Evaluation of staff performance and interpretation of the screening program for prevention of thalassemia.

Simaporn Prommetta,Goonnapa Fucharoen,Attawut Chaiboonroeng,Kanokwan Sanchaisuriya,Supan Fucharoen,Supawadee Yamsri

doi:10.11613/bm.2017.040

Abstract

IntroductionThalassemia screening program has been implemented for years in Southeast Asia, but no external quality assessment program has been established. We have developed and initiated the proficiency testing (PT) program for the first time in Thailand with the aim to assess the screening performance of laboratory staff and their competency in interpretation of the screening results.Materials and methodsThree PT cycles per year were organized. From the first to the third cycle of the PT scheme, a total number of participant laboratories increased from 59 to 67. In each cycle, 2 PT items (assigned as blood samples of the couple) were provided. Performance evaluation was based on the accuracy of screening results, i.e. mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and the dichlorophenolindophenol (DCIP) test for haemoglobin E, including the competency in interpretation of screening results and assessment of foetal risk. Performance was assessed by comparing the participants’ result against the assigned value.ResultsOf all 3 cycles, most laboratories reported acceptable MCV and MCH values. From the first to the third cycle, incorrect DCIP test and misinterpretation rates were decreased while incorrect risk assessment varied by cycle to cycle. Combining the accuracy of thalassemia screening and the competency in interpretation and risk assessment, approximately half of participants showed excellent performance.ConclusionImproved performance observed in many laboratories reflects the achievement and benefit of the PT program which should be regularly provided.

Highlights

Thalassemia screening program has been implemented for years in Southeast Asia, but no external quality assessment program has been established
From the first to the third cycle, incorrect DCIP test and misinterpretation rates were decreased while incorrect risk assessment varied by cycle to cycle
Improved performance observed in many laboratories reflects the achievement and benefit of the proficiency testing (PT) program which should be regularly provided

Summary

Introduction

Thalassemia screening program has been implemented for years in Southeast Asia, but no external quality assessment program has been established. Amongst the inherited blood disorders in Southeast Asia, thalassemia is the most common one. It is considered as an emerging burden of health among the world population [1,2]. In this region, there are several forms of thalassemia, only three severe forms namely haemoglobin (Hb) Bart’s hydrops fetalis (homozygous α0-thalas semia), homozygous β-thalassemia and Hb E-βthalassemia are of major concern, requiring appropriate prevention and control program [3]. The program comprises three steps: 1) screening for thalassemia in pregnant women and their husbands, 2) providing genetic counselling to the at-risk couples, and 3) offering after genetic counselling, option for a prenatal diagnosis and termination of pregnancy with affected foetus [3,4]

Methods

Results

Conclusion