14 January 2021 (Thursday) - NEQAS Blood Film Morphology

 I managed to get hold of the latest NEQAS blood film morphology results today…

 2008 BF1

I said:   Blast cells Agranular neutrophils NRBCs Target cells Polychromasia

Consensus Top Ten:   Blast cells NRBCs Thrombocytopenia Polychromasia Agranular neutrophils Monocytosis Target cells Pelger cells Macrocytosis Howell Jolly Bodies

 

This was (as I thought) a case of AML

 

2008 BF2

 

I said:   Blasts Myelocytes NRBC Tear-drop cells Thrombocytopenia

Consensus Top Ten:   Blast cells Thrombocytopenia NRBCs Tear drop cells Smear cells Lymphocytosis Myelocytes Atypical mononuclear cells Polychromasia Prolymphocytes

 

This was a case of essential thrombocythaemia which had transformed to AML with a clonal oddity complicating the matter. The consensus view was that this was a lymphoproliferative disorder or lymphoma or CLL with AML.

I dodn’t hazard a guess at the diagnosis as it would have been a guess at best. Quite frankly such a complicated diagnosis is nigh on impossible to arrive at with the incredibly limited information that we were given.

2004 DF 

I said (Consensus range in bracket) 

Neut   19.1    (11.1 – 34.9)

Lymph 11.8   (1.6 – 16.4)

Mono  3.9       (0 – 23.3)

Eos     0.6       (0 – 8.4)

Baso   0          (0 – 1.5)

Meta   0          (0 – 5.1)

Myelo 0          (0 – 6.4)

Pro      0          (0 – 4.0)

Blast   25.1    (21.6 – 72.4)

NRBC 2.4       (0 – 10.9)

 

Well… what can I say? I was in the range but quite frankly a random number generator would have probably have given results in that range. It was on the wide side… Is there anything to be said for having an exercise like this on a weekly basis rather than quarterly, if only to try to get some national consensus? I think so..

Overall – I did OK. By one of those odd coincidences I had my personal morphology competence review yesterday. I passed  that (which was something of a relief) but although far be it from me to find fault with the competency review system, there is no nationally  or internationally recognised standard for reviewing morphology competence.

Back in the day I would have been keen to have got involved with organising something along those lines. Nowadays… I just look at what I got and am happy that I had got close enough (judged by my own subjective standards)