Pathologist Review of Peripheral Blood Smears



Pathologist Review of Blood Smear

Name________________________________ Date: _________ Tech _______

Doctor ____________________ Acc.# ______________ Sex/Age ______

Referral Indication: TECH MUST CIRCLE BEFORE SUBMITTING TO PATHOLOGIST

The peripheral blood smear was submitted by the technician for Pathologist review: (Circle one template response from this section)

|Resulting |Description |

|Mnemonic | |

|@RIHB |Due to the hemoglobin result < 6.9 |

|@RIPR |At the request of Dr. ______________ |

|@RIPT |Due to the platelet count result 1001 |

|@RITR |Due to immature or atypical cells, or atypical inclusions in cells |

|@RIWC |Due to the WBC result 30.1 |

Interpretive Statement:

Pathologist review of blood smear demonstrates: (Circle one template response from this section)

|Resulting |Description |Resulting |Description |

|Mnemonic | |Mnemonic | |

|@BS31 |A microcytic / hypochromic anemia suggestive of iron |@BS44 |Red blood cell inclusions suggestive of previous splenectomy. |

| |deficiency. Recommend iron studies as clinically warranted. | | |

|@BS32 |Severe, slightly microcytic anemia consistent with acute blood |@BS45 |Evidence of hemoconcentration suggestive of dehydration. |

| |loss and iron deficiency. | | |

|@BS33 |A microcytic anemia suggestive of hemoglobinopathy. Recommend |@BS46 |Relative lymphocytosis consisting of mature normal lymphocytes |

| |hemoglobin electrophoresis as clinically warranted. | |which may indicate viral infection. |

|@BS34 |A microcytic anemia, which may indicate hemoglobinopathy or |@BS47 |Lymphocytosis with increased reactive lymphs suggestive of viral |

| |iron deficiency. Suggest hemoglobin electrophoresis or iron | |infection. |

| |studies as clinically appropriate. | | |

|@BS35 |Normocytic anemia consistent with acute blood loss. |@BS48 |Reactive lymphocytes suggestive of viral infection. |

|@BS36 |Normocytic anemia consistent with chronic disease and/or acute |@BS49 |The presence of increased reactive lymphocytes which, while |

| |blood loss. | |consistent with a viral infection, are not specific for infectious |

| | | |mononucleosis. If clinically warranted, suggest reevaluation in one|

| | | |week, or more sensitive testing for infectious mononucleosis. |

|@BS37 |Normocytic, normochromic anemia. Suggest work-up for combined |@BS50 |Lymphocytes suggestive of infectious mononucleosis. Suggest mono |

| |nutritional (iron/vitamin B12/folate) deficiency. | |test as clinically warranted. |

|@BS38 |A macrocytosis which may indicate vitamin B12/folate |@BS51 |Lymphocytosis with smudge cells suggestive of chronic lymphocytic |

| |deficiency. Recommend B12/folate levels as clinically | |leukemia (CLL). Recommend flow cytometry of peripheral blood for |

| |warranted. | |confirmation. |

|@BS39 |An increased number of target cell erythrocytes. These cells |@BS52 |Lymphocytosis with a few smudge cells. Suggest repeat CBC in 3-4 |

| |may be seen in iron deficiency anemia, some hemoglobinopathies,| |weeks to rule out chronic lymphocytic leukemia (CLL), followed by |

| |thalassemia, liver disease and after splenectomy. | |flow cytometry of peripheral blood for confirmation. |

|@BS40 |Sickle cells consistent with sickle cell anemia. |@BS53 |Abnormal lymphoid cells suggestive of peripheral blood involvement |

| | | |by lymphoma. Recommend flow cytometry of peripheral blood for |

| | | |confirmation. |

|@BS41 |Anemia with schistocytes suggestive of hemolytic anemia. A |@BS54 |Mature granulocytosis suggestive of a reactive or infectious |

| |serum haptoglobin level may be helpful. | |process. |

|@BS42 |Anemia with RBC rouleaux, rule out multiple myeloma/ |@BS55 |Left shift of granulocytes suggestive of reactive, infectious or |

| |lymphoproliferative disorder. | |therapeutic process. |

|@BS43 |Nucleated red blood cells which may be consistent with the |@BS56 |Left shift of granulocytes suggestive of reactive, infectious or |

| |patient's age. Suggest repeat CBC in 2-3 weeks. | |therapeutic process; cannot rule out myeloproliferative disorder. |

| | | |Recommend repeat CBC in 2-3 weeks, followed by bone marrow |

| | | |examination if findings persist. |

MORE INTERPRETATIONS CONTINUED ON BACK

Discrepancies between tech results and pathologist findings must be resolved. Consult with supervisor. Pathologist Initials/date ____

Abnormal Blood Smear Review: continued

Name_________________________________ Acc. # ______________ Tech _______

|Resulting |Description |Resulting |Description |

|Mnemonic | |Mnemonic | |

|@BS57 |Leukocytosis and thrombocytosis consistent with infectious or |@BS72 |Increased numbers of nucleated red blood cells suggestive of a |

| |inflammatory process. | |therapeutic response. |

|@BS58 |A leukopenia demonstrating morphologically normal leukocytes. |@BS73 |Normocytic, normochromic anemia with hypersegmented neutrophils |

| |Recommend repeat CBC, followed by bone marrow examination if | |suggestive of combined nutritional deficiency (iron, B12, |

| |leukopenia persists. | |folate.) Bone marrow examination may be helpful if these studies|

| | | |are normal. |

|@BS59 |A leukopenia and thrombocytopenia demonstrating morphologically |@BS74 |Macrocytic anemia which may represent vitamin B12/folate |

| |normal leukocytes and platelets. Recommend repeat CBC followed by | |deficiency. Recommend B12/folate levels as clinically indicated.|

| |bone marrow examination if abnormalities persist. | |Consider thyroid, bone marrow or liver diseases or alcohol abuse|

| | | |if serum nutritional factors are normal. |

|@BS60 |Eosinophilia demonstrating mature, morphologically normal |@BS75 |Red cell inclusions (including Howell-Jolly bodies and |

| |eosinophils which may reflect an atopic condition or parasitic | |Pappenheimer bodies) which may be seen post-splenectomy and with|

| |infection. | |megaloblastic and sideroblastic anemias. Nutritional studies may|

| | | |be helpful. |

|@BS61 |Immature cells suggestive of acute leukemia. Recommend bone |@BS76 |Increased numbers of schistocytes which may be seen in hemolytic|

| |marrow examination for further classification as clinically | |anemias including microangiopathic hemolytic anemias such as DIC|

| |warranted. | |and TTP. Please correlate with the clinical scenario. |

| | | |Coagulation studies and a serum haptoglobin may be helpful. |

|@BS62 |Immature granulocytosis suggestive of chronic myelogenous leukemia|@BS77 |Anemia, increased schistocytes, and increased nucleated re blood|

| |(CML). Suggest flow cytometry, chromosome analysis and/or bone | |cells in a newborn suggestive of hemolytic disease of the |

| |marrow examination for further classification as clinically | |newborn. Recommend DAT (direct antiglobulin test) and |

| |warranted. | |Kleihauer-Betke studies as clinically warranted. |

|@BS63 |Quantitative and morphologic abnormalities suggestive of |@BS78 |Marked granulocytosis with mild left shift consistent with an |

| |myeloproliferative disorder. Recommend follow-up studies as | |infectious or inflammatory response. |

| |appropriate. | | |

|@BS64 |Dysplastic cells suggestive of myelodysplasia. Recommend bone |@BS79 |Relative monocytosis; this may be seen in some chronic |

| |marrow examination for further classification as clinically | |infections, neoplasms, collagen vascular diseases and ITP. |

| |warranted. | |Recommend correlation with the clinical scenario. |

|@BS65 |Immature granulocytes accompanied by NRBCs suggestive of |@BS80 |Immature cells suggestive of acute leukemia. Recommend bone |

| |leukoerythroblastic response. | |marrow examination and immunophenotyping for further |

| | | |classification as clinically warranted. |

|@BS66 |Pancytopenia with morphologically normal platelets, leukocytes and|@BS81 |Increased hemoglobin and hematocrit most likely secondary to |

| |red blood cells. Bone marrow examination may be helpful in ruling | |hemoconcentration with decreased plasma volume. This can be seen|

| |out aplastic anemia or a myelodysplastic or myeloproliferative | |in chronic hypoxia or dehydration. |

| |process. | | |

|@BS67 |Cytopenia consistent with chemotherapeutic effects. |@BS82 |Dimorphic RBC’s present with hypochromic forms. Iron studies are|

| | | |recommended. |

|@BS68 |Thrombocytopenia demonstrating morphologically normal platelets |@BS83 |Dimorphic RBC’s present most likely secondary to transfusion. |

| |Recommend repeat CBC followed by bone marrow examination if | | |

| |thrombocytopenia persists. | | |

|@BS69 |A thrombocytosis demonstrating morphologically normal platelets. |@BS84 |___________ (ordering physician or designee) was contacted on |

| |Recommend repeat CBC followed by bone marrow biopsy if | |______________ (date & time) & approved add-on flow testing (x |

| |thrombocytosis persists. | |designates choice): ____ Chronic Lymphoproliferative Panel |

| | | |____ Leukemia Lymphoma Screening Panel. |

|@BS70 |Rare nucleated red blood cells with anemia suggestive of a |@BS85 |Essentially unremarkable peripheral blood smear. |

| |reactive process secondary to the anemia. | | |

|@BS71 |Rare nucleated red blood cells suggestive of a reactive or |@BS86 |Demonstrates: |

| |therapeutic process. | |________________________________________________________________|

| | | |____. / _ |

Discrepancies between tech results and pathologist findings must be resolved. Consult with supervisor. Pathologist Initials/date ____

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