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Critical results should be reported to the physician as soon as possible so that the physician can take the necessary follow-up actions. Failure or non-timely reporting of such results may lead to serious health damage or death to the patient. This article focusses on the reporting of results from the laboratory to the physician and discusses the bottlenecks and the separate (legal) responsibilities of the physician and the laboratory. Improving the process of the reporting and follow-up of critical results is a joint responsibility of the laboratory and the physician requesting the laboratory tests. This could be achieved by local partnership agreements.

A 53-year-old woman with respiratory discomfort came to the Emergency Department. The blood smear, made because of a new thrombocytopenia, showed leukocytes with butterfly-shaped nuclei and fine cytoplasmic granulation. The diagnosis 'microgranular variant of acute promyelocytic leukemia' was made.

The criteria for the diagnosis of chronic lymphocytic leukaemia (CLL) have recently been changed, with the absolute number of monoclonal B cells instead of the total number of lymphocytes now important. CLL is diagnosed when the number of monoclonal B cells with the characteristic CLL phenotype in peripheral blood exceeds 5 x 10(9)/l; fewer than 5 x 10(9)/l of monoclonal B cells with the characteristic CLL phenotype present in peripheral blood leads to a diagnosis of monoclonal B-cell lymphocytosis (MBL): a new diagnostic entity. The prevalence of MBL is estimated to be 3% and has a relatively mild course with a progression rate from MBL to CLL of 1-2% per year. After a single evaluation by a haematologist to exclude lymphadenopathy, organomegaly and infection as causes of the lymphocytosis, patients with MBL need only be evaluated once annually by their general practitioner for measurement of the blood lymphocyte count and referral in case of progression.