26 July 2018 (Thursday) - Blood FIlm NEQAS

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 pl​atelet 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.

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