Hematology testing automation is a fairly ubiquitous technology in today’s clinical laboratory, with layers of sophistication, as well as various ways to initiate interaction with other lab technologies. Demands for increased productivity and more expeditious TAT have driven the need for basic hematology testing automation that a lab assistant can easily load samples into without having to manipulate individual or racks of tubes. The latest automated analyzers also benefit from advanced, rule-driven middleware packages that support automated slide making and staining, repeat testing of critical specimens, and autoverification.

At the Virtua Hospitals in southern New Jersey, our latest hematology automation is greatly augmented by its attendant middleware decision management package, which allows us to customize rules that enable normal results to autoverify directly to the LIS without technologist intervention. In fact, the middleware capability is what drove the implementation of hematology result autoverification at Virtua.

Many labs do not use their core LIS to manage autoverification, as specialized middleware has quickly established itself as generally easier and more robust in managing rules-based logic than a typical LIS, which focuses largely on core functions of order and result management. This has led many vendors to partner with specific middleware companies and present those options as part of their overall sales package. While analyzers can be run without middleware, we have found the efficiencies gained through its use to be substantial.

At Virtua, reflex testing for abnormal results is now automatic and will occur before the sample reaches the end of the automated line; a technician does not need to physically replace and re-run the sample. Thus, the re-run rules built into our middleware govern reflex orders, such as a microscopic exam, and the rules will dictate that the sample be routed for automatic slide creation and staining. No human interaction is needed, thereby removing the subjective process of individual technicians deciding which samples should be made into slides. Most of the samples being tested never need to be reviewed thanks to autoverification. Ultimately, the successful marriage of hematology testing automation with advanced middleware has yielded impressive results.

Dee Snyder, BS, MT(HHS), is the laboratory quality director at Virtua Health in Voorhees, New Jersey.

UniCel DxH Connected Workcell
UniCel DxH by Beckman Coulter is an easy-to-use hematology instrument that comes complete with decision-making support for each analyzer. The device eliminates the need for pre-sorting and offers workflow enhancements with three-lane, bi-directional transport. The optional DxH SMS enables reliable, automated slidemaking and staining with minimal user maintenance and cleaning. The DxH 1600 model measures 78.7 x 152.4 x 180.3 centimeters and weighs 486.2 kg. The 2401 model has a sample throughput of up to 300 samples and 140 slides per hour. By connecting up to six UniCel DxH Workcells using the Power Express automation solution, a throughput of up to 1800 specimens per hour is attainable. The analyzers allow for three independent, first-pass platelet counts with every CBC; patented DataFusion for accurate flagging and enumeration; and single aspiration pathways to minimize calibration, QC, and regulatory reporting requirements.

From Beckman Coulter
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DM9600
The CellaVision DM9600 system automates and simplifies the process of performing blood and body fluid differentials. With a loading capacity of 96 slides, a mechanism for continuous feed, and a 30 slide-per-hour throughput, the DM9600 system is ideal for hematology labs with high-volume testing requirements. The system scans and reads the slide bar code and queries the LIS for patient demographics and order data. The slide is automatically positioned under the microscope, the monolayer is identified, cells are located, and high-quality cell images are captured. Image analysis technology delivers a pre-classification of white blood cells and a pre-characterization of red blood cell morphology for review and verification by a technologist. Structured interfaces, smart functionalities, and embedded tools help speed up the review process, while promoting accuracy and consistency. The system has a footprint of 22.8 x 22 x 31.1 inches and weighs 205 pounds.

From CellaVision AB
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EasyCell
The EasyCell assistant from Medica helps improve productivity by automatically locating 100 or 200 white cells on a blood smear and pre-classifying them on a display, grouped by cell type. The analyzer also displays images of red cells and platelets for performance of red cell morphology and platelet estimate. Slides are loaded into the 30-position carousel or placed in the EasyCell Stat position for immediate analysis; the technologist can walk away while slides are being processed. Immature, abnormal, and unrecognized cells are displayed separately. The technologist can easily compare white cell images, which helps in final classification of cells. During review of red cell morphology images, the technologist can note any abnormalities on the user interface. Platelet estimate and morphology also can be recorded. In addition, the EasyCell Remote software can be installed on existing computers in the lab, creating additional review workstations. The software allows networking of multiple EasyCells and review workstations, and has all the functionality of an assistant except for processing of slides. These workstations can be located anywhere, allowing access to all EasyCell images, as well as patient and physician data.

From Medica Corporation
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DM1200
The CellaVision DM1200 system automates and simplifies the process of performing blood and body fluid differentials. With a loading capacity of 12 slides, and a 20-slides-per-hour throughput, the DM1200 system is suitable for both medium and large laboratories. The system scans and reads the slide bar code and queries the LIS for patient demographics and order data. The slide is automatically positioned under the microscope, the monolayer is identified, cells are located, and high-quality cell images are captured. The image analysis technology delivers a pre-classification of white blood cells and a pre-characterization of red blood cell morphology for review and verification by a technologist. Structured interfaces, smart functionalities, and embedded tools help speed up the review process while promoting accuracy and consistency. The system has a footprint of 22.7 x 17.7 x 28.0 inches and weighs 176 pounds.

From CellaVision AB
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XN-1000 PR
Sysmex introduces the XN-1000 PR small-scale hematology analyzer, which offers a fully reportable, six-part differential, including immature granulocytes, NRBCs with every CBC, comprehensive reticulocyte panel including RET-He, and advanced investigation of thrombopoiesis with immature platelet fraction and PLT-F. The system is compact at under 24-inches wide, and is complete with user-definable decision rules.

From Sysmex Corporation
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Drew D3
The Drew D3 differential automatic hematology system from Erba Diagnostics is a three-part, complete blood count analyzer that has a convenient onboard reagent pack good for 365 cycles, and an easy-to-use touchscreen interface. The D3 can run 60 samples an hour, and the system has the ability to customize 20 different patient profiles, ranging from neonates and pediatrics to geriatrics. The system can process sample sizes as small as ten microliters and has a pre-diluted mode, making it ideal for pediatric use. Even though it takes up little space on the bench, the system’s data management stores up to 1000 sample records and QC statistics. The D3 is efficient, with a low consumption of reagents, helping to minimize costs.

From Erba Diagnostics
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XN-9000
Sysmex’s large-scale hematology analyzer, the XN-9000, is custom scalable, modular, and configurable. The system may consist of a combination of single or multiple modules such as advanced hematology analyzers with slidemaking/staining, cell image analysis, EDTA tube sorting/archiving, HPLC-HbA1c analysis, and decision logic software. The design and flexibility also is compatible with total lab automation (TLA) environments.

From Sysmex Corporation
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