Suspected blasts on peripheral blood smear: Difference between revisions

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Exclude acute promyelocytic leukemia (APL)
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*Whether the cells are '''definite''' blast cells, '''suspected''' blast cells, or another cell type.
*Whether the cells are '''definite''' blast cells, '''suspected''' blast cells, or another cell type.
*The '''percentage''' of blasts compared to all white blood cells.
*The '''percentage''' of blasts compared to all white blood cells.
 
If it is a new finding, generally proceed as follows:
==New finding of blast cells==
If it is a new finding (not already being part of a known diagnosis), generally proceed as follows:
*During '''regular work hours''', confirm that the person who reports on peripheral blood smears is notified about the case, so that the case is prioritized. Generally, the procedure is to make a complete peripheral blood smear report, in addition to calling the clinician about the presence of blasts. {{further|Peripheral blood smear}}
*During '''regular work hours''', confirm that the person who reports on peripheral blood smears is notified about the case, so that the case is prioritized. Generally, the procedure is to make a complete peripheral blood smear report, in addition to calling the clinician about the presence of blasts. {{further|Peripheral blood smear}}
*During '''on call hours''', ask the technician to perform a manual count if not already done.  
*During '''on call hours''', ask the technician to perform a manual count if not already done.  
:*If you are '''close''' to the lab, generally look at the slide yourself as well to estimate the blast percentage.  
:*If you are '''close''' to the lab, generally look at the slide yourself as well to estimate the blast percentage.  
:*If you are '''far''' from the lab, ask a technician if images can be sent to you by '''[[micrography and telepathology]]'''.
:*If you are '''far''' from the lab, ask a technician if images can be sent to you by '''[[micrography and telepathology]]'''.
:Consult with a senior or hematopathologist as needed, before conveying a preliminary report to the lab technician and/or clinician. At least during on call hours, it is not necessary to speculate about further sub-classification of blast cells.
 
===Exclude acute promyelocytic leukemia (APL)===
Even a suspected APL mandates immediate initiation of ATRA treatment (which only costs about $40 as a first dose) before confirming or disproving the diagnosis by further workup.<ref name="pmid30803991">{{cite journal| author=Sanz MA, Fenaux P, Tallman MS, Estey EH, Löwenberg B, Naoe T | display-authors=etal| title=Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet. | journal=Blood | year= 2019 | volume= 133 | issue= 15 | pages= 1630-1643 | pmid=30803991 | doi=10.1182/blood-2019-01-894980 | pmc=6509567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30803991  }} </ref><ref group=note>Dosage of ATRA in APL is 45 mg/m<sup>2</sup>/day administered as two evenly divided doses, which for a typical adult is about 40 mg as a first dose. The cost per 10mg capsule is about $10.<br>- Dosage: {{cite journal| author=Osman AEG, Anderson J, Churpek JE, Christ TN, Curran E, Godley LA | display-authors=etal| title=Treatment of Acute Promyelocytic Leukemia in Adults. | journal=J Oncol Pract | year= 2018 | volume= 14 | issue= 11 | pages= 649-657 | pmid=30423270 | doi=10.1200/JOP.18.00328 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423270  }}
<br>- Cost per 10mg capsule: {{cite web|url=https://www.pharmacychecker.com/vesanoid/#!|title=Vesanoid Prices|website=pharmacychecker.com|accessdate=2022-11-09}}<br>The treatment must be started immediately to counteract severe coagulopathy of untreated APL.</ref>
 
===Consulting and reporting===
[[Consultation|Consult]] with a senior or hematopathologist as needed, before conveying a preliminary report to the lab technician and/or clinician. At least during on call hours, it is not necessary to speculate about further sub-classification of blast cells.
{{Bottom}}
{{Bottom}}

Revision as of 19:00, 29 November 2022

Author: Mikael Häggström [note 1]

File:Myeloblast with Auer rod.jpg
Blast cell, generally having large nucleus, immature chromatin, a prominent nucleolus, scant cytoplasm and few or no cytoplasmic granules. This example has an Auer rod (to the left of the nucleus).

When a tech or equivalent lets you know that there are suspected blasts on a peripheral blood smear, the following needs to be determined:

  • If it is a new finding or a known condition in the patient, generally by a medical records lookup.
  • Whether the cells are definite blast cells, suspected blast cells, or another cell type.
  • The percentage of blasts compared to all white blood cells.

New finding of blast cells

If it is a new finding (not already being part of a known diagnosis), generally proceed as follows:

  • During regular work hours, confirm that the person who reports on peripheral blood smears is notified about the case, so that the case is prioritized. Generally, the procedure is to make a complete peripheral blood smear report, in addition to calling the clinician about the presence of blasts. Further information: Peripheral blood smear
  • During on call hours, ask the technician to perform a manual count if not already done.
  • If you are close to the lab, generally look at the slide yourself as well to estimate the blast percentage.
  • If you are far from the lab, ask a technician if images can be sent to you by micrography and telepathology.

Exclude acute promyelocytic leukemia (APL)

Even a suspected APL mandates immediate initiation of ATRA treatment (which only costs about $40 as a first dose) before confirming or disproving the diagnosis by further workup.[1][note 2]

Consulting and reporting

Consult with a senior or hematopathologist as needed, before conveying a preliminary report to the lab technician and/or clinician. At least during on call hours, it is not necessary to speculate about further sub-classification of blast cells.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ Dosage of ATRA in APL is 45 mg/m2/day administered as two evenly divided doses, which for a typical adult is about 40 mg as a first dose. The cost per 10mg capsule is about $10.
    - Dosage: Osman AEG, Anderson J, Churpek JE, Christ TN, Curran E, Godley LA (2018). "Treatment of Acute Promyelocytic Leukemia in Adults. ". J Oncol Pract 14 (11): 649-657. doi:10.1200/JOP.18.00328. PMID 30423270. Archived from the original. . 
    - Cost per 10mg capsule: . Vesanoid Prices. pharmacychecker.com. Retrieved on 2022-11-09.
    The treatment must be started immediately to counteract severe coagulopathy of untreated APL.

Main page

References

  1. ↑ Sanz MA, Fenaux P, Tallman MS, Estey EH, Löwenberg B, Naoe T (2019). "Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet. ". Blood 133 (15): 1630-1643. doi:10.1182/blood-2019-01-894980. PMID 30803991. PMC: 6509567. Archived from the original. . 

Image sources


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