An audit of thrombophilia screens: results from the National Pathology Alliance benchmarking review

High prevalence of protein C, protein S, antithrombin deficiency, and Factor V Leiden mutation as a cause of hereditary thrombophilia in patients of venous thromboembolism and cerebrovascular accident

OBJECTIVES

To determine the frequency of Protein C, Protein S (PC & PS), antithrombin deficiency (AT III) and Factor V Leiden mutation (FVL) as a cause of thrombophilia in the patients with venous thromboembolism (VTE) and cerebrovascular accident (CVA).

METHODS

It was an observational study conducted at Department of Haematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan. All patients referred for thrombophilia screening from July 2009 to June 2012 were screened. Patients with evidence of VTE or CVA were screened for PC & PS, AT III deficiency, and FVL.

RESULTS

Total 404 patients of age between 1-71 years mean 33 ± 14 with male to female ratio of 2.4:1 had evidence of thrombophilia. Two hundred eighteen (54%) patients presented with CVA, 116 (29%) with deep vein thrombosis (DVT), 42 (10.5%) with pulmonary embolism (PE), and 28 (7.5%) with portal or mesenteric vein thrombosis (PV). Protein C & S deficiency was detected in 35/404 (8.7%), ATIII in 9/404 (2%), and FVL in 25/173 patients (14.5%). The findings were suggestive of a significant association of FVL mutation for developing DVT (OR=11.0, 95% C I 4.6-26.3), CVA (OR=5.7, 95% C I 2.1-15.1), and PV (OR=5.4, 95% C I 1.3-21.9). PC & PS deficiency was a significant risk factor for developing PE (OR=3, 95% C I 0.8-11.4).

CONCLUSION

FVL mutation and Protein C & S are the leading causes of thrombophilia with strong association of Factor V Leiden mutation as risk for developing DVT.

An audit of the implementation of the international consensus group's guidelines on reporting of blood films

Aims

This study was carried out as part of the Pathology Benchmarking Review and it audits the implementation of the guidelines for the reporting of blood films published by the International Consensus Group for Haematology Review.

Methods

Each laboratory completed a questionnaire about the number of blood counts and blood films performed. Information was collected on the criteria that were used for preparing a blood film and whether they had followed the guidelines of the International Consensus Group.

Results

74 National Health Service organisations (151 laboratory sites) participated in the study. 24 laboratories had implemented the guideline, 21 with local modification, and 3 without modification. The reasons that prevented the full implementation of the guideline included the inability of laboratory information systems to be modified to include the guideline rules, the laboratory not agreeing with the guideline criteria, and the staff time required to implement the guide to justify the perceived local benefits of implementation.

Conclusion

This is the first study that has assessed the implementation of the International Consensus Guidelines at a national level. Many laboratories had experienced difficulty in implementing the consensus guideline partly due to the complexity of the guideline. As a result 21 of the 24 laboratories that had attempted to implement the guideline had made local modification to the guideline. Since it was not possible to estimate the impact that local modification of the guideline would have on the percentage of blood films it was not possible to establish a benchmark of practice following implementation of the guideline.

An audit of the indications for the reporting of blood films: results from the National Pathology Benchmarking Study

BACKGROUND

The National Pathology Benchmarking Review has completed seven years of analysis of the workload of haematology laboratories in the United Kingdom.

OBJECTIVE

To audit criteria that laboratories use for preparing blood films against guidelines published by the International Consensus Group for Haematology Review.

METHODS

Each laboratory completed a standard questionnaire about the number of blood counts and blood films done each year. Information was collected on the criteria that were used for preparing a blood film and the manufacturer of the equipment used to carry out the full blood count.

RESULTS

46 NHS trusts (93 laboratory sites) participated in the study. There was wide variation in the criteria used for preparing blood films when compared with the consensus guidelines. The variation in practice appeared to be irrespective of the type of hospital or the manufacturer of the equipment used for the blood count.

CONCLUSIONS

There is a wide range in laboratory practice in preparing blood films. The publication of the consensus guidelines should help to standardise practice in this area. The next step in the study is to determine what the film review rate should be if these guidelines are implemented. This will then provide a benchmark of good practice which laboratories can use to assess their performance.