CLINICAL PRACTICE CHANGE: Hematology Body Fluids Testing
Date effective: December 2, 2024
Background Information: Cerebrospinal fluid (CSF) and non-CSF body fluid testing for automated cell count have been validated and in use across Manitoba Hematology Laboratory sites beginning in November 2023 with the introduction of updated Sysmex CBC analyzers. Effective December 2 2024, the new middleware platform (CaresphereWS) will be fully integrated into body fluid processing.
Clinical Practice Change:
- All Serous and Peritoneal Dialysate fluids for Cell Count will be performed only by automation.
- Minimum Volume of 500uL (0.5mL)
- Reporting units are standardized:
- Automated WBC/TNC x 10^6/L
- Manual WBC/RBC x 10^6/L
- Automated RBC x 10^12/L
- Note: x10^6/L is equivalent to #/uL
- Absolute differential values will be included in the patient report and reported at x 10^6/L
- Introduction of new Critical Values of non-CSF fluids recommended by the Emergency Room (ER) and Nephrology clinical user groups:
- Synovial – Absolute Neutrophil Count (ANC) >50,000 x 10^6/L
- Peritoneal – ANC >250 x 10^6/L
- Peritoneal Dialysate (also known as Dialysis fluid, peritoneal dialysis effluent) –
WBC >100 x 10^6/L together with Neutrophil % >50 %
- CSF Critical Values remain unchanged.
- Stability, sample requirements, and reference ranges remain unchanged.
References/Resources: Please refer to the Laboratory Information Manual (LIM)
CSF: Lab Information Manual Serous: Lab Information Manual Synovial: Lab Information Manual
Patient Impact:
- Immediate alert of clinically defined critical results to ensure prompt recognition of possible septic peritonitis/arthritis.
System Improvements:
- Standardization of lab processing through automation
- Improved laboratory workflow with middleware integration and streamlined registration processes
- Real time data review and interlaboratory support
Contact Information:
Andrew Hartel, Provincial Technical Director, Hematology, Shared Health
Email
204-599-3275
Dr. Ping Sun, Provincial Medical Director, Hematology, Shared Health
Email
204-787-4682
Submitte by: Tamara Burnham, Collaborative Practice Lead