ABSTRACT
BACKGROUND AND OBJECTIVE: With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review. MATERIALS AND METHODS: This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed included inpatient and outpatient samples, frequency of peripheral film review, identifying reasons of smear review, and addition of information missed by the automated analyzer. RESULTS: We analyzed 1200 consecutive CBC samples. Peripheral smear was reviewed in 500 (42%) of the cases of which, 241 were inpatient, and 259 were outpatient samples. In 384/500, the findings of hematology analyzer correlated with peripheral smear review. Flags identified included nucleated red blood cells (NRBCs) in 155 (40%), immature white blood cell (WBC) 129 (34%), and atypical lymphocytes 100 (26%). In 23% of the cases, the analyzer missed important findings. The sensitivity of abnormal histogram in our study was 91.3%, while the sensitivity of abnormal parameters was 100%. CONCLUSION: Peripheral smear review was performed in 42% of the cases. The analyzer identified NRBC, immature WBC precursors, and atypical lymphocytes as the most common abnormality. The information correlated in 77% of the cases.
ABSTRACT
OBJECTIVE: To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and coronary revascularization. METHODS: A cross-sectional study was conducted on 416 patients admitted in Tabba Heart Institute, Karachi from December 2010 to May 2011. Patients admitted with diagnosis of acute myocardial infarction (AMI) or who underwent elective coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) procedures were offered cardiac rehabilitation (CR). Out of these, patients who enrolled in 6 weeks outpatient CR programme were followed for number of CR sessions and their socio-demographic and clinical data were collected. Data was analyzed by Statistical Package for Social Sciences (SPSS) software, version 15.0. Chi-square test was applied to test association between categorical variables and Student's t-test for continuous variables. RESULTS: Out of 416 patients identified, only 151 patients (36.2%) enrolled and attended the CR programme. Of the 151 attendees, 111 (73.4%) patients subsequently completed more than 6 weeks of outpatient CR programme. We found significant association between CR attendance and easy access to the programme, elective CABG procedure, employment status, presence of diabetes or hypertension and baseline level of exercise (all p < or = 0.01). No association was found between CR attendance and patient age, gender, body mass index or different economic groups. CONCLUSION: Attendance rates of patients attending outpatient CR programme after AMI or coronary revascularization procedures are suboptimal. Patients who underwent elective CABG surgery and had easy access to the CR programme had better attendance. Factors contributing to poor attendance rates at CR programmes in developing countries need to be explored and subsequently addressed.
