Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists
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Victor Tseng
Abstract
Background: Peripheral smear review is a critical, but labor intensive adjunct for evaluation of lymphocytosis. Standard practice based on consensus guidelines is to review cases with absolute lymphocyte count (ALC) >5×109/L. We hypothesize that identifying cases for review by applying appropriately adjusted ALC and age discriminators will decrease laboratory workload without compromising patient care.
Methods: 1170 complete blood counts with ALCs >5×109/L analyzed in the core laboratory during a 2-year period were included. Patients were categorized into diagnostic groups based on follow-up criteria. A total of 402 patients with new onset lymphocytosis who met criteria for reactive lymphocytosis (82%) or lymphoproliferative disorder (18%) were used to establish optimal ALC and age thresholds from receiver operating characteristic (ROC) curve analysis.
Results: ALC as a discriminator for neoplastic lymphocytosis had an ROC area under the curve (AUC) of 0.732. Selecting cases with ALC >10×109/L enriched the proportion of neoplastic cases in the review pool (90% specificity); however, many cases with ALC below this threshold were also neoplastic (52% sensitivity). For cases with ALC between 5 and 10×109/L, age as a discriminator had an ROC AUC of 0.886. Selecting patients >50 years old in this group for review captured the neoplastic cases while excluding the reactive cases (93% sensitivity, 62% specificity). When applied to a validation cohort, the predictive performance of the thresholds was maintained while reducing smears reviewed by 50%.
Conclusions: We show that modifying the standard 5×109/L ALC smear review threshold through retrospective analysis of institutional data can reduce laboratory workload without compromising quality.
References
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©2014 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Editorials
- CCLM Award for The Most Cited Paper Recently Published
- Laboratory preparedness to face infectious outbreaks. Ebola and beyond
- Reviews
- Determination of reference limits: statistical concepts and tools for sample size calculation
- Recent advances in physiological lipoprotein metabolism
- New laboratory markers for the management of rheumatoid arthritis patients
- General Clinical Chemistry and Laboratory Medicine
- The impact of repeat-testing of common chemistry analytes at critical concentrations
- Performance of CKD-EPI equation to estimate glomerular filtration rate as compared to MDRD equation in South Brazilian individuals in each stage of renal function
- The serum uromodulin level is associated with kidney function
- Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists
- Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100
- UF-1000i: validation of the body fluid mode for counting cells in body fluids
- Newborn screening for haemoglobinopathies by high performance liquid chromatography (HPLC): diagnostic utility of different approaches in resource-poor settings
- Progressive chromogenic anti-factor Xa assay and its use in the classification of antithrombin deficiencies
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- Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample
- Reference ranges for serum β-trace protein in neonates and children younger than 1 year of age
- A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
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- Acknowledgment
- Acknowledgment
- Letters to the Editor
- Interference in thyroid hormones with Roche immunoassays: an unfinished story
- Discrepant results in plasma, but not serum in the Beckman Coulter DxI Access HYPERsensitive hTSH 3rd generation assay affect the management of differentiated thyroid cancer and hyperthyroid patients
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- Congress Abstract
- 5th Italian GREAT Network Congress
- Congress of Laboratory Medicine and Clinical Chemistry
Artikel in diesem Heft
- Frontmatter
- Editorials
- CCLM Award for The Most Cited Paper Recently Published
- Laboratory preparedness to face infectious outbreaks. Ebola and beyond
- Reviews
- Determination of reference limits: statistical concepts and tools for sample size calculation
- Recent advances in physiological lipoprotein metabolism
- New laboratory markers for the management of rheumatoid arthritis patients
- General Clinical Chemistry and Laboratory Medicine
- The impact of repeat-testing of common chemistry analytes at critical concentrations
- Performance of CKD-EPI equation to estimate glomerular filtration rate as compared to MDRD equation in South Brazilian individuals in each stage of renal function
- The serum uromodulin level is associated with kidney function
- Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists
- Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100
- UF-1000i: validation of the body fluid mode for counting cells in body fluids
- Newborn screening for haemoglobinopathies by high performance liquid chromatography (HPLC): diagnostic utility of different approaches in resource-poor settings
- Progressive chromogenic anti-factor Xa assay and its use in the classification of antithrombin deficiencies
- Reference Values and Biological Variations
- Thyroid-stimulating hormone reference range and factors affecting it in a nationwide random sample
- Reference ranges for serum β-trace protein in neonates and children younger than 1 year of age
- A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers
- Serum reference intervals of homoarginine, ADMA, and SDMA in the Study of Health in Pomerania
- Cancer Diagnostics
- Low SOX17 expression: prognostic significance in de novo acute myeloid leukemia with normal cytogenetics
- Results of first proficiency test for KRAS testing with formalin-fixed, paraffin-embedded cell lines in China
- Aberrant hypermethylation of CTNNA1 gene is associated with higher IPSS risk in patients with myelodysplastic syndrome
- Cardiovascular Diseases
- Association between SNP rs13376333 and rs1131820 in the KCNN3 gene and atrial fibrillation in the Chinese Han population
- Acknowledgment
- Acknowledgment
- Letters to the Editor
- Interference in thyroid hormones with Roche immunoassays: an unfinished story
- Discrepant results in plasma, but not serum in the Beckman Coulter DxI Access HYPERsensitive hTSH 3rd generation assay affect the management of differentiated thyroid cancer and hyperthyroid patients
- Improper serum separation on gel tubes: a trivial laboratory problem or an indicator of monoclonal gammopathy?
- Analytical comparison of the new point-of-care troponin T immunoassay on AQT90Flex® analyzer (Radiometer) and the high-sensitivity troponin T immunoassay on ModularE170® (Roche Diagnostics)
- Performance characteristics of the enzymatic Abbott Architect HbA1c whole blood assay
- Multi-center proficiency tests for Lab-MELD score diagnostics to improve the quality and safety for patients awaiting liver transplantation
- The apolipoprotein B/apolipoprotein A-I ratio in healthy men with normolipidemia: limits of variation and relationship with other lipid parameters
- Validity and reliability of the 13C-methionine breath test for the detection of moderate hyperhomocysteinemia in Mexican adults; statistical issues in validity and reliability analysis
- Enzymatic and endpoint methods yield comparable adenosine deaminase activity in pleural fluid samples
- Congress Abstract
- 5th Italian GREAT Network Congress
- Congress of Laboratory Medicine and Clinical Chemistry
