Repeat patient testing shows promise as a quality control method for veterinary hematology testing

Background

Repeat patient testing‐based quality control (RPT‐QC) is a potential method for veterinary laboratories (eg, that have a limited budget for quality commercial control material [QCM] or that wish to use material with a species‐specific matrix).

Objectives

To determine whether total error (TE_a), probability of error detection (Ped), and probability of false rejection (Pfr) similar to that achievable with QC materials can be controlled using RPT‐QC

Methods

Control limits (WBC, RBC, HGB, HCT, MCV, and PLT) for the Advia 120 (n = 23) and scil Vet ABC (n = 22) were calculated using data from normal canine specimens from a routine caseload. Specimens were measured at accession and again after 24 hours. Control limits were validated using 23 additional canine specimens tested similarly. Achievable TEa, Ped, and Pfr were investigated using the Westgard EZRules3 and compared to those achievable with commercial QCM.

Results

Theoretical performance of RPT‐QC and commercial QCM‐QC are similar for 1‐3s with both n = 1 and 1‐3s with n = 2 for all measurands and both instruments. Achievable TE_a values for RPT‐QC were close to ASVCP recommendations for most measurands; exceptions were PLT (both instruments) and WBC (scil Vet ABC).

Conclusions

Repeat patient testing‐based quality control advantages include a species‐specific matrix, low‐cost, and absence of QC material deterioration over time (since a fresh specimen is used each day). A potential disadvantage is daily access to normal canine specimens. A challenge is determining control limits, which has a subjective element. Further study is needed to confirm actual RPT‐QC performance and to determine if RPT‐QC with abnormal patient specimens is feasible.     

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