Nationwide Survey of Laboratory-Initiated Peripheral Blood Smear Review Practices in Korea: Criteria, Workload, and Reimbursement

Background: Peripheral blood (PB) smear review is an essential component of the diagnostic workup for hematological disorders. Laboratory-initiated PB smear reviews (LIRs) are performed based on predefined criteria involving complete blood count (CBC) parameters, analyzer-generated flags, and clinical information. However, nationwide data on LIR practices, workloads, and reimbursements are limited. Therefore, we investigated the status of LIR practices in Korean institutions. Methods: A nationwide survey of medical institutions in South Korea was conducted between October and November 2025. Responses covering LIR criteria, analyzer flag utilization, workload, reporting, and reimbursements were collected from 103 institutions. Workload was assessed using case- and time-based approaches. Results: Among the participating institutions, 94.1% used predefined LIR criteria. Analyzer-generated flags were the most frequently applied criteria (95.8%), followed by CBC (85.4%) and automated differential count (85.4%) parameters. Compared with the 2010 Korean nationwide survey, supplementary criteria for reticulocyte count, clinical information, and delta checks were less frequently used. The numerical thresholds exhibited notable inter-institutional variability. The operational burden was concentrated on technologist-performed workflows, with median monthly times of 4,825 and 575 min for technologists and hematology specialists in large academic centers, respectively. Most institutions (79.4%) did not claim reimbursements for LIRs. Conclusions: LIR practices in Korea have evolved toward simpler, analyzer-centered workflows; however, variability persists in terms of review criteria, workload, reporting, and reimbursements. Therefore, updated consensus recommendations and reimbursement policies are required.