TITLE: Review of Abnormal Hematologic Findings

PRINCIPLE

To provide a consistent routine in the department of Hematology for the follow up of abnormal findings. Those peripheral blood smears with abnormal erythrocytic, leukocytic or platelet morphology are to be reviewed by the Senior Technologist in Hematology or a Pathologist.

PERSONNEL

Medical Technologists and Technicians

SPECIMEN

Peripheral blood smears

REAGENTS AND EQUIPMENT

N/A

QUALITY CONTROL

STEPWISE PROCEDURE

When the technologist finds an “abnormal” peripheral blood smear that fits the following criteria, those CBC results should be verified if possible, and then the print out and smear left for review by the Hematology Senior Technologist. In the absence of the Senior Technologist, a designee will be assigned to review “abnormals”. In any patient that presents with these criteria for the 1st time, the smear will be reviewed.

A.	Erythrocytic abnormalities:

Several fragmented erythrocytes, and sickle cells

More than 10 NRBC’s on patients other than newborns.

Rouleaux formation.

B.	Leukocytic abnormalities:

Immature leukocytes (such as bands and younger forms when greater than 20%, or when any number of promyelocytes or blasts are present).

Lymphocytosis (greater than 70%).

Hyposegmentation of leukocytes except in known Pelger-Huet patients.

Marked leukocytosis, with abnormal cells (WBC above 35.0x109/L ).

Marked leukocytopenia, with abnormal cells (WBC below 2.0x109/L).

Basophils greater than 15%.

Monocytes greater than 30%.

Reactive or atypical lymphs (>20%).

C.	Platelet abnormalities:

Severe decrease in the number of platelets.

Giant platelets when it is more than a rare platelet seen.

CALCULATIONS

N/A

REPORTING RESULTS

Review comments are noted in the notebook for “Abnormal Smear Review” and documentation is entered in the LIS on the patient order number.

NORMALS

N/A

REFERENCE

CAP Standards Hematology Checklist, December 29, 2004 HEM.34600