Igor Rozenvald

ABSTRACT Objectives: This review highlights some important problematic issues in hematology laboratory and hematopathology diagnostic process, which are well known to professionals in these areas but are largely ignored for a variety of reasons.

Methods: Microscopic evaluation of peripheral blood smears at Quest Diagnostics; Ameripath Nort East (ANE; part of Quest Diagnostics); Umass Memorial Medical Center (UMMC), Tufts Medical Center (TMC), Beth Israel Deaconess Medical Center (BIDMC). Microscopic evaluation of aspirate smears, bone marrow biopsies and clots, cytospins of lymph nodes and body fluids (including CSF, peritoneal and pleural fluids) and Flow Cytometry testing within laboratories listed above.

Conclusions: While operation of clinical hematology laboratories and laboratory components of hematopathology services is extensively regulated, there is insufficient attention to the quality of materials arriving for diagnostic work up. For example, there is no College of American Pathologist Checklist item dealing with issues of how laboratory establishes stability criteria to assure that a process generating stability criteria addresses reasons for blood cells’ alteration and disruption during transportation. Also, there is little attention to how hematopathology services identify and report suboptimal or inadequate materials in relation to a clinical history prompting evaluations (bone marrow biopsy, aspirate, and flow cytometry). The specific issues relevant to the above and some possible steps for remediation are discussed below in more detail.

The key pathogenetic mechanisms of COVID-19 involve tissue damage, inflammation, and thrombosis. Based on pathogenetic mechanisms of this disease, our initial literature search, prior to the first wave of COVID-19, identified well-known, inexpensive, and widely available medications (indomethacin, famotidine and azithromycin), which could target multiple components of pathophysiologic process triggered by SARS-CoV-2. We describe three adult patients managed via telemedicine, discuss details of treatment, including medication dosages, and propose ambulatory implementation of this approach for preventing progression of the disease to a stage requiring hospitalization. We discuss some key goals related to prompt delivery of treatment to adult patients facilitated by telemedicine, aimed at reducing risks of spread of infection, and accelerating treatment initiation.