Clincal pearls for peripheral smear reading

[Gastrin]

Hi guys,

I am a new hematology/oncology fellow. I am just learning to review path smears. I would appreciate some clinical pearls and suggestions for resources.

e.g. I'm having trouble differentiating the different precursor white cells.

I will start with a few I know of

- >3 schistos/HPF is concerning
- avf no of platelets per HPF x20 = roughly the platelet count
- features of BM dysplasia: neutrophils w bilobed nuclei or hyperlobulated nuclei, pale granules in granulocytes
- it's easy to find WBCs at the top or bottom edge of the smear

Any suggestions would be appreciated.

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[Mace1370]

For differentiating the different precursor white cells, try to get an atlas that has pictures of each stage (there are a bunch). Review that so that you know what you are supposed to be looking for. You can then sit with a pathologist or a tech (many are good at the identification of white cells) to practice.

 

[univlad]

For differentiating the different precursor white cells, try to get an atlas that has pictures of each stage (there are a bunch). Review that so that you know what you are supposed to be looking for. You can then sit with a pathologist or a tech (many are good at the identification of white cells) to practice.

Yes. Sit down with one of the techs who counts marrows in the lab. They are best since they count a lot of marrows per day. Otherwise, the hemepath fellow or attending would likely be willing to sit down with you.

 

[yaah]

Lots of good books that give good general outlines

Like this one Atlas of Peripheral Blood – Livros no Google Play

There are also a lot of tutorial websites Blood Smear: The Test | Blood Smear Test: Peripheral Blood Smear; Blood Film | Lab Tests Online - there are many others with better images.