Should peripheral blood smears be manually read?

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Question from an MPN patient:
Please comment on the need (or not) for having peripheral blood smears “manually” read:  

  • Can automated cell counts report cell “aberrations” such as morphology changes and should morphology changes be monitored?
  • Can automated cell counts detect blasts in the peripheral blood?
  • Can observations from manual reads help to distinguish drug induced versus other types of anemia?

Answer from Dr. Leclair:
First—there is nothing more accurate than a trained professional's set of eyes and mind. But minds get distracted and eyes get tired. So automation gives you precision, but it cannot take the place of that trained operator.

There are multiple levels of sophistication in instrumentation. Typically, the most expensive, such as those seen in major hospitals, can identify the most cells since their software, and testing is more complete. No one believes the automated system's report of abnormal cells without a manual review, so all morphology changes are monitored. Sometimes this is not necessary—say you had 5% abnormal lymphocytes the last time and the time before. This time you have 5% abnormal lymphocytes. A leaner/meaner person would say—release the report as is. But the laboratory staff will not—until they have had a chance to review it themselves. 

The expensive instruments can pick out some blasts but not all.

The observations can help in discerning many but not all types of anemia. It won't be able to identify drugs as a cause, but it can narrow the options down.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Have a question for the experts? Send them to questions@patientpower.info.

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Page last updated on September 24, 2015