Q&A column

A common misconception among laboratories is that training and competency are the same process. Training is required for all new employees and when new methods, tests, or instruments are implemented. Training is the development of skills, knowledge, and experience for a particular test, method, or instrument prior to reporting patient test results. Training must be documented. The laboratory may develop a training checklist that lists the essential steps for performing a test or use a manufacturer’s checklist when training an employee on an instrument, or both. There are no educational requirements for the person performing training. However, the trainer must be aware of all steps in patient testing—from sample preparation to test reporting and troubleshooting. Staff may be trained by a technical specialist from an instrument manufacturer and obtain a checklist and certificate of completion. Both the trainer and the employee should sign and date the training document. If an employee develops performance problems related to testing at any time, retraining must be conducted and documented.

Once an employee has successfully completed training and is allowed to report patient test results, the clock starts for performing competency assessment.

Competency is the application of the skills, knowledge, and experience after initial training to assess if personnel are performing testing correctly. In contrast to training, there are strict requirements regarding the frequency of competency assessment and who can perform the assessment. During the first year of an employee’s duties, competency must be assessed at least semiannually. If a person has completed training in one discipline but still has several areas in which to train, the clock will start for the semiannual competency assessment once the employee starts reporting patient test results. The laboratory should not wait until all training is completed.

Standard: Personnel Assessment. 42 CFR §493.1713 (1992).
Standard: Technical Consultant Responsibilities. 42 CFR §493.1413. https://j.mp/345dR11
Standard: Technical Supervisor Responsibilities. 42 CFR §493.1451(b). https://j.mp/2SXvEQK

Joan K. Kosiek, MS, MT(ASCP)SH, MB
Technical Analyst, CAP Accreditation Programs
College of American Pathologists
Northfield, Ill.

Q. How do you calculate RDW-SD and RDW-CV values in dimorphic anemia cases on the Sysmex XN-3000? Most of the dimorphic anemia cases report a masked parameter.

A. The XN-Series analyzers use algorithms for the red blood cell curve to determine normal (Gaussian) distribution of RBCs analyzed in the impedance aperture. When there is evidence of multiple populations, the red cell distribution width–coefficient of variation (RDW-CV) and red cell distribution width–standard deviation (RDW-SD) are masked (indicated by four dashes) and a “dimorphic population” flag is generated. This alerts the instrument operator to possible interference in the RBC count and related indices. Instances in which this may occur include fragmented RBCs, poikilocytosis, rouleaux, RBC agglutination, interference from small round lymphocytes, and multiple RBC populations. When this flag is generated, Sysmex recommends that the operator review the smear for the presence of the aforementioned features and report any abnormal morphologies.

There is no service or research data available to the operator that can be used to manually calculate the RDW results. The “RBC abnormal distribution” interpretive message that sometimes accompanies a curve with multiple peaks should be handled in the same manner as the “dimorphic population” flag.

XN-Series flagging interpretation guide. Rev. 5. Sysmex America; 2019.

Kimberley Kabb, MT(ASCP)SH^CM
Manager, Scientific Communication and Education
Sysmex America
Lincolnshire, Ill.