CSIR And NHLS Join Forces: Building A National Resource For Increasing Quality Of Pathology Service In South Africa

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The full blood count (FBC) is one of the most commonly performed diagnostic test in the initial diagnosis and subsequent management of patients in the practice of clinical medicine today. For about 10–20% of FBCs performed, a specialist technician, technologist, or haematologist is required to perform an additional, manual evaluation of the blood cells under a microscope and for appropriate interpretation. These individuals, collectively known as expert morphologists, are currently very scarce however, the demand for their diagnostic expertise is increasing. This scarcity is particularly acute in South Africa with high epidemic disease burden of HIV, TB and malaria. The CSIR’s Medical Devices Research Group has been working with haematology experts at the National Health Laboratory Service (NHLS) to develop focused, scalable and practical  health care technologies and associated systems. The NHLS has a national footprint servicing 80% of the country’s pathology needs. The CSIR has engineering and innovation skill set that qualifies it as a suitable partner in finding a comprehensive solution to the challenge.

Working together under the leadership of Professor Johnny Mahlangu, head of  the School of Pathology at the NHLS and WITS University, a task team consisting of members from the NHLS and the CSIR has constructed the first version of a national digital morphology database.

“The core challenge of modern pathology service delivery in South Africa, is a scarcity of diagnostic skills and the inability to meet the high volume and complex disease burdens encountered in medical practice. This includes complicated pathology associated with HIV and TB. Barriers to effective service delivery in pathology include the lack of skilled personnel and, inaccessible terrains that lack appropriate training and teaching facilities. Therefore, the utilization of digital technology to address these unmet needs in diagnostic pathology is an exciting possibility not yet fully explored in pathology.” – Professor Johnny Mahlangu

The anonymized database was assembled using a multifaceted comprehensive approach of case finding, recording of associated clinical features and full blood count, digitization of morphology and appropriate annotation of digital images. Annotation was performed by experienced morphologists and subjected to peer review following upload to the database.

To date, the national digital morphology pilot database has included 101 fully annotated case studies, comprising of 1214 peripheral- and bone marrow images, including 740 cell annotations. The assembly of the cases allows the teaching and training at various levels, from the basic introductory level to specialist trainees requiring a comprehensive diagnostic tool for learning. Through digital distribution, this morphology database is now ready for rollout to various teaching and training platforms previously inaccessible to the limited haematology expertise.

There is growing excitement at the prospects of tackling HIV, TB and related haematology challenges in South Africa, with the aim of becoming the power house for haematology- and morphology related pathology information in Africa.

The current NHLS and future national databases will function to increase the number of skilled staff in the domain, thereby improving the number and accuracy of differential diagnoses made. This is expected to reduce the need for referrals, turnover times for diagnosis and ultimately impact on the health of the people of South Africa and Africa by providing a higher standard of health care.

The database and associated infrastructure will facilitate an increase in the number of staff that can be trained yearly by providing an education infrastructure including high quality training material. This database will also serve as a national reference database for assistance during routine evaluation of blood slides.

The practical session for the annual national NHLS morphology course was for the first time in 2014 held using the digital morphology database as opposed to the microscope practical session. Eight of twelve attendees preferred the use of the digital database. All the presenters preferred using the digital database to using the microscopes for the practical session.