RED CELL MORPHOLOGY REPORTING - CHANGES IN PROGRESS

It was customary in our lab, and most other hematology laboratories, for the technologist to report every morphologic deviation seen, whether significant or not. Thus, occasional truly diagnostic blood smear characteristics are sometimes obfuscated by the concurrent reporting of non-specific findings and even normal variants. The term that would point to the diagnosis may even be omitted in favor of one that is non-specific: marked spherocytosis may be called "anisocytosis". Finally, technologists have traditionally reported findings rather than diagnoses, expecting the physician to interpret correctly the significance of reported morphologic abnormalities.

We thought the system did not work well, and we changed it. Starting in 1/94, we modified our red cell morphology reporting so that:

1. only abnormal findings would be reported: we do not report "slight ovalocytosis" or "fine basophilic stippling".
2. where red cell morphology indicates one or several likely diagnoses, we will report the probable diagnoses along with the important findings. However, if the specific diagnosis is certain, we will generally not report the findings that lead to a smear diagnosis. Thus, if the patient has sickle cells, target cells, polychromatophilia, nucleated red cells and other inclusions we will report "major sickling disorder", or a specific diagnosis such as "sickle-thalassemia", if we know it, instead of the individual findings that could lead to that conclusion.
3. vague and non-specific terms such as anisocytosis and basophilic stippling (unless the stippling is coarse), will be avoided.

4. abnormalities already indicated by other parts of the report will not be reported: we will not comment on red cell size, since the MCV is available; nor will we report poikilocytosis when we can more usefully report what the poikilocytes are, such as spherocytes or target cells.

What you should see is fewer descriptive terms on the normal differential reports than previously. However, what is reported is likely to be significant. An occasional diagnosis will be offered.

Peter McPhedran, M.D