Instrument Flags Should Never be Ignored

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.