#06-5558 Accrd Manual V7 - COLA

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CRITERIA FOR QUALITY LABORATORY PERFORMANCE>SPECIALTY SPECIFICHematologyHE 1 EIs all venous blood collected in an anti-coagulant which will not affect cellular morphology or interfere with thecell count?EDTA (lavender-top tube) is the anti-coagulant of choice. Heparin will distort the cells and should not beused. Note that this question addresses venous collections. Capillary collections do not require anti-coagulantif diluted in saline immediately or may be collected in heparinized tubes, if not being used for the evaluationof cellular morphology.HE 2 EAre specimens checked for clots before testing and rejected if clots are detected?This question applies to instruments that aspirate the specimen, to manual cell counting, and to centrifugalhematology analyzers if the specimen is collected in EDTA prior to processing. It does not apply to centrifugalanalyzers in the capillary mode. Check for clots by visually inspecting the specimen while tilting the tubeor by stirring the specimen with a wooden applicator stick and looking for clots adhering to the stick.HE 3 EIf you perform automated hematology, (CBC’s and/or reticulocyte counts) are a minimum of two levels of commercialcontrol run each day of patient testing?Laboratories are encouraged to consider their individual operating environments, instrument stability, andpersonnel competency when determining the total number of times to perform controls each day of patienttesting.Laboratories are encouraged to run all levels of control provided for their system each day of testing. Thisprovides a higher level of assurance that results covering the entire reportable range are reliable.Laboratories with multiple shifts may wish to have staff on each shift perform controls. In such cases the laboratorymay elect to use a patient control on additional shifts. A patient control is a patient specimen whichwould have been held over from the morning. It should not be more than twenty four hours old and keptunder refrigeration until needed and brought completely to room temperature and well mixed prior to use.The patient specimen should be picked so as to be different from the control to be used. For example, if anormal patient is used, a high or low control should be run or if a normal control is to be used, a patient specimenwith abnormal values should be used. The laboratory also needs to establish acceptable ranges forpatient replicates. For example, a WBC of +/ 0.5 or an Hct +/ 3.0 of the original value obtained for that specimenmay be deemed acceptable. Another option for establishing acceptable ranges is to use the ranges thatthe control manufacturer has established for the equivalent control to the patient specimen used. For example,use the spread (range) for the high control when using a patient specimen that originally read in the highrange as the second control.HE 4 RIf you perform automated differential counts, have criteria been established for when a manual cell count mustbe performed to verify the automated count?You may also answer this question “yes” if you have established criteria for when to send a differential to areference laboratory. The differential does not need to be performed in-house to meet this criterion.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FOR MORE INFORMATION CONTACT <strong>COLA</strong> PHONE 800.981.9883 | FAX 410.381.8611 | ON-LINE www.cola.org35
CRITERIA FOR QUALITY LABORATORY PERFORMANCEHE 5 RIf you prepare blood smears, are they properly stained; free of precipitate; and have a uniform cell distribution?You need to record that your smears are checked regularly for appropriateness of staining. This can beincluded in the records of your hematology instrument’s daily, weekly, or monthly checks.HE 6 RDoes the blood smear report include an evaluation of red cell morphology?Red blood cell morphology provides clues to the diagnosis of many diseases, including anemias and sicklecell disease.HE 7 RDoes the blood smear evaluation include a platelet estimate from the peripheral smear?HE 8 EIf you perform manual cell counts on a hemacytometer: Is a control counted in duplicate and the results documentedat least every eight hours of testing?Be sure to record the date, time, and result of the control.HE 9 RIf you perform manual cell counts on a hemacytometer: Are diluting fluids checked to be sure they do not containcontaminants or particles that could falsely elevate cell counts?If a prepackaged diluting system is used (e.g., Unopette), check at least one vial per lot number to verify anacceptably low particle count. Be sure to record.HE 10 RIf you perform manual cell counts on a hemacytometer: Are the counting chambers clean and free of scratches?Dirt and scratches can result in incorrect cell counts.HE 11 RIf you perform manual cell counts on a hemacytometer: Is a certified or approved coverslip used on the hemocytometer?The coverslip used on a hemocytometer is precision-ground to fit the chamber. Plain coverslips used in thelaboratory do not fit properly and will result in incorrect cell counts.HE 12 RIf you perform manual cell counts on a hemacytometer: Do you set up manual red and white blood cell andplatelet counts in duplicate, count each dilution on one side of the counting chamber, and document the resultsof each count?This requirement should be recorded in the procedure manual for these tests. Laboratory records shouldinclude the values obtained for each dilution.HE 13 RIf you perform manual cell counts on a hemacytometer: Are manual platelet counts correlated with a plateletestimate from a peripheral smear?Be sure to record on a work sheet, if applicable, or on the patient report.36. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FOR MORE INFORMATION CONTACT <strong>COLA</strong> PHONE 800.981.9883 | FAX 410.381.8611 | ON-LINE www.cola.org
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CYTOLOGY740. EAre non-gynecologic s
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CYTOLOGYEnsuring Quality of Examina
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HISTOPATHOLOGYThe laboratory shall
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HISTOPATHOLOGY859. EAre the stained
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HISTOPATHOLOGY873. EAre unsatisfact
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#06-5558 Accrd Manual V7 - COLA

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