{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T05:10:57Z","timestamp":1768799457485,"version":"3.49.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T00:00:00Z","timestamp":1728000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clinician-ordered peripheral smear review by pathologist (CPSR) is commonly ordered and has been recommended for decades. However, the clinical utility of this labor-intensive test in the reference laboratory has not been examined. The objective of this study is to assess hematologic abnormalities identified in CPSR orders and to correlate them with complete blood count (CBC) and laboratory-derived smear review (LDSR) in the reference laboratory.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Two hundred consecutive CPSRs with corresponding CBCs from April 2023 were run by Sysmex\u00ae XN-11 analyzers, and their peripheral smears were examined by a board-certified hematopathologist. Hematologic abnormalities of CPSRs were assessed, and the correlation between CPSR and CBC\/LDSR was reviewed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Nearly one-third of CPSRs (29%) had normal peripheral smears and CBCs. The majority of CPSRs showed nonspecific quantitative abnormalities. When compared against CPSR results, LDSR criteria identified 100% of hematologic abnormalities appropriately. Samples that were not flagged for review by LDSR rules were also reviewed (n = 174) to rule out clinically meaningful false negatives. One minor discrepancy (0.6% of cases) of small platelet aggregates was observed in a patient with a reported platelet count of 139\u2005K\/uL that was missed by the LDSR process.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the reference laboratory setting, our findings demonstrate that LDSR adequately detects significant hematologic abnormalities and, therefore, CPSR should be discontinued.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jalm\/jfae101","type":"journal-article","created":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T17:07:43Z","timestamp":1728061663000},"page":"352-358","source":"Crossref","is-referenced-by-count":1,"title":["Clinician-Ordered Peripheral Smear Review by a Pathologist Has Low Clinical Utility\u2014A Reference Laboratory Perspective"],"prefix":"10.1093","volume":"10","author":[{"given":"Sanjai","family":"Nagendra","sequence":"first","affiliation":[{"name":"Laboratory Corporation of America , Burlington, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Mongillo","sequence":"additional","affiliation":[{"name":"Alamance Community College , Graham, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystin","family":"Dodge","sequence":"additional","affiliation":[{"name":"Laboratory Corporation of America , Burlington, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pratistha","family":"Ranjitkar","sequence":"additional","affiliation":[{"name":"Laboratory Corporation of America , Burlington, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Burns","sequence":"additional","affiliation":[{"name":"Laboratory Corporation of America , Burlington, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lavonda","family":"Allen","sequence":"additional","affiliation":[{"name":"Laboratory Corporation of America , Burlington, NC ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,10,4]]},"reference":[{"key":"2025030423060783500_jfae101-B1","first-page":"71","article-title":"Peripheral blood film\u2014a review","volume":"12","author":"Adewoyin","year":"2014","journal-title":"Ann Ib Postgrad Med"},{"key":"2025030423060783500_jfae101-B2","first-page":"203","article-title":"Evaluation of macrocytosis","volume":"79","author":"Kaferle","year":"2009","journal-title":"Am Fam 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anemia?","volume":"55","author":"Fairbanks","year":"1971","journal-title":"Am J Clin Pathol"},{"key":"2025030423060783500_jfae101-B7","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1001\/archinte.1983.00350060042005","article-title":"The value of the peripheral blood smear in anemic inpatients: the laboratory\u2019s reading v a physician's reading","volume":"143","author":"Jen","year":"1983","journal-title":"Arch Intern Med"},{"key":"2025030423060783500_jfae101-B8","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/ijlh.13069","article-title":"Blast flagging of the Sysmex XN-10 hematology analyzer with supervised cell image analysis: impact on quality parameters","volume":"41","author":"Petrone","year":"2019","journal-title":"Int J Lab Hematol"},{"key":"2025030423060783500_jfae101-B9","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1309\/MY7077989KWDYP88","article-title":"Comparative evaluation of schistocyte counting by an automated method and by microscopic determination","volume":"121","author":"Lesesve","year":"2004","journal-title":"Am J Clin Pathol"},{"key":"2025030423060783500_jfae101-B10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1093\/clinchem\/hvab253","article-title":"Increased mean cell hemoglobin concentration","volume":"68","author":"Cook","year":"2022","journal-title":"Clin Chem"},{"key":"2025030423060783500_jfae101-B11","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.4102\/ajlm.v12i1.2140","article-title":"Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa","volume":"12","author":"Ramiah","year":"2023","journal-title":"Afr J Lab Med"},{"key":"2025030423060783500_jfae101-B12","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13000-020-01033-8","article-title":"Clinician-ordered peripheral blood smears have low reimbursement and variable clinical value: a three-institution study, with suggestions for operational efficiency","volume":"15","author":"Beckman","year":"2020","journal-title":"Diagn Pathol"},{"key":"2025030423060783500_jfae101-B13","doi-asserted-by":"crossref","first-page":"99","DOI":"10.7754\/Clin.Lab.2017.170703","article-title":"Clinical utility of ordered pathology blood smear reviews\u2014an overused resource?","volume":"64","author":"Kurt-Mangold","year":"2018","journal-title":"Clin Lab"}],"container-title":["The Journal of Applied Laboratory 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