Jim Poggi
By Jim Poggi
The CBC: 3, 2, 1 … blast off!
The finger resting on the button knows that once it presses the button things will change. Excitement and anticipation builds. Whether the finger is resting on the button that launches a rocket, starts a Formula 1 race car or a sleek, speedy ocean racer, it knows that pressing the button will set exciting events into motion and that nothing will ever be the same again.
The finger resting on the “start” button of a hematology analyzer has tremendous power as well. In less than the time it takes for the Formula 1 racer to complete one lap, this finger will perform one of the most important lab tests there is, the complete blood count with differential, or “CBC with diff” as it is often referred to. As a result, typically in one to three minutes, the clinician has the power to know everything a CBC with differential can determine: general health status, anemia, infection, blood loss due to trauma and a host of other diagnostic indications. Whether used in primary care, internal medicine, oncology, rheumatology, urgent care or an ER clinical setting, the CBC with differential changes everything in under three minutes with a single press of the button.
What’s the big deal clinically?
The CBC with differential, CPT code 85025, was the single most frequently performed lab test in the United States in 2016 with 42 million tests performed. That’s as many as the number of basic metabolic panels, hemoglobin A1c and vitamin D tests combined that year.
Clinically, CBC is the champ for the quantity of clinical information it provides with a single button press. It’s fast, works with whole blood, is easy to perform, always performs the same tests, and delivers 15 or more important clinical results quickly and reliably. The typical CBC is also economical, and most hematology instrument suppliers offer CBC reagent costs in the $1.50 to $2.50 per sample range, depending on testing volume, number of test parameters and automation provided and whether the instrument also performs some of the newer hematology parameters, including reticulocytes.
Many contemporary hematology instruments offer closed tube cap piercing for additional speed and safety. There is an excellent range of high-quality hematology system choices available for the physician practice, including some with novel test parameters and even a new, waived system option. Instrument choices also span a wide range of prices and automation options that allow the hematology analyzer to fit well into virtually any size clinical practice and fit most work flow needs. Hematology customization choices offer a solution for virtually any size practice and clinical need. As always, talk to your favorite hematology system suppliers to find out what’s new and discuss prospects in your area to target for discussions about this important and efficient test system.
How does it fit in the typical primary care practice?
For years, CBC testing has been regarded as the “gateway to moderate complexity testing” due to its unique one-button operation, high clinical utility, economy of operation and ease of training. Most customers who consider embarking on moderate complexity testing start with hematology. The typical reasons cited by practices who have adopted hematology testing include:
- Clinicians are confident and familiar with the tests in the CBC
- One-button simplicity makes use and training a breeze
- EASILY fits in the “15-minute” patient visit window
- Safety
- Economy
- Gets the job done clinically
- Tremendous range of excellent products and suppliers suits virtually any size practice
What differentiates choices and preferences for CBC instruments?
Overall accuracy and precision, reliability, small footprint, RBC, WBC and platelet histogram displays and economy of operation have become “table stakes” among hematology systems from all major suppliers. Differentiation among supplier choices involves automation, closed tube sampling options, and throughput options to suit the clinical needs of individual practices.
While virtually all systems offer connectivity solutions to LIS and EMR, some include required connectivity software and hardware as part of their system. Some systems offer novel test parameters including C-reactive protein, reticulocytes, immature granulocytes, and others. Some also offer the option to test body fluids other than whole blood. Others claim the ability to handle difficult patient samples including pediatric and oncology patients. In addition, most hematology instrument manufacturers offer a choice of 3 part or 5 part differential systems to tailor the amount of available information to the varying clinical needs and experience of individual clinical practices.
Managing the hematology opportunity
Your role as a key consultant to the physician practices who rely on you makes it important that you stay informed. You need to know the needs of your clients who already use a hematology system and are considering upgrading, and also be able to guide the practice just considering adding hematology testing. With the vast number of changes and choices available, it’s easy to default to the “well, many of my customers prefer this option” approach and close for a demonstration of the product you are most familiar and comfortable with. As in most areas of testing, this approach may lead to a solution that may not be the best fit for a specific customer.
Dig deep and get to what matters most to your customer or prospect. Knowing the volume of tests they plan to perform, their available space, clinical preferences (which elements of the CBC are most important), staff knowledge, experience and interest in testing help get you off to a good start. Consulting with your most trusted suppliers and getting their advice on qualifying questions is also useful, as are ride-days with these suppliers. You will learn quickly and be able to deliver highly qualified prospects to follow up and close with your hematology supplier.
The well-informed distributor rep not only makes sure the customer is pressing the “hematology button,” but also makes sure it is the right button with the right solution for them.