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Routine manual blood cell differential counts and identification of the presence or absence of atypical or abnormal cell morphology play important roles in the diagnosis of leukaemias and other diseases. 1 The ability to guarantee high levels of consistency and quality and to continue the development of expertise is invaluable. Quality assessment of blood cell morphological testing, such as of the white blood cell (WBC) differential and its interpretation, is one of the most important and difficult assignments in a haematology laboratory. 1 2 A total of 2700 laboratories in Japan register for the annually administered proficiency survey conducted by the Japanese Association of Medical Technologists. The Japanese Association of Medical Technologists proficiency survey, which consists of 16 blood cell images in colour photographs, has several limitations, including the small number of presented cells, the poor image quality compared with that of optimal or digital images, and the often discussed 'correct' answers submitted by participants that may not reflect their routine work quality. The UK National External Quality Assessment Scheme for General Haematology (NEQAS (H)) recently conducted pilot studies of the utilisation of digital morphology in haematological external quality assessment (EQA) and continuing professional development (CPD) and obtained considerably more reliable results. 3 4
There is emerging appreciation of the use of high-quality digital imaging technology in clinical haematology education. 2 5 CellaVision competency software (CCS; CellaVision, Lund, Sweden) is proficiency testing and educational software for manual blood cell differentials, which can use cell images collected by a digital computer-aided microscope system, CellaVision DM96. 6 In this study, we conducted a monthly survey to assess the possible role of the proficiency testing program produced by CCS in the EQA of the clinical laboratories affiliated with a university hospital and the effective utilisation of this program in CPD.
Materials and methods
The monthly proficiency survey was performed in collaboration with four clinical laboratories affiliated with the teaching hospitals of Juntendo University of Medicine in Japan. A total of 26 technologists participated in this study, of whom 14 were from the main (M) hospital (1020 beds, 4000 outpatients/day) and 12 were from the three branch hospitals, each of which employs four technologists (A: 348 beds, 900 outpatients/day; B: 400 beds, 1200 outpatients/day; and C: 653 beds,...