This study showed that the use of CBC and reticulocyte results for clinical decision making in patient management in Addis Ababa hospitals was inadequate. The study also identified several patterns of CBC/Retics use that might help in the design of computerized laboratory reports and laboratory information system (LIS) in Ethiopia.
Complete blood count
The red cell indices: The study indicated that HCT and HGB were the most frequently used red cell measurements by the majority of clinicians. Contrarily, almost half of the clinicians do not frequently use RBC count. Other studies have also reported that RBC count is not used commonly in decision making [9].
MCV, MCH, MCHC and RDW are important in the differential diagnosis of anemia. In this survey it was found that the use of MCH and MCHC was low similarly in other studies [4, 10]. MCV is regarded as the single most useful and critical erythrocyte index in the evaluation of anemia [9, 10]. Nevertheless, this survey revealed that only a third of the clinicians used this key parameter frequently in the classification of anemia. It is a daily practice to treat anemia in Addis Ababa hospitals [5], and despite the fact that the first step in approaching anemia is to classify the process as microcytic, normocytic or macrocytic using this valuable diagnostic tool, clinicians in Addis Ababa have differently very low use of the MCV [4, 10].
RDW was found to be used even much less frequently compared with other red cell indices. In another study, it has been shown that the majority of the clinicians [10] reported to use RDW always or frequently; however, it has been also reported that RDW is a largely overlooked parameter [11].
Among the professionals, interns and residents demonstrated a highest rate of use which is assumed more of superfluous [7, 12]. MCV was rated to be used by 38% of Specialists > 28% of GPs and > 16% of HOs. RDW was reported to be used highest by specialists (15%) > GPs (11%) > HOs (2%). This difference can be because specialists are geared to look for differential diagnoses; which orient them toward laboratory workups [12] than GPs and HOs [13, 14]. Moreover, MCV was used more frequently in internal medicine departments as internists tend to treat more cases of anemia and other internal disorders compared to specialists in other categories.
Cell morphology comments
Obtaining a peripheral blood smear (PBS) during the initial evaluation of anemia has been recommended by other researchers as it gives additional clues from morphologic features of RBC and WBCs which substantially enhances the initial process of differential diagnosis and provides guidance for further testing [4]. This survey found only 19% of the clinicians use RBC morphology in most of the cases, while the Sandhaus study found 52% of the clinicians use RBC morphology always and frequently for anemia diagnosis and differentiation [10].
Platelet parameters
The present survey indicated that the MPV and PDW are perceived by clinicians as the least useful index. Only less than 10% of the clinicians reported that they use the MPV or PDW frequently or always in medical practice. In spite of the clinical benefits of platelet parameters, the contribution of the MPV and PDW to clinical practice in Addis Ababa hospitals was low.
WBC count, WBC differential and unit of reporting
The data from the survey showed 93% of clinicians use the WBC count in most of the cases. Likewise, 90% of the clinicians use the WBC differential mostly in medical practice. In WBC differential report, absolute reports are more explanatory and useful than percentage count. The present study showed that more than a third of the clinicians prefer percentages of WBC differential than the more useful absolute numbers. This indicates that a significant number of the clinicians interpret differential reports incorrectly, and may not be obtaining the valuable information required, which could mislead diagnosis.
Reticulocyte count
The use of the reticulocyte parameter in Addis Ababa hospitals is quite low. Lack of hematology analyzers that perform both CBC and Retics in most hospitals can largely limit Retics use; yet as a strategy clinicians could use extra laboratory services when additional investigations are required. The use of reticulocyte count as percentage and absolute unit assessed from the frequency of use of reticulocyte parameter indicated that slightly more than half of the clinicians claimed to use reticulocyte count in percentage units. Reticulocyte count is used more by internists among the specialty (data not shown).
Feedback of clinicians on complete blood count
Units of measurement: Cell counts such as RBC, PLT and WBC can be reported per mm3, per μL, or per L. This study showed that most of the clinicians prefer cell count to be reported in mm3 unit. This implies that emphasis should be given in the reporting systems during medical training thus clinicians are well acquainted with the use of the international standard (SI) measurement units [15, 16].
Amount of data
Most clinicians suggested the amount of data in the hematology CBC report was just right. Only about one in ten respondents mentioned that the amount of data was inadequate and most of these were internists. This phenomenon was also reflected in internists’ frequent use of reticulocyte reports, which further suggests that there is a need for additional laboratory tests for use by a segment of medical specialties (internists). Although more dozens of hematology parameters useful for patient management are not part of the CBC reports of Addis Ababa hospitals, majority of the clinicians are satisfied with the limited CBC parameters available from the common hematology analyzers. In fact use of more advanced parameters parallels expansion of the health standard and service within the country.
Clinical laboratory methods course
The results of this study indicated that most clinicians were not satisfied with the quality of their CLM course, although more than a quarter rated it as ‘excellent’ or ‘very good’. This shows that there is room for improvement in the course, both in terms of quality and quantity of materials covered.
