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October 2022 Q. How many blocks should a histotechnologist with multiple responsibilities cut per day in a semiautomated laboratory? Read answer. Q. Is it acceptable to release results from an analyzer with flags or alarms if a pathologist sends an email instructing to do so, even if the manufacturer’s instructions state that results with flags or alarms should be verified by another method before reporting? I am referring to hematology analyzer auto-differential results with asterisk flags. The emailed instructions from the pathologist are applied to all samples but are not incorporated into our standard operating procedure. We report auto-differential results that have asterisk flags and then perform a manual differential. The report, therefore, contains two differential results that, when compared, are almost always different clinically and statistically. Read answer. Q. How useful is an aPTT value if the value falls below the reference interval? Read answer.

I am referring to hematology analyzer auto-differential results with asterisk flags. The emailed instructions from the pathologist are applied to all samples but are not incorporated into our standard operating procedure. We report auto-differential results that have asterisk flags and then perform a manual differential. The report, therefore, contains two differential results that, when compared, are almost always different clinically and statistically.

A. The average number of blocks cut by histotechs per day is about 26 (6,433 blocks per full-time equivalent staff per year), according to a study jointly published by the National Society for Histotechnology and CAP in 2011.1 However, this study also reported that histotechs spend only about 25 percent of their time at the microtome.

February 2023—Using gender-affirming hormone therapies is increasingly common in transgender and nonbinary populations, and monitoring hormone concentrations may help provide optimal outcomes for these patients.

A. February 2023—IgG4-related disease (IgG4-RD) is a fibroinflammatory disease that can affect any organ and was first recognized as a unique clinical entity in 2003. The most affected organs include the pancreas, bile duct, major salivary glands, lacrimal glands, retroperitoneum, and lymphatic ducts. Key features of the disorder include elevated serum IgG4 concentrations, neoplastic-like swelling of the affected organs, as shown on an imaging test, specific histopathological characteristics on immunostaining, as well as a good response to treatment with glucocorticoids.

January 2023—Mass-spectrometry–based assays are preferred for measuring estradiol (E2) in populations where low concentrations are expected, such as in males, postmenopausal females, prepubertal children, and those receiving estrogen-suppressing medications or therapies. Comparing the E2 reference interval for postmenopausal females (approximately <10 pg/mL) to that of premenopausal females (15–350 pg/mL, depending on the phase of the menstrual cycle) illustrates what concentrations could be considered low.

February 2023—The chart in the manual lists volume limits for a single blood draw at 2 cc/kg. Other charts online list 2.5 cc/kg and a maximum milliliters per 30-day period that is twice the single blood draw (5 cc/kg). I am going to use 2 cc/kg and add a column for maximum milliliters in a 30-day period at 4 cc/kg. The phlebotomists are confused about whether a single blood draw means every day of the patient’s admission or if you would take the single blood draw and only allow the remainder of the 30-day limit. You could essentially draw the single blood draw volume limit on day one and the remainder on day two. Please clarify.

November 2022—We also calculate total analytical error based on a formula (TAE = bias + 2 SD) and compare the TAE with the allowable total error recommended by CLSI and other sources. For example, if TAE for platelets (based on reading control material 20 times) is less than 25 percent (a CLSI recommended value), we accept the target range; otherwise, we reject it. However, since low concentrations of analytes are prone to a higher degree of variation, the aforementioned target range verification process frequently fails. Is it necessary to accept or reject established target values based on total analytical error? Or is there an alternative way to do that?

November 2022—If an activated partial thromboplastin time is accelerated but a clot is not visible in the sample, the sample should be reinspected for the presence of a clot and a redraw for repeat testing should be considered.

November 2022—Secretory change superimposed on endometrial hyperplasia is well recognized, as are the challenges of making this diagnosis. Although secretory change is most commonly seen in the setting of progestin therapy for previously diagnosed endometrial hyperplasia, it may also be seen de novo due to the effect of progesterone, resulting from ovulation or pregnancy, on preexisting hyperplasia.

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