Novel automated peripheral blood smear reporting system using the Sysmex hematology analyzer and middleware

Abstract

A peripheral blood smear (PBS) report, which is prepared by observing the morphological characteristics of peripheral blood cells, is valuable for diagnosing various diseases. It is considered particularly important as a screening test for hematologic malignancies, such as leukemia, and a confirmation test for diseases that target red blood cells (RBCs), such as malaria and babesiosis. 1,2 While the PBS report furnishes substantial insights to clinicians, its interpretation demands a substantial investment of time and effort from hematopathologists.The International Society of Hematology (ICSH) published standard guidelines for the nomenclature and grading of peripheral blood cell morphological features for internationally consistent blood cell description in a PBS report. 3,4 Based on this, the Standardization Committee of the Korean Society of Diagnostic Hematology prepared detailed guidelines for standardizing PBS reports. 5 Despite these efforts for standardization, in the absence of an automated, standardized method that can easily apply the guidelines, the types of reports will vary owing to the different reporting styles of hematopathologists. This inevitably leads to communication difficulties between clinicians and laboratories and a decrease in the efficiency of patient care.The first step in generating a PBS report is to obtain complete blood count (CBC) results, which form the basis of the PBS report. Thereafter, the morphological examination of the PBS and other information, such as additional test results, diagnosis, age, and past history, are gathered to complete the PBS report. The description of the quantitative abnormalities in the CBC is a part of the PBS report. ICSH recommends using hematology analyzer-generated results rather than microscopic observation for the microcytes, macrocytes, anisocytosis, polychromasia, and quantitative WBC abnormalities in cases without abnormal cell populations. 5 We developed a standardized version of the PBS reporting format according to the ICSH recommendations and a system that allowed automatic descriptions of quantitative values of CBC data in this reporting format.