NEW YORK STATE DEPARTMENT OF HEALTH Wadsworth Center HEMATOLOGY

HEMATOLOGY PROFICIENCY TESTING – February 1, 2016

This proficiency test event includes some or all of the specimens listed below for each test category. The specimen have been tested by FDA accepted methods and found non-reactive for Hepatitis B Surface Antigen (HBsAg), antibody to Hepatitis C (HCV) and antibody to HIV-1/HIV-2. All specimens should be handled with the same precautions that are used in handling any other possibly infectious specimen.

Cellular Hematology- routine blood counts Cytohematology Diagnostic- cell identification Coagulation- PT/INR, APTT, Fibrinogen

It is strongly recommended that testing be performed as soon as proficiency specimens are received to avoid unavailability of replacement specimens. Replacement deadline is February 8, 2016. If specimens are received in an unsatisfactory condition, if the shipment is incomplete, or if there are any questions concerning the specimens call (518) 474-9878. Routine Blood Counts Protocol: Five specimens: B21, B22, B23, B24, B25

1. Store at 2-8ºC. Protect from heat and freezing. 2. Remove tubes from refrigerator and equilibrate to room temperature for 15 minutes. 3. To mix, hold tube horizontally between the palms of the hands. Do not pre-mix on a mechanical mixer.

a. Roll the tube back and forth for 20 - 30 seconds; occasionally invert the tube. Mix vigorously, but do not shake. b. Continue to mix in this manner until the red cells are completely suspended. Tubes stored for a long time may require

extra mixing. c. Gently invert the tube 8 - 10 times immediately before sampling.

4. Process proficiency test specimens as patient specimens. 5. After sampling, return tubes to refrigerator (2-8 ºC) within 30 minutes of use.

ANALYZER INSTRUCTION: CD 4000, Sapphire: PIC/POC error may occur on platelet parameter. Please ignore and report the optical platelet value. CD 3500, CD3700, CD3200, Ruby: WBC Flags may occur. Please ignore and report the WOC value for the WBC count. ADVIA 120/2120: WBC Flags may occur. Please ignore and report the WBCB (Baso) value for the WBC count. Sysmex users: Report impedance platelet value. Sysmex XN-Series only: Deselect PLT-F and report impedance platelet value Cell Identification Protocol: Images: 421, 422, 423, 424, 425

1. Review each image at http://www.wadsworth.org/chemheme/cellPT and select the identification code that best describes the finding(s) identified by the arrow(s).

2. All images were taken with a 100x oil immersion lens. Coagulation Protocol (PT/INR, APTT, Fibrinogen): Five specimens for: C21, C22, C23, C24, C25

1. Store at 2-8ºC. Protect from heat or freezing. 2. Reconstitute each specimen with 1.0 ml of distilled water. 3. Replace the stoppers and swirl gently. Do not mix vigorously. Allow to stand at room temperature for 15 minutes. 4. Perform the assays within one hour of reconstitution. Test the specimens in the same manner as routine patient specimens, with

your laboratory’s primary instrument and appropriate reagents. International Sensitivity Index (ISI): Please indicate the ISI of your thromboplastin reagent. International Normalized Ratio (INR): If your laboratory reports prothrombin times as INR’s, please indicate the INR for specimens C21-C25. Reference ranges: Please include normal reference ranges for coagulation assays in the spaces provided on page 3. Page 1 of 4 (1/16)

Laboratory Identification Code: ___ ___ ___ ___ Routine Blood Counts

Analyte

Instrument

Codes*

Vial B21 Vial B22 Vial B23 Vial B24 Vial B25

White Cell Count

(x109/L)

____ ____ ____

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

Red Cell Count

(x1012/L)

____ ____ ____

__ __ . __ __

__ __ . __ __

__ __ . __ __

__ __ . __ __

__ __ . __ __

Hemoglobin

(g/dL)

____ ____ ____

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

Hematocrit

(%)

____ ____ ____

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

Platelet Count

(x109/L)

____ ____ ____

__ __ __ __.

__ __ __ __.

__ __ __ __.

__ __ __ __.

__ __ __ __.

*If using instrument/reagent code OOO (Other), please specify:_________________________________________________________

Cytohematology: Cell Identification PLEASE NOTE: Images can be viewed at http://www.wadsworth.org/chemheme/cellPT Indicate the identification code that best describes the finding(s) identified by the arrow(s). All images were taken with a 100x oil immersion lens.

Image Number

Image 421

Image 422

Image 423

Image 424

Image 425

Identification Code

___ ___ ___

___ ___ ___

___ ___ ___

___ ___ ___

___ ___ ___

Page 2 of 4 (1/16)

Coagulation

Analyte

Instrument

Codes*

Reagent Codes*

Vial C21

Vial C22

Vial C23

Vial C24

Vial C25

Prothrombin Time (seconds)

___ ___ ___

___ ___ ___

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

__ __ __ . __

INR Thromboplastin ISI

__.__ __ __

___ ___ ___

___ ___ ___

__ __ __ . __ __

__ __ __ . __ __

__ __ __ . __ __

__ __ __ . __ __

__ __ __ . __ __

Activated Partial Thromboplastin Time (seconds)

___ ___ ___

___ ___ ___

__ __ __ __. __

__ __ __ __. __

__ __ __ __. __

__ __ __ __. __

__ __ __ __. __

Fibrinogen

(mg/dL)

___ ___ ___

___ ___ ___

___ ___ ___ ___.

___ ___ ___ ___.

___ ___ ___ ___.

___ ___ ___ ___.

___ ___ ___ ___.

*If using instrument/reagent code OOO (Other), please specify:_________________________________________________________ Please provide your laboratory’s normal reference ranges and reagent lot numbers for coagulation assays. Prothrombin Time Lower Upper Normal Reference Range: __________ - __________ seconds Lot#____________________ APTT Lower Upper Normal Reference Range: __________ - __________ seconds Lot#____________________ Fibrinogen Lower Upper Normal Reference Range: __________ - __________ mg/dL Lot#_____________________ Page 3 of 4 (1/16)

Attestation Statement: The laboratory director or authorized assistant director and personnel analyzing these specimens must sign this report form in the space provided below, attesting that proficiency testing samples were analyzed in the same manner as patient samples. We, the undersigned, attest that the test findings provided were produced in this laboratory from the analysis of proficiency test samples which were introduced into the routine workflow of the laboratory and analyzed using protocols and procedures which are (or will be) routinely applied to clinical specimens. We further attest that the laboratory did not engage in any form of communication with individuals outside of our laboratory regarding the proficiency test and/or results obtained therefrom. Analysis performed by (print name): Signature: Test Date: Analysis performed by (print name): Signature: Test Date: Laboratory Director or Authorized Director (print name): Signature: Test Date: Submission Deadline: February 12, 2016

PLEASE NOTE: Information regarding electronic submission of proficiency test results has been sent to your laboratory. Questions regarding the electronic submission system should be directed to: Clinical Laboratory Evaluation Program (CLEP) at 518.485.5378 or clepeptrs@health.state.ny.us Until you electronically submit your results, please fax your completed form to: +518.474.9185

Please fax your completed form to: +518.474.9185

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