18 July 2016 (Monday) - NEQAS Morphology

The latest NEQAS morphology scheme report came through this morning:

General Digital Morphology CPD Scheme
Report and Certificate
Participant Me !
Case Number: 1403DM
CPD Date: 2014-05-07 14:53:07

Consensus of morphological features recorded:
Total number of participants: 986
Group's top 5 observations:
Rank Morphological Feature Participants that selected this feature(%)
1 Thrombocytopenia 57.7
2 Myelocytes 42.1
3 Monocytosis 36.8
4 Promyelocytes 34.5
5 Blast cells 29.2

Your observations:
Rank Morphological Feature Participants that selected this feature(%)
1 Blast cells 29.2
2 Auer rods 1.5
3 Promyelocytes 34.5
4 RBC Fragments/Schistocyte.. 28.3

Reviewing your findings what action would you take?
Urgent - film requires immediate referral to clinician and renal unit should be

Considering your morphological findings, what is your suggested
myelodysplastic transformation

Actual pathological diagnosis:
Renal Failure with Chronic Myelomonocytic Leukaemia.

Of those offering a diagnosis, more than two-thirds suggested that this was a neoplastic condition: 20% suggested MDS, 10% suggested acute myeloid leukaemia (AML or AMML, noting the primitive monocytoid cells), and 10% suggested CML. Congratulations to the 25% who accurately pinpointed the final diagnosis.
This was a difficult and unusual case. Initially the increased white cell count could easily have been interpreted as reactive due to sepsis, but on closer inspection, the lack of toxic granulation in the neutrophils and the primitive and abnormal morphology of the monocytes should lead to this film being referred for clinical review.
It was encouraging to see that >90% of participants would have taken this action. Monocytosis and blast cells were among the top 5 selections made by participants, with an additional 26% correctly noting that agranular neutrophils were present. The platelet count in this case was 160 x 10^9/L; interestingly 58% of participants recorded the film as showing thrombocytopenia.

I don’t think I did that badly. Mind you I’d welcome the chance to discuss blood films with someone (anyone) on a regular basis…

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