Effective Test Utilization Recommendations

Clinician-ordered peripheral smear review by pathologist in routine practice is discouraged. Instead, a complete blood count with differential (CBC with differential) should be ordered

Hematology
Clinician-ordered peripheral smear review by pathologist has traditionally been ordered in patients suspected of hematologic disease or to assess CBC abnormalities. However, with the advent of sophisticated hematology analyzers, flags, and middleware rules, clinician-ordered peripheral smear review by pathologist is considered obsolete and of low clinical utility. A CBC with differential should be ordered instead; if there is evidence of hemolysis or malignancy, the laboratory will generate a report to the clinician.

REFERENCES

  1. Kurt-Mangold ME, Grieme CV, Krasowski MD, Rosenthal NS. Clinical Utility of Ordered Pathology Blood Smear Reviews - an Overused Resource? Clin Lab. 2018;64(1):99-104. doi:10.7754/Clin.Lab.2017.170703
  2. Nagendra S, Mongillo J, Dodge K, Ranjitkar P, Burns B, Allen L. Clinician-Ordered Peripheral Smear Review by a Pathologist Has Low Clinical Utility-A Reference Laboratory Perspective. J Appl Lab Med. 2025;10(2):352-358. doi:10.1093/jalm/jfae101
  3. Petrone J, Jackups R Jr, Eby CS, Shimer G, Anderson J, Frater JL. Blast flagging of the Sysmex XN-10 hematology analyzer with supervised cell image analysis: Impact on quality parameters. Int J Lab Hematol. 2019;41(5):601-606. doi:10.1111/ijlh.13069
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