1. Peripheral Blood Smear : generated and ordered 2003.06.12 혈액학계 한양선

2. Introduction When? –Ordered PBS –Generated PBS:PBS Review 기준에 해당될때 Why? –Improve clinical and laboratory management of the patient

3. PB smear review - power 신속, 정확한 진단 알맞은 further study: 불필요한 검사제거 –RBC agglutination autoimmune hemolytic process –Rouleaux plasma cell dyscrasia –Fragmented RBCs microangiopathic hemolytic process severe megaloblastic anemia, more benign disorder

4. PB smear review - power 치료 방향 결정 –leukemia 의 분류 : Lymphoid vs. myelogenous –parasitemia 의 분류 :Plasmodium Additional confirmatory studies – 성인환자의 nRBC recent significant blood loss:hemolytic process thalassemia, severe thermal injury myelodysplasia, erythroleukemia –Basophilic stippling disordered erythropoiesis

5. PB Smear review - reason Quantitative – 분석기 결과의 정확성을 확인 PLT count 확인 Diff. count 확인 Qualitative –Diagnose hematological malignancy –Diagnose hematological stem cell disorder Chronic myelo/lymphoproliferative disorder Myelodysplasia –Diagnose hereditary leukocyte disorder (eg.May-Hegglin anomaly)

6. Both quantitative and qualitative –Evaluate cytopenia Acquired anemia (hemolysis, liver diseases) Acquired thrombocytopenia (DIC, TTP) Paroxysmal nocturnal hemoglobinuria Plasma cell dyscrasias Inherited platelet disorders (gray-platelet syndrom) –Evaluate hereditary hemolytic disorders Membrane defects (hereditary spherocytosis) Hemoglobinopathies,thalassemia Enzyme deficiencies –Evaluate presence of infectious agents (malaria) –Classify lymphoproliferative disorders (infectious versus malignant) PB Smear review - reason

7. Flow of the work Blood cell examination:sequential manner 자동혈구 분석기 Gen-S I,II Advia120 I,II SE-9000 PBS MT Review PBS Review 기준 Blast flag Diff. count 불능 N-RBC Plt < 20,000/  l Plt < 130,000/  l & Clumping WBC>50,000/  l LUC 10% 이상 Baso 10% 이상 NICU: Mono 30% 이상 Eo 10% 이상 소아과 :lympho 80% 이상 의뢰된 PBS 자동혈구분석기 Advia120 MD Review

8. PBS Review 내용 의뢰된 PBS –RBC Morphology –PLT Morphology –Diff Count –WBC Morphology PBS review –PLT,WBC Count 확인 –Diff Count

9. PBS 의뢰 건수 (5.1~5.31) 진료과건수 소아과 115 (31.4%) 종양학과 71(19.4%) 일반 (ER) 50(13.7%) 신경외과 26(7.1%) 소화기내과 13(3.5%) 기타 91(24.9%) 합계 366

10. PBS Review 건수 ( ’03 年 6 月 2-6 日 ) 진료과 Review 혈액종양내과 63(30.1%) 소아과 45(21.5%) 종양학과 41(19.6%) 소화기내과 16(7.7%) 기타 44(21.1%) 합계 209

11. Clinical relevance ( ’03 年 6 月 2-6 日 ) Review 의뢰 Essential44 (35.5%)15 (23.8%) Relevant51 (41.1%)18 (28.6%) Others29 (23.4%)30 (47.6%) Total12463 Essential – hematologic malignancy, anemia, etc. Relevant – various solid cancer, sepsis, etc. Others

12. Proposal Essential for proper patient care Improve the quality of laboratory data Improve quality management PBS Review - consequent order? 보험수가 WBC Diff PBS