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Reporting RBC morphology Macro/Micro and/or Aniso

  • 1.  Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-09-2018 11:56
    ​​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.

    Victoria Robbe
    Laboratory Operations Manager
    Seattle, WA
    (206) 987-4099

  • 2.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-10-2018 04:43
    ​We do that at my facility. It seems to work out for everyone. It does kill me sometimes to not call a high RDW or low MCV. What we end up calling is "Mild RBC Morphology" as a means to indicate a response to the abnormal values. The only value we still take notice of is MCHC due to anemia.

    Hope this helps!

    Ian Wallace
    Medical Laboratory Scientist
    Saint Joseph Hospital
    Lakewood CO
    (505) 577-2230

  • 3.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-10-2018 07:03
    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.

    Rick Panning
    Senior Administrative Director
    Bloomington MN

  • 4.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-10-2018 12:36
    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!

    Holly Weinberg
    Region VIII Director

  • 5.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-11-2018 08:07
    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 - NCBI

    Does 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.

    Daniel Haun
    Clinical Instructor/ eLearning Developer
    LSU Health Sciences Center
    New Orleans LA

  • 6.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-13-2018 18:28
    I just watched that video. Bravo, ladies, for providing those guidelines.  I wish they were in place now, it would make it easier to teach morphology.  Our MLS program is affiliated with over 20 hospitals.  We created a standardized morphology training sheet for use during Hematology class using what we considered to be the best practices. I hope that our grads are putting it in place where they work. The comment about docs working at more than one hospital is an important consideration.

    Kristina Behan
    Professor of MLS
    University of West Florida
    Pensacola, FL
    (850) 4743060

  • 7.  RE: Reporting RBC morphology Macro/Micro and/or Aniso

    Posted 08-11-2018 13:59
    The lab I work at only comments on RBC morphology when the RDW-CV is >21% rather than the 15% recommended in many text books. We do not use the comments anisocytosis or poikilocytosis in general. We will only comment on specific abnormalities such as schistocytes, acanthocytes, spherocytes, etc.

    I hope this was helpful.

    Robert Sheehan, MLS(ASCP)CM
    Pittsburgh PA