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International Journal of Laboratory... Feb 2024
Topics: Humans; Hematology; Leukocyte Count; Reproducibility of Results
PubMed: 37909428
DOI: 10.1111/ijlh.14194 -
Improving blood cells classification in peripheral blood smears using enhanced incremental training.Computers in Biology and Medicine Apr 2021Peripheral Blood Smear (PBS) analysis is a vital routine test carried out by medical specialists to assess some health aspects of individuals. The automation of blood...
Peripheral Blood Smear (PBS) analysis is a vital routine test carried out by medical specialists to assess some health aspects of individuals. The automation of blood analysis has attracted the attention of researchers in recent years, as it will not only save time, money and reduce errors, but also protect and save lives of front-line workers, especially during pandemics. In this work, deep neural networks are trained on a synthetic blood smears dataset to classify fifteen different white blood cell and platelet subtypes and morphological abnormalities. For classifying platelets, a hybrid approach of deep learning and image processing techniques is proposed. This approach improved the platelet classification accuracy and macro-average precision from 82.6% to 98.6% and 76.6%-97.6% respectively. Moreover, for white blood cell classification, a novel scheme for training deep networks is proposed, namely, Enhanced Incremental Training, that automatically recognises and handles classes that confuse and negatively affect neural network predictions. To handle the confusable classes, we also propose a procedure called "training revert". Application of the proposed method has improved the classification accuracy and macro-average precision from 61.5% to 95% and 76.6%-94.27% respectively.
Topics: Blood Cells; Deep Learning; Humans; Image Processing, Computer-Assisted; Leukocytes; Neural Networks, Computer
PubMed: 33621895
DOI: 10.1016/j.compbiomed.2021.104265 -
Diagnostic Pathology Sep 2020Peripheral blood smears are performed to evaluate a variety of hematologic and non-hematologic disorders. At the authors' institutions, clinician requests for...
BACKGROUND
Peripheral blood smears are performed to evaluate a variety of hematologic and non-hematologic disorders. At the authors' institutions, clinician requests for pathologist-performed blood smear reviews have increased in recent years. Blood smears may contribute significantly to pathologists' workloads, yet their clinical value is variable, and professional reimbursement rates are low. This study aimed to identify clinical scenarios in which smear review is likely to provide value beyond automated laboratory testing.
METHODS
Blood smear review practices at three institutions were examined, and the indications for and interpretations of clinician-initiated smears were reviewed to determine the percentage of smears with potential added clinical value. A smear review was classified as having added clinical value if the pathologist's interpretation included a morphologic abnormality that had the potential to impact patient management, and that could not be diagnosed by automated complete blood count with white blood cell differential or automated iron studies alone.
RESULTS
Among 515 consecutive clinician-requested smears performed during the study timeframes, 23% yielded interpretations with potential added clinical value. When sorted by indication, 25, 19, and 13% of smear reviews requested for white blood cell abnormalities, red blood cell abnormalities, and platelet abnormalities, respectively, had findings with potential added clinical value. The proportion of smears with potential clinical value differed significantly across these three categories (p = 0.0375).
CONCLUSIONS
Smear review ordering practices across three institutions resulted in a minority of smears with potential added clinical value. The likelihood of value varied according to the indication for which the smear was requested. Given this, efforts to improve the utilization and efficiency of smear review are worthwhile. Solutions are discussed, including engaging laboratory staff, educating clinicians, and modifying technology systems.
Topics: Blood Cells; Clinical Laboratory Techniques; Diagnostic Tests, Routine; Efficiency; Female; Humans; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 32943102
DOI: 10.1186/s13000-020-01033-8 -
International Journal of Laboratory... Aug 2016Peripheral blood smear review (PBSR) is a labour-intensive test, and skilled morphologists are in short supply. It is therefore helpful for laboratories to establish...
INTRODUCTION
Peripheral blood smear review (PBSR) is a labour-intensive test, and skilled morphologists are in short supply. It is therefore helpful for laboratories to establish rules for PBSR to improve laboratory efficiency. Previously published guidelines in this regard are useful, but make few recommendations specific to neonates. Neonatal blood is characterized by several peculiarities which would be considered pathological if present in adults. Consequently, smear review rules (SRR) are often triggered in neonates without significant value being added on review. This study aimed to assess and fine-tune the SRR triggered in neonatal samples in order to improve laboratory efficiency.
METHODS
Full blood counts collected from 188 neonatal inpatients of the Chris Hani Baragwanath Academic Hospital in South Africa were retrospectively reviewed, the triggered rules documented, and the value added on PBSR determined.
RESULTS
Smear review rules were triggered in 148 (78.7%) samples, with significant morphological abnormalities identified in 84 (54.4%), and a false-positive rate of 34.0%. In patients with unhelpful review, the commonest rules triggered were the flags querying the presence of abnormal lymphocytes, blasts or nucleated red blood cells. When one or more of these flags were triggered in the absence of any other SRR, PBSR was always noncontributory. Disregarding these flags in the current cohort would reduce both the review and the false-positive rates by >20% without increasing the false-negative rate.
CONCLUSION
False-positive smear review is common in neonates, and minor modifications to SRR can substantially reduce the smear review rate without increasing the false-negative rate.
Topics: Blood Cell Count; Blood Cells; Clinical Laboratory Techniques; Cohort Studies; False Positive Reactions; Hematologic Tests; Humans; Infant, Newborn; Inpatients; Practice Guidelines as Topic; Retrospective Studies; South Africa
PubMed: 27087063
DOI: 10.1111/ijlh.12491 -
Archives of Pathology & Laboratory... May 2006Automated laboratory hematology analyzers are capable of performing differential counts on peripheral blood smears with greater precision and more accurate detection of...
Laboratory productivity and the rate of manual peripheral blood smear review: a College of American Pathologists Q-Probes study of 95,141 complete blood count determinations performed in 263 institutions.
CONTEXT
Automated laboratory hematology analyzers are capable of performing differential counts on peripheral blood smears with greater precision and more accurate detection of distributional and morphologic abnormalities than those performed by manual examinations of blood smears. Manual determinations of blood morphology and leukocyte differential counts are time-consuming, expensive, and may not always be necessary. The frequency with which hematology laboratory workers perform manual screens despite the availability of labor-saving features of automated analyzers is unknown.
OBJECTIVE
To determine the normative rates with which manual peripheral blood smears were performed in clinical laboratories, to examine laboratory practices associated with higher or lower manual review rates, and to measure the effects of manual smear review on the efficiency of generating complete blood count (CBC) determinations.
DESIGN
From each of 3 traditional shifts per day, participants were asked to select serially, 10 automated CBC specimens, and to indicate whether manual scans and/or reviews with complete differential counts were performed on blood smears prepared from those specimens. Sampling continued until a total of 60 peripheral smears were reviewed manually. For each specimen on which a manual review was performed, participants indicated the patient's age, hemoglobin value, white blood cell count, platelet count, and the primary reason why the manual review was performed. Participants also submitted data concerning their institutions' demographic profiles and their laboratories' staffing, work volume, and practices regarding CBC determinations. The rates of manual reviews and estimations of efficiency in performing CBC determinations were obtained from the data.
SETTING
A total of 263 hospitals and independent laboratories, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program.
RESULTS
There were 95,141 CBC determinations examined in this study; participants reviewed 15,423 (16.2%) peripheral blood smears manually. In the median institution (50th percentile), manual reviews of peripheral smears were performed on 26.7% of specimens. Manual differential count review rates were inversely associated with the magnitude of platelet counts that were required by laboratory policy to trigger smear reviews and with the efficiency of generating CBC reports. Lower manual differential count review rates were associated with laboratory policies that allowed manual reviews solely on the basis of abnormal automated red cell parameters and that precluded performing repeat manual reviews within designated time intervals. The manual scan rate elevated with increased number of hospital beds. In more than one third (35.7%) of the peripheral smears reviewed manually, participants claimed to have learned additional information beyond what was available on automated hematology analyzer printouts alone.
CONCLUSION
By adopting certain laboratory practices, it may be possible to reduce the rates of manual reviews of peripheral blood smears and increase the efficiency of generating CBC results.
Topics: Blood Cell Count; Clinical Laboratory Techniques; Efficiency; Hematology; Humans; Laboratories, Hospital; Quality Assurance, Health Care; Quality Control; Societies, Medical; United States
PubMed: 16683868
DOI: 10.5858/2006-130-596-LPATRO -
Romanian Journal of Internal Medicine =... Sep 2019Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such... (Review)
Review
INTRODUCTION
Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such as the percentage of band cells or grading of neutrophil toxic changes) has not been studied previously.
METHODS
We prospectively recorded all hospitalized adult (> 18 years old) patients with LR (≥ 30000/ul) of neutrophilic predominance, excluding patients with pre-existing leukocytosis due to hematological malignancies. We examined the diagnoses and prognosis (in-hospital mortality and post-discharge mortality up to a year after the end of the study) of these patients as well as the value of manual peripheral smear review.
RESULTS
We recorded a total of 93 patients with LR from January 2017 to December 2017. Infection was the most common diagnosis (70%), followed by malignancy (7.5%) and bleeding (6.5%). In-hospital mortality (45%) and post-discharge mortality (35% of those discharged) were very high. Among blood smear findings, only neutrophil vacuolation was significantly more common in patients with infections (34%), although it was also observed in many patients without any infection (13%). Blood smear findings were not associated with prognosis.
CONCLUSION
Detailed manual smear review is a labor-intensive procedure and it has limited diagnostic and prognostic value in unselected hospitalized patients with neutrophilic LR.
Topics: Adult; Aged; Aged, 80 and over; Blood Cell Count; C-Reactive Protein; Female; Hemorrhage; Hospital Mortality; Hospitalization; Humans; Infections; Leukemoid Reaction; Male; Middle Aged; Neoplasms; Neutrophils; Prognosis; Prospective Studies
PubMed: 30862764
DOI: 10.2478/rjim-2019-0006 -
IEEE Reviews in Biomedical Engineering 2021Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders.... (Review)
Review
Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders. Pathological examinations are being the gold standard in many haematology and histophathology, and also play a key role in the diagnosis of diseases. In clinical diagnosis, white blood cells are analysed by pathologists from peripheral blood smears samples of patients. This analysis is mainly based on morphological features and characteristics of the white blood cells and their nuclei and cytoplasm, including, shapes, sizes, colours, textures, maturity stages and staining processes. Recently, Computer Aided Diagnosis techniques have been rapidly growing in the digital haematology area related to white blood cells, and their nuclei and cytoplasm detection, as well as their segmentation and classification techniques. In digital haematology image analysis, these techniques have played and will continue to play, a vital role for providing traceable clinical information, consolidating pertinent second opinions, and minimizing human intervention. This study outlines, discusses, and introduces the major trends from a particular review of detection and segmentation methods for white blood cells and their nuclei and cytoplasm from digital haematology microscope images. Performance of existing methods have been comprehensively compared, taking into account databases used, number of images and limitations. This study can also help us to identify the challenges that remain, in achieving a robust analysis of white blood cell microscope images, which could support the diagnosis of blood disorders and assist researchers and pathologists in the future. The impact of this work is to enhance the accuracy of pathologists' decisions and their efficiency, and overall benefit the patients for faster and more accurate diagnosis. The significant of the paper on intelligent system is that provides future potential techniques for solving overlapping white blood cell identification and other problems microscopic images. The accurate segmentation and detection of white blood cells can increase the accuracy of cell counting system for diagnosing diseases in the future.
Topics: Algorithms; Cell Nucleus; Cytoplasm; Hematology; Humans; Image Processing, Computer-Assisted; Leukocytes; Microscopy; Support Vector Machine
PubMed: 32746365
DOI: 10.1109/RBME.2020.3004639 -
Journal of Pediatric Hematology/oncology Jan 2022We report on a 12-year-old boy with congenital thrombotic thrombocytopenic purpura, on who had an erroneous diagnosis as chronic immune thrombocytopenia. The patient...
We report on a 12-year-old boy with congenital thrombotic thrombocytopenic purpura, on who had an erroneous diagnosis as chronic immune thrombocytopenia. The patient presented with complaints of jaundice and skin rash. Laboratory analysis showed nonimmune hemolytic anemia and severe thrombocytopenia. Peripheral blood smear showed 8% schistocytes, polychromasia, and anisocytosis. The ADAMTS13 antigen and activity were suspected to be lower than 5% with any antibodies against the enzyme. The DNA sequence analyses resulted in compound heterozygosity consisting of c.291_391del in exon 3 and c.4143dupA in exon 29. Schistocyte (fragmented erythrocytes) on the peripheral blood smear is a light that illuminates the diagnosis. Early recognition of the disease can prevent inappropriate treatments and morbidities due to organ damage.
Topics: ADAMTS13 Protein; Base Sequence; Child; Erythrocytes, Abnormal; Exons; Humans; Male; Purpura, Thrombotic Thrombocytopenic; Sequence Deletion
PubMed: 33306605
DOI: 10.1097/MPH.0000000000002032 -
Clinical Laboratory Feb 2024In several situations, spurious results are observed in the use of hematology analyzers including pseudothrombocytosis caused by part of the cytoplasm of abnormal cells...
BACKGROUND
In several situations, spurious results are observed in the use of hematology analyzers including pseudothrombocytosis caused by part of the cytoplasm of abnormal cells which was reported in leukemic blasts, monoblasts, or lymphoblasts.
METHODS AND RESULTS
Here, we report a rare case of pseudothrombocytosis caused by mature leukocyte fragments associated with heatstroke. It was identified by the peripheral blood smear and obvious difference between the PLT-F (fluorescence) and I (impedance) channel.
CONCLUSIONS
Observation of peripheral blood smears and determination on the PLT-F channel can identify this interference caused by leukocyte fragments in heatstroke.
Topics: Humans; Platelet Count; Blood Platelets; Leukocytes; Cytoplasm; Heat Stroke
PubMed: 38345993
DOI: 10.7754/Clin.Lab.2023.230731 -
Clinical Laboratory Jul 2022Hematology analyzers provide quick and accurate results in most situations. However, spurious results related to the parameters from the complete blood count (CBC) may...
BACKGROUND
Hematology analyzers provide quick and accurate results in most situations. However, spurious results related to the parameters from the complete blood count (CBC) may be observed in several instances. False increases in WBC count can occur for many reasons, including erythroblasts, insufficiently lysed red blood cells (RBC), platelet aggregates, lipids, and cryoglobulins. However, cases of pseudoleukocytopenia due to plasma related factors are rare.
METHODS AND RESULTS
Here, we report a case of pseudoleukocytopenia in CBC test. It was identified by the peripheral blood smears and different scatter plots of WNR and WDF channel. The interference from plasma was con-firmed by simulating the state of blood in the WBC channel and plasma exchange.
CONCLUSIONS
It was confirmed that the interference of pseudoleukocytopenia was from the plasma. This may be due to the high amount of albumin and other therapeutic drug reactions. Observation of peripheral blood smears and scatter plots can identify this interference.
Topics: Blood Cell Count; Blood Platelets; Erythrocyte Count; Erythrocytes; Humans; Leukocyte Count
PubMed: 35975519
DOI: 10.7754/Clin.Lab.2021.211050