Many years ago, our lab abandoned the use general terms like aniso and poik in favor of specific terms like microcytes, acanthocytes, etc. So that if you could not say something specific above a reporting threshold, it was normal. I believe that change was a significant improvement to eliminate the noise of "slight aniso' and 'slight poik'. We also adopted a ranked grading scheme proposed by Pat Garrity and Jerry Walters in a 1993 training video on the subject. Here you will find the reporting thresholds and the two tiered grading scheme. The video has been digitized and is currently posted on YouTube (
Standardization of Red Cell Morphology Reporting) . Our students chuckle at the 1993 production techniques but we use this video to this day in our curriculum. My colleague Argie Leach and I published our experience in CLS in the year 2000.
Assessing competence in finding and reporting abnormal morphologic features while scanning peripheral blood smears. - PubMed - NCBIDoes the grading have value? I think of it like this: If my child had a CBC investigating a clinical finding, would I like to look at the slide? The answer is a resounding yes because I have seen enough misleading indices in my career.
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Daniel Haun
Clinical Instructor/ eLearning Developer
LSU Health Sciences Center
New Orleans LA
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Original Message:
Sent: 08-10-2018 12:36
From: Holly Weinberg
Subject: Reporting RBC morphology Macro/Micro and/or Aniso
I was involved in a project to update our morphology reporting a few years back. One change we made was to stop reporting any 'size' parameters on the manual scan/diff. The measured parameters, MCV and RDW are more accurate than looking at distorted cells with the naked eye. Also, its very common to over-report aniso, micro and macro often just out of habit. Aniso is grossly over-reported to the point that the clinician sees nothing on the report but 'slight aniso' and misses the significant findings later in the morphology report. The worst one to me is the report of 'slight aniso, slight micro, slight macro' - aka - normal!
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Holly Weinberg
Region VIII Director
Original Message:
Sent: 08-10-2018 07:03
From: Rick Panning
Subject: Reporting RBC morphology Macro/Micro and/or Aniso
First of all we are not actually looking at a slide to be able to comment on micro/macro, aniso, etc. on a minority of our specimens as we rely on reporting the automated CBC and differential on about 90+% of our samples. The qualitative morphology comments are only made when a manual differential or slide review is required, or when the clinician has specifically ordered a blood morphology or slide review. This applies the same in our clinic labs, small hospital labs and large hospital laboratories as all have the capability to perform an automated 5 part diff.
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Rick Panning
Senior Administrative Director
HealthPartners
Bloomington MN
6512805909
Original Message:
Sent: 08-09-2018 11:55
From: Victoria Robbe
Subject: Reporting RBC morphology Macro/Micro and/or Aniso
Question: Does anyone just report the CBC indices and RDW and forego reporting micro/macro and/or aniso on the differential? We are starting to explore doing this and wondered if others have given up reporting these parameters.
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Victoria Robbe
Laboratory Operations Manager
Seattle, WA
(206) 987-4099
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