Nakashima Megan O, Coulter Suzanne Nelson, Blond Barbara J, Brown Richard W, Vos Jeffrey A
From the Department of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (Nakashima).
From the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Coulter, Blond).
Arch Pathol Lab Med. 2025 Jul 1;149(7):618-626. doi: 10.5858/arpa.2024-0117-CP.
CONTEXT.—: The aim of the study was to determine the impact of peripheral blood (PB) smear review by a pathologist when requested by a technologist or provider to measure the rate of pathologist-detected clinically relevant findings.
OBJECTIVE.—: To report and analyze the results of clinically relevant morphologic findings on PB smears that were pathologist reviewed because of either a request from a technologist or an order from a provider.
DESIGN.—: During a 4-week study period, participants enrolled in the College of American Pathologists Q-Probes program submitted data on PB smear reviews including review request source, reason for review request, and if the pathologist's review resulted in a clinically relevant morphologic finding.
RESULTS.—: Twenty-two institutions submitted data on 835 eligible PB smears. Pathologists identified clinically relevant findings on a median 53.4% of technologist-requested PB smear reviews and a median 14.3% of provider-ordered PB smear reviews. The most frequently identified pathologist finding on technologist-requested PB smear reviews was "blasts" in 91 of 532 (17.1%) followed by "atypical (possibly neoplastic) lymphocytes" in 74 of 532 (13.9%); the most frequent finding on provider-ordered reviews was "other" in 55 of 315 (17.5%) followed by "immature cells/left shift in myeloid cells or monocytes" in 12 of 315 (3.8%). Pathologists agreed with technologists' indications for review in 458 of 513 requested reviews (89.3%). Institutions that conducted postanalytic follow-up on previously reviewed PB smears had a higher rate of clinically relevant findings detected on technologist-requested smears.
CONCLUSIONS.—: Pathologist review of PB smears flagged by technologists for review frequently yielded clinically relevant findings. This was higher in institutions that conducted postanalytic reviews. Provider-ordered reviews resulted in clinically relevant findings in a median of 14.3% of smears.
