Parcels are posted on the scheduled dates (usually a Monday) and take 1-3 days for delivery, slightly longer for some international destinations.

Participants should keep an eye on the schedule so they know when to expect their survey parcel. This will aid in planning workflow for your laboratory and also alert the laboratory that a parcel may be taking longer than expected to arrive allowing the laboratory time to investigate delivery problems.

Most of the Haematology QAP samples are freeze dried and the FBC samples are stabilised blood (with an expiry date). This ensures that sample integrity is intact during postage and distribution.

QAP samples undergo rigorous testing to ensure both Homogeneity and Stability. Randomly selected samples are tested for homogeneity and samples are tested under various conditions and temperatures to ensure integrity for the length of the proficiency testing round.

Slides used for the Morphology cases are spread and stained, using ICSH stain, by the Haematology QAP staff. 800 slides are needed for each case.

The homogeneity testing protocol for these cases involves checking every 20th slide for diagnostic features and stain quality. If a participant slide is unsatisfactory, please call the Haematology QAP and request another slide.

The volume provided in the FBC sample is 1mL of stabilised blood. The FBC samples are commercially prepared samples which is compatible with all instrumentation.

Increasing the volume of sample will also increase the cost of this module considerably and the QAP has considered this option in the past. As a study undertaken by Haematology QAP, in 2004, showed that the majority of instruments did not demonstrate a significant variation in results between open and closed modes, the QAP has decided to keep the volume at 1mL.

There are over 700 laboratories participating in the RCPA Haematology QAP programs. The majority of participants fax results on closing day.

QAP recommends participants fax results as soon as they are available and not wait till closing day.

The Haematology QAP introduced Direct Data Entry in 2005 for many of the programs and this should alleviate this problem.

The current sample numbering system uses the cycle and run or despatch number to identify the sample i.e. FB (program name) 4 (cycle number) – 09a (specimen number).

Where a test has only one cycle for the year, the numbering system is fairly explanatory. The FBC however has 2 cycles per year and so the numbering system tends to be confusing to some participants. Haematology QAP has no immediate solution to this, as it is a software limitation issue.

Conversion factors are used to standardise participant’s results. The current Haematology QAP data analysis system does not allow 2 results to be entered into the system.

The margin of error may increase, however since there are only 100 participants in this program the Haematology QAP does not see the value in submitting results in different units.

Where possible the Haematology QAP provides participants with the history that was provided when the patient first presented. This is to simulate real life situation in a laboratory.

The Morphology Advisory Committee keeps this in mind when assessing acceptable/unacceptable responses. It is hoped that participants view the Morphology cases as educational, as this is the main focus of this program.

Historically the Haematology QAP only provided indices for WCC, Hb and Plt. We have added the RCC, MCV, MCH and MCHC as additional parameters. These parameters and the clinical information provided atttempt to simulate a laboratory environment.

Morphology responses are reviewed and tallied by QAP staff, then;

• Results entered and a report of reponse incidence is sent to Morphology committee
• The Morphology committee is required to allocate a score for each description/diagnosis (members are given 48 hours to respond)
• Chair makes the final decision after reviewing committee responses
• Chair reviews histograms  and prepares comments to include with final report
• Final report sent to Morphology committee for final review and comment (24 hour to respond)
• Final amendments made and report issued

As participants may appreciate this is a long and labour intensive process, but the QAP staff endeavour to keep the TAT to an absolute minimum.

While the Haematology QAP encourages all staff who reviews blood films to attempt a diagnosis, it is understood that there are many branch laboratories in remote areas with no Pathologist on site, full time.

These scientists are required to review the blood films and report any abnormalities. They are not expected to diagnose the case, only to refer onto a Pathologist.

Where a scientist reports the morphology cases and provides an acceptable response, they will be coded accordingly. However, where a scientist has taken the extra step and provides a diagnosis which is unacceptable, the Haematology QAP will then review the features noted and if all diagnostic features are provided then a ‘Good Description’ code will be given. The QAP does not wish to discourage scientists in remote locations who do not see many abnormal films from ‘having a go’.

Stained blood films are provided for the following reasons;

• Standardise stain of blood films
• Staining process renders any infectious agents inactive, which is a distribution requirement
• In order to establish homogeneity of blood films, every 20th slide is reviewed which is not possible without staining