Many hematology laboratories are consistently asked to perform more tests each year at a lower cost and with less staff. As a result, more labs are seeking increased automation for their hematology departments.
For those hematology laboratories that still have “hands on” tasks (the manual slide-making and -staining steps), automated slide preparation systems introduce a higher level of operational efficiency and consistency for the CBC workload.
Process improvements through automation
Newer slide preparation stations are rules-driven instruments that can interface with other instruments on an automated hematology line. They also have the capability to interface directly with CBC analyzers to identify which samples need slides based on laboratory-defined CBC results. In addition, smears can now be optimized to ensure an evenly distributed monolayer based upon the hematocrit level determined during the CBC test in the hematology analyzer.
The latest generations of automated slide preparation systems innovate by making and staining slides one patient at a time, rather than “batching” slides. The newer models place a single slide into a cassette for individual staining that is ready for the differential to be performed as needed, especially for laboratories with a busy emergency department. By eliminating the batching of multiple slides in an open air bath, the integrity of the stain allows for more efficient operations.
Slides are made using self-cleaning spreaders to create a useable monolayer on each slide while limiting sample carry-over. The dried, stained smears are presented in the output area. Whether the laboratory is performing manual differentials or using the newer automated cell image analyzers, the optimized slide preparation provides laboratory staff with consistent smears for easier review. These smears are not only optimal for examination, but they also can include patient-specific information such as name or accession number, either within or in addition to one or two-dimensional barcodes, automatically printed on the frosted area of the slide by the system.
In addition to peripheral blood smears, automated slide preparation systems can also accommodate the staining of other types of samples that are prepared off-line. These include body fluid samples prepared by cyto-centrifuge or bone marrow samples.
Automated slide preparation systems provide consistency in both smear preparation and staining. Each slide is thoroughly dried on the system before the staining process begins. With open reagent systems, lab leaders can choose the stain brand they prefer to use. They can also choose the length of time slides are stained to achieve the desired stain saturation. The systems allow multiple slide types to be placed on board, which is also efficient if the laboratory uses color-coded slides, perhaps for identifying stats.
Bookends of automation
Many higher-volume hematology laboratories have seized the opportunity to utilize high efficiency hematology processing lines. Automated slide preparation units are typically the center of these lines, with bookends of automation attached. Picture a hematology line, automated throughout. The sample on the line starts with automated bar-coded sample sorting at the front end; next comes complete CBC analysis of the patient sample with rules-driven optimal smear preparation. Then imagine automated cell image analyzers that receive the optimally prepared smears, directly on the line, for the digital white cell differential, red cell morphology, and platelet assessment. This example demonstrates the ultimate integrated work cell for hematology automation and standardization. It also can include the ability to add automated tube sorting and A1C testing all in the same line.
Value to laboratories and clinicians
The value of consistently prepared slides moves beyond the borders of the clinical hematology laboratory. Laboratories that have implemented slide preparation units are able to provide physicians with a consistent slide history for assessment and reference for individual patients. Variability in staining characteristics can make cell classification uncertain and is potentially worrisome when physicians are attempting to follow changes over time with specific patients.
Consistency in slide preparation and staining is also critical for teaching and for building a laboratory-specific hematology slide library. With the manpower issues currently facing the laboratory, these systems not only lighten the clinical load, but provide a teaching platform for technologists and pathology residents.
In their own words: user experiences
“We purchased automated slide preparation for the walk-away ability” says Julia Witt, Core Lab Manager at Mercy Medical Center in Springfield, Missouri. “My techs are confident; they can leave the area, answer the phones, or perform other tasks and know that if a slide is needed, it will be produced. They also know the slide will be well made, consistently stained, and labeled without any intervention from them….Our physicians have come to expect fast turnaround times, which we would no longer be able to guarantee if we didn’t have the automated slide prep. If we had to revert to a totally manual process, we would certainly not be able to walk away into other departments; we would need to hire more staff, and we would lose the consistent slide quality we have come to depend upon.”
“The goal for the Laboratory is to provide value and improve patient outcomes by decreasing turnaround times,” says Denise Uettwiller-Geiger, PhD, Clinical Chemist and Director of Clinical Trials at J. T. Mather Memorial Hospital in Port Jefferson NY. “Avoiding delays in patient diagnosis and/or inventions is critical for enhancing patient safety and increasing patient and physician satisfaction. Harnessing the latest automated technology can help us achieve these goals. The adoption of the automated slide processor, along with leveraging the interface to middleware, allow for a hands-free process that increases operational efficiency and productivity while significantly reducing turnaround time.”
Carol Davis at Phelps County Regional Medical Center in Rolla, Missouri, says, “Originally, I did not even want the automated slide processing unit. I felt it was a waste of money and that our workflow did not warrant automation. However, our manager insisted. Now that we have it, I cannot imagine how we ever did without. The smear and stain quality are consistent and perfect for every patient, and there is literally no tech time involved.”