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CBC Outdate Time Frame

  • 1.  CBC Outdate Time Frame

    Posted 05-26-2019 21:17
    Hey all!

    Our facility has recently partnered with some organizations locally for outreach testing for their patients. Already we are receiving questions/concerns about adding on to hematology specimens. Our SOP currently states that if ambient, testing can be performed within 8 hours, refrigerated-24 hours. Does anyone allow testing on EDTA tubes for hematology for a longer period of time? If so, how long and at what temperatures?

    Thanks!

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    Ian Wallace
    Hematology Technical Specialist
    Saint Joseph Hospital
    Lakewood CO
    (505) 577-2230
    iwallace0904@gmail.com
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  • 2.  RE: CBC Outdate Time Frame

    Posted 05-27-2019 08:11
    Hi Ian - this feels like the sort of thing where there might be some CLSI guidance.  Have you checked?  Regards, Kathy

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    [Kathy] [Doig]
    [Leadership Development Committee Chairperson 2018-19]

    [doig@msu.edu]
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  • 3.  RE: CBC Outdate Time Frame

    Posted 05-27-2019 08:44
    Kathy,

    I have asked those in the lab if we happen to have access to a CLSI Handbook for Heme somewhere and have not heard back yet. The joys of things occurring over a long weekend.

    Thanks for the advice!​

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    Ian Wallace
    Hematology Technical Specialist
    Saint Joseph Hospital
    Lakewood CO
    (505) 577-2230
    iwallace0904@gmail.com
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  • 4.  RE: CBC Outdate Time Frame

    Posted 05-28-2019 15:49

    ​I checked in Team this morning and they accept specimens and add-on for 24 hours at room temp and refrigerated.  This was validated internally as our organization completely standardized to Sysmex at all hospital and clinic locations.

    Rick



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    Rick Panning
    Senior Administrative Director
    HealthPartners
    Bloomington MN
    6512805909
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  • 5.  RE: CBC Outdate Time Frame

    Posted 05-28-2019 08:02
    ​There seem to be two applicable CLSI documents.
    1.  CLSI H26 A2:2010 - I see two different times in the document where it refers to specimen stability for heme.  Both were room temp.  One said 8 hours and another said 4, but it says that the lab needs to do its own study for specimens beyond that timeframe.
    2.  CLSI GP44 A4:2010 - This is a general venous specimen document, but my quick review didn;t see anything specific.

    Rick

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    Rick Panning
    Senior Administrative Director
    HealthPartners
    Bloomington MN
    6512805909
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  • 6.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 09:56
    Here is an old study reference that sheds some light on this topic. Hopefully, it will help.

     deBaca ME, Gulati GL, Kocher W, Schwarting R: Effects of storage of blood at

          room temperature on hematologic parameters measured on Sysmex XE-2100.

          Lab Med 37(1): 28-36, 2006.

     



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    Gene Gulati
    Professor Emeritus
    Thomas Jefferson University
    Cranbury NJ
    908-797-1705
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  • 7.  RE: CBC Outdate Time Frame

    Posted 05-27-2019 12:41
    ​Ian:  This is what our lab catalog says about this issue and it also is the timeframe built into Epic and Beaker for add-ons.  I am verifying with our hematology technical specialist team.



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    Rick Panning
    Senior Administrative Director
    HealthPartners
    Bloomington MN
    6512805909
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  • 8.  RE: CBC Outdate Time Frame

    Posted 05-28-2019 09:00
    ​Ian,

    Just for a point of reference we follow the same policy you've outlined.

    Best,
    Kristina

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    Kristina Martin
    Clinical Pathology Operations Manager
    University of Michigan

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  • 9.  RE: CBC Outdate Time Frame

    Posted 05-28-2019 09:40
    Ian,
    We have a ambient stability of 24hr and refrigerated of 48hrs. I reviewed what Mayo and ARUP had as well, and they also have 24 A, and 48 R.​

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    Lori Murray
    Outreach Manager
    --
    Brandon SD
    (605) 582-2299
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  • 10.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 01:35
    As a traveler, I have been to many labs and the general rule is 24 hours for the CBC at room temp and 48 hours at 2-8 degrees. There is literature that seems to indicate that a CBC is stable up to 72 hours at 2-8 degrees, but other studies indicate that stability starts to decrease at the 24 hour mark. Ideally it appears that CBC samples should be tested immediately or stored at 4 degrees until testing can take place. Of course the logistical challenges of doing so may prevent labs from implementing such measures. The link below consists of a review published in 2017 if you are interested.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652294/

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    Chad C. McMillan, M.Sc. MT/MDxT(AAB)
    Aureus Medical Group
    Groveland FL
    352 348-3354
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  • 11.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 10:06
    Chad, the best course of action is to do an internal study and validate stability in your own lab.  Despite what may be published in guidelines and by other labs, an internal study is always in the interest of the patients and the lab. (IMHO)
    Eloise Alta, PhD
    President
    New York State Clinical Lab Association

    ------------------------------
    Eloise Aita
    President
    New York State Clinical Laboratory Association
    1-833-4-NYSCLA
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  • 12.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 10:17
    Eloise,

    Of course internal studies are the best when possible. However, I am not able to do an internal study for Ian, so I am merely suggesting literature that could possibly help him.

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    Chad C. McMillan, M.Sc. MT/MDxT(AAB)
    Aureus Medical Group
    Groveland FL
    352 348-3354
    ------------------------------



  • 13.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 10:23
    Sorry Chad, I was trying to respond to the originator of the thread.
    My comments were meant for Ian.  I do not disagree with your statement.
    Apologies.
    Eloise

    ------------------------------
    Eloise Aita
    President
    New York State Clinical Laboratory Association
    1-833-4-NYSCLA
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  • 14.  RE: CBC Outdate Time Frame

    Posted 05-29-2019 13:50
    I have similar experience as someone stated in this post. 24 hour at RT and 48 hour at 2-6.

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    Drona Pandeya, M.S., MLS (ASCP)CM
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  • 15.  RE: CBC Outdate Time Frame

    Posted 05-30-2019 10:19
    Ian,

    We also have validated 24 hours RT and 48 refrigerated, even though most of our outlying facilities can do their own CBCs. My big concern is the reflex to a manual diff. If they know they will need one, they really need to make the slide on the sample when it is fresh. Once it gets to be around 24 hours old, some of the WBCs start breaking down and getting harder to classify. You can actually see this one happen.

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    Stacey Lyn Robinson
    Supervisor, Clinical Microscopy
    Walter Reed National Military Medical Center
    staceylynrobinson@gmail.com
    ------------------------------