Digital morphology and complete remote reporting capabilities by scientists and haematologists – a review

Abstract

Aim: To establish a workflow for full remote reporting of blood films by laboratory haematologists. Methods: A review of a fully digital morphology workflow by a scientist and haematologist was undertaken as an audit to determine the ability of digital morphology to be utilised as a complete workflow process without the aid of a glass slide to assist with authorising referred cases requiring haematologists review. Over 100 slides were first reviewed by a haematology scientist and referred for haematologist examination on the basis of established laboratory referral criteria. These referred films were first analysed by a haematologist via the digital morphology platform. All cases were then analysed by traditional microscopy from the glass slide. Cases were assessed for reliability and concordance of the digital morphology platform to standard glass slide analysis. Cases not concordant between the digital platform and glass slide review were reassessed by an extended scan function of the digital morphology platform and concordance and reliability were again assessed and recorded. Results: One hundred and nineteen cases were assessed by both methods. There was concordance for 102 cases. The discrepant cases were discordant due to missing platelet clumping in two cases, one case missed low number myelocytes on film and the remainder of the cases were discordant due to discrepancies in assessing red cell morphology. Following the review of the extended scan file for each discordant case all 17 discordant cases were able to be assigned as concordant. Conclusion: A digital morphology workflow is a feasible alternative to standard glass slide review for FBC film cases requiring a haematologist review. The addition of the extended scan function allowed all cases to be assigned as concordant between digital morphology platform and glass slide review. This is a promising technology which will allow quicker remote authorisation of cases requiring haematologist intervention for blood film review. This approach provides flexibility in work arrangements and also offers increased access for rural and remote laboratories to centralised specialist expertise in a timely manner.