Suspected blasts on peripheral blood smear
Author:
Mikael Häggström [note 1]
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
- ↑ 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.
- ↑ 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:. 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
- ↑ 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:. PMID 30803991. PMC: 6509567. Archived from the original. .
Image sources