rev bras hematol hemoter. 2017;39(4):295–296
w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Scientific
Comment
Blood
film
in
the
era
of
streaming
cells
夽
Diego
Villa
Clé
∗FaculdadedeMedicinadeRibeirãoPretodaUniversidadedeSãoPaulo(FMRP/USP),SãoPaulo,SP,Brazil
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Articlehistory: Received31July2017 Accepted31July2017
Availableonline23August2017
Thecomplete bloodcount(CBC) withleukocytedifferential count(LDC)isapowerfultooltodiagnoseandmonitor dis-easeprogressionandtherapy;itisoneofthemostordered laboratorytests.SinceDr.WallaceH.Coulterintroducedan automated cell counter in 1953,1 the laborious and
time-consuming eye-count method using a microscope and a hemocytometerhas beenreplaced byautomatedanalyzers withfasterturnaroundtimes, reducedburdenon technolo-gistsandlaboratorycosts,andimprovedcountaccuracyand reproducibility.2,3
Modern machinesincorporatingflow cytometry,withor withoutcytochemicalstaining,maximizecellrecognitionand providereliableLDCresultsinthemajorityofcases.4Although
automatedhematologyanalyzers varyinmethod,a signifi-cantoverlapexists.Atypicalinstrumentdiscriminatesacell dependingonitssize,complexity orstaining.Ifacelldoes notfitapredeterminedsettingexpectedforneutrophils, lym-phocytes,monocytes,eosinophilsorbasophils(e.g.,immature leukocytes,plasmacells,fragmentedredcells,platelet aggre-gates),itisnotclassifiedandtriggersaflag.Awarningflagis presentin10–30%ofsamplesandshouldpromptthe technol-ogisttoprepareandreviewabloodsmearusingamicroscope oradigitalimagingdevice.5–7
Bloodsmearexaminationsareroutineinclinical laborato-riestoreviewflagsbutalsocrucialtoanalyzeredandwhite
夽
SeepaperbyComaretal.onpages306–17.
∗ Correspondenceto:DepartmentofInternalMedicine,FaculdadedeMedicinadeRibeirãoPretodaUniversidadedeSãoPaulo(FMRP/USP),
Av.Bandeirantes,3900,14049-900RibeirãoPreto,SP,Brazil.Tel.:+551636022294. E-mailaddress:[email protected]
cell morphology.8 Poikilocytosis and cytoplasmicinclusions
may provide ancillary clues fordiagnosis;Sézary cells and prolymphocytesareonlydetectedbymorphology.Theblood film is also essential to identify dysplastic changes. How-ever,flagsarenotspecificandfalsepositiveflagsmayreach 20%offlaggedsamples,7impactingonlaboratoryroutineby
addingunnecessarymanualreviewsthatconsume technol-ogist timeand resources. Conversely,falsenegativeresults (abnormal samplesnot flagged for review) may jeopardize patient care.Laboratories must, therefore, customize their ownsmearreviewrulestominimizefalsepositiveandfalse negativeresults.
TheInternationalConsensusGroupforHematologyReview (ICGHR) published a set of41 rules as criteria for review-ingCBCsofaheterogeneouspopulationfrom15institutions, yielding a false positive rate of 19% and a false negative rate of 2.9%.5 Comar et al. evaluated these same set of
rules in a Brazilian university hospital setting, and found a false positive rate of 23% and a false negative rate of 6.7%, yielding a microscopy review rate of 46% and con-cludedthattheICGHRruleswerenotsuitableorsafeintheir setting.9
InthecurrentissueoftheRevistaBrasileiradeHematologiae Hemoterapia,Comaretal.proposenewsetsofarbitrarilyand empiricallydesignedcriteriaforbloodsmearreviewfollowing
http://dx.doi.org/10.1016/j.bjhh.2017.07.003
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revbrashematolhemoter.2017;39(4):295–296automatedCBC.10Asetwithwidecut-offlimitsshowedthe
bestrelationshipbetweensafety andefficacy.However,the proposedrulesmustbevalidatedinotherpatientpopulations beforeextrapolatedtootherlaboratorieswithsimilarpatient profilesandinstruments.Moreimportantly,thisworkserves asaguide forclinicallaboratoriestoindividualizerulesfor slidereviewaccordingtolocalcharacteristics.
Conflicts
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interest
Theauthordeclaresnoconflictsofinterest.
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