Practice-based learning. Go through different blood smears in a few steps and learn to recognise normal, reactive and malignant specimens.
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Count 100 leukocytes by dragging them to the appropriate categories. You can also have 70% counted automatically.
Check and name any leukocyte abnormalities.Look for abnormalities in the red blood count.Receive additional diagnostics and information about the patient.Decide whether the specimen is normal, reactive or malignant and make a diagnosis.Look at a summary of your results and share it with someone for a debrief.
These exercises are designed to get a feel for different types of specimens. The actual assessment and method of assessment may be different at your institute. Reference values may also be different. Some cells and properties can be discussed, please do so.
For students
For teachers
A random slide
A normal or reactive slide
A reactive or malignant slide
Normal
N001
No pathology
Normal blood smear from a 65 year old male
N002
No pathology
Normal blood smear of a 45-year-old woman
N003
No pathology
Normal blood smear of a 25-year-old man
N004
No pathology
Normal blood smear of a 15-year-old male
N005
No pathology
Normal blood smear of a 12-year-old girl
N006
No pathology
Normal blood smear of an 8-year-old girl
N007
No pathology
Normal blood smear of a 5-year-old boy
N008
No pathology
Normal blood smear of a 1-year-old child
N009
No pathology
Normal blood smear of a 2-month-old baby
Reactive
R001
Viral infection
Slide with moderately reactive lymphocytes and monocytes.
R002
Bacterial infection
Moderate left shift up until myelocytes. Includes thrombocytosis.
R003
Sepsis
Slide with very toxic neutrophils, including left shift.
R004
Viral infection
Typical EBV with an abundance of reactive lymphocytes and plasmacytoid cells. Some toxic granulation in the neutrophilic lineage.
R005
Viral infection
Somewhat in-between R001 and R004. Reactive lymphocytes including some toxic aspects in neutrophils. Many smudged cells.
R006
Sepsis
Slide with very toxic, but hypogranulated, neutrophils. Includes left-shift with atypical myelocytes.
R007
Viral infection
Viral infection in a 3 year old with only mildy reactive lymphocytes but many smudged cells, which may give the appearance of a malignancy.
R008
Malaria
Very obvious Malaria infection with many plasmodium falciparum trophozoites.
R009
Sepsis
Slide from a 1 year old with toxic neutrophils. Contains somewhat reactive, atypical lymphocytes which may appear malignant but are not uncommon for a child of this age.
R010
Deficit in B12 or FA
Slide with hypersegmentation, teardrops and intravascular hemolysis. Leukocyte morphology itself is not very difficult, but recognizing the disorder may be.
R011
Deficit in B12 or FA
Deep vitamin B12 deficiency due to a vegan diet. Hyper-segmented neutrophils, tear drop cells and blastular cells are seen in the diff.
R012
Viral infection
A highly reactive smear from a patient with COVID-19. The biggest challenge in this specimen is distinguishing between monocytes and reactive lymphocytes and recognizing it as being an infection and not a malignancy.
R013
Reaction to medication/drugs
This blood smear shows strongly abnormal neutrophils. Although the morphology is not necessarily difficult, medication, infection and chemotherapy all play a role in this specimen.
Malignant
M001
Chronic Myeloid Leukemia
Slide with 300 thrombocytes and left shift and some blasts. Good slide to discuss bacterial infection vs. malignancy and different types of MPN.
M002
Chronic Lymphatic Leukemia/Lymphoma
Obvious malignant slide with a monotonous population of small lymphocytes.
M003
Acute Myeloid Leukemia
Slide with 86% blasts. Only one blast contains an auer rod.
M004
Acute Promyelocytic Leukemia
90% of atypical blasts/promyelocytes. Very difficult to distinguish between maturation stages. Could be mistaken for another type of AML. Expect a lot of ‘wrong’ answers.
M005
Hairy Cell Leukemie
Classic hairy cell leukemia with a monotonous population of lymphocytes with a hairy, irregular shape
M006
Multiple Myeloma
Rouleaux formation and many plasma cells (with two atypical ones)
M007
Myelodysplastic Syndrome
Contains bilobular neutrophils and monocytes
M008
LGL Leukemia
Appears viral, but contains a lot of moderately granulated lymphocytes
M009
Acute Monocytic Leukemia
Contains monoblasts, promonocytes and normal monocytes. In addition a left shift is present up until promyelocytes.
M010
Acute Lymphatic Leukemia
Blood smear contains blasts that may be mistaken for a hefty viral infection.
