PB2295 AUDIT OF CRITERIA FOR MEDICAL REVIEW OF PERIPHERAL BLOOD FILMS AT DISTRICT GENERAL HOSPITAL REFERRED FOR MEDICAL REVIEW BY THE LABORATORY HAEMATOLOGISTS.

Abstract

Background: Abnormalities in the FBC is the most useful investigation to alert clinicians of the primary and secondary haematological abnormalities. Review of blood smears by well-trained haematomorpholigist serves as a quality control/assurance and allows appropriate interpretation of blood results with other laboratory finding and clinical information. The local referral criteria/SOP is based on National (RCPath) and International (ICSH) recommendations in collaboration with senior clinical and biomedical scientists. Aims: The aim was to analyse the utility of the criteria for medical review of peripheral blood film at the London Northwest University Healthcare NHS Trust. Methods: Peripheral blood films referred for medical review over a span of 8 days was included. The data from laboratory information management system and written communication was analysed. Data regarding the source, clinical details, urgency turnaround time, reason and fulfilling referral criteria was collected. Results: Over the span of 8 days, FBC was performed on 1656 samples, blood films made on 152 (44%) samples,10(9%) of them referred for medical advice.Of the 69 blood film referrals, 26 (38%) did not fulfil criteria for medical review. Of these,10 had reactive or toxic features (38%), seven had been previously reported with similar findings (27%), five had a known haematological diagnosis (19%), three (12%) had iron deficiency anaemia, and one was referred inappropriately as nonurgent.Of the 69 films, 11 of them, although fulfilled the referral criteria, had poor clinical correlation with clinical details and history.Of the 69 referrals, 10(14.5%) of them had no comments from the biomedical scientists.13(19%) of them had only the referral reason mentioned with no comment on morphological features.Of the 69 films, 31 films were reported <24 hours, 17 films between 1 to 3 days, 17 films between 3 to 8 days and 4 films more than 8 days. Of the total, 11 of them were referred urgently, all of which were appropriate. 4 of the results needed to be informed to their admitting teams. Summary/Conclusion: Nine percent of the total blood films were referred for medical review (Three percent, Gulati et al., 2002). Thirty-eight percentage of referrals did not fulfil referral criteria. Recommendation 1.Access to medical records would help them correlate the morphological findings with the patient's medical history. 2.Detailed description of the morphological features and review of previous results by the biomedical team would help better interpretation of the pathology by the laboratory haematologists. Senior BMS review is recommended for all blood films referred. 3. The medical review criteria needs more periodic updation based on patient population, training and experience of examiners, teaching and education consideration. 4. Regular morphology teaching/discussion between biomedical scientists and clinical Haematologists, use of digital telepathology systems will enhance better communication and understanding and improve turnaround times. 5. More strict adherence to the ICSH/RCPath recommendations regarding documentation, notification process would encourage consistency of standardization of pathology practise. 6. Benchmarking data and discrepancy meetings would help improve quality of reporting and turnaround times.