New World Hematology - Utilizing Automation, …userfiles/pdfs/6 New World Hematology... · New...

New World Hematology - Utilizing Automation,

Technology, and Advanced Clinical

Parameters Efficiently in Declining Medical

Technologist Market

Gina Schneider, MT(ASCP),CA(CLS)

Long Term

Healthcare

Difficulties

CAN WE MEET THE LABORATORY STAFFING SHORTAGE?

Demand for qualified lab staff far outpaces supply

19.5% Hematology techs anticipated to retire in next 5 years

MT/MLT programs closing due to lack of funding, 15%-1990

Clinical rotation placements reduced with declining staff

Nation’s labs need 7K jobs filled/yr, programs producing 6K

CMS (Centers for Medicade and Medicare Services) suggesting

nurses can perform high complexity testing

Goal: Become more creative and efficient

Clinical Laboratory News, Nov 2015

OBJECTIVES: HOW TO IMPROVE HEMATOLOGY

EFFICIENCY & PATIENT CARE

Automation vs Non-Automation

Technology

Advanced Clinical Parameters:

AUTOMATION VS NON-AUTOMATION?

Pochi-3 part,

1-10 CBC’s/Day

XP-300-3 part,

10-20 CBC’s/Day

XS-1000 AL, 5 part,

10-30 CBC’s/Day

XN-1000 BPR, 7 part,

30-75 CBC’s/Day

XN-9000 BPR, 7 part,

200+ CBC’s/Day

Hematology Automation with Cellavision

XN-3000 DI-60

Efficiency

Standardized platelet estimate tools

Standardized RBC views & tools

Problems with Manual Microscopy

• Declining availability

of medical technologists

• Labor intensive

• Not standardized

• Difficult to train

• No historical images

• Limited consultation

• Connectivity between

providers

The Future YOU!!!

XN-3000 DI-60

-Millipore Provided as Needed

WORKFLOW ANALYSIS

HEMATOLOGY OBJECTIONS TO IMPROVE EFFICIENCY

Automation

Technology

Advanced Clinical Parameters

Rerun/Reflex Rules

Hydrodynamic Focusing &

Floating Discriminators

Technology

Flow Cytometry

WNR channel WDF channel PLT-F channel RET channel

88 μL Sample Volume

Up to 100 /hr /module

WDF Channel Scattergram - Normal Pattern

LYMPHNEUT+BASO

Debris

Reportable Immature Granulocytes

Multiple Myeloma with IG’s

IG – XN DIFF Abstract

Solution:

Automated Immature Granulocyte Count

• May be a useful complement to current infection surveillance program even when other tests are negative

• With other information may help physicians identify patients with infection sooner

O•Automated, rapid, accurate, decreases manual reviews

•Speeds information to physicians

• Decreased labor needed for manual slide reviews

• Could reduce cost of care when part of comprehensive infection surveillance

WNR Channel Scattergram - Normal Pattern

Debris SFL

WNR Channel

• Fluorescent Flow Cytometry Technology

• Maximized Efficiency

• NRBC the first time – all the time

– No additional steps

– Accurate WBC Counts in the presence of NRBCs

• Virtually eliminates interference from:

• Lyse resistant RBCs

• Lipids

Reference Ranges:

IRF 2.3-15.9 %

RetHe 28.2-36.6 pg

• CHr/Ret-He-Recommended in

guidelines for Chronic Kidney

Disease (CKD)

Decrease Blood Transfusions-RetHe

Muusze, R. et al (2009). Protocol for Transfusion Free Major OrthopaedicOperations Using RET-He. Sysmex Journal International, 19:1, 1-8.

Solution:

Automated Reticulocyte Hemoglobin

• More comprehensive workup of patients without access to primary care (POA)

• Less variation than acute phase reactants in patients with inflammation or infection

• Used with other information may improve care of patients on ESA / IV Iron therapy

O• Speeds information to clinicians

• Direct cellular measurement for faster indication of patient response

F• Manage cost of care for severe anemias, incl. ESA / Iron

• Potential savings from better transfusion management

Secondary Platelet Methodology

Rouleaux, RBC Fragments

IPF (Immature Platelet Fraction)

Reference

Ranges:

IPF 0.9–11.2 %

AML – Initial Run

AML – Reflex Run

Solution: Immature Platelet Fraction

• Use in conjunction with patient diagnosis and platelet count

• May assist in determining cause/differential diagnosis of thrombocytopenia

• Provides a direct cellular measurement of thrombopoietic activity

• May help in determining need for prophylactic transfusions

• Automated, rapid, inexpensive, speeds information to clinicians

• Direct measurement of immature cell production for faster indication of response to changes in therapy

• Could reduce time and cost of diagnosis of thrombocytopenia

• Could reduce time to assess response to changes in therapy, saving cost

• Potential savings from better transfusion management

Technology Improves Efficiency

& Patient Care

BEFORE AFTER

IG, RET He, IPF

Automation vs Non-Automation

Technology Benefits

Advanced Clinical Parameters:

SUMMARY

New World Hematology - Utilizing Automation, …userfiles/pdfs/6 New World Hematology... · New...

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