Volume 49, Issue 2 - Special Issue: Routine Haematological Diagnostics; Issue Editor: Peter Schuff-Werner

Objectives Myelodysplastic neoplasms and dysplastic chronic myelomonocytic leukemia are characterized by cytopenia. Therefore, transfusion dependency is high in these dysplastic neoplasms. We investigated the impact of molecular genetics on the transfusion dependency in dysplastic neoplasms. Methods We investigated the impact of the myeloid mutation burden on transfusion dependency in myelodysplastic neoplasms and dysplastic chronic myelomonocytic leukemia. In addition, the effect of different functional genetic groups, such as spliceosomes and epigenetic regulator gene mutations, on transfusion dependency was assessed in these patients. Confounding transfusion triggers were ruled out by the patient selection criteria and regression analyses. Results A greater number of mutations lead to a higher transfusion dependency for red blood cells and platelet concentrates. A higher transfusion dependency was associated with a higher transformation to acute myeloid leukemia. Spliceosome mutations were associated with a higher transfusion dependency of red blood cell concentrates than epigenetic regulator mutations. Conclusions Molecular genetics has the potential to improve the precision of patient blood management in dysplastic neoplasms.

Objectives Digital pathology is becoming standard in the delivery of timely, high-quality clinical services, inclusive of morphological assessment in laboratory hematology. While many digital hematology systems are designed with high-throughput in mind, CellaVision ® has recently developed a low-throughput instrument, the CellaVision ® DC-1. The utility of the CellaVision ® DC-1 was tested in a distributed laboratory system, with a focus on turn-around times (TATs). Methods We evaluated the TATs of a CellaVision ® DC-1 workflow, with specimens originating in a small spoke-laboratory referring materials to a central hub-laboratory. Our spoke-laboratories perform on-site complete blood counts (CBC’s) and manual peripheral blood smears (PBS’s), with complex cases referred for review to the hub-laboratory. Baseline TATs were collected, followed by prospective evaluation of 21 cases analyzed using the CellaVision ® DC-1, with digital review by spoke-laboratory staff in concert with remote review by hub-laboratory staff. The TATs for the same 21 cases by standard manual assessment were compared. Results Improvement in the distribution of TATs using the CellaVision ® DC-1 was noted relative to the retrospective spoke-laboratory data (Mann–Whitney U=26, p<0.0001) and the parallel manual PBS review (Wilcoxon W=190, p<0.0001). The CellaVision ® DC-1 permitted a significant reduction in case-assessment times (Wilcoxon W=105, p=0.0001). No significant diagnostic discrepancies were identified during the testing timeframe. Conclusions We describe a real-world assessment of the CellaVision ® DC-1 analyzer in a distributed (hub-and-spoke) laboratory network, linking low-volume laboratories to high-throughput sites. Our evaluation highlights significant improvements in case TATs with a CellaVision ® DC-1 assisted digital pathology workflow.

Objectives While manual review is the gold standard, automated hematology analyzers are increasingly used. This study assessed the efficiency of white blood cell (WBC)-related flagging messages from the Sysmex XN-1000 and Alinity hq analyzers compared to peripheral blood smear (PBS) findings and evaluated their inter-platform agreement. Methods K 3 EDTA blood samples from hospitalized patients were analyzed using the Sysmex XN-1000. Samples triggering a morphology flag were reanalyzed on the Alinity hq, with PBS reviewed per CLSI protocol H20-A2-2007. Results Of 5530 samples, 196 had morphology-related flags requiring PBS review. Sysmex flagged 144 samples with leukocyte-related messages; Alinity flagged 120. The positive predictive value (PPV) for the Left Shift flag was 100 % for Sysmex and 77.5 % for Alinity; for Immature Granulocytes, it was 19.4 % for Sysmex and 94.6 % for Alinity. The Blast Flag’s PPVs were 9.3 % for Sysmex and 17.9 % for Alinity. Left Shift specificities were high (>94 %), but sensitivities varied. Sysmex showed 100 % sensitivity for the Blast flag but moderate specificity (53 %), while Alinity performed well (77–82 %). Agreement between platforms ranged from poor to good. Conclusions Tailored SOPs are crucial for optimizing laboratory workflow based on different flagging performances. Understanding each analyzer’s strengths and limitations improves interpretation and workflow management.

Objectives This study aims to investigate the frequency, detection, and distribution of platelet clumps, assess the performance of automated digital microscopy (Cellavision) for detecting platelet clumps and explore strategies to optimize detection efficiency. Methods We conducted a retrospective analysis of 987,586 hemograms to evaluate the frequency of platelet clumps, and a study of 246 hemograms with platelet clumps for manual and digital microscopic reviews of blood smears. We investigated the locations and sizes of these clumps along the smear, and evaluated the detection capacity of the Cellavision system. Results Platelet clumps were found in 0.29 % of cases, with a higher incidence in pediatric and elderly populations. Platelet clumps were more frequent and larger at the smear periphery. Cellavision achieved 93 % sensitivity when combining the leukocyte and red blood cell observation fields. The strategy of reviewing only selected cases (platelet count <50 × 10 9 /L or history of clumps) detected 97 % of platelet clumps, while reducing manual reviews by fourfold. Conclusions Automated digital microscopy is an effective tool for detecting platelet clumps, but it requires manual review in specific cases. Expanding image acquisition to the feather edge could further improve detection. A combined approach maximizes efficiency and ensures diagnostic accuracy, particularly in critical cases with low platelet counts.

Objectives Proficiency programs allow hospital laboratories to evaluate and improve diagnostic performance. A cloud-based proficiency program was launched in 2017 to standardize peripheral blood morphology assessments in hospital laboratories across the province of Nova Scotia. Methods The CellaVision ® Proficiency Software was used to evaluate peripheral blood morphology assessments. A different blood film featuring a specific red or white cell finding or normal morphology was evaluated each month. Each hospital’s proficiency slide completion and pass rates were monitored, which helped inform remediation efforts. Results In 2017, 213 medical laboratory technologists from 14 hospital laboratories enrolled in the proficiency program. The average completion rate for monthly proficiency assessments between 2017 and 2022 was 90 %. During that time, the pass rate increased from 59 to 95 % and 73 to 89 % for red and white blood cell assessments, respectively. By 2022, four hospital laboratories and 83 medical laboratory technologists stopped performing peripheral blood assessments. Conclusions The CellaVision ® Proficiency Software facilitated a centralized peripheral blood morphology proficiency assessment program for geographically distributed hospital sites. The use of this software increased the quality of peripheral blood morphology assessments in Nova Scotia by simplifying the evaluation of and education on peripheral blood morphology skills.