Challenges in haematology morphology external quality assurance

Abstract

Morphology remains a key skill for haematology staff despite the introduction of new non-morphological techniques. The Haematology Morphology program of the RCPA Quality Assurance Program (QAP) began over 30 years ago and now has >600 participating laboratories who are sent 12 survey cases annually. With this increase, challenges have arisen to ensure: • Sufficient diagnostic material sometimes including bone marrow for all participants. • A balance of basic cases for proficiency testing and more unusual cases for education. • A balance between scenarios requiring morphological skills alone and those providing more information which may better resemble clinical practice but allow bypassing of morphological skills. • The most effective means for submitting and recording participant responses. • A graded assessment of participants’ ability to recognise morphological features and to make a diagnosis which is relevant for the full spectrum of participants and provides some credit for partially correct responses. A virtual microscopy system is being developed to enhance the program in relation to the first three issues. An online data entry option and a numerical scoring system for assessment have been introduced to address the last two issues. Ongoing modifications continue in response to feedback and to participants’ needs.