby

Beckman Coulter DxH, HMX, LH, XL, STKS, MAXM

Samples are not compatible with the:

Beckman Coulter Gen-S


Specimens do not require reconstitution. Prior to testing mix as follows:

  1. Refrigerate specimens upon arrival and until ready to test.
  2. Mix specimens by gentle inversion between thumb and index finger until the red blood cells are completely re-suspended. Do not mix mechanically. Do not rub between palms of hands.
  3. Perform testing as you would patient samples.


Digital Slides for Manual Counts

Digital slide images are only available online at our website http://www.aab‐pts.org as a link to your online reporting form.  The digital slide images require access to a computer with access to the AAB-PTS website via the internet. Additionally, it requires Internet Explorer version 11.0 or later (limited support for IE 9 and 10), FireFox 4.0 or later, Safari 3 or the latest Google Chrome version.  See DigitalScope Instructions on the online reporting form for using the Miller Ocular with the digital slide image.


Example


Elevated

Normal




RETICULOCYTE COUNT, MANUAL


Two specimens per testing event, 1.0 mL

Liquid specimens are for manual counts only.

Specimen Handling

  1. Refrigerate specimens upon arrival.  Allow to equilibrate to room temperature (18-30oC) for about 15 minutes prior to testing.
  2. Mix specimens by gentle inversion between thumb and index finger until the red blood cells are completely re-suspended.  Do not mix mechanically.  Do not rub between palms of hands.
  3. Perform testing as you would patient samples.


Digital Slides for Manual Counts

Digital slide images are only available online at our website http://www.aab‐pts.org as a link to your online reporting form.  The digital slide images require access to a computer with access to the AAB-PTS website via the internet. Additionally, it requires Internet Explorer version 11.0 or later (limited support for IE 9 and 10), FireFox 4.0 or later, Safari 3 or the latest Google Chrome version.  See DigitalScope Instructions on the online reporting form for using the Miller Ocular with the digital slide image.


Example


Elevated

Normal



RETICULOCYTE COUNT, SYSMEX


Two specimens per testing event, 1.0 mL

Liquid specimens are for Sysmex automated instruments only.

Specimen Handling

  1. Refrigerate specimens upon arrival.  Allow to equilibrate to room temperature (18-30oC) for about 15 minutes prior to testing.
  2. Mix specimens by gentle inversion between thumb and index finger until the red blood cells are completely re-suspended.  Do not mix mechanically.  Do not rub between palms of hands.
  3. Perform testing as you would patient samples.


Digital Slides for Manual Counts

Digital slide images are only available online at our website http://www.aab‐pts.org as a link to your online reporting form.  The digital slide images require access to a computer with access to the AAB-PTS website via the internet. Additionally, it requires Internet Explorer version 11.0 or later (limited support for IE 9 and 10), FireFox 4.0 or later, Safari 3 or the latest Google Chrome version.  See DigitalScope Instructions on the online reporting form for using the Miller Ocular with the digital slide image.


Example


Elevated

Normal



SICKLE CELL SCREEN


Two whole blood specimens per testing event, 2.5 mL

Specimens are human cells in a preservative media, for manual, semi-automated and automated instruments for testing the presence of Hemoglobin S using solubility tests or hemoglobin electrophoresis.

Samples are compatible with the following sickle cell solubility kits:

Streck SICKLEDEX®

Dade® Behring Sickle-Sol™ Solubility Test,

Pacific Hemostasis SickleScreen® Sickling Hemoglobin Screening Kit

Chembio Diagnostic System Sickle-STAT

Columbia Calibre® Sickle Cell Reagent


Specimens do not require reconstitution. Prior to testing mix as follows: