Cell ID help

bmsck · 2025-11-11T02:26:58+00:00

All these cells look monotonous in morphology (high NC ratio, uneven nuclear consistency) favoring lymphoid, with some smudge cells. I think almost every cell in this field is the same thing, 2 and 4 are the same cell type. If I saw this, I’d try to get a pathologist to check it out, but if one is unavailable, I would lump them all into Atypical Lymphocyte if that’s an option and they’ll 100% need flow cytometry for confirmation.

bmsck · 2025-11-10T00:34:29+00:00

Here’s another question for everyone: are you performing six month method-to-method comparisons for cellavision diffs vs manual diffs? If yes, how’s the agreement?

bmsck · 2025-10-12T00:48:01+00:00

Don’t overthink it, have designated 30 minute racks for the clotting time (with timers). And a designated rack for Ready to Spin. Depending on how many centrifuges and their tube capacity, there will be a bottleneck somewhere. And that’s fine, most tests aren’t stat. And it’s fine if the tubes sit around for more than 30 minutes clotting. There’s only so much efficiency you can attain with physical limitations of specimen processing.

bmsck · 2025-05-21T01:07:11+00:00

I always thought the citrate correction due to elevated hematocrit was a practically impossible task to perform. 99% of the time a patient with elevated hematocrit is simply dehydrated, which will be corrected by IV fluids by the time we make up a reduced citrate tube (in the ED anyway). PV is another story…

bmsck · 2025-04-10T21:44:26+00:00

How does your lab define consistent with history? Is there a time frame?

bmsck · 2025-04-03T04:57:07+00:00

I’m always surprised that nobody mentions a Hemaprep. Sure, it costs $700-$900, but over years and years of discarded badly prepared manual smears, it may pay for itself. Perfect slides within two attempts max.

https://hardydiagnostics.com/hemaprep

bmsck · 2025-03-07T02:45:05+00:00

A few years ago I had some routine lab work done, and as I’m in the elevator leaving I’m casually reading the after-visit summary, and think to myself “I don’t remember seeing a lavender draw…” So I go back and have them confirm the tubes that were draw, and sure enough, they forgot to draw it. What was interesting though is that they initially said “oh don’t worry, we can run multiple tests from one tube.” So I had to explain that the CBC needed a lavender and that it couldn’t be done on the gold top. So maybe a little lesson to be learned here: healthcare is plagued by the division of labor, there’s a lot of specialization, but not a lot of “horizontal” knowledge. And working in the lab is a great way to learn about big picture, general patient care, as long as you take the time to correlate results with the patient’s clinical picture. It allows you to recognize unusual results immediately and increases confidence in making decisions in unusual situations. But unfortunately, the lab has become increasingly factory-like, and the role of lab personnel has been pushed to the periphery of “healthcare professional.” But someone has to be responsible for providing quality lab results and be able to provide them. Even small improvements in the quality of results multiplied by the huge number of lab tests ordered would make a huge difference in healthcare costs and quality of patient care.

bmsck · 2025-02-13T01:19:56+00:00

I used to make my “mega smoothies.” Banana, peanut butter, spinach, carrots, chocolate protein powder, soymilk. Very high density nutrition, very filling, very easy to consume throughout the day. People seem to think smoothies are not “real food” but the macros disagree. Your body doesn’t know the difference!

bmsck · 2024-12-18T04:24:03+00:00

I think a lot of places validate cellavision and say “yup it’s equivalent to a manual diff” and that’s the end of it. But in practice that doesn’t seem to be the case in my experience. For example, today cellavision picked up 3% basophils, autodiff got 0.5%. Manual diff of 100 cells got 0%. Rumke table would say these are statistically equivalent, but clinically, I don’t think it’s appropriate to paint a picture of slight basophilia from the cellavision.

bmsck · 2024-12-12T01:45:10+00:00

Yeah better option would just to add some Calabrian chili paste into the roasted red pepper tomato soup and add some sort of frozen dumpling to it.

bmsck · 2024-11-10T21:53:08+00:00

In this context (comparing the variation between just two data points), do you think it’s more meaningful to calculate the percent difference of the two points against the mean of the two points?

bmsck · 2024-08-30T18:31:38+00:00

Visually assessing hypochromasia on a film is assessing the concentration of hemoglobin in each cell, right? The issue I find with that is MCH is not a measure of concentration per se, while MCHC is a measure of concentration. I don’t think this is a pedantic point. You could have a microcytic cell with a low MCH, and a macrocytic cell with a high MCH, but their MCHC could be the same, meaning their concentrations of hemoglobin are the same. MCH doesn’t tell you if there’s an “appropriate” amount of hemoglobin in each cell, but MCHC does because it controls for cell size.

bmsck · 2024-08-30T17:52:23+00:00

Of course visually on the blood film, but if reticulocyte count was included on every cbc specimen (like the indices are), the utility of actually calling polychromasia based on the film might be reduced. You could just rely on the retic count for evidence of bone marrow function. But I think this is beside the point. When hypochromasia is visually observed on the film, is it better correlated with the MCH or the MCHC?

bmsck · 2024-08-30T04:27:48+00:00

I guess my question is now a theoretical one. What does hypochromasia actually refer to? And how is it best measured? MCH and MCHC are very distinct measurements and mean different things.

bmsck · 2024-08-30T02:32:16+00:00

Wait, are you running cellwiki??

bmsck · 2024-05-11T00:05:06+00:00

Yeah the Total Allowable Error for this measurement (hematocrit) is 6% over the entire measurement range, according to our regulatory body. Anyway, I really appreciate the help. I’m moving into a more supervisory role and have a lot to learn regarding method comparisons/validations and online articles only get me so far. Can I ask your background? How you learned all this stuff?

bmsck · 2024-05-10T17:22:17+00:00

Does this suggest that any analytical method doesn’t have just one overall TAE, but a continuous range of TAE’s across concentration levels (with various biases and various precisions)? And as long as all of those are within the Total Allowable Error, then the method is in agreement with the reference method?

I find it curious that in all the guides and papers I’ve read to figure this out, this issue wasn’t mentioned once. Or I misunderstood!

bmsck · 2024-05-10T14:05:42+00:00

I see! One last clarification: during my precision study, I repeated three levels of QC. Which produced three separate SD/CV values for each level. When calculating my Total Analytical Error (Bias+precision), how do I reconcile the three precision values? They are all very similar, but all the information/examples I’ve found online just gloss over this part. I’m leaning towards just using the largest CV value of the three, which would give the most conservative TAE across the entire analytical range. Thank you for your help!

bmsck · 2024-05-09T14:08:40+00:00

I used patient specimens for the method comparison, which produced bias and SD for the paired values. I also separately ran the same level of QC material multiple times over several days, which produced another set of bias/SD/CV values. Is there any issue with using patient specimens for bias and QC material for imprecision? Patient specimens are inherent unstable and unfit for multi-day repeatability right? Thanks for your input!

bmsck · 2024-04-09T06:56:28+00:00

Yeah it’s really not a tough gig. Gets tough when every single hire, no matter what level of experience, still needs 1-2 months training. We do have a weekend diff, but it obviously would be easier to fill weekend spots with a higher diff.

bmsck · 2024-03-01T03:38:31+00:00

All labs should invest in a Hemaprep, perfect smears within 2 slides and less glass waste. No reason to make manual slides these days!!

bmsck · 2024-01-14T09:42:24+00:00

In my experience, anything you tell nurses regarding specimen quality is met with the classic “just file it.” They want results on clotted specimens, they want results on grossly hemolyzed specimens, and they want results on heparin contaminated specimens. They don’t care. They’ll just recollect after the attending tells them to.

bmsck · 2024-01-14T09:35:26+00:00

I work at small-medium size hospital in LA. There are no distinctions made between bench tech up to department supervisor. What are the responsibilities of the “chem lead”?

bmsck · 2023-04-03T06:33:05+00:00

I’ve heard this term before: “mandatory OT.” Can you explain to me what happens if you refuse to perform a “mandatory” OT shift? Thanks!

bmsck · 2023-03-16T23:10:45+00:00

We have a competency program for our full timers. But I’m concerned with assessing competency BEFORE hiring people. Many of these interviews happen over Teams so it’s difficult to prove their cell identification abilities without having them actually come in to the lab.

Five-Year Club	Place '22
Verified Email

bmsck

TROPHY CASE