Summary We report the results of a pilot study assessing the use of digital ‘virtual slides’ in haematological quality assessment. Conducted together with the UK National External Quality Assessment Scheme for General Haematology, the study involved 166 separate participants, using the format of a typical assessment exercise. The results revealed substantial concordance of observations made using digital slides with those reported in previous glass slide surveys that used identical cases. Participant feedback strongly supported the use of electronic slides in teaching and assessment roles. Our results suggest roles for this new electronic resource in external quality assessment (EQA), education and continuing professional development.

A knowledge of the limitations of automated platelet counting is essential for the effective care of thrombocytopenic patients and management of platelet stocks for transfusion. For this study, 29 external quality assessment specimen pools with platelet counts between 5 and 64 × 10(9)/L were distributed to more than 1,100 users of 23 different hematology analyzer models. The same specimen pools were analyzed by the international reference method (IRM) for platelet counting at 3 reference centers. The IRM values were on average lower than the all-methods median values returned by the automated analyzers. The majority (~67%) of the automated analyzer results overestimated the platelet count compared with the IRM, with significant differences in 16.5% of cases. Performance differed between analyzer models. The observed differences may depend in part on the nature of the survey material and analyzer technology, but the findings have implications for the interpretation of platelet counts at levels of clinical decision making.

The United Kingdom National External Quality Assurance Scheme for General Haematology [UK NEQAS (H)] collaborated with a team of medical, scientific and academic staff from the Manchester Royal Infirmary (MRI) and Manchester Universities to develop an internet-based pilot scheme for digital morphology. The aim of the collaboration was to explore the use of digital images for the morphological examination of peripheral blood cells in an external quality assessment (EQA) setting. This pilot scheme was credited by S U M M A R YUK NEQAS (H) developed and instigated a pilot scheme for digital morphology, which was accessed by participants over the internet in order to assess the viability of using high quality images as an educational tool for continuing professional development. The pilot scheme was trialled over a 2-year period with eight releases totalling 16 morphology cases. Digital images allowed participating individuals to examine and comment on exactly the same cells and compare their findings with those of other participants, consensus data from traditional glass slide surveys and expert opinion. Feedback from participants on their experience was then relayed back to the development team by UK NEQAS (H) in order to drive the educational format and to ensure that any new scheme would meet the requirements of the users.

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Between April 2005 and September 2007 the UK National External Quality Assessment Scheme for General Haematology (UK NEQAS (H)) trialled an internet based pilot scheme for Digital Morphology. The Scheme was registered with the Institute of Biomedical Science for Continuing Professional Development. Participating laboratories of the conventional glass slides Morphology External Quality Assessment Scheme were invited to register one individual to participate, in April 2006 registration was increased from 221 to 413 individuals from 14 countries (>85% UK). Following closure of the successful pilot scheme UK NEQAS (H) launched a full internet based Digital Morphology Scheme in April 2008. We report on the initial results from this novel digital morphology scheme. The scheme is aimed at providing educational feedback for the laboratory scientists who participate. Laboratory managers are invited to register their staff with UK NEQAS(H), participants are then instructed by email when surveys are available for analysis and access the cases by the internet. Cases are built from high quality images, blended and stitched, to give large scale fields of view, equal to an area of at least 60 separate fields at × 60 objective. The “virtual slides” are viewed using appropriate software to allow the participant to move across the image, alter viewer settings and change magnification of the image. Morphology comment assessment sheets are then accessed along with the image and participants complete and submit their findings on line. Once submission is completed the participant has immediate access to detailed educational information about the morphology of the case, including electronic links to relevant internet sites. Once the survey has closed participants receive an email allowing then to access overall completed case data including consensus data from the survey, statistical data and expert opinion. Furthermore they can print a reflective report of their findings against the consensus data. Since April 2008 two surveys have been fully completed and three more are due for release before the end of the year. For the last release (a case of TPLL), 552 individuals fully completed the survey, whilst a further 51 accessed the case but did not fully complete. Some 95 laboratory managers have registered laboratory staff for the scheme with 1102 individuals now registered for the next case release. Although this novel digital morphology scheme is an initial phase, the keen interest shown by laboratory managers in the UK to register the staff who routinely report morphology may reflect the requirement of laboratories to present evidence that staff are being educated and maintaining their skills in morphology. The system allows participants immediate access to relevant material and examples of morphological features using annotated quality images. The Scheme’s aim is one of educatin rather than assessment, directed at individuals rather than laboratories or centres. With the key theme of personal professional development promoting improvement to the quality of heamatological morphology this novel internet based Scheme has potential for expansion internationally.