Emily Thompson MT (ASCP) MSE
Contents
1. 00000000000000 00000000000000 i ee oo o o 9 8 2014 15 9 8 2014 CELLAVISION Po a Examiner LL Results for Test 1 Show data for slides UN Summary 3 sides Showing e op S 122 ni HDD Total parbapania lug 2 i L WWE 3 1 0 T r LEFT FI RBC Linda 12 TT CELLAVISION dP Rosulls for fest 1 Show data for slides 100 Segmented neutrophil Emme Nr i teen EE specs wit cna nesults Humber of cells bere CLaan ratve nag ries with ciamis resulta 16 9 8 2014 CELLAVISION WR ia eet lis Results fer Test 1 I i Show data for slides WBC cells Compara individuals 100 Lymphocyte Disagreements 42 IDM ib Examiner Lymphocyte HUNN 2 Martin Eege Show data tor slides e 1009 REC O 10004 L a O 1005W O 100614 O 1007W C 1008 EI I degree d erence lo referenco am 2 degrees difference bo reference lis 3 degrees difference lo reference Characterization degree Exam Ma MN 0 1 1 f 3 IR a d e 85 E amp ao 2 2 E 2 EN amp EE E amp ENER amp amp amp Bh m T E AU D a e cb e OD e e m m o oU OO O LE IRSE UMS O O ZERE VE YNG YO Y UONA Od 17 Free Trial Version Expreience how easy Hematology Competency assesment can be Go to www cellavision proficiency com and get your free trial account e 9 8 2014 CELLAV2. Lab results were mostly normal with a slightly elevated WBC count CELLAVISION 9 8 2014 39 Systemic Candida Disease certavision Systemic Candida Disease The Candida yeast is normally harmless and resides in the mouth and the digestive track When your immune system is lowered or favorable conditions like warm and humid atmosphere are available Candida grows uncontrollably and becomes an infection Systemic Candida is most often caused by a simple infection that goes untreated or insufficiently treated CELLAVISION 6 9 8 2014 40 Case H2 A 35 year old man went to visit relatives for vacation Two weeks after his return he presented tothe ER and told them he wasn t feeling well He told them he had just returned from visiting family nothing out of the ordinary He reported high fevers shaking chills and flu like a symptoms HGB HCT Upon examination he was found to have an enlarged liver and spleen Neut 96LY Lab Results see below along with a slightly elevated MO TBili EO BAS Did anyone ask him where his family lived No ctuAvision eenavision 0 9 8 2014 41 LL mu CELLAVISION Plasmsodium Vivax Mn ges E E Ex ge TH n I Taal ms DSBBO Ese 7 mnu Dc8nnaa 2a BIH x sec SE mn ES zs we 7 rf aar set 1 Om Ma me oan etuAvision 9 8 2014 42 9 8 2014 Plasmodium Viva
3. Steinbrinck in 1948 Ch diak in 1952 and Higashi in 1954 Mutations have been found in the CHS1 also called LYST gene The primary defect in this disease is found in certain granules normally present in skin cells and certain white blood cells For example in people with this disease a skin granule that normally contains melanin is not made properly resulting in decreased skin color pigmentation A defect in granules found in certain types of white blood cells causes immune system problems Not only do you see the inclusions in the Neutrophils but the eosinophils have granules that are odd and of different sizes This patient has a sister that was a match for Bone Marrow Transplant While that will help the functionality of the Neutrophils the patient will be left with peripheral neuropathy CELLAVISION 9 8 2014 47 Case 46 60 Year Old male Abdominal pain pain in neck and armpit and sore throat Night sweats and fever Unexplained weight loss over 1096 Swelling of lymph nodes CBC results normal w suspect flag for variant lymphocytes on automated differential Flow cytometry e CD19 e CD5 e CD10 ctuAvision A CELLAVISION d 9 8 2014 48 Mantle Cell Lymphoma Mantle cell lymphoma is a non Hodgkins lymphoma that occurs in the B cells found on the outer edge of the lymph node follicle an area known as the mantle zone The uncontrolled growth of these B cells causes the lymph nodes to
4. 8 2014 36 Common problems Using Cell location test for trouble shooting Problem e g incomplete analysis on many slides Run a OC slide w current stain Not OK OK contact service Run an old OK customer QC slide OK Not OK otaining issues Hardware problem CELLAVISION Export the Log Files Make sure that the analyzer is ON Go to Tools Export Log Files Insert a flash drive into USB port Choose Export to LAN and browse for the flash drive Click on Export Burn When finished compress or zip Email to your vendor CELLAVISION 6 9 8 2014 37 Remote Review Software Questions about Installation e AManuals and Instructions VMnstallation Instructions PM 10237 Installation instruction CellaVision Remote Review Software ver 3 x pdf Remote Review for Citrix e 9 8 2014 CELLAVISION Support User manuals LIS Interface manual CellaVision IT Configuration Guidelines www cellavision com Join the blog for educational cases CellAtlas free app for iProducts and Android Your CellaVision vendor representatives CELLAVISION 9 8 2014 38 Case Studies CELLAVISION Case 1 A 44 year old woman presents to her GP with the following symptoms Bloated Feeling Heartburn Irregular Bowels Two months prior the patient had itchy flat red rashes with scalloped edges for which she tried topical anti bacterial and anti fungal creams with only limited success
5. Burkitt lymphoma occurs more readily in persons who have been weakened by malaria and in persons suffering from AIDS Research suggests that it is caused by a genetic mutation in which a piece of chromosome 8 is translocated to chromosome 14 Can present as lymphoma or leukemia Similar disease characteristics to diffuse large B cell lymphoma DLBCL Synonym s Mature B cell high grade lymphoma Mature B cell acute lymphoblastic leukemia L3 type FAB classification Despite the fast growing nature of this tumor Burkitt s lymphoma is also one of the most curable types of lymphoma depending on CELLAVISION 9 the stage of the disease at the time it is diagnosed Case 5 This case was recently captured on DM 96 in The Western United States Patient was 1 year old Asian female Flu like symptoms with fever infections Gray Hair Very pale gray skin WBC 3 2 RBC 4 51 CBC 13 7 39 8 95 94 CELLAVISION 9 8 2014 46 Chediak Higashi ctLLAVISION Chediak Higashi Syndrome Ch diak Higashi syndrome CHS is a rare childhood autosomal recessive disorder that affects multiple systems of the body Patients with CHS exhibit hypopigmentation of the skin eyes and hair prolonged bleeding times easy bruisability recurrent infections abnormal natural killer cell function and peripheral neuropathy They also frequently complain of solar sensitivity and photophobia CHS was described by Beguez Cesar in 1943
6. Vineyard Massachusetts Block Island Rhode Island and Shelter Island Fire Island and eastern Long Island New York State To supplement a blood smear diagnoses should be made with an indirect fluorescent antibody IFA test Other possible ways of becoming infected with Babesia include receipt of a contaminated blood transfusion no tests have been licensed yet for donor screening or transmission from an infected mother to her baby during pregnancy or delivery The Centers for Disease Control and Prevention have issued a warning about babesiosis According to the CDC the illness is transmitted through blood transfusions and has infected at least 122 people since 2000 This was released on Sept 7 2011 A differential diagnosis needs to include Plasmodium spp CELLAVISION Case 9 83 year old man Fatigue Lethargy Had removed a tick three weeks ago Segs Bands Lymphs Monos Reactive Lymph CELLAVISION 9 8 2014 51 9 8 2014 Erlichia Anaplasmosis DN cELLAVISION Anaplasmosis Anaplasmosis is often characterized by sudden high fever fatigue muscle aches headache The disease can be mild or life threatening Severely ill patients can have low white blood cell count low platelet count anemia elevated liver enzymes kidney failure and respiratory insufficiency Older people or people with immune suppression are more likely to reguire hospitalization Deaths have occurred
7. archived images from that Database Y You can store 150 slides on one CD Only signed orders can be archived PArchiving takes 20 min per 1 GB of data 200 slides CELLAVISION Q Minor Database Maintenance Delete Unsigned slides gt X days old Suggestion Use Export DB instead of Protect for long term saving CELLAVISION 9 8 2014 24 Pre Classification Accuracy Subheading e 9 8 2014 CELLAVISION What factors affect pre classification accuracy e Slide making e Slide Staining e Stain too light too pink e Eos in with segs or segs with eos e Stain too dark too blue e Overcalling of blasts Left shifted cells misclassified overclassified Too much artefact 9 8 2014 CELLAVISION 9 8 2014 25 Staining Wright or Wright Giemsa Slides Too Pink Increase fixation time ncrease Stain time Increase pH of buffer Decrease the Rinse Time Too Much Artefact Filter Stain Make sure slides are dry Increase Rinse Make sure slides are clean Make sure stain is not expired Total number of objects S Pre classified in agreement P Sum verified leukocytes Sum non WBC Sum re classified objects Pre classification data absolute Cell class Segmented neutrophil Eosinophil Basophil Lymphocyte Monocyte Band neutrophil Var Ly Plasma Promyelocyte Myelocyte Metamyelocyte Blast cell Smudge cell Erythroblast NRBC Artefact Giant thrombocyte 9 8 20
8. eELLAVISION ALL Acute Lymphoblastic Leukemia is the fastest of the leukemic cancers Approximately 6 000 new persons are diagnosed with ALL each year in the US It is the most comment type of leukemia in children under the age of 15 Symptoms depend upon whether the cell counts are elevated or decreased High numbers will cause joint pain headache vomiting Low numbers will cause symptoms consistent with anemia etc Inability to fight disease Fatigue anemia Easy bleeding and bruisability Initial treatment is chemotherapy Secondary treatment is BMT CELLAVISION 44 Case 44 6 year old boy Repeated illnesses colds etc Fatigue No weight gain Initial testing CT scan Spinal Fluid e CT Scan showed an Abdominal Mass ctuAvision Burkitt s Lymphoma CSF Talal means mmn CYEJCO CH aa ma zma 9 8 2014 45 Burkitt s Lymphoma Burkitt s Lymphoma is a non Hodgkin s Lymphoma that has an especially high incidence in eguatorial Africa among children 3 to 16 years of age but is also found in Western countries The disease is characterized by tumors of the jaw bones and abdomen and is named after Denis Burkett who mapped its peculiar geographic distribution across Africa in the 1950s Mature B cell neoplasm that arises in lymph node germinal centers The Epstein Barr virus which causes infectious mononucleosis is present in almost 10096 of persons afflicted with Burkitt lymphoma
9. swell Mantle cell lymphoma can also affect the bone marrow liver and gastrointestinal tract Though it looks like a slow growing low grade tumor under the microscope it grows fast and behaves like a high grade lymphoma Mantle cell lymphoma accounts for approximately six percent of all non Hodgkin s lymphoma related diseases according to The Leukemia and Lymphoma Society The overall 5 year survival rate for MCL is generally 5096 advanced stage MCL to 7096 for limited stage MCL CELLAVISION O Case 8 53 year old woman from New Jersey no recent travel Fatigue malaise loss of appetite Occasional fever WBC E Segs Bands Lymphs Monos Eos Reactive Lymphs Retic Elevated ESR Liver function tests Elevated TBili LDH and liver transaminases CELLAVISION O 9 8 2014 49 9 8 2014 Mh ai ceiavision 0 Babesia ES APR rmm ct avision fo 50 Babesiosis Because Babesia parasites infect and destroy red blood cells babesiosis can cause hemolytic anemia which can lead to jaundice and dark urine Where do most of the cases of babesiosis occur in the United States Tickborne transmission of B microti primarily occurs in the Northeast and upper Midwest particularly in parts of New England New York State New Jersey Wisconsin and Minnesota In the Northeast babesiosis occurs in both inland and coastal areas including off shore islands such as Nantucket and Martha s
10. 14 Slides Too Blue Decrease fixation time Decrease Stain time Increase Stain Buffer Time Increase Rinse Time Lower pH of Buffer a CELLAVISION O Accuracy all objects Accuracy SN BN Number of re classified objects not being part of the cell groups preclassified by the system Pre classification data relative Pre classifying In agreement with final Cell class agreement result Segmented neutrophil 95 496 75 896 Eosinophil 63 496 92 996 Basophil 11 196 Lymphocyte 97 4 Monocyte 86 7 Band neutrophil 0 0 DIV 0 Var Ly 0 0 HDIV O Plasma HDIV O HDIV O Promyelocyte 0 0 Myelocyte 0 0 Metamyelocyte 0 0 Blast cell 86 2 Smudge cell 95 1 Erythroblast NRBC 90 9 Artefact 75 9 Giant thrombocyte 58 3 CELLAVISION 9 8 2014 26 Total number of objects S Pre classified in agreement P Sum verified leukocytes Sum non WBC Sum re classified objects Pre classification data absolute Cell class Segmented neutrophil Eosinophil Basophil Lymphocyte Monocyte Band neutrophil Var Ly Plasma Promyelocyte Myelocyte Metamyelocyte Blast cell Smudge cell Erythroblast NRBC Artefact Giant thrombocyte 53 9 8 2014 Accuracy all objects Accuracy SN BN Number of re classified objects not being part of the cell groups preclassified by the system Pre classification data relative Pre classifying Cell class agreement Segmented neutrophil 98 896 Eosinop
11. 8 E Bb E Wes enl LEE ee 0 DEBE E illc GE ee SCD EE nt a 9 8 2014 ctuAvision Low Count CSF Overview ge ML nr Eroen E as 9 8 2014 CELLAVISION Low Count CSF Cell Location 1 9 8 2014 CELLAVISION d 9 8 2014 9 8 2014 Not ideal but passes JET TV CELLAVISION f E heo je 00 0 55 VV E Lu 7 e CELLAVISION 9 8 2014 I Too Thick Cell Location Fails 9 8 2014 CELLAVISION CellaVision Proficiency Software Competency amp Educational tool for e Peripheral Blood differentials Body Fluid differentials Compatible with CellaVision DM So 9 8 2014 CELLAVISION c 10 Key Features Web based program that can be accessed from any computer no installation of software Support for Peripheral Blood and Body Fluids Supports any size laboratory Cell images can be uploaded from your CellaVision instrument Allows you to assess classification down to the individual cell level Automated result analysis and report generation are available for instant viewing and exporting 9 8 2014 va suen ff Ki belan rg re en Epilation Basar atter n PROFICIENCY TESTING Work Flow Two user levels e Examiner creates tests e Participant takes test 9 gt gt e Select the participants 3 Review the tel and vend il 9 8 2014 9 8 2014 11 9 8 2014 Create a Test Case 9 8 2014 CELLAVI
12. 9 8 2014 CellaVision Users Group D H i d D TE q ll e r gt ASS MW TAE rye D 9 8 2014 CELLAVISION Agenda Cell Location Body Fluids Moving Cells Efficiently Archiving Autodelete amp Backup Pre classification Accuracy Methods for collecting images Tools and Settings Maintenance Troubleshooting CRRS 9 8 2014 CELLAVISION o 9 8 2014 Cell Location is used to test the analyzer s ability to LOCATE cells You are really performing OC on your slide making and staining as well Cell Location slides should e Have a WBC Count of at least 7 0 X 106 uL e Be a freshly made and freshly stained slide e Be a properly made and properly stained slide 9 8 2014 CELLAVISION Slides that should not be run on CellaVision systems 9 8 2014 CELLAVISION 9 8 2014 Tips and Tricks Always keep a OC slide which has had a passing value of 10096 available e f this slide passes again the trouble is with your slide stain e If this slide fails you may have a mechanical problem f you have two stainers you should be running two Cell Location slides Cell Location should be run at least once a day or anytime you change your stain The boxes DO NOT need to be around the cells 9 8 2014 CELLAVISION e CELLAVISION 9 The object ha been located by the system if there is a box associated with it The boxes are not always centered on the cel
13. ISION Moving Cells Efficiently Subheading 9 8 2014 CELLAVISION 9 8 2014 18 9 8 2014 What is the fastest way Use of Shift to move cells that are next to each other Cannot be used across cell classes Use of Ctrl to move a number of cells that are not contiguous Can be used across cell classes 9 8 2014 CELLAVISION What is the fastest way e Split cell e Is it faster to move and then split or split and then move e Sometimes it is faster to move ALL the cells in a class and then use Ctrl to move the ones you don t want back e Do you need to move things from artefact to smudge or PLT clump to artefact 9 8 2014 CELLAVISION 19 Multiple Slide Orders Excellent for Low WBC counts Make multiple slides with the same Order ID Run all slides on DM Review and decide Sign the Order e All slides in the order should be either not reviewed e 9 8 2014 CELLAVISION Database Management Subheading 9 8 2014 CELLAVISION 9 8 2014 20 9 8 2014 Database Management It is crucial that you keep the size of your databases under 20GB Two Strategies by moving the images elsewhere for I storage 9 8 2014 CELLAVISION Archiving Autodelete Strategy Warn when the following wo conditions are met 1 The number o signed oder exceeds Auodslete 2 These orders are cicer than mn days r Archiving media Path for archi
14. SION CELLAVISION Ip sides A PARTICIFANTS uceuses SETTINGS A Anna Kapterer dn Create new test Available slides y Selected slides Paripberal blood samples Ede JD Anazed 1 Ramma Ma 110208 APL Motes AM 12 9 8 2014 CELLAVISION i AR PARTICIPANTS JM LICENSES L SETTINGS de Create new test i Available Participants Selected Participants amp CELLAWISIOM ds ll Stines A PARTICIPANTS ucrusrs SETTINGS amp Create now tost Stop 1 Step Slop 4 Boeri vrir gelen Choose your test settings o Set a test duration Automatically close ha lesten t Wed e NM v 201 ow C Denn zat am muinmahe complete duin Decide what participants can see E Show patent informan E1 Show slide graphics r Maka reference cella available ki Grew escht dciis lo Peru Write a test comment 13 9 8 2014 CELLAWISIOM y A SLIDES A PARTICIPANTS A LICENSES amp Croate now tost Step 1 Heine your gier Review your test Test Name One Slides Participants Slide 1 1003W r Slide 2 1004W Slide 1003W w Bow patient information Test ends v Make reference celis available Mon Dec 18 2011 w Show slide graphics w Give each acces lo results Taking the Test 9 8 2014 CELLAVISION 14 CELLAVISION lt gt 1001M m CELLAVISION lt gt 1001M KI II oeooooooooooo
15. actor 0 0 Defaults for PLT tab 3x3 0 89 HPF squere Count PLTs per cnd square vi Calcuisted level X Intervals for average PLTs HPF value P Significantly decreased lt 0 me mse Increased CELLAVISION 6 32 Maintenance Dail a Monthly Wipe Stage Area Change Bulb DM96 Perform Cell Location As Needed Refill Oil Delete Unsigned Turn off and restart PC Slides Weekly Clean Lenses 9 8 2014 CELLAVISION 6 Common problems Peripheral Blood Application No monolayer found Incomplete analysis No slide PID Poor preclassification Low performance throughput Long time to logon to the software CELLAVISION 9 8 2014 33 Common problems No monolayer found Dirt oil on the 10x objective Clean the 10x objective weekly maintenance Immersion oil on slide gt Wipe off immersion oil Sample not prepared according to recommendations Too long smear Too short smear Too thin smear a 5 15 mm 33 mm Too thick smear x gt Adjust according to User s manual CELLAVISION 0 Common problems Incomplete analysis Too few WBCs found due to Too much small artifact gt Adjust rinse Slide Maker amp Stainer if applicable gt Better control of manual staining fresh stain etc XY offset is not correct Call Service Too dark or light stain gt Verify with running QC slides gt Adjust stai
16. d disseminated histoplasmosis and it can be fatal if left untreated Histoplasmosis is common among AIDS patients because of their suppressed immune system H capsulatum grows in soil and material contaminated with bird or bat droppings guano The fungus has been found in poultry house litter caves areas harboring bats and in bird roosts particularly those of starlings Histoplasmosis can be diagnosed by samples containing the fungus taken from sputum blood or infected organs It can also be diagnosed by detection of antigens in blood or urine samples by ELISA or PCR It can also be diagnosed by a test for antibodies against Histoplasma in the blood CELLAVISION 9 8 2014 54
17. due to anaplasmosis There are two kinds of ehrlichiosis both of which are caused by tick borne rickettsial parasites called Ehrlichia that infect different kinds of white blood cells In HME human monocytic ehrlichiosis they infect monocytes In HGE human granulocytic ehrlichiosis they infect granulocytes HGE was renamed anaplasmosis in 2003 It is likely that the lone star tick transmits HME and that the deer tick transmits HGE Ehrlichiosis HME was originally thought to be only an animal disease It was described in humans in 1987 and is now found in 30 states predominately in the southeast south central and mid Atlantic states Europe and Africa CELLAVISION 6 52 Case 10 A 47 year old woman who is an avid spelunker came to her doctor with complaints of malaise a general ill feeling fever dry or nonproductive cough headache shortness of breath joint and muscle pains chills She also noted this sore on her forehead The physician ordered a CSF due to her severe headache etuAvision a CELLAVISI mum NY TA on o 9 8 2014 53 Histoplasmosis 1 E CELLAVISION O Histoplasmosis Histoplasmosis also known as Reticuloendotheliosis Spelunker s Lung and Caver s disease is a disease caused by the fungus Histoplasma capsulatum Symptoms of this infection vary greatly but the disease primarily affects the lungs Occasionally other organs are affected this is calle
18. ettings Disabled cELLAVISION Default settings Include code in comment Disabled Y Always show expanded Standard Comment Editor Code Comment type include code in comment Always show expanded Comment Enabled Note WBC RBC and PLT standard comments are context sensitive CELLAVISION 31 9 8 2014 RBC Pre Classification Users Language Database PB Reclassification PLT PB Reference Cells Standard Comments EMal Repot Sgn Archiving Autodelete Analysis REC Precharacterization BF Analysis Area Enable RBC precharacterization RBC limits 1 Slight 2 Moderate 3 Marked 2 Moderate 3 Marked Polychromasia j 25 35 6 15 30 Hypochromasia e E 30 e 15 30 Poikilocytosis E e 15 e 15 30 Anisocytosis sizes micrometers Microcytosis lt e 5 lt Nomal lt Macrocytosis Reset RBC Limits and Anisocytosis size to their default values Reset Note Default values according to O Connor Barbara H A Color Atlas and Instnuction Manual of Peripheral Blood Cell Morphology Lippincott Williams amp Wilkins 1984 etuAvision PLT Tab EMal Repor Sign Archivmg Atodelete Analysis REC Precharactenzation BF Analysis Ama Users Language Database PB Reclassfication PLT PE Reference Cele Standard Comments Uss only manual PLT concentration estimation Number cf HPFs 8 per overview image PLT estimate f
19. hil Basophil Lymphocyte Monocyte Band neutrophil Var Ly Plasma Promyelocyte Myelocyte Metamyelocyte Blast cell Smudge cell Erythroblast NRBC Artefact Giant thrombocyte CELLAVISION 47 6 14 3 99 7 100 0 0 0 0 0 0 0 0 0 0 0 12 5 0 0 95 8 2 9 79 5 44 4 In agreement with final result 77 9 83 3 HDIV O HDIV O HDIV O HDIV O 100 0 100 0 55 4 80 0 Methods of Collection Images for Other Uses e Saving one or a few images from a particular sample e Saving ALL of the images including RBC View particular sample Collecting and Exporting a screen shot 9 8 2014 CELLAVISION fora 9 8 2014 27 Tools and Settings What can and can t you customize 9 8 2014 CELLAVISION Create a database settings 00000000 0 0 os Eug Repotsi Archwngiiaiodeiele Ansi RBCPrecharecteizson DF Anakis Area Usern Loo Dabam poreca pr fP ReeexeCeh tended Comments Teachrg Side Aien ehid uer to seuweh bir C Panl D Dreier OR Binh Patient ID and Cures ID CELLAVISION 9 8 2014 28 9 8 2014 5 types of users Define users in Users Observer Full Name Email User DbserverLlser Observerlser Observer Z Normallser NomalU ser User Restricted RestrictedUser RestrictedUser Restricted Authorizedl ser AuthorizedU ser Authorized Administrator ser Administrator ser Administrator A ut h orize d adm
20. in Administrator created by the system Administrator Administrator n Note Users are gt Delte E defined per database User Full Name lu ser Password Password again See Appendix E in User s Email G U i d e Access level Observer v Observer IV Account Active User Restricted Authorized Administrator CELLAVISION Operating settings Analysis tab PB Anaysis Default settings ee ug Peripheral Blood Number of WBCs to count 100 Number of WBCstocount 100 Default iH of WBCs 105 Type of order Type of order Type of Order WBC RBC 7 WBC 7 Dit PLT v RBC v Overview M PLT Overview 10x Enable LIS Disabled for C Overview 10x 50x j now Enable LIS j E Enable autostart Add processed slides to 7 Add processed side o wodd worklist Enabled CELLAVISION 6 29 Operating settings Analysis tab BF PB default values Number of WBCs to count 100 Number of WBCs to count 10d Analysis BF default values Type of order Iv WBC v RBC PLT Type of order Iv Dit v Overview Overview 10x C Overview 10x 50x Enable LIS v Enable autostart IV Add processed slide to worklist CELLAVISION Operating settings Report Sign tab Default settings Users Language Database WBC Reclassification Standard Comments Reference Cells PT EMai Report Sign Analysis RBC Precharac
21. itative yield varies from 30 75 The speed and time of centrifugation the amount of sampie in the chamber and the filter paper absorbance are factors that can influence both the cell yield and morphology ref Body Fluid Analysis for Cellular Composition CLSI H56 A Vol 26 No 26 9 8 2014 CELLAVISION 9 8 2014 How do you classify e WBC count or Nucleated Cell Count ai Make sure that your test name reflects what you are y reporting y e WBC Diff or Nucleated Cell Diff Where should mesothelial cells lining cells etc go What happens if you are not including them in the diff and you get a lot of them 9 8 2014 CELLAVISION c BF Overview Tab How much of the button do you need to look at At what power What are you looking for 9 8 2014 CELLAVISION 9 8 2014 Body Fluid Cell Location 9 8 2014 Excellent Preparation 9 8 2014 Cell Location tab is found on the Overview tab The light shaded area shows where the diff has been done What was the percentage of missed cells Make sure that you view all of the light shaded area Just like PB should be done at least once a day or whenever stain has been changed What if my only first BF slide is a mess ct ovision esuavisi n 9 8 2014 Excellent Cell Location ITE a l gre D b v re 1 I fs 9 8 2014 T EKn i os ctuAvision O Example Low Count CSF un IE E
22. ls and can be completely separated from the cells As long as there 15 a box associated with a cell this indicates that the system ha found the cell 1 Cell at the edge of the image If a cell 15 at the edge of the image the cell box can sometimes be outside the image To confirm that the cell has been located double click on the cell to view the magnified image and confirm that the cell has a box associated with it Note On screen cell images are not always presented in the same order az the system iz working Cells marked with black boxes may occur in the middle of the test not only towards the end Cont d Amendment Users Manual PM 10454 3 CELLAVISION 9 8 2014 Body Fluids on CellaVision Just as with Peripheral Blood the specimen you run is important Properly made properly stained Could require different stain settings Will always do diff from the center of the button 9 8 2014 CELLAVISION Preparation Guidelines The BF program will always do the diff starting with the center of the button Therefore it is important that the button not be too thick Buffered saline or standard tissue culture media both with a drop or two of bovine serum albumin 85A which promotes cell adhesion to the microscope slide may be used as a diluent The recommendation is to have 5000 12000 cells in total on the slide Note Cells are concentrated approximately 20 fold by cytocenmifuganon however the quant
23. ning protocol Poor smear preparation gt Prepare smear according to CELLAVISION recommendations 9 8 2014 34 Common problems Slide jam use procedure found in Section 13 2 10 in User s Guide to unjam For magazine jam use procedure 13 2 11 Poor barcode quality gt Verify barcode quality high contrast white area between lines quite zone Debris on the stage Clean the stage daily maintenance Slide outside specifications gt Verify length width cut corners Slide handling misaligned gt Contact service to calibrate CELLAVISION Common problems No Slide PID Could not identify barcode label e Poor barcode quality gt Verify barcode quality high contrast white area between lines quite zone print area e Slide inserted upside down 9 8 2014 35 Common problems Slow sluggish system Database is gt 20 GB gt Configure archiving auto delete or archiving Too many databases running gt Disable delete databases not in use PC has not been restarted for a long period of time gt Restart the PC once a week CELLAVISION Q Common problems Long time to logon to software Database is gt 20 GB gt Configure archiving auto delete or archiving PC has not been restarted for a long period of time gt Restart the PC once a week Database check is done Make sure to turn off the computer as recommended CELLAVISION 9
24. terization Rom A Report template FULL Default report template created by the system FULLGerman Default report template created by the system MEDIUM Default report template created by the system MEDIUMGerman Default report template created by the system MINIMAL Default report template created by the system MINIMALGerman Default report template created by the system gt Nnmal Default renart temnlate created hv the svstem Prefill password Disabled Sign order when signing slide Enabled Send order to LIS when gt signed Enabled PE ee Print order when signed Default settings for Sign dialogs Prefill password IV Sign order when signing slide Je Send order to LIS when signed Print order when signed Disabled CELLAVISION 6 9 8 2014 30 Operating settings WEBC Reclassification tab PLT E Ma l Report Sign Analysis RBC Precharacterization Rom A Users Language Database 7 WBC Heclassfication Standard Comments Reference Cells Forward preclassified cells Forward cells from Band neutrophil to Segmented neutrophil Metamyelocyte to Segmented neutrophil Lymphocyte variant form to Lymphocyte Plasma cell to Lymphocyte Immature cells to Other Operating settings Standard Comments Arosa ABC Prechameteszation Rom A PMT EMW Ram Users Language Database WBC Feciossficaton 9 8 2014 Default settings All s
25. ths images stored 12 months 8050 8 05 1 15 17 kuggested Settings for Archive or Auto delete signed orders exceeds 100 slides and orders older than 17 days Time required to perform Time Required to Archive once dy Time Required to auto delete N A bata Strorage Requirements Storage Space required for Archives amp Backup files Note In order to maintain total backup archive space to above size IT will need to delete all archive files older than 12 months CELLAVISION Q Archiving slides Possible to archive onto CD R CD RW LAN and external hard drive While there is a DVD player on the DM there is no functionality to write to a DVD Y Archiving slides will move images to the archive The numerical result and patient demographics will remain in the CellaVision DM database Y Archived slides are indicated in the database view with an icon Y Opening an archived slide is done by double clicking on the Order ID in the Database View If archived on LAN the images will automatically be loaded If archived onto CD you will be prompted to insert a CD with a certain number created during the archiving process CELLAVISION 9 8 2014 23 Archiving slides You need access to the original database to be able to open a archived slide the path to where the slide is archived is stored in the database A crashed database without a proper backup effectively loses all
26. ving Te Network path or local dive Boe C CD archiving Images to archive Cell images PB overview images RBC PLT PB cell images C None aj Normal WBCs Abnormal WBCs Non WBCz 99 E Oveniew mage C Now SI C 1050 Region of interest mages H ane Ze Al EF cell images WBCs Non WBCs a 9 8 2014 CELLAVISION 6 21 9 8 2014 What is the difference between Archive and Backup Y Archive Having access to slides analyzed a long time ago Backup Makes it possible to restore the database and archives if there is a hard disk crash Export Long term storage of interesting slides in another database a ceLLavision Archiving Backup Archiving maintains size of DB by stripping the images from other patient data storing them elsewhere and mapping their location in the DB If DB crashes w o a backup all Archived files become useless Archiving is initiated by lab someone with Administrator status Backup is the copying of all databases and archive files for protection The frequency and process for doing this is dictated by IT e Initiated by IT using 3 party backup software or CV provided scripts little programs CELLAVISION 22 Calculate Archive settings Workload Data Slides MB GB GB days to per day per week per week per day 20GB Differentials 100 2800 2 8 0 40 50 Body Fluids 5 5250 5 25 0 75 mon
27. x Malarial parasites work by digesting red cell proteins and making the RBC membrane less deformable causing hemolysis increased splenic clearance and anemia Red cell lysis stimulates release of cytokines and TNF a The systemic manifestations of malaria such as headache fever and rigors nausea and vomiting diarrhea anorexia tiredness aching joints and muscles thrombocytopenia immunosuppression coagulopathy and central nervous system manifestations have been largely attributed to the various cytokines released in response to these parasite and red cell membrane products P Vivax makes up 1696 of cases reported in US Not found in West Africa as no Duffy Antigen which is required for entry in to the RBC Characterized by Low to Normal Platelet Count Anemia White blood cell WBC counts during malaria are generally characterized as being low to normal a phenomenon that is widely thought to reflect localization of leukocytes away from the peripheral circulation and to the spleen and other organs rather than actual depletion or stasis In P Vivax it is common to see more than one stage in the life cycle at the same time in the Peripheral Blood rt CELLAVISION 9 7 year old male Hemoglobin of 4 5 Came to the ER because he could not stand up CELLAVISION 43 9 8 2014 One blast was found by the technologist using a microscope We found 3 using Cellavision The bone marrow had 9096 blasts
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