ࡱ> }|W +bjbjɒ 0ee"k   8C<4 B.-------$(02---"""F-"-""j*,t]]$Fm,2-.0B.,233d,3,""--B.3 : Pathologist Review of Blood Smear Name________________________________ Date: _________ Tech _______ Doctor ____________________ Acc.# ______________ Sex/Age ______ Referral Indication: TECH MUST CIRCLE BEFORE SUBMITTING TO PATHOLOGIST The peripheral blood smear was submitted by the technician for Pathologist review: (Circle one template response from this section) Resulting MnemonicDescription@RIHBDue to the hemoglobin result < 6.9@RIPRAt the request of Dr. ______________@RIPTDue to the platelet count result <50 or > 1001@RITRDue to immature or atypical cells, or atypical inclusions in cells@RIWCDue to the WBC result <1.8 or > 30.1 Interpretive Statement: Pathologist review of blood smear demonstrates: (Circle one template response from this section) Resulting MnemonicDescriptionResulting MnemonicDescription@BS31A microcytic / hypochromic anemia suggestive of iron deficiency. Recommend iron studies as clinically warranted. @BS44Red blood cell inclusions suggestive of previous splenectomy. @BS32Severe, slightly microcytic anemia consistent with acute blood loss and iron deficiency. @BS45Evidence of hemoconcentration suggestive of dehydration. @BS33A microcytic anemia suggestive of hemoglobinopathy. Recommend hemoglobin electrophoresis as clinically warranted. @BS46Relative lymphocytosis consisting of mature normal lymphocytes which may indicate viral infection. @BS34A microcytic anemia, which may indicate hemoglobinopathy or iron deficiency. Suggest hemoglobin electrophoresis or iron studies as clinically appropriate. @BS47Lymphocytosis with increased reactive lymphs suggestive of viral infection. @BS35Normocytic anemia consistent with acute blood loss. @BS48Reactive lymphocytes suggestive of viral infection. @BS36Normocytic anemia consistent with chronic disease and/or acute blood loss. @BS49The presence of increased reactive lymphocytes which, while consistent with a viral infection, are not specific for infectious mononucleosis. If clinically warranted, suggest reevaluation in one week, or more sensitive testing for infectious mononucleosis. @BS37Normocytic, normochromic anemia. Suggest work-up for combined nutritional (iron/vitamin B12/folate) deficiency. @BS50Lymphocytes suggestive of infectious mononucleosis. Suggest mono test as clinically warranted. @BS38A macrocytosis which may indicate vitamin B12/folate deficiency. Recommend B12/folate levels as clinically warranted. @BS51Lymphocytosis with smudge cells suggestive of chronic lymphocytic leukemia (CLL). Recommend flow cytometry of peripheral blood for confirmation. @BS39An increased number of target cell erythrocytes. These cells may be seen in iron deficiency anemia, some hemoglobinopathies, thalassemia, liver disease and after splenectomy. @BS52Lymphocytosis with a few smudge cells. Suggest repeat CBC in 3-4 weeks to rule out chronic lymphocytic leukemia (CLL), followed by flow cytometry of peripheral blood for confirmation. @BS40Sickle cells consistent with sickle cell anemia. @BS53Abnormal lymphoid cells suggestive of peripheral blood involvement by lymphoma. Recommend flow cytometry of peripheral blood for confirmation. @BS41Anemia with schistocytes suggestive of hemolytic anemia. A serum haptoglobin level may be helpful. @BS54Mature granulocytosis suggestive of a reactive or infectious process. @BS42Anemia with RBC rouleaux, rule out multiple myeloma/ lymphoproliferative disorder. @BS55Left shift of granulocytes suggestive of reactive, infectious or therapeutic process. @BS43Nucleated red blood cells which may be consistent with the patient's age. Suggest repeat CBC in 2-3 weeks. @BS56Left shift of granulocytes suggestive of reactive, infectious or therapeutic process; cannot rule out myeloproliferative disorder. Recommend repeat CBC in 2-3 weeks, followed by bone marrow examination if findings persist.  MORE INTERPRETATIONS CONTINUED ON BACK Discrepancies between tech results and pathologist findings must be resolved. Consult with supervisor. Pathologist Initials/date ____ Abnormal Blood Smear Review: continued Name_________________________________ Acc. # ______________ Tech _______ Resulting MnemonicDescriptionResulting MnemonicDescription@BS57Leukocytosis and thrombocytosis consistent with infectious or inflammatory process. @BS72Increased numbers of nucleated red blood cells suggestive of a therapeutic response.@BS58A leukopenia demonstrating morphologically normal leukocytes. Recommend repeat CBC, followed by bone marrow examination if leukopenia persists. @BS73Normocytic, normochromic anemia with hypersegmented neutrophils suggestive of combined nutritional deficiency (iron, B12, folate.) Bone marrow examination may be helpful if these studies are normal.@BS59A leukopenia and thrombocytopenia demonstrating morphologically normal leukocytes and platelets. Recommend repeat CBC followed by bone marrow examination if abnormalities persist. @BS74Macrocytic anemia which may represent vitamin B12/folate deficiency. Recommend B12/folate levels as clinically indicated. Consider thyroid, bone marrow or liver diseases or alcohol abuse if serum nutritional factors are normal.@BS60Eosinophilia demonstrating mature, morphologically normal eosinophils which may reflect an atopic condition or parasitic infection. @BS75Red cell inclusions (including Howell-Jolly bodies and Pappenheimer bodies) which may be seen post-splenectomy and with megaloblastic and sideroblastic anemias. Nutritional studies may be helpful.@BS61Immature cells suggestive of acute leukemia. Recommend bone marrow examination for further classification as clinically warranted. @BS76Increased numbers of schistocytes which may be seen in hemolytic anemias including microangiopathic hemolytic anemias such as DIC and TTP. Please correlate with the clinical scenario. Coagulation studies and a serum haptoglobin may be helpful.@BS62Immature granulocytosis suggestive of chronic myelogenous leukemia (CML). Suggest flow cytometry, chromosome analysis and/or bone marrow examination for further classification as clinically warranted. @BS77Anemia, increased schistocytes, and increased nucleated re blood cells in a newborn suggestive of hemolytic disease of the newborn. Recommend DAT (direct antiglobulin test) and Kleihauer-Betke studies as clinically warranted. @BS63Quantitative and morphologic abnormalities suggestive of myeloproliferative disorder. Recommend follow-up studies as appropriate.@BS78Marked granulocytosis with mild left shift consistent with an infectious or inflammatory response.@BS64Dysplastic cells suggestive of myelodysplasia. Recommend bone marrow examination for further classification as clinically warranted. @BS79Relative monocytosis; this may be seen in some chronic infections, neoplasms, collagen vascular diseases and ITP. Recommend correlation with the clinical scenario.@BS65Immature granulocytes accompanied by NRBCs suggestive of leukoerythroblastic response. @BS80Immature cells suggestive of acute leukemia. Recommend bone marrow examination and immunophenotyping for further classification as clinically warranted. @BS66Pancytopenia with morphologically normal platelets, leukocytes and red blood cells. Bone marrow examination may be helpful in ruling out aplastic anemia or a myelodysplastic or myeloproliferative process. @BS81Increased hemoglobin and hematocrit most likely secondary to hemoconcentration with decreased plasma volume. This can be seen in chronic hypoxia or dehydration.@BS67Cytopenia consistent with chemotherapeutic effects. @BS82Dimorphic RBCs present with hypochromic forms. Iron studies are recommended.@BS68Thrombocytopenia demonstrating morphologically normal platelets Recommend repeat CBC followed by bone marrow examination if thrombocytopenia persists. @BS83Dimorphic RBCs present most likely secondary to transfusion.@BS69A thrombocytosis demonstrating morphologically normal platelets. Recommend repeat CBC followed by bone marrow biopsy if thrombocytosis persists. @BS84___________ (ordering physician or designee) was contacted on ______________ (date & time) & approved add-on flow testing (x designates choice): ____ Chronic Lymphoproliferative Panel ____ Leukemia Lymphoma Screening Panel. @BS70Rare nucleated red blood cells with anemia suggestive of a reactive process secondary to the anemia.@BS85Essentially unremarkable peripheral blood smear.@BS71Rare nucleated red blood cells suggestive of a reactive or therapeutic process.@BS86Demonstrates: ____________________________________________________________________. / _ Discrepancies between tech results and pathologist findings must be resolved. Consult with supervisor. 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