In our continual effort to improve our services, the Morphology section of the IQMH Hematology Scientific Committee conducted a review of the Morphology analysis worksheet, and several improvement opportunities were identified.

The following changes have been made to the analysis worksheet to reflect information found in current guidelines and published literature and are also expected to better support the move forward with providing digital images for future surveys.

Changes to the Morphology Analysis Worksheet

1. Absolute differential will now be based on a 100-cell count unless otherwise stated.¹
2. Report what you consider the most likely diagnosis based on the evidence provided. The diagnostic portion of the morphology surveys will remain voluntary and no follow-up by IQMH will take place.
3. The reporting of the differential has been simplified. Participants will no longer need to distinguish between reactive and abnormal lymphocytes. Instead, both reactive and abnormal lymphocytes should be included in the lymphocyte count if present. If abnormal lymphocytes are present, they can be acknowledged in the descriptive morphology statement section.²
4. The descriptive morphology statement section will include a section for lymphocyte description with a drop-down for participants to select from the following:

• No morphological lymphocyte abnormality
• Reactive lymphocytes (when deemed to be significant and/or when relevant to the diagnosis)
• Abnormal lymphocytes, with a comment field

5. An additional section has been included for participants to select additional laboratory investigations needed to confirm the diagnosis.
6. Reporting of smudge cells: count as the cell from which they are derived. If this is not readily apparent, then indicate the presence in the comment section.²
7. These changes will be in effect for the January 2021 MORP-2101-VSB survey.

References

1.   Leung E, Johnston A, Olsen B, Chang H, Martin T, Wozniak M, Good D. Laboratory practices for manual blood film review: Results of an IQMH patterns of practice survey. Int J Lab Hematol. 2020 Sep 17.

2.  Palmer L, Briggs C, McFadden S, Zini G, Burthem J, Rozenberg G, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol. 2015;37:287–303.

Contact Information

Institute for Quality Management in Healthcare
Centre for Proficiency Testing
1500–393 University Avenue
Toronto, Ontario
M5G 1E6
Tel: 416-323-9540
Fax: 416-323-9324

Suggestions or inquiries should be addressed to:
Anna Johnston, Consultant Technologist, Hematology-Morphology
Email: ajohnston@iqmh.org
Extension: 231
Alternate email: info@iqmh.org