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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

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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


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OBJECTIVES: HOW TO IMPROVE HEMATOLOGY
EFFICIENCY & PATIENT CARE
Automation vs Non-Automation

Technology

Advanced Clinical Parameters:

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AUTOMATION VS NON-AUTOMATION?
XN-9000 BPR, 7 part,
200+ CBC’s/Day

Pochi-3 part, XP-300-3 part, XS-1000 AL, 5 part, XN-1000 BPR, 7 part,
10-30 CBC’s/Day 30-75 CBC’s/Day
1-10 CBC’s/Day 10-20 CBC’s/Day

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Hematology Automation with Cellavision

XN-3000 DI-60

© 2010 Sysmex America, Inc. All rights reserved.

© 2015 Sysmex America, Inc. All rights reserved.


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
The Future YOU!!!

-Millipore Provided as Needed

XN-3000 DI-60

© 2010 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

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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.
Rerun/Reflex Rules

© 2010 Sysmex America, Inc. All rights reserved.

© 2015 Sysmex America, Inc. All rights reserved.


Technology
HCT

Hydrodynamic Focusing &


Floating Discriminators
HGB
Flow Cytometry

88 μL Sample Volume

Up to 100 /hr /module

WNR channel WDF channel PLT-F channel RET channel


WDF Channel Scattergram - Normal Pattern

MONO

IG

LYMPH
NEUT+BASO

Debris

EO
Reportable Immature Granulocytes
Multiple Myeloma with IG’s
Multiple Myeloma with IG’s
IG – XN DIFF Abstract
Solution:
Automated Immature Granulocyte Count
• 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
C infection sooner

•Automated, rapid, accurate, decreases manual reviews


•Speeds information to physicians
O
• Decreased labor needed for manual slide reviews
• Could reduce cost of care when part of comprehensive infection
F surveillance
WNR Channel Scattergram - Normal Pattern

FSC
BASO

NRBC

WBC

Debris
SFL
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
• CHr/Ret-He-Recommended in
guidelines for Chronic Kidney
Disease (CKD) Reference Ranges:
IRF 2.3-15.9 %
RetHe 28.2-36.6 pg
Decrease Blood Transfusions-RetHe

Muusze, R. et al (2009). Protocol for Transfusion Free Major Orthopaedic


Operations Using RET-He. Sysmex Journal International, 19:1, 1-8.
Solution:
Automated Reticulocyte Hemoglobin

• 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
C

• Speeds information to clinicians


• Direct cellular measurement for faster indication of patient response
O

• Manage cost of care for severe anemias, incl. ESA / Iron


• Potential savings from better transfusion management
F
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

• 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
C • May help in determining need for prophylactic transfusions

• Automated, rapid, inexpensive, speeds information to clinicians


• Direct measurement of immature cell production for faster indication of response
O to changes in therapy

• Could reduce time and cost of diagnosis of thrombocytopenia


• Could reduce time to assess response to changes in therapy, saving cost
F • Potential savings from better transfusion management
Technology Improves Efficiency
& Patient Care

BEFORE AFTER

AC
P
IG, RET He, IPF
SUMMARY

Automation vs Non-Automation

Technology Benefits

Advanced Clinical Parameters:

© 2015 Sysmex America, Inc. All rights reserved.


© 2015 Sysmex America, Inc. All rights reserved.

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