--- title: Instrument Flags Should Never be Ignored description: Recently we have encountered several laboratories in which the employees were not paying adequate attention and in some cases ignoring flags generated by hematology analyzers during testing. image: https://blog.cola.org/hubfs/dreamstime_xl_19338152-2.jpg --- ISO 9001:2015 - [Careers](http://www.cola.org/careers/) - [A Great Place to Work](http://www.cola.org/careers/a-great-place-to-work/) - [Current Openings](http://www.cola.org/careers/current-openings/) - [Press Room](http://www.cola.org/press-room/) - Member Login - [COLAcentral](https://www.colacentral.com) - [Board of Directors](http://board.cola.org/) - visit related COLA sites - [GiveBack365](http://www.GiveBack365.org) - [Lab Testing Matters](http://www.LabTestingMatters.org) - [MyConsultantCentral](http://www.myconsultantcentral.com/) - 1-800-981-9883 ![ColaUpdatedLogoStackedWhiteBackground-1](https://blog.cola.org/hs-fs/hubfs/ColaUpdatedLogoStackedWhiteBackground-1.png?width=306&height=111&name=ColaUpdatedLogoStackedWhiteBackground-1.png)   ![ColaUpdatedLogoStackedWhiteBackground-1](https://blog.cola.org/hs-fs/hubfs/ColaUpdatedLogoStackedWhiteBackground-1.png?width=210&height=76&name=ColaUpdatedLogoStackedWhiteBackground-1.png)   ISO 9001:2015 - [Careers](http://www.cola.org/careers/) - [A Great Place to Work](http://www.cola.org/careers/a-great-place-to-work/) - [Current Openings](http://www.cola.org/careers/current-openings/) - [Press Room](http://www.cola.org/press-room/) - Member Login - [COLAcentral](https://www.colacentral.com) - [LabUniversity](https://cola.absorbtraining.com/default.aspx#/login) - [Board of Directors](http://board.cola.org/) - visit related COLA sites - [COLA Resources, Inc.](http://www.criedu.org/) - [GiveBack365](http://www.GiveBack365.org) - [Lab Testing Matters](http://www.LabTestingMatters.org) - [LabUniversity](http://www.labuniversity.org) - [MyConsultantCentral](http://www.myconsultantcentral.com/) 1-800-981-9883 [![2021_newest_logo_cola-footer (1)](https://blog.cola.org/hs-fs/hubfs/2021_newest_logo_cola-footer%20(1).png?width=261&name=2021_newest_logo_cola-footer%20(1).png)](http://www.cola.org/) - [About COLA Inc.](http://www.cola.org/cola-clia-certification-accreditation-application/) - [Overview](http://www.cola.org/lab-testing-accreditation-quality/) - [History Mission and Values](http://www.cola.org/cola-clia-certification-accreditation-application/) - [Joint Commission Affiliated Labs](http://www.cola.org/lab-testing-accreditation-quality/joint-commission-affiliated-labs/) - [California](http://www.cola.org/lab-testing-accreditation-quality/cola-accreditation-in-california/) - [Board of Directors](http://www.cola.org/cola-clia-certification-accreditation-application/board-of-directors/) - [Executive Team](http://www.cola.org/cola-clia-certification-accreditation-application/executives-of-cola/) - [News Releases](http://www.cola.org/cola-news/) - Additional COLA Sites - [GiveBack 365](http://www.cola.org/giveback-365/) - [Lab Testing Matters](https://www.cola.org/lab-testing-matters/) - [Near Patient Testing Matters](https://www.cola.org/near-patient-testing-matters/) - [MyConsultantCentral](https://www.cola.org/myconsultantcentral/) - [Our ISO Certification](http://www.cola.org/lab-testing-accreditation-quality/iso-certification-quality-control/) - [Apply for COLA](http://www.cola.org/lab-testing-accreditation-quality/clia-application-clia-accreditation/) - Quality Accreditation Services - [Accreditation - Clinical Laboratory](http://www.cola.org/lab-testing-accreditation-quality/what-is-cola/) - [Mobile Laboratory Accreditation for EMS](https://education.cola.org/mobile-laboratory-accreditation) - Laboratory Experts - [Surveyors](http://www.cola.org/cola-clia-certification-accreditation-application/cola-surveyors/) - [CDC LOCS Updates](https://blog.cola.org/updates) - [Insider Blog](https://blog.cola.org/blog) - Additional Resources - [Patient Safety Program](https://www.cola.org/patient-safety/) - [HIPAA Information](https://www.cola.org/hipaa-information/) - [Lab Tests Online](https://www.cola.org/lab-tests-online/) - [Apply for COLA](http://www.cola.org/lab-testing-accreditation-quality/clia-application-clia-accreditation/) - Training & Development - [Individualized Quality Control Plan](https://education.cola.org/individualized-quality-control-plan-course) - Laboratory Enrichment Forum - [Attendees](https://education.cola.org/2023-laboratory-enrichment-forum) - [Sponsors](https://education.cola.org/en-us/2023-sponsor) - [Laboratory Director Course](https://www.cola.org/laboratory-director-course/) - [Waived Testing Toolkit](https://education.cola.org/colas-waived-testing-toolkit) - [Lab Link](https://www.cola.org/lab-link/) - [COLA Primers/Ebooks](https://www.cola.org/education-resources/cola-primers-ebooks/) - [COLA's Insights](http://www.cola.org/education-resources/laboratory-education/) - [Webinars](http://www.cola.org/webinars/) - [Workforce Action Alliance](https://education.cola.org/2023-workforce-action-alliance) - FDA Services - [Third Party Review](http://www.cola.org/third-party-review/) - [Contact Us](https://education.cola.org/contact-us-page) # Instrument Flags Should Never be Ignored - [Home](http://www.cola.org/) - Instrument Flags Should Never be Ignored [November 20, 2018](https://blog.cola.org/insider/archive/2018/11/20) [News](https://blog.cola.org/insider/topic/news) [clinical laboratory](https://blog.cola.org/insider/topic/clinical-laboratory) [Dr. John Daly](https://blog.cola.org/insider/author/dr-john-daly) [![](https://blog.cola.org/hubfs/dreamstime_xl_19338152-2.jpg)](https://blog.cola.org/insider/lab-director-requirements-0-0-0-1-0-0-0-0-0-1-0-0-0-0-0) - [Tweet](https://twitter.com/share) Recently we have encountered several laboratories in which the employees were not paying adequate attention and in some cases ignoring flags generated by hematology analyzers during testing.  The technological developments over the past thirty plus years have enabled guidelines to be programmed into the analyzers that will flag results notifying testing personnel of the need for additional action.   --- --- Some flags may indicate when the analytic reportable range as determined by the instrument verification procedure has been exceeded.  Values exceeding reference range generally are flagged.  Values which are sufficiently abnormal to be considered “alert” results which should lead to practitioner notification also will have flags.  Many of these flags are useful in the laboratory but also are helpful to the treating clinician reviewing patient results. Specimen pre-analytic issues can be highlighted by flagging specimens which are lipemic or specimens containing clots which could lead to erroneous results.  In addition, the presence of abnormal red or white cells (such as nucleated red blood cells or immature white cells), or clumped platelets can be indicated by instrument flags alerting the technologist to the potential for action before reporting patient results.   It is an imperative that the technologists operating the hematology analyzer understand the instrument flags, their use and their meaning with particular attention being paid to those where action on the part of the technologist is indicated.  It is important to review all flags described in the operator manual which comes with your hematology instrument.  When results are flagged, if there is unfamiliarity with the flag meaning, the manual should be consulted.   Likewise, in a CLIA moderate complex laboratory, if a flag which indicates the possible need for review by peripheral smear examination of a specimen, the technologist needs to be certain the specimen is referred for examination to an appropriate facility, as indicated in the laboratory procedure manual.   In addition, your laboratory should have a procedure for “alert” or “critical” values with the procedure indicating what these values are, who should be immediately informed and how the transmission of the results is documented.   *Also, don't forget to stay connected and join our [Quality Lab Group](https://www.linkedin.com/groups/12067669?utm_campaign=E-Newsletters&utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-8fnN3G8A11fmX7PhJNxW_Wtfi3CDDVARgIRfAs8HwAr6ydFt7YraMnW2InLvTIwRI9QTU1v2P88WiYX_Ei0mg6CGcKIQ&_hsmi=2) on LinkedIn!*   [News](https://blog.cola.org/insider/topic/news), [clinical laboratory](https://blog.cola.org/insider/topic/clinical-laboratory) ### Related posts [The Next Big Thing in Diagnosis of Ebola](https://blog.cola.org/insider/fda-warning-potential-false-negative-cardiac-tests-0) December 04, 2019 [The Continued Rise in Cost of Healthcare](https://blog.cola.org/insider/the-continued-rise-in-cost-of-healthcare) February 06, 2020 [The A to Z of Testing for Folate Deficiency](https://blog.cola.org/insider/the-a-to-z-of-testing-for-folate-deficiency) January 16, 2020 [Scarlet Fever: The Comeback Kid](https://blog.cola.org/insider/scarlet-fever-the-comeback-kid) October 31, 2019 [FDA Warning: Potential False Negative Cardiac Tests](https://blog.cola.org/insider/fda-warning-potential-false-negative-cardiac-tests) November 14, 2019 [Declining Reimbursement in the Clinical Laboratory](https://blog.cola.org/insider/declining-reimbursement-in-the-clinical-laboratory) January 30, 2020 About the author ### Dr. John Daly ![](https://blog.cola.org/hubfs/John%20Daly%20-%20COLA_Headshot37.jpg) John T. Daly, M.D. received his MD degree at Weill Cornell University Medical College, performed his internship and residency in Anatomic and Clinical pathology at Duke University Medical Center and a residency in Forensic Pathology at the Office of the Chief Medical Examiner in Chapel Hill, N.C. He is board certified in anatomic, clinical and forensic pathology. Through the course of his career, Dr. Daly has had extensive experience directing and advising laboratories of all sizes including physician office practices, Federal Health Clinics, surgical centers, Community Hospitals and the integrated academic health system clinical laboratories of Duke Medicine. He retired as Director of Laboratories of Duke Medicine, and continues his affiliation as a member of the emeritus staff. Advertisement - [The Continued Rise in Cost of Healthcare](https://blog.cola.org/insider/the-continued-rise-in-cost-of-healthcare) February 06, 2020 - [Declining Reimbursement in the Clinical Laboratory](https://blog.cola.org/insider/declining-reimbursement-in-the-clinical-laboratory) January 30, 2020 - [The A to Z of Testing for Folate Deficiency](https://blog.cola.org/insider/the-a-to-z-of-testing-for-folate-deficiency) January 16, 2020 - [The Next Big Thing in Diagnosis of Ebola](https://blog.cola.org/insider/fda-warning-potential-false-negative-cardiac-tests-0) December 04, 2019 - [FDA Warning: Potential False Negative Cardiac Tests](https://blog.cola.org/insider/fda-warning-potential-false-negative-cardiac-tests) November 14, 2019 Advertisement ### Posts by Tag - [accurate test results (20)](https://blog.cola.org/insider/tag/accurate-test-results) - [bitcoin (1)](https://blog.cola.org/insider/tag/bitcoin) - [cancer (1)](https://blog.cola.org/insider/tag/cancer) - [clia (1)](https://blog.cola.org/insider/tag/clia) - [clia 1988 regulations (1)](https://blog.cola.org/insider/tag/clia-1988-regulations) - [clia accreditation (1)](https://blog.cola.org/insider/tag/clia-accreditation) - [clia guidelines (1)](https://blog.cola.org/insider/tag/clia-guidelines) - [clia regulations (1)](https://blog.cola.org/insider/tag/clia-regulations) - [clinical laboratory (57)](https://blog.cola.org/insider/tag/clinical-laboratory) - [cms clia (1)](https://blog.cola.org/insider/tag/cms-clia) - [colon (1)](https://blog.cola.org/insider/tag/colon) - [cost effective lab management (2)](https://blog.cola.org/insider/tag/cost-effective-lab-management) - [health care costs (1)](https://blog.cola.org/insider/tag/health-care-costs) - [health care trends (2)](https://blog.cola.org/insider/tag/health-care-trends) - [healthcare finance (1)](https://blog.cola.org/insider/tag/healthcare-finance) - [lab equipment (1)](https://blog.cola.org/insider/tag/lab-equipment) - [lab test (5)](https://blog.cola.org/insider/tag/lab-test) - [lab test utilization (7)](https://blog.cola.org/insider/tag/lab-test-utilization) - [lab tests (7)](https://blog.cola.org/insider/tag/lab-tests) - [lab utilization (2)](https://blog.cola.org/insider/tag/lab-utilization) - [Laboratory Management (9)](https://blog.cola.org/insider/tag/laboratory-management) - [laboratory medicine (23)](https://blog.cola.org/insider/tag/laboratory-medicine) - [Laboratory Operations (10)](https://blog.cola.org/insider/tag/laboratory-operations) - [laboratory test utiliazation (3)](https://blog.cola.org/insider/tag/laboratory-test-utiliazation) - [News (56)](https://blog.cola.org/insider/tag/news) - [patient outcomes (1)](https://blog.cola.org/insider/tag/patient-outcomes) - [patient satisfaction (1)](https://blog.cola.org/insider/tag/patient-satisfaction) - [Personnel Competence (1)](https://blog.cola.org/insider/tag/personnel-competence) - [reference laboratory (1)](https://blog.cola.org/insider/tag/reference-laboratory) - [test utilization (2)](https://blog.cola.org/insider/tag/test-utilization) See all   Search Blog: [Careers](http://www.cola.org/careers/) | [Press Room](http://www.cola.org/press-room/) ![ColaUpdatedLogoStackedWhiteBackground-1](https://blog.cola.org/hs-fs/hubfs/ColaUpdatedLogoStackedWhiteBackground-1.png?width=175&height=64&name=ColaUpdatedLogoStackedWhiteBackground-1.png) 9881 Broken Land Pkwy Suite 200 | Columbia, MD 21046-3016 Phone (800) 981-9883 | Fax (410) 381-8611 | Email [info@cola.org](mailto:info@cola.org) [Privacy Policy](http://www.cola.org/privacy-policy/) | [Terms Of Service](http://www.cola.org/terms-of-service/) | [Interested In Advertising?](https://education.cola.org/cola-adnetwork) - follow us: - - - - Visit: [Near Patient Testing Matters](http://www.nearpatienttestingmatters.org/) [Lab Testing Matters](http://www.labtestingmatters.org/) [My Consultant Central](http://www.myconsultantcentral.com/) Member Login: [COLAcentral](https://www.colacentral.com) [Board of Directors](http://board.cola.org/) site development by [![](https://blog.cola.org/hubfs/COLA-Jun2017/images/NL_bug.png)](http://www.nextlogik.com) © 2004 - 2017 COLA All Rights Reserved ![](https://dc.ads.linkedin.com/collect/?pid=169932&fmt=gif)