I got the results of NEQAS 2505DM today.
The case gave me a blood film and said:
“A 72 year old man attended the
Emergency Department overnight with symptoms of a chest infection. An initial
blood count showed a normal haemoglobin, neutrophil count and platelet count.
However, the white cell count was significantly elevated with a marked
lymphocytosis.
The analyser suggested
the lymphocytes may be neoplastic. You are asked to examine the film and see if
there are any immediate clinical concerns. What is your view?”
I can’t remember much about it, but my
notes were:
“The neutrophils,
platelets and red cells all look OK to me.
The lymphocytes are
pleomorphic (all different) with smear cells.
This is CLL and should
be referred to the consultant, but not with any immediate urgency”.
The expert opinion was:
“Making a definite diagnosis of
chronic lymphocytic leukaemia can be tricky, especially during the night, but
having the confidence to offer that reassurance to clinicians can make a big
difference that prevents concern about other diagnoses. In this case, the
normal haemoglobin, neutrophil and platelet counts are very reassuring, and the
morphological features are fairly typical of the disorder. Faced with these
decisions, it is important to look at the overall features rather than focusing
too strongly on occasional cells that might not fit perfectly with your
opinion. Particularly when the normal cells are well represented, it is often
appropriate to give your preferred diagnosis even when waiting for formal
confirmation the next morning. CLL can have varied morphology, but the
appearances shown in this case are fairly typical”.
I’m taking that as a result…
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