Introduction
Unnecessary ordering of peripheral blood film (PBF) is affecting cost and time. PBF is a laboratory work-up that involves cytology of peripheral blood cells smeared on a slide. It can be requested by clinician on account of a clinical suspicion or by the laboratory based on abnormal findings from automated blood count. The aim of this study is to evaluate the PBF initiated by clinician.
Materials and Methods
We retrieved all 2017 PBF requested by clinician. Based on the results, the PBFs were grouped into normal PBF and PBF with abnormal findings. We evaluated the normal PBF based on full blood count (FBC) and clinical indication, and we grouped it into appropriate PBF request and unnecessary PBF request. Descriptive statistical analysis was performed.
Results and Discussion
301 PBFs were requested in 2017. 36 (12.0 %) were normal PBF and 265 (88.0 %) showed abnormal findings. 34 (94.4%) of normal PBF showed normal FBC and 2 (5.6 %) showed abnormal FBC. 25 (69.4%) out of 36 PBFs showed no clear clinical justifications of request. 24 (66.7%) of normal PBF showed normal FBC and no clear indication of request.
We consider 8% of PBF requested in 2017 were unnecessary. Possible causes include failure to check previous FBC before requesting PBFs examination, non-user friendly medical record system which caused failure of tracing previous results leading to repeated request of PBFs and inexperience or lack of knowledge about the clinical indications of PBFs examination.
Conclusions
There is a possibility of increase in PBF request in the future. To reduce unnecessary request, early measures should be implemented. These include implementation of hospital guidelines on clinical indication of PBF and improvement on hospital information system. We suggest training sessions on clinical guidelines of PBF examination for young practitioners.