Northern Haematology Quality Assurance Group
Date: 14/10/04
Membership
Attendees: Margaret Hammond, Glen Devenie, George Chan (Ak) Vani Sugumaran (NSH) John Peters, Lynn Palmer, Hilary Blacklock (MMH)
Greg Elias (North Path) Robin Allen (Waikato) Eric Odyn (H MedLab) Ross Anderson, Simon Jones, Edward Theakston (DML)
NorthQAG website http://mmhaem.tripod.com/northqag.html
password = norqach
Apologies: David Pees, Gordon Royle, Alan Neal
Item Discussed
Actions/Agreed Comments
INR Waikato Survey
Red Cell Folate
– Kit change
Folates
Red Cell v Serum
Date to be
Actioned by
By Whom
A questionnaire is to be sent out with the next Waikato Coagulation Survey to see how labs are
calculating and using the ISI. There is a large spread of results with the survey. It was
mentioned that at the International Symposium on Technological Innovations in Laboratory
Hematology held earlier this year a paper was presented on Use of the INR in the US.
Progress and Problems. This paper mentioned different ways of producing incorrect results
e.g. incorrect use of ISI, wrong ISI for reagent/analyser combination etc.
Roche have changed kit reagents. RDNZ Customer bulletin “… An extensive analysis of the
reagent packs revealed there were two raw reagents that could be identified as the major
source of instability…” These kits were giving results 15-20% too high.
Kit changes have to be notified to the Labs. We need to state our requirements when we set up
Standing Orders with suppliers. We have to be more proactive and make each other aware of
possible problems. Have found that some companies say that “you” are the only lab to have
this problem. If we communicate within ourselves we present a united front.
Eric produced a comparison of about 16,000 samples of Serum Folate v Red Cell Folate, p =
0.65.
As a screening test the Serum folate is good if the patient’s diet is stable. Red Cell Folate if the
diet is fluctuating.
Hospital versus Community Lab situation. Interpret on clinical situation.
Consensus statement:
For general screening Serum Folate is adequate but if there is reason to believe that there may
be fluctuation e.g. with improved diet after hospital admission, then RBC Folate is preferable
because it is a better reflection of tissue folate stores.
Smear Cells
All called them Smear cells as per HSIG Standardised Reporting of Haematology Laboratory
results. 3rd edition 1988.
 MMH – Manual diff done. CLL – smear cells reported when ~10-15% and above.
 Waikato – Smear cells counted.
 Ak – Have flow chart to follow. Dependent on number of smear cells, clinical diagnosis and
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Band Neutrophils
Pelger Huet
Lab Review
ARQAG
International
Consensus group for
Haematology review
Next Meeting
whether the analyser differential had flags or not..
Consensus:
Smear cells should be counted as smear cells when more than approximately 10% of the
differential.
Albumin film done at the discretion of the individual laboratory e.g if immature cells are
suspected to be present.
Hamilton MedLab, Rotorua and Waikato comment on the presence of bands but call them
Segmented Neutrophils except for children under 5 years old where they are counted as bands
Ak report Bands on Neonates so to make it simple count bands on all samples.CV approx.
20%
NSH and MMH report Bands on all samples.
Rotorua only count Bands when the patient is a neonate.
Bands have been published as being useful in diagnosing the onset of infection for neonates.
Consensus:
 Pelger Huet:
Call the cells segmented (i.e. mature) neutrophils and comment on Pelger Huet.
 Band neutrophils in general:
Call band neutrophils in neonates.
No consensus reached for other patient groups.
Auckland Regional Review. Impossible to see where it is going. The consultant has been
through Auckland and DML.
Next meeting 9:30 Thursday November 11th at Lab Plus.
From Colleen Harvey (Chemistry Lab Plus)
We are hoping to finalise (or almost finalise) the Vitamin B12 and folate reference intervals at
the next meeting. This will obviously require input from haematologists so please invite anyone
who you think may be interested to the next meeting on November 11th at LabPlus. We will
make this the first agenda item so the haematologists can participate and then leave if they
wish.
George suggested we look at this Suggested Criteria for Action Following Automated CBC and
WBC Differential Analysis at a future NORTHQAG Meeting.
http://www.islh.org/2004/Committees/ConsensusGroup/CGICGHReview.htm
DML Thursday 18th November 10am.
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