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Background Although hematologic review criteria for general hospitals have been established, they may be insufficient for cancer hospitals. This study aimed to establish the appropriate review criteria for hematology analyzers in cancer hospitals. Methods A total of 1003 samples from our hospital were randomly selected for blood smear preparation and microscopic review. The review criteria of the International Consensus Group for Hematology Review (ICGH) and Chinese consensus group were used to obtain the review, true‐negative (TN), true‐positive (TP), false‐negative (FN), and false‐positive (FP) rates, as well as the triggered rules. Our review criteria were established by comparing flag or numeric value information of TP and FP samples, adjusting rules to obtain better efficiency, a low slide review rate, and an acceptable FN rate. Results Overall, 197 (19.64%) samples showed positive smear findings. Compared to the ICGH criteria, the slide review rate of the newly established criteria declined from 51.25% to 39.28%, and the TP and TN rates increased from 17.85% and 46.06% to 23.13% and 55.83%, respectively. The FN rate of the newly established criteria was 3.69%. Another set of samples used to validate the newly established criteria yielded the review, FN, and FP rates as 33.49%, 1.86%, and 25.58%, respectively. Conclusion The newly established review criteria for hematology analyzers enabled the prompt identification, smear, and further verification of doubtful specimens, without a significant increase in the workload, thus improving the efficiency of the review process. This study provided data support for other cancer hospitals to establish review criteria. The automated hematologic analyzers are widely used in medical laboratories, and review criteria keep the balance between quality and efficiency in hematologic analysis system. The reported review criteria were unsuitable for cancer hospitals, thus, the new review criteria were established on basis of the characteristic of our hospital. We evaluated the performance of the newly‐established criteria and obtained the review, false‐negative, and false‐positive rates as 39.28%, 3.69%, and 17.35%, respectively.

To provide a comprehensive overview of the complexities associated with cardiac troponin (cTn) testing. An emphasis is placed on the sources of error, organized into the preanalytical, analytical, and postanalytical phases of the testing pathway. Controversial areas are also explored. A case scenario and review of the relevant literature describing laboratory considerations involving cTn testing are described. Advanced comprehension of the specific assay used in a given laboratory is necessary for optimal reporting, utilization, and quality monitoring of cTn. cTn assays are reliable diagnostic tests for acute myocardial infarction, but understanding their limitations is required for appropriate result interpretation.

Objective To determine if time to disposition decisions for emergency department (ED) patients can be reduced when blood tests are processed using point-of-care (POC) devices and to conduct a cost-effectiveness analysis of POC compared with laboratory testing. Methods This randomised trial enrolled adults suspected of an acute coronary syndrome or presenting with conditions considered to only require blood tests available by POC. Participants were randomised to have blood tests processed by POC or laboratory. Outcomes measured were time to disposition decision and ED length-of-stay (LOS). The cost-effectiveness analysis calculated the total and mean costs per ED presentation, as well as total and mean benefits in time saved to disposition decision. Results There were 410 POC participants and 401 controls. The mean times to a disposition decision for POC versus controls were 3.24 and 3.50 h respectively, a difference of 7.6% (95% CI 0.4% to 14.3%, p=0.04), and 4.32 and 4.52 h respectively for ED LOS, a difference of 4.4% (95% CI −2.7% to 11.0%, p=0.21). Improved processing time was greatest for participants enrolled by senior staff with a reduction in time to disposition decision of 19.1% (95% CI 7.3% to 29.4%, p<0.01) and ED LOS of 15.6% (95% CI 4.9% to 25.2%, p=0.01). Mean pathology costs were $12 higher in the POC group (95% CI $7 to $18) and the incremental cost-effectiveness ratio was $113 per hour saved in time to disposition decision for POC compared with standard laboratory testing. Conclusions Small improvements in disposition decision time were achieved with POC testing for a moderate increase in cost. Greatest benefit may be achieved when POC is targeted to senior medical staff.

Background Lipemia can interfere with haemoglobin (HGB) levels, which is critical for evaluating anemia and polycythemia. This study aims to develop and evaluate the performance of a lipid flagging and haemoglobin correction system. Methods Lipemic samples were simulated by the addition of a fat emulsion to 79 whole‐blood samples from healthy participants. Additional blood samples were collected from 152 patients with lipemia. Plasma exchange was performed to eliminate lipid interference and establish reference HGB values. A lipid interference flagging method was developed, showing the “Lipid Particles?” flag on the hematology analyzer. Lipid interference was defined as samples showing a percentage change in HGB (ΔHGB%) before and after plasma exchange exceeding 4%. The accuracy of the optical haemoglobin (HGB‐O) value was assessed in the samples with confirmed lipid interference. Results A flagging method was developed based on the changes in routine blood parameters and blood cell scattergram. Among the 152 clinical lipemic samples, 27 were identified as lipid interference. While the “Lipid Particles?” flag was triggered for 28 samples, yielding a sensitivity of 92.59%, specificity of 97.60%, positive predictive value (PPV) of 89.29%, and negative predictive value (NPV) of 98.39%. Additionally, among the 27 lipid‐interfered samples, the HGB‐O value showed excellent correlation (Pearson's r = 0.935) and an average deviation of 0.72% (95% CI, −1.02% to 2.47%) with the reference value. Conclusions These findings highlight the clinical value of the “Lipid Particles?” flag in identifying lipid interference, demonstrating the accuracy of HGB‐O in providing a reliable haemoglobin measurement. A flagging method was developed based on the changes of routine blood parameters and blood cell scattergram. It highlights the clinical value of the “Lipid Particles?” flag in effectively identifying lipid interference. This study supports the use of HGB‐O measured by ERP channel as a robust tool for improving diagnostic accuracy in lipid interference samples, improving patient care in clinical practice. From the identification of lipid interference samples to the HGB correction of interference samples, this study is devoted to improving the management of laboratory lipid interference on blood routine spurious detection. Flowchart for management of lipid interference samples.

BackgroundThe testing and result communication process in primary care is complex. Its successful completion relies on the coordinated efforts of a range of staff in primary care and external settings working together with patients. Despite the importance of diagnostic testing in provision of care, this complexity renders the process vulnerable in the face of increasing demand, stretched resources and a lack of supporting guidance.MethodsWe conducted a series of focus groups with patients and staff across four primary care practices using process-improvement strategies to identify and understand areas where either unnecessary delay is introduced, or the process may fail entirely. We then worked with both patients and staff to arrive at practical strategies to improve the current system.ResultsA total of six areas across the process were identified where improvements could be introduced. These were: (1) delay in phlebotomy, (2) lack of a fail-safe to ensure blood tests are returned to practices and patients, (3) difficulties in accessing results by telephone, (4) role of non-clinical staff in communicating results, (5) routine communication of normal results and (6) lack of a protocol for result communication.ConclusionsA number of potential failures in testing and communicating results to patients were identified, and some specific ideas for improving existing systems emerged. These included same-day phlebotomy sessions, use of modern technology methods to proactively communicate routine results and targeted training for receptionists handling sensitive data. There remains an urgent need for further work to test these and other potential solutions.

The Eastern spot-billed duck ( Anas zonorhyncha ) is a common migratory waterfowl widely distributed throughout East Asia. However, the lack of species-specific reference intervals, defined as the normal range of values derived from a healthy population for clinical interpretation, hampers accurate health assessment and clinical diagnostics in this species. This is further complicated by hematologic characteristics of avian blood, such as nucleated red blood cells and thrombocytes, which pose challenges to conventional automated measurement systems optimized for mammals. This study aimed to establish hematological and biochemical reference intervals for juvenile Eastern spot-billed ducks and to evaluate the accuracy of an automated hematology analyzer (XN-1000V, Sysmex, Japan), which newly supports avian blood analysis, compared to traditional manual counting methods. Blood samples were collected from 55 clinically healthy juvenile ducks. The established reference intervals were largely consistent with those reported in related Anas species, though Eastern spot-billed ducks exhibited a heterophil-predominant leukogram. No significant differences were observed between sexes. Comparison between manual and automated methods revealed statistically significant differences in most hematological parameters; however, most of these differences were not clinically relevant, except for thrombocyte counts. Moderate correlations were found for key parameters, including WBC, RBC, hemoglobin, PCV, and MCV, suggesting potential clinical applicability of the automated analyzer with some limitations. This study provides the first species-specific hematologic and biochemical reference intervals for juvenile Eastern spot-billed ducks under semi-captive conditions, offering valuable baseline data for clinical assessments in this subset of the population. Additionally, it highlights the need for further optimization of XN-1000V analyzers for reliable and precise application in avian diagnostics.

The present study is the first from Pakistan being reported with an objective to assess performance of Rayto RT-7600Vet hematology analyzer (HA) for Cholistani cattle blood (n = 134), in comparison to the manual hematological methods. The four hematological attributes viz . total erythrocyte count (TEC), hemoglobin (Hb), packed cell volume (PCV) and platelet count (PLT) were deduced through HA (A) and manual (M) methods. Various statistical tests were implied to ascertain level of interrelationship, accuracy and level of agreement between the two methods. All attributes attained through manual methods had high positive, leptokurtic distribution (having many outliers) except for PLT-M and PCV-M. The coefficient of variation for attributes attained through HA and manual methods ranged from 16–24% and from 16–59%, respectively. Comparison between the overall results revealed that all the studied attributes, except TEC, were significantly (P≤0.05) different for both methods. A weak relationship was noticed between the attributes attained through two methods as indicated by weak r-values and adjusted r-square values. The reliability level of estimating Hb and PCV had highest intraclass correlation coefficient value of 0.722 and 0.555 for average measures, respectively. However, accuracy level, as determined through Lin’s concordance correlation coefficient was highest for TEC (0.9504) for both analytical methods. Poor level of agreement, in general, was shown for the two methods of analysis regarding all four hematological attributes through Bland and Altman test. In conclusion, the Rayto RT-7600Vet) may present data having higher skewness, kurtosis, and CV%, however, they are valid for multi-species hematological analysis. Caution must however, be taken in interpreting their results with corrected reference intervals and CV% for each machine and for each tested attribute.

Background and Objectives: Laparoscopic cholecystectomy is one of the most performed surgical procedures worldwide. In low-risk patients, routine postoperative blood tests are frequently ordered despite limited evidence supporting their necessity. The aim of the study was to evaluate the predictability of complications that may occur with routine postoperative blood tests. Materials and Methods: This retrospective study examined 538 patients who underwent surgery in Cam and Sakura City Hospital between May 2020 and May 2021. Patients were divided into two groups: no postoperative complications (Group NC, n = 521) and postoperative complications (Group C, n = 17). Demographic characteristics, including age and gender, duration of surgery, cystic duct closure method, drain use, complications, preoperative and postoperative blood tests, and the mean time of hospital stay, were the collected data throughout the study. Results: The analysis of the post-operative blood test values revealed that the total bilirubin (p = 0.005), ALT (p = 0.002), AST (p = 0.002), GGT (p = 0.02) and amylase (p = 0.034) values were statistically significantly higher in Group C than in Group NC, but these values did not exceed the normal range except for ALT, AST and GGT, which were slightly higher than the normal parameters. Seventeen patients (3.15%) developed postoperative complications, including biliary leakage (n = 1); choledocholithiasis (n = 2); cardiac (n = 2), pulmonary (n = 9), and hemorrhagic (n = 2) complications; and a superficial wound infection (n = 1). Most complications were identified by symptoms and clinical observation. Conclusions: Routine postoperative blood tests in low-risk laparoscopic cholecystectomy patients do not significantly contribute to the early detection of complications. Clinical observation and targeted use of laboratory or imaging tests in selected high-risk cases might be more efficient. This approach can help reduce unnecessary workload, hospital costs, and healthcare expenditures without compromising patient safety.

Malaria control depends primarily on rapid and accurate diagnosis followed by successful treatment. Light microscopy is still used as a gold standard method for the diagnosis of malaria. The Sysmex hematology analyzer is a novel method for malaria detection. Therefore, the aim of this review was to investigate the diagnostic accuracy of the Sysmex hematology analyzer for malaria diagnosis. Electronic databases like PubMed, PubMed Central, Science Direct databases, Google Scholar, and Scopus were used to find relevant articles from April to June 14, 2023. The studies' methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Using Review Manager 5.4.1, the estimates of sensitivity and specificity, as well as their 95% confidence intervals, were shown in forest plots. Midas software in Stata 14.0 was utilized to calculate the summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Heterogeneity was assessed by using I2 statistics. In addition, publication bias was assessed using a funnel plot and Deeks' test. Sub-group and meta- regression analysis were also performed. A total of 15 studies were assessed for diagnostic accuracy. The sensitivity and specificity of Sysmex hematology analyzer for studies ranged from 46% to 100% and 81% to 100%, respectively. The summary estimate of sensitivity and specificity of Sysmex hematology analyzer were 95% (95% CI: 85%-99%) and 99% (95% CI: 97%-100%), respectively. It had excellent diagnostic accuracy. There were significant heterogeneity among the studies included in this meta-analysis. The summary estimate of sensitivity and specificity of Sysmex hematology analyzer using polymerase chain reaction as the gold standard was 97.6% (95% CI: 83.2, 99.7) and 99.4% (98.5, 99.8), respectively. In this review, Sysmex hematology analyzer had excellent diagnostic accuracy. Therefore, it could be used as an alternate diagnostic tool for malaria diagnosis in the hospital and health center. Systematic review registration PROSPERO (2023: CRD42023427713). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023427713.