Cost effective improvement in the protocol for detection of haemoglobin variants –a step forward in quality assurance
© Ali and khurshid; licensee BioMed Central Ltd. 2013
Received: 19 December 2012
Accepted: 8 May 2013
Published: 9 May 2013
We report the results of a cost effective improvement in the protocol for detection of haemoglobin variants which incorporates the findings of peripheral blood film along with the results of HPLC.
A total of n = 10,844 samples were received from January 2011 till August 2011. Diagnosis of haemoglobinopathy was made in n = 1123 samples while other abnormalities included iron deficiency anaemia, megaloblastic anaemia, malarial parasite, autoimmune haemolytic anaemia and G6PD deficiency (n = 2473).
We diagnosed 23% of abnormalities other than haemoglobinopathy by reviewing peripheral smear of samples received for detection of haemoglobin variants. This resulted in providing proper diagnosis to the referring physician without increment in cost.
We report the results of a cost effective improvement in the protocol for haemoglobin variant detection which incorporates the findings of peripheral blood film along with haemoglobin and its variants. Modern healthcare these days requires multidisciplinary approaches to patient centred management. Similarly, the diagnosis of haemoglobin disorders requires combination of techniques . Haemoglobin electrophoresis is still the most common technique for initial detection and characterisation of abnormal haemoglobin variants . However, high performance liquid chromatography is increasingly taking its place. At our laboratory, samples sent for detection of abnormal haemoglobin variants are performed on high performance liquid chromatography (HPLC). In the year 2001, the College of American Pathologists committee members concluded that physician’s review of peripheral smear comprised an essential component of proper patient care. As part of implementing continuous improvement in quality assurance, we review peripheral blood films of all samples that are received for HPLC. These blood films are reviewed irrespective of physician’s request, in return providing extra results to help in diagnosis with no increase in cost.
Breakdown of other results n = 2473
Autoimmune Haemolytic Anaemia
Iron Deficiency Anaemia
By following this protocol, we diagnosed 23% of abnormalities which were other than haemoglobinopathy. This resulted in providing the right diagnosis to the requesting physician hence better service without cost increment. The next step would be to encourage adaptation of this protocol at the national level which would result in timely diagnosis, improved quality of laboratory data and better patient management.
The authors would like to acknowledge Ms. Mashooda Irfan for collection of data.
- Sangkitporn S, Sangkitporn SK, Tanjatham S, Suwannakan B, Rithapirom S, Yodtup C, Yowang A, Duangruang S: Multicenter validation of fully automated capillary electrophoresis method for diagnosis of thalassemias and hemoglobinopathies in Thailand. Southeast Asian J Trop Med Public Health. 2011, 42 (5): 1224-1232.PubMedGoogle Scholar
- Fucharoen S, Winichagoon P, Wisedpanichkij R, Sae-Ngow B, Sriphanich R, Oncoung W, Muangsapaya W, Chowthaworn J, Kanokpongsakdi S, Bunyaratvej A, Piankijagum A, Dewaele C: Prenatal and postnatal diagnoses of thalassemias and hemoglobinopathies by HPLC. Clin Chem. 1998, 44 (4): 740-748.PubMedGoogle Scholar
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