I finally got round to looking up the results of
the blood film morphology NEQAS exercise 1803 today.
In film 1803 BF1 I saw lymphocytosis
with cleft nuclei and granular lymphs.
Interestingly this was from a “normal healthy individual” but a
sizeable proportion of participants agreed with me in feeling there was
something odd about the lymphocytes.
In
film 1803 BF2 I saw myeloblasts with
auer rods, promyelocytes and I felt there was a low platelet count.
This was a case of AML.
I’m rather pleased with how this survey went
for me, but I feel I must take exception with the scheme organiser’s comment “There was the usual disappointing minority
of laboratories that did not suggest a diagnosis. It is very important when you
examine a blood film to have a diagnostic hypothesis; in this way you continue
to learn. In this particular case the only satisfactory diagnostic hypothesis
is of acute promyelocytic leukaemia. Only if this is suspected will the patient
be assessed and treated with the degree of urgency that is necessary”.
I disagree with this. We do not give a
diagnosis when studying a blood film “for
real” so why should we be judged on something we don’t do.
No comments:
Post a Comment