4 October 2021 (Monday) - Seriously ?!

The results of the most recent digital morphology NEQAS exercise are available. I did the thing a month ago and can’t really remember much about it. My notes at the time said ” echinocytes, polychromasia, helmet cells, target cells, Howell Jolly bodies, blister cells, basophilic stippling, nucleated red cells, raised platelet count,?? toxic granulation (probably the staining)  ??? rbc enzyme deficiency

The case was actually one of pyruvate kinase deficiency post-splenectomy. Well… I got the enzyme deficiency bit right. But I’d seen the post splenectomy changes… and I’ll go out on a limb here.

This exercise was utterly unrealistic. Cases of red cell enzyme deficiency do present from time to time. In forty years I’ve seen four. Which is double the amount that my lecturers told me to expect (these things are rather obscure). And a patient who has had their spleen out is going to be known to the laboratory.
Yet again we are presented with an unrealistic case with absolutely no laboratory or clinical data whatsoever.
(Going to lie down now…)

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