Grading Morphology

[SMILLER 841]

Does anyone still grade morphology when reporting out a smear review for a CBC?

We stopped years ago, the idea being that a particular morphology is either significantly apparent or it is not--so we report only if present in significant amounts on the scope.

Likewise we do not report redundant morphologies that can be inferred from automatic CBC results, such as hypochromia, microcytosis, anisocytosis, etc.

[Auntie-D 363]

Ditto! It's hard getting the 'old timers' to stop doing films though

[SMILLER 841]

Auntie- Ya, I know what you mean! We have problems with certian techs holding automated results (sometimes critical and/or STAT) while they wait to see the smear on a low platelet count or whatnot. We even get an occasional unecessary redraw based on something they do not like on the auto CBC!

[Steven Jeff 41]

I would be interested to know what percentage of routine blood counts you examine a stained blood film on. I know this will vary from active oncology units to the more routine laboratories.

Secondly have you fine tuned your analyser to what you see on a blood film, i.e. if the blast flag comes up on the analyser have you confirmed this microscopically and adjusted if the the flag is oversensitive or otherwise?

Steve

[Auntie-D 363]

Secondly have you fine tuned your analyser to what you see on a blood film, i.e. if the blast flag comes up on the analyser have you confirmed this microscopically and adjusted if the the flag is oversensitive or otherwise?

Steve

Of course

[SMILLER 841]

Steve

Not a big percentage. We do have quite a long list based on certian flags, combination of results and diagnosis that direct the tech to perform a smear review or manual differential.

Many abnormal CBCs that would normally be reviewed, if they correlate with a recent one, do not get another review. The idea being that those additional morphology comments are already present on the chart.

[Steven Jeff 41]

Thanks Smiller and Antie D, I asked purely out of interest. I was made redundant in May and for the last 3 months have worked as a locum running two Sysmex XE 2100 analysers. We do about a 1000 FBC's a day and probably make 50 to 75 blood smears a day on non Haematology clinic days. I have been surprised at how good the modern haematology analyser is in flagging abnormalities (my previous lab analyser was 14 years old). However, they do need to be fine tuned to reduce the level of unnecessary flagging. The process of fine tuning develops staff confidence in the capabilities of the analyser.

Steve

:)

[eric1980 13]

I wouldn't report anything that can be interpreted from FBC.

Unless a morphology is ordered, we will have to report hypochromia, microcytosis, etc... even if it can be seen straight from FBC.

[Alan Neal 16]

Within NZ HAematology laboratory's we have an agreed standard on terminology and grading when reporting of Blood films- including grading of RBC morphology (Which is graded Increased or Marked Increased).

If you would like a copy of information I can e-mail (or will locate web address when published).

RE view rates (We are still fine tuning), within my lab approx. 1400 CBC's day, film review rate 6 % (of which approx 10 have manual differential - No diff available or immature cells >1%).

We have fune tuned our system and utlise some research parameters to identify abnormal clusters (ing) of WBC information.

[astridfeline 2]

Hi,

I'd like to revive this old thread, because I am running into issues with the techs using & feeling comfortable with our new grading scale.  Also, although I'm the supervisor, I'm pretty rusty on reading smears (trying to improve!)

Our scale for most RBC morphology parameters skips 1+ and starts with 2+ (5-20%).  Schistocytes is the only parameter that we will report at 1+ (1%).  I think that part of the problem is getting them to actually enumerate & quantitate abnormalities, they still want to eyeball it.

The specific question that I'd like to pass on from one of my techs is for Howell-Jolly bodies.  We are using 1+ (NA); 2+ (2-3%); 3+ (>3%).  The tech thinks that seeing any number of HJ bodies is significant (eg one HJ body on the whole slide review).  Is this true?  I haven't found any reference to support that.  Thank you.

Rachel

[nziegler 36]

I bought "Blood Cell Morphology Grading Guide" by Gene Gulati - an excellent reference for bench techs.  One of anything seen in an entire slide is not significant. All references give a percentage of cells with the specific morphological feature as a guide for grading. I always tell people, you shouldn't have to look for morphology, it should jump out at you. (with the exception of malaria/babesia - they can be sneaky)

[astridfeline 2]

Thank you, very helpful.

[Vivek 0]

Hi I'm new to this forum. This thread is of interest because we are trying to standardise reporting of peripheral smears in our lab. If anyone of you can help by sending links, pdf's /ebooks etc it would be most helpful. What is especially of importance is which of the grades will have clinical significance. Thanks.

[SMILLER 841]

Welcome Vivek.

You may note, from some of the old posts above from 2017, that many labs do not use grading.  In my lab, for instance, we have a chart of all appropriate morphology that we report here.  The chart lists the proper name for each, causes, and what a significant level would be when reviewing a slide.  If a particular morph is not present in significant numbers, it is not reported.  When it is reported, we do not grade it.

Scott

[Vivek 0]

Hi Smiller, Thanks for your input. Could you or any one else in this forum give  a link/pdf as to what is your significant number for a particular morphology. The internet is full of references with widely varying cut offs. Thanks

[alialameen 0]

Dear Smiller

We used this reference in our SOP:

”ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features”

It is nice and simple