At present,the blood analyzer has become an essential instrument for the complete blood count (CBC). It not only reduces the labor intensity of the staff, improves the accuracy of the experimental results, but also provides more relevant experimental indicators. The diagnosis and differential diagnosis played an important role. With the popularity of blood analyzers, some problems have gradually been exposed, and we put forward some questions worth considering.
1.Buying an instrument or a detection system
1.1 "Detection System" According to the past concept, the purchase of equipment is to purchase equipment based on cost performance. However, with the improvement of inspection management, the government has put forward higher requirements for each inspection project carried out by the laboratory. The notice of the Ministry of Health on the issuance of the "Management Measures for Clinical Laboratories in Medical Institutions" (Weiyifa (2006) No. 73 ) (Hereinafter referred to as the "Administrative Measures") pointed out: "The clinical laboratory of medical institutions should ensure the integrity and effectiveness of the testing system." What is a detection system? The 3rd edition of the National Clinical Laboratory Operational Regulations clearly states: the combination of instruments, reagents, calibrators, quality control products, consumables, operating procedures, maintenance procedures, etc., involved in the completion of a test project In order to detect the system, if it is operated manually, the operator must also be included.
1.2 "Importance of purchasing a detection system" The quality of the detection system will directly affect the precision, accuracy and traceability of the test results, but it is difficult for clinical laboratories to evaluate the test system for each test item. Therefore, in addition to providing instruments, manufacturers also provide supporting reagents and supporting calibrators, and also stipulate operating procedures, forming a reliable and traceable detection system. In the 1990s, the US FDA and the relevant European Union departments have clearly stipulated that when applying for product licenses, it is no longer the approval of one instrument, but the application of the entire testing system and the approval of www.med126.com. The user checks patient specimens according to the prescribed detection system (i.e. closed system), and the quality is guaranteed. Long-term practice has proved that only a fixed combination of detection systems can guarantee the accuracy and reliability of the detection results. It is the difference between traditional and current concepts to choose a single blood analyzer or a detection system with traceability evaluation. The author believes that choosing the latter can guarantee the quality of the detection results.
2.Formal training of operators
2.1 "The content of formal training" The instrument must be operated by humans, and the level of the operator will determine whether the detection system can obtain the correct results, so formal training is very important. The current situation is: After purchasing the instrument, the engineer came to install it quickly. Generally, it does not perform calibration and does not write a detailed installation report. It only teaches the operator simple operation and can print the report. The fastest is only half a day. Obviously, such training cannot meet the requirements. Because the operators have not received formal training, they often only operate without calibration, and the daily maintenance of the instrument cannot be guaranteed. Generally, the factory engineers are only consulted when there is a failure. The author believes that formal training should include: standardized training materials, lectures and teaching by teachers who have been formally trained, and should teach instrument principles, factory performance indicators, operation, calibration, quality control, result analysis, instrument maintenance and evaluation, etc. Good pre-job training records, after passing the examination, a job certificate will be issued.
2.2 The organization and implementation of training work Because blood cell analyzers are used in a wide range of units, there are many manufacturers, and the instrument models of each factory are different, and the principles are not necessarily the same. The author believes that the current more realistic method is: the instrument manufacturer should Pre-job training is one of our after-sales technical service tasks. The staff who have passed the training should master the skills of regular calibration, analysis of quality control results, interpretation reports, daily maintenance, small troubleshooting, and all records of the use of the instrument. This is also in line with the "Management Measures" for quality assurance and reduction of instrument failures. Requirements. After formal training for customers, the repair rate of the instrument will be significantly reduced, achieving a win-win situation for both the supplier and the user. In addition, in accordance with the spirit of "Notice on Strengthening the Management of Large-scale Medical Equipment" of the Ministry of Health [1996] No. 216, in order to standardize the training and management of operators, it is recommended that the Ministry of Continuing Education of the Chinese Medical Association implement it in a planned manner. Some unified training and examinations for commonly used instruments in the laboratory.
3.Re-examination afterthe blood analyzer
3.1 Re-examination standards are established for automatic blood analyzer counts and white blood cell classification counts. The international hematology expert group recommends 41 automatic CBC and DC re-examination standards. The national hematology re-examination expert group also counts blood cells. The re-inspection standard is explained. The formulation of automatic blood cell count and white blood cell classification and re-examination rules has important guiding significance for clinical laboratories at all levels in my country. Long-term clinical practice has proved that the results of the blood analyzer are only screening. At present, there is no specific re-inspection standard in my country. Each laboratory should draw up a line according to the type of instrument, model and the knowledge level of the staff. The actual re-inspection standards are implemented in the post, included in the operation manual (SOP, also known as the work instruction), and strictly implemented. In addition to the re-examination under the microscope, some manual method verification should also be included. There are still many units that have not implemented re-inspection. Article 5 of the "Management Measures" proposes that clinical laboratories should act in accordance with the "seven principles of safety, accuracy, effectiveness, economy, convenience, and protection of patient privacy". This is not only an industry standard, but also a code of conduct for laboratory workers. According to this criterion, a qualified inspection worker should do a good job of re-inspection after hematology analyzer testing with a high sense of responsibility.
3.2 Strengthen the training of inspectors under the microscope. With the popularity ofblood analyzers, the idea of blindly relying on instruments has become more and more serious, which has greatly weakened the training under the microscope, and even the red and white blood cells in the body fluids are unrecognizable. Sometimes the malaria parasites are missed. Occurrence, red and white blood cells are not seen in the report
In the description of morphology, even neutrophil toxic lesions disappeared from the report sheet, and the phenomenon of missed detection, missed diagnosis and misdiagnosis occurred frequently. It should be clearly recognized that examination under the microscope is still a basic method of morphological examination and plays an irreplaceable role in the diagnosis and treatment of some diseases. The morphological examination of blood cells is still the main content of CBC, and it is also the basic skill that the inspector must master. It should be familiar and mastered through perennial training and accumulation.
4.Reasonable use of three-group, five-category blood analyzer
The five-category blood analyzer adds some new parameters than the three-category blood analyzer, especially the platelet count is more reliable. It is an inevitable trend for the former to replace the latter. However, there are also some fake five-category instruments, which should be identified. What kind of equipment should be selected should be considered in combination with the setting requirements of the department, the price of the equipment, and the affordability of patients. At present, regardless of whether it is tri-group or five-classification, the white blood cell classification results are "preliminary screening", and the price of the five-class blood analyzer and the cost of consumption reagents are much higher than those of the three-class blood analyzer. The blood analyzer is calibrated, managed, carefully operated, and re-examined. In some small and medium-sized hospitals, clinical and patient satisfactory results can also be obtained. At present, there are still more economically underdeveloped areas in our country, and the masses' ability to bear it is limited. We should firmly oppose the practice of blindly seeking for economic benefits.
5.Strengthen clinical communication with nurse recruitment network
5.1 Improve the application value of the test report The blood analyzer provides at least more than 10 parameters, and some as many as more than 40, but many clinicians only look at the red blood cell, white blood cell, platelet count and hemoglobin amount, and the value of other parameters does not match. Do not understand and rarely apply, this is the biggest waste. To this end, strengthen the academic exchanges between the laboratory and clinical departments, and hold special lectures for doctors and nurses in the clinical departments from time to time to help doctors master new knowledge better and faster, so as to improve the application value of laboratory reports and enable experimental data to be used. It is really used in clinical diagnosis and treatment.
5.2 "Strengthen self-learning and research" Inspectors should not only operate various instruments to obtain data, but also understand some clinical knowledge, and be familiar with the clinical significance of the measurement results in order to achieve the purpose of communicating with the clinic. For this reason, inspectors must strengthen regular learning and expand their knowledge. For example, they must first understand the clinical significance of each parameter ofthe blood analyzer and the relationship between the parameters, and it is best to use their own examples and statistical results in practice. Analysis makes the communication more convincing. my country is a multi-ethnic country with a vast territory. According to the actual situation in the region, conditions should be created to investigate and formulate reference intervals suitable for blood analysis parameters in the region. In addition, some of the newly emerged parameters need to be further demonstrated, or the scope of application is expanded. These are all good scientific research topics. Through scientific design, careful investigation, careful recording, data processing and analysis and summary, not only improve one's professional level, but also the results can be used clinically to achieve better social and economic benefits.
