UK NEQAS for General Haematology is the expert centre within UK NEQAS for all aspects of General Haematology diagnostic testing external quality assessment (EQA). The Scheme provides EQA for automated haematology counting,blood and bone marrow morphology, haemoglobinopathies and other inherited red cell disorders.

UK NEQAS Haematology offers a wide range of related EQA schemes from which participants may select the combination that fits their laboratory profile.  This makes the Scheme flexible and adaptable to participants’ needs. UK NEQAS Haematology serves over 1300 participants, with approximately 750 laboratories and other pathology service providers in the UK and a further 600 internationally.

All UK NEQAS Haematology services comply with the UK NEQAS Charity’s Code of Practice and are offered on a not for profit basis.

UK NEQAS Haematology, on behalf of the World Health Organization (WHO), also organises an International EQA Scheme (IEQAS Haematology) which has been designed mainly for developing countries. IEQAS Haematology has nearly 80 participants in over 50 countries.

Purpose

This scheme is designed for users of automated haematology analysers providing full blood count (FBC or CBC) data in clinical, veterinary, research, pharmaceutical and health surveillance settings. The survey material is suitable for all the major analyser models.

Point of care testing analysers are accommodated in this scheme, either in the full blood count (FB) option, or in the haemoglobin only (HB) option, depending on the parameters supplied by the instrument.

Analytes and units
  • White blood count (WBC) 109/L
  • Haemoglobin (Hb) g/L
  • Red blood count (RBC) 1012/L
  • Haematocrit (Hct) L/L
  • Mean cell volume (MCV) fL
  • Mean cell haemoglobin (MCH) pg
  • Mean cell haemoglobin concentration (MCHC) g/L
  • Platelet count (PLT) 109/L
Scheme design

Full blood count (FB) option: Two whole blood specimens are issued per distribution, with 12 distributions per year on a monthly basis (24 specimens per year). All participants receive the same material type, although instruments are grouped for performance analysis. The specimens are prepared from pooled human blood donations (collected from individually consented donors by the UK NHS Blood and Transplant Service), partially fixed and treated with antibiotics. Haemoglobin concentration, red blood count, white blood count and platelet count are varied to test performance at levels of clinical decision making. Participants may register up to 3 instruments for a single fee, with an additional fee for each instrument above 3. A single set of survey material is dispatched for multiple analysers. Point of care instruments that provide a full blood count result, i.e. more than a haemoglobin result, may register in this scheme.

Hb only (HB) option: Participants with point of care instruments that only produce a haemoglobin result are registered in the Hb only option of the scheme. Two whole blood specimens are provided 12 times per year. The specimens are treated with antibiotics but not stabilised. Participants may register up to 3 instruments for a single fee, with an additional charge for each instrument above 3. A single set of specimens is dispatched for each analyser, making this option convenient for analysers in multiple point of care testing locations.

Both options are performance monitored for participation and analytical performance, for all the parameters listed.

Instrument groups available

The instrument groupings available are shown in table 3 in the Performance Scoring section. The Scheme Office can supply the most up to date list of instrument groups.

Purpose

This scheme is designed to complement the Full Blood Count scheme for any participant who offers an automated differential count as part of their extended full blood count.

Analytes
  • Three or five population differential leucocyte count, as performed using an automated haematology analyser.
  • Scheme design

Two specimens of commercially prepared whole blood material are distributed, six times per year (12 specimens per year). Seven types of commercially prepared survey material are available and the choice of material type (matrix) is instrument dependent. Analysis of results is by material type and in some cases by individual instrument type. Table 2 lists the matrices that are distributed and the instruments covered by each matrix. The information in table 2 is a guide only and the scheme office can provide the most up to date information on availability of the scheme for particular analysers. Participants may register up to 3 instruments for a single fee, with an additional fee for each instrument above 3. A single set of survey material is dispatched for multiple instruments; where a participant registers analysers that require different matrices, these are supplied at no additional cost.

The scheme is performance monitored for participation and analytical performance is undertaken for neutrophil and lymphocyte counts. Analysis of other data is provided for information only.

Purpose

This scheme is designed as a supplement to the Full Blood Count scheme for laboratories that prepare therapeutic blood components. The scheme supplies specimens for haemoglobin concentration, haematocrit and platelet count at the levels found in blood components, beyond the normal physiological ranges.

Analytes and units
AnalyteUnits
Haemoglobin (Hb) g/L
Haematocrit (Hct)L/L
Platelet count (PLT)109/L
Scheme design

Four distributions, each containing 2 red cell specimens for haemoglobin/haematocrit and 2 platelet concentrate specimens for platelet count, are made each year. Red cell specimens are not stabilised but are treated with antibiotics. Platelet concentrate specimens are fully fixed. Participants may register up to 3 analysers or modes of analysis, for a single fee.

The scheme is performance monitored for participation and analytical performance, for all the parameters listed. Performance is monitored in a single instrument group.

Purpose

This scheme is designed for the performance monitoring of reticulocyte counting by automated analysers or visual, microscopy methods.

Analytes and units
AnalyteUnits
Reticulocyte count 109/L
Scheme design

Two whole blood specimens are distributed six times per year (12 specimens per year). For most analyser types, four specimens per year are commercially produced; the remainder are prepared by UK NEQAS Haematology from partially fixed human whole blood, as for the full blood count specimens. Both types of material should be suitable for manual staining methods and automated reticulocyte counts. Beckman Coulter LH series analysers require a separate survey material (Matrix X). Participants may register up to 3 instruments for a single fee, with an additional fee for each instrument above 3. A single set of survey material is dispatched for multiple instruments; where a participant registers instruments that require different matrices, these are supplied at no additional cost.

The scheme is performance monitored for participation and analytical performance. Performance monitoring for automated counting methods is by instrument group, and all microscopy methods are analysed in a single group.?
Purpose

This scheme monitors the performance of plasma viscosity.

Analytes and units
AnalyteUnits
Plasma viscosity mPas
Scheme design

Two specimens of plasma are distributed 12 times per year (24 specimens per year). Survey material is prepared from donated plasma surplus to that required for therapeutic use. The viscosity of the plasma is manipulated and the material treated with antibiotics and an antifungal.

Analysis of results is by all methods and by instrument group, where there are sufficient instruments available. Participants may register up to 3 instruments for a single fee.

The scheme is monitored for participation and analytical performance. Performance is monitored against all methods and instrument group, where sufficient instruments are registered.

Purpose

This scheme is designed to maintain and improve skills in blood film morphology, manual differential counting and blood parasite identification. Participation is by organisation. Participants may opt out of blood parasite identification, if this is not a service that is offered as part of their clinical repertoire; however, many sites in this situation choose to remain in this part of the scheme for educational purposes. The fee is the same, whatever the level of participation.

Analytes
  • Peripheral blood films (with occasional bone marrow films) for the identification of significant morphological features (BF slides)
  • A 200 cell differential count is requested on selected blood films (DF surveys) and results are returned as both percentage and absolute counts
  • Peripheral blood films for the detection and identification of blood parasites (PA slides)
  • A parasitaemia count (%) is requested if Plasmodium falciparum or Plasmodium knowlesi is present
Scheme design

Two blood films for morphology comments are distributed eight times per year (16 BF slides per year). A WBC differential is requested on four of the BF slides each year (4 DF cases per year). Two blood films for blood parasite identification are distributed four times per year (8 PA slides per year). Films for morphology are fixed in methanol and stained with May-Grünwald-Giemsa; films for parasite identification are fixed in methanol or acetone and stained as appropriate for the specific parasite.

The scheme is monitored for participation, gross errors of morphological identification, blood parasite detection and species identification and percent parasitaemia counting (Plasmodium falciparum and Plasmodium knowlesi infections). DF surveys are reported in summary format only, without individual participant performance assessment.

The performance assessment of blood films for parasite identification is under review and a new system is being shadow scored in 2014.
Purpose

This scheme is designed to monitor the performance of iron stain for bone marrow and urinary haemosiderin, and the performance of Sudan Black B (SBB) or myeloperoxidase (MPO) stain.

Analytes
  • Iron stain (Perls’ stain)
  • Sudan Black B (SBB) or Myeloperoxidase (MPO)
Scheme design

Participants may register for Iron Stain or SBB or both. For Iron Stain, participants are asked to stain the films for iron and to score the strength of the staining reaction; additionally, they are asked to report the presence of sideroblasts. For SBB/Myeloperoxidase, participants are asked to stain the films and report the results as positive or negative and the strength of the staining reaction in specific cell groups.

Two slides of either bone marrow or peripheral blood are issued per distribution for either Iron Stain or SBB/Myeloperoxidase, with four distributions per year (8 slides per year in total). Bone marrow slides for Iron Stain are fixed in methanol; peripheral blood films for SBB are unfixed and are accompanied by a methanol fixed film of the same case for Romanowsky staining.

The scheme is monitored for participation. The analytical results are reported to participants for self-assessment purposes.

Purpose

This scheme is designed to monitor the performance of the erythrocyte sedimentation rate (ESR).

Analytes

Erythrocyte sedimentation rate (ESR) in mm per hour

Scheme design

The scheme is offered in two modules: ES and ESX.

The ES module is suitable for sedimentation methods based on the Westergren method. Four distributions of 2 commercially produced, whole blood specimens each are provided each year. Instruments and methods are grouped for performance analysis.

The ESX module is suitable for latex-based methods (Alifax instruments). Four distributions of 3 commercially produced, latex specimens are provided each year. Performance is reported separately from the ES module.

Participants may register as many instruments as they wish in either module and the fee charged is based upon the module and the number of instruments.

The scheme is monitored for participation and analytical performance.

Purpose

This scheme is designed to assess the performance of rapid diagnostic tests for malaria detection. It is operated in collaboration with UK NEQAS Parasitology and is offered to UK NEQAS Haematology participants registered for the Blood Films scheme.

Analytes
  • Species specific malarial antigen in blood
Scheme design

Participants may register more than one kit method but must identify the results generated from each kit registered.

Two specimens of lysed whole blood containing recombinant malarial antigen are distributed 4 times a year, with each distribution of Blood Films for Parasite Identification. Results are returned as positive or negative with speciation if positive, dependent on the kit used.

The scheme is monitored for participation and analytical performance.

Purpose

This scheme is designed to assess the performance of non-molecular detection techniques in the screening and diagnostic testing for the haemoglobinopathies, using liquid blood specimens. There are 3 options for participation:

  • Option 1: Sickle screening only (SS specimens), for participants who perform sickle solubility testing or other similar technique only.
  • Option 2: Full participation (SS and AH specimens), for participants who undertake haemoglobin variant detection and identification (adult specimens), fraction quantification and interpretation. Full participation includes the sickle screening only option.
  • Option 3: Full participation plus the liquid capillary specimens for newborn haemoglobinopathy screening option (SS, AH and LN specimens) for participants who undertake the diagnostic testing of newborn infants’ specimens for haemoglobin variants in addition to testing adult specimens.

Participants may register for any or all of the analytes offered; the tariff of fees varies according to the option selected.

Analytes and units
  • Sickle screening test (SS specimens)
  • Hb variant identification: adult (AH) specimens
  • Hb variant identification: liquid newborn (LN) specimens
  • Quantification of Hb A2, Hb F and Hb S (AH) % total Hb
  • Assessment of Hb A2 and Hb F in terms of the participant’s reference range (AH)
  • Interpretation of results (AH and LN)
Scheme design

There are 6 distributions per year of each option. Sickle screening only participants receive 3 specimens in each survey for sickle screening (SS specimens). Full participants receive the specimens for sickle screening, plus an additional 3 specimens (AH specimens) for Hb variant identification using all available methods, including sickle screening, fraction quantification and interpretation. The specimens are prepared by UK NEQAS Haematology, and are accompanied by background details of full blood count, age, gender, ethnic group and clinical condition. The survey material is treated with antibiotics but is not fixed. Participants registered for the liquid capillary newborn specimens (LN) receive an additional 6 specimens per year for haemoglobin variant identification and interpretation.

Participants are monitored for participation, sickle solubility test, Hb A2 measurement and Hb S measurement. Fraction identification (AH or LN specimens), Hb F quantification and interpretation of results are performance assessed but there is no numerical performance score provided at present. Where applicable, performance monitoring is based on the laboratory standards published by the National Sickle and Thalassaemia Screening Programme in England.

Purpose

This scheme is designed to performance assess the screening of dried blood spot cards for clinically significant variant haemoglobins by laboratories that offer newborn sickle screening, either as a primary testing or a confirmatory testing site.

Analytes
  • Identification of sickle haemoglobin and other clinically significant variant haemoglobins
  • Interpretation of results obtained
  • Scheme design

12 distributions are made per year on a monthly basis. Each distribution contains 3 dried blood spot newborn screening cards prepared from EDTA anti-coagulated umbilical cord blood (36 specimens per year). The specimens are suitable for screening by high performance liquid chromatography (HPLC), isoelectric focusing (IEF), capillary electrophoresis (CE) and tandem mass spectrometry (TMS).

Performance is scored for participation, fraction identification and interpretation. The performance monitoring is based on the laboratory standards published by the National Sickle and Thalassaemia Screening Programme in England.

Purpose

This scheme is designed to performance assess the mutational analysis for thalassaemia, with occasional samples for the identification of variant haemoglobins, and the interpretation of the results obtained in context of the patient’s clinical background and other haematology. It is suitable for specialist laboratories that offer molecular haemoglobinopathy testing as part of their diagnostic repertoire.

Analytes
  • Mutational analysis for alpha and beta thalassaemia, with occasional specimens for variant haemoglobins
  • Interpretation of results obtained
  • Recommendations for follow up
  • Annotation of results making the correct use of the HGVS nomenclature system
Scheme design

Three distributions, each containing 2 specimens, are made per year (6 specimens in total). Survey material is supplied as DNA in TE buffer and is suitable for all molecular haemoglobinopathy techniques. Each specimen is supplied with clinical case details, gender, ethnic background and haematology results.

Participants may register for full participation (alpha and beta thalassaemia mutational analysis) or for alpha or beta thalassaemia mutational analysis only. All receive the same specimens.

Participants are monitored for participation, mutational analysis, interpretation, recommendations for follow up and the use of annotation. Performance is measured against a model answer defined by the scheme with the support of a panel of expert advisors.

Purpose

This scheme monitors the screening and/or quantitative assay of red cell enzymes. These surveys are currently restricted to Glucose-6-phosphate dehydrogenase (G6PD) specimens only.

Analytes and units
  • Qualitative screening test
  • Quantitative assay IU/gHb
  • Assessment of quantitation in terms of the participant’s reference range
Scheme design

Six distributions of 2 specimens each are made per year. The specimens are prepared by UK NEQAS Haematology from human whole blood and animal whole blood. The survey material is treated with antibiotics but is not fixed, and is dispensed using the same method as for full blood count specimens. The survey material is suitable for most recognised methods currently available, although variable results have been reported with screening methods based on dye decolourisation. For this reason, this method is not actively performance assessed.

Participants may register for the screening test or the quantitative assay or both. The same fee is charged in all cases. Performance is scored for participation, screening and quantitative assay.

Experimental trials to identify specific sources of error or to test new materials and assay procedures may also be distributed. These experimental trials are distributed as additional, free of charge, surveys usually in the same mailing as the normal surveys. Individual laboratory performance is NOT assessed in these trials.

Participants may be invited to take part in studies as part of larger projects. Participation in these studies is always voluntary.

Some trials may involve the use of questionnaires. Where possible, these are distributed electronically, usually to the main laboratory contact. Again, participation is voluntary. UK NEQAS Haematology greatly appreciates the effort and support of participants in any development work.

Before a new scheme is recognised as a full scheme, it is operated on a pilot basis. These schemes may or may not be charged for depending upon the degree of development and the availability of alternative sources of funding.

Pilot schemes are not formally performance assessed and out of consensus performance is reported to the participant only, for information.

UK NEQAS Haematology offers pilot schemes in development for:
  • Nucleated red blood cell count
Parasitology Teaching

The Parasitology Teaching day is offered in conjunction with the UK NEQAS Parasitology Scheme. The day covers all aspects of blood parasite identification and each participant receives a teaching manual and set of teaching slides to keep. The participant fee covers up to two members of staff. Teaching sessions are offered at a variety of locations throughout the UK and Republic of Ireland during the year. Once registered, you will be offered a place at the geographical location closest to your organisation.

Location

The Scheme is hosted by the West Hertfordshire Hospitals NHS Trust and is based at Watford General Hospital, in a Unit shared with UK NEQAS (H) and (FMH)

Contact the Scheme Office (see above) and request a registration pack

Between January and March of each year, participants are contacted and asked to confirm their re-registration details for the following financial year on-line.

Alterations to your registered details, including changes in instrument or method details, should be sent to us in writing, either by letter, fax or email and signed or sent by one of the named contacts, the head of the laboratory or laboratory manager. Changes must be received at least 3 weeks before the scheduled distribution date to be effective for that distribution.

Please contact the Scheme Office for a copy of the current fees sheet or a quotation.

This is a 5 digit, unique reference number that is issued when you register and should be quoted in all communications with the Scheme.

Laboratory managers can register a group of staff for Digital Morphology when registering or re-registering for other UK NEQAS (H) services. Individual practitioners should register via www.ukneqash.org, following the links to the Digital Morphology home page.

Specimen packages should be received within 2 days of dispatch for participants in the UK. Outside the UK, courier delivery usually takes up to 4 – 5 days.

Please contact the Scheme Office and request a replacement specimen pack.

Repeat specimens are generally available throughout the survey period to replace specimens received in an unsatisfactory condition (i.e. broken, leaking, unlabelled, haemolysed or clotted) and to replace those accidentally damaged or misplaced in the laboratory. Specimens may be neither available nor suitable for analysis after the survey has closed. Please contact the Scheme office for availability of repeat specimens.

If you are unable to return your results by the closing date, you may submit them late subject to certain conditions. Web Users should contact the Scheme for results sheets for those surveys using the Web Results Service or download a blank results form from the data entry website. If you use a blank form, remember to include you participant reference number (PRN). The first report you receive may not show your results, but a second ‘late’ report, showing your results, will be generated before the next survey is processed. Unless we have agreed to accept your results late without penalty, you will receive a non-participation score (see Performance Monitoring). Specimens analysed after the closing date may no longer be suitable for analysis and you should contact the scheme office for advice.

A PDF copy of the web entry instructions is available for download from the documents section of the website (www.ukneqash.org).

Please contact the Scheme Office (preferably by e-mail) in the case of forgotten login details.

Your web entry password can be changed by contacting the Scheme Office by e-mail quoting your current details and your preferred password.

If you realise you have made an error in your on-line submission or you submit an incomplete set of results, contact us directly. We are able to reset your data entry page until the closing date, allowing you to resubmit your results.

This usually occurs because data has been submitted late or not at all, or has not been received. If you know you have returned your results in time, contact the Scheme immediately.

Results are generally loge transformed before calculating statistics, this includes the calculation of DI value. It is not possible to calculate the SD from the GCV using the usual formula.

These are available to download from the documents section of the Scheme web-site (www.ukneqash.org)

For the JWG Conditions of Participation please visit : RCPATH JWG

Only participants with a current, active licence can access open cases. Ensure you have activated your licence. If not, see your lab manager to obtain the activation key.

Contact the UK NEQAS (H) Scheme office to verify your email address is on the database.

Contact the UK NEQAS (H) Scheme office or click on the ‘forgotten password’ link from the Digital Morphology home page.

You can register staff for the Parasitology Teaching Day with your other UK NEQAS (H) services, at re-registration. Contact the UK NEQAS (H) Scheme office if you wish to register at other times or you wish to register additional staff. Registration at other times is subject to availability of places.