Effective October 3, 2023, the following changes to CBC and Blood Smear testing will be made at Corewell Health Reference Lab – West:
What is Changing:
Complete Blood Count with Manual Differential [LAB2111032] will be inactivated
Replacement test is Complete Blood Count (CBC) w/Differential [LAB293]
See blog post: Complete Blood Count (CBC) with Manual Differential Order Discontinuation for more information.
Manual Differential, Blood [LAB815] will be made a lab only orderable.
Pathology Consult Hematology (West and South) [LAB1231502] will be available to order.
• Pathology Consult Hematology (West and South) [LAB1231502] is a lab panel which will include CBC w/Diff [LAB293] and Pathology Consult, Hematology Smear Review [LAB1231501]
Pathology Consult, Hematology Smear Review [LAB1231501] is a component test and should only be ordered if a CBC w/diff has been resulted and a slide has been created.
A new order question will need to be answered in order to order. “What is the CBC abnormality you are concerned about?”
In Epic results for Pathology Review, Blood Smear for Consult will now flow to the “Labs” section instead of the “Notes” section. Interfaced results should flow back to the provider’s EMR.
• Pathologist Review Smear [LAB7550] will be made a lab only orderable.
PROVIDER WORKFLOW OPTIONS
• If a provider orders CBC w/Diff [LAB293] – Recommended
If CBC w/Diff meets criteria for a review by a Hematopathologist (see chart below), the Lab will order a Pathologist Review Peripheral Smear [LAB7550]
If CBC does not meet criteria, no further testing will be performed.
• If a provider orders Pathology Consult Hematology (West and South) [LAB1231502]
A CBC w/Diff will be performed and Pathology Consult, Hematology Smear Review will be reviewed by the Hematopathologist.
If a CBC has been ordered in the last 24 hours, it will add the Pathology Consult, Hematology Smear Review onto the CBC.
Pre-established criteria for tech initiated pathologist review are as follows:
Component |
Criteria |
White Blood Cell (WBC) Criteria |
|
| WBC | < 1.5 x 103/µL or > 30.0 x 103/µL |
| Absolute Basophil Count (BASOAB) | >0.50 x 103/µL |
| Absolute Eosinophil Count (EOSIAB) | >2.00 x 103/µL |
| Absolute Lymphocyte Count (LYMPAB) | >5.0 x 103/µL |
| Absolute Monocyte Count (MONOAB) | >2.0 x 103/µL and >30% on differential |
| Absolute Neutrophil Count (NEUTAB) | <0.50 x 103/µL |
| Blasts or Immature cells | 1st time or unexpected |
| Abnormal Lymphocytes | Example: circulating lymphoma cells, hairy cells, villous lymphocytes |
Red Blood Cell (RBC) Criteria |
|
| Hemoglobin | <7.0 g/dL or >19.0 g/dL |
| MCV | <60.0 fL or >115.0 fL |
| Nucleated Red Cell Count (NRBC) | >10 in 100 cell manual differential (not newborn) |
| Schistocytes, spherocytes, teardrops on erythrocytes | Moderate or many |
Platelet Criteria |
|
| Platelets | <50 x 103/µL (all ages), >700 x 103/µL (adults), >899 x 103/µL (<18 years of age) |
| Circulating Megakaryocytes | Present |
Other Peripheral Blood or Body Fluid Smear Criteria |
|
| Presence of any: Unidentified Cells, Malignant Cells, Lymphoma Cells, Blasts or immature cells that might be blasts, Organisms | |
| Anything abnormal, suspicious, or with a significant change from previous slides that the technologist believes should be reviewed by a pathologist. | |
For questions or inquiries please use the “Contact Us” link above.
