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Automated hematology analyzers that produce image-guided cell differential counts and morphologic flags potentially provide greater accuracy and improve the detection of morphologic abnormalities in peripheral blood specimens. Manual microscopic reviews of peripheral blood (PB) smears by the technologist, and subsequently by the pathologist, are typically performed on cases that meet certain criteria, either recommended by manufacturing companies or established by laboratory directors based on the International Society of Laboratory Hematology guidelines. In addition, a significant proportion of PB smear review cases by pathologists are directly requested by providers.

Pathologists reviewing peripheral blood smears can play a pivotal role in patient care by recognizing and confirming the presence of significant morphologic abnormalities such as blasts, schistocytes, and malignant lymphocytes. However, for PB smear reviews directly requested by providers, careful reviews by experienced technologists are often sufficient, and reviews by pathologists may not add significant value. In this scenario, laboratories may consider adjusting the PB smear review policy in order to focus pathologist time and expertise on those cases that truly require it.

Enrollment in this Q-PROBES study will help participants address the CAP Laboratory Accreditation Program Checklist statement HEME.34600 regarding criteria for blood film review.


This study will investigate the impact of peripheral blood smear review by the pathologist when requested by the technologist or provider, and measure the rate of detection of clinically relevant findings reported by the pathologist. The study will provide a measure of the rate of peripheral smear differentials that undergo pathologist review compared to all peripheral smear differentials, and the rate of peripheral smear differentials that undergo pathologist review compared to all complete blood counts (CBCs) performed during the study period.

Data Collection

During a four-week study period, participants will prospectively collect information on PB smears requested for pathologist review, including the request source and reason for the request for both inpatients and outpatients. Pathologists will select clinically relevant findings that they added to the case during their review from a standardized short list. For cases requested by technologists, pathologist agreement status will be recorded. Pathologists will indicate if their review provided a morphologic diagnosis and/or recommendations for further evaluation. In addition, the total number of provider-ordered PB smear pathologist reviews, PB smear differentials, and CBCs performed during the study period will be collected.

Participants will provide additional information about general peripheral blood smear review practices in their institutions, including the chosen criteria that result in a pathologist-reviewed slide.

Performance Indicators

  • Rate of clinically relevant findings disclosed by pathologists during provider-ordered PB smear review (%)
  • Rate of clinically relevant findings disclosed by pathologists during technologist-requested PB smear review (%)

Additional Measures

  • Peripheral smears that undergo pathologist review/all manual differentials performed during the study period (%)
  • Peripheral smears that undergo pathologist review/all CBCs performed during the studio period(%)

Shipping Schedule

D Mailing: September 3, 2019

Additional Information

This is a one-time study conducted in the fourth quarter.

Q-PROBES qualify for Self-Reported Training Opportunities to be used for fulfilling requirements for certification maintenance by agencies such as the American Society for Clinical Pathology (ASCP). Please verify with your certifying agency to determine your education requirements.

For Comprehensive Collection of Tools, see Quality Management Tools.

Select Q-PROBES and Q-TRACKS studies to support your quality improvement initiatives.
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Expression Rates in Invasive Breast Carcinoma (QP193)
The Impact of Pathologist Review on Peripheral Blood Smears (QP194)
Patient Identification Accuracy (QT1)
Blood Culture Contamination (QT2)
Laboratory Specimen Acceptability (QT3)
In-Date Blood Product Wastage (QT4)
Gynecologic Cytology Outcomes: Biopsy Correlation Performance (QT5)
Satisfaction With Outpatient Specimen Collection (QT7)
Stat Test Turnaround Time Outliers (QT8)
Critical Values Reporting (QT10)
Troponin Turnaround Times (QT15)
Corrected Results (QT16)
Outpatient Order Entry Errors (QT17)

*The CAP requires accredited laboratories to have a quality management plan that covers all areas of the laboratory and includes benchmarking key measures of laboratory performance (GEN.13806, GEN.20316, COM.04000). The Joint Commission requires accredited hospitals to regularly collect and analyze performance data (PI.01.01.01, PI.02.01.01). CLIA requires laboratories to monitor, assess, and correct problems identified in preanalytic, analytic, and postanalytic systems (§493.1249, §493.1289, §493.1299).