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© 2015 Sysmex America, Inc. All rights reserved.
New World Hematology - Utilizing Automation,
Technology, and Advanced Clinical
Parameters Efficiently in Declining Medical
Technologist Market
Gina Schneider, MT(ASCP),CA(CLS)
© 2015 Sysmex America, Inc. All rights reserved.
Long Term
Healthcare
Difficulties
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
CAN WE MEET THE LABORATORY STAFFING SHORTAGE?
Demand for qualified lab staff far outpaces supply
19.5% Hematology techs anticipated to retire in next 5 years
MT/MLT programs closing due to lack of funding, 15%-1990
Clinical rotation placements reduced with declining staff
Nation’s labs need 7K jobs filled/yr, programs producing 6K
CMS (Centers for Medicade and Medicare Services) suggesting
nurses can perform high complexity testing
Goal: Become more creative and efficient
Clinical Laboratory News, Nov 2015
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
OBJECTIVES: HOW TO IMPROVE HEMATOLOGY
EFFICIENCY & PATIENT CARE
Automation vs Non-Automation
Technology
Advanced Clinical Parameters:
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
AUTOMATION VS NON-AUTOMATION?
Pochi-3 part,
1-10 CBC’s/Day
XP-300-3 part,
10-20 CBC’s/Day
XS-1000 AL, 5 part,
10-30 CBC’s/Day
XN-1000 BPR, 7 part,
30-75 CBC’s/Day
XN-9000 BPR, 7 part,
200+ CBC’s/Day
© 2015 Sysmex America, Inc. All rights reserved.
© 2010 Sysmex America, Inc. All rights reserved.
Hematology Automation with Cellavision
XN-3000 DI-60
Efficiency
Standardized platelet estimate tools
Standardized RBC views & tools
Problems with Manual Microscopy
• Declining availability
of medical technologists
• Labor intensive
• Not standardized
• Difficult to train
• No historical images
• Limited consultation
• Connectivity between
providers
© 2015 Sysmex America, Inc. All rights reserved.
© 2010 Sysmex America, Inc. All rights reserved.
The Future YOU!!!
XN-3000 DI-60
-Millipore Provided as Needed
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
WORKFLOW ANALYSIS
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
HEMATOLOGY OBJECTIONS TO IMPROVE EFFICIENCY
Automation
Technology
Advanced Clinical Parameters
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.© 2015 Sysmex America, Inc. All rights reserved.
© 2015 Sysmex America, Inc. All rights reserved.
© 2010 Sysmex America, Inc. All rights reserved.
Rerun/Reflex Rules
Hydrodynamic Focusing &
Floating Discriminators
HGB
HCT
Technology
Flow Cytometry
WNR channel WDF channel PLT-F channel RET channel
88 μL Sample Volume
Up to 100 /hr /module
WDF Channel Scattergram - Normal Pattern
LYMPHNEUT+BASO
EO
MONO
Debris
IG
Reportable Immature Granulocytes
Multiple Myeloma with IG’s
Multiple Myeloma with IG’s
IG – XN DIFF Abstract
Solution:
Automated Immature Granulocyte Count
C
• May be a useful complement to current infection surveillance program even when other tests are negative
• With other information may help physicians identify patients with infection sooner
O•Automated, rapid, accurate, decreases manual reviews
•Speeds information to physicians
F
• Decreased labor needed for manual slide reviews
• Could reduce cost of care when part of comprehensive infection surveillance
WNR Channel Scattergram - Normal Pattern
NRBC
WBC
BASO
Debris SFL
FS
C
WNR Channel
• Fluorescent Flow Cytometry Technology
• Maximized Efficiency
• NRBC the first time – all the time
– No additional steps
– Accurate WBC Counts in the presence of NRBCs
• Virtually eliminates interference from:
• Lyse resistant RBCs
• Lipids
Reference Ranges:
IRF 2.3-15.9 %
RetHe 28.2-36.6 pg
• CHr/Ret-He-Recommended in
guidelines for Chronic Kidney
Disease (CKD)
Decrease Blood Transfusions-RetHe
Muusze, R. et al (2009). Protocol for Transfusion Free Major OrthopaedicOperations Using RET-He. Sysmex Journal International, 19:1, 1-8.
Solution:
Automated Reticulocyte Hemoglobin
C
• More comprehensive workup of patients without access to primary care (POA)
• Less variation than acute phase reactants in patients with inflammation or infection
• Used with other information may improve care of patients on ESA / IV Iron therapy
O• Speeds information to clinicians
• Direct cellular measurement for faster indication of patient response
F• Manage cost of care for severe anemias, incl. ESA / Iron
• Potential savings from better transfusion management
Secondary Platelet Methodology
Rouleaux, RBC Fragments
Rouleaux, RBC Fragments
Rouleaux, RBC Fragments
IPF (Immature Platelet Fraction)
Reference
Ranges:
IPF 0.9–11.2 %
AML – Initial Run
AML – Reflex Run
AML
Solution: Immature Platelet Fraction
C
• Use in conjunction with patient diagnosis and platelet count
• May assist in determining cause/differential diagnosis of thrombocytopenia
• Provides a direct cellular measurement of thrombopoietic activity
• May help in determining need for prophylactic transfusions
O
• Automated, rapid, inexpensive, speeds information to clinicians
• Direct measurement of immature cell production for faster indication of response to changes in therapy
F
• Could reduce time and cost of diagnosis of thrombocytopenia
• Could reduce time to assess response to changes in therapy, saving cost
• Potential savings from better transfusion management
Technology Improves Efficiency
& Patient Care
BEFORE AFTER
AC
P
IG, RET He, IPF
© 2015 Sysmex America, Inc. All rights reserved.
Automation vs Non-Automation
Technology Benefits
Advanced Clinical Parameters:
SUMMARY
© 2015 Sysmex America, Inc. All rights reserved.