Dear Sir,

We read with interest the article titled ‘Haematologist-reviewed peripheral blood smear (PBS) in paediatric practice’.(1) We would like to share our thoughts on Lee’s observation that “The practice of laboratory-initiated PBS review requires re-evaluation. Haematologist-reviewed PBS is an important diagnostic tool for children with anaemia, bleeding disorders and acute febrile illnesses.”(1) Re-evaluation of the PBS should be done for any patient by the physicians who requested for the laboratory test. Nevertheless, the high workload sometimes results in the need for laboratory-initiated PBS review. In addition, haematologists may not be available in all hospitals. Doubtless, there might be discordance between the PBS interpretation of a haematologist and that of other medical personnel.

To help decrease the workload, there should be a system to increase the reliability of the laboratory-initiated PBS review. According to quality standards such as ISO 15189,(2) regular proficiency testing and continuous education are required to guarantee the efficacy of the laboratory clinical technician who performs the laboratory-initiated PBS review. Lee’s observation might have arisen due to the lack of a good system for verifying the reliability of the laboratory-initiated PBS review in the study’s setting.

Yours sincerely,

Lee AC. Haematologist-reviewed peripheral blood smear in paediatric practice. Singapore Med J. 2018;59:64-8.
Guzel O, Guner EI. ISO 15189 accreditation: requirements for quality and competence of medical laboratories, experience of a laboratory I. Clin Biochem. 2009;42:274-8.