Review of peripheral blood smear slides: assessment of the compliance with criteria used by analysts in a laboratory of a public hospital in Bahia, Brazil

ABSTRACT Introduction: Recommendations in the literature and publications of scientific societies have proposed classification systems and levels to report blood cell changes in the complete blood count (CBC). Aiming to standardize the results released in the clinical laboratory, the standardization in hematoscopy is an important action within the quality assurance, contributing for diagnosis and appropriate follow-up of patients. Objective: To verify the adequacy of the classification criteria of the blood smear changes adopted by the laboratory professionals at the General Hospital of Vitória da Conquista, Bahia, Brazil. Material and method: In the 12-week period, 159 slides of CBC were selected from 53 patients from the four intensive care units (ICUs) at the hospital, three slides per patient. The readings of the slides were performed by the analysts on duty and by two other quality analysts-control who used the criteria standardized by Palmer (2015), all analyses were blind and independent. The results were compared using the Cohen's kappa agreement tests between the analysts-control and between the quality control analysts and the analysts on duty. Results: For the analyzed parameters, there was moderate to excellent agreement among the quality analysts-control, and when they were compared to the analysts on duty, there was a slight to substantial agreement. Discussion: The lowest agreement occurred in the expression of poikilocytosis and lymphocytic atypia, which are not detected by the hemocytometer, and the analyst's technical capacity is required. Conclusion: The study evidenced the need of standardization of the criteria for hematoscopy used by analysts to obtain reproducible results that reflect quality and reliability by the prescribing physician. Therefore, it is necessary to invest in training the professionals involved in revision of blood smear slides.