Leucocyte Differential Count and Evaluation of Blood Cell

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External Quality Assessment Scheme

Leucocyte Differential Count and Evaluation of Blood Cell Morphology, virtual Round 1, 2020 Specimens Two May-Grünwald-Giemsa stained virtual microscopical slides S001 and S002 are available at Labscala. Background information Patient’s age, sex and some data of clinical history are given also online. Parameters Leucocyte Differential Count Evaluation of Blood Cell Morphology Results Please return the results via LabScala. This round will be open starting 01.06.2020 in LabScala.

1. First after logging in the result page opens for the differential count. Please fill in the results and add the date and copy it for all rows.

2. Click ”Case 1” and the virtual microscopy picture appears.

3. In this view you can make the view smaller of bigger by clicking or by choosing the magnification on the upper right corner. The view can be moved by pressing the mouse with the left button and moving it at the same time. Perform the differential count as usual. Return to the dropdown menu by shutting the sheet and save the results as percentage. Note that the sum must be 100%. The result fields can’t be left empty. Fill in 0 if there is no findings.

4. Move to the menus of the evaluation of blood cell morphology. Menu appears when replying ’No’ to the question: ‘Normal blood film, no abnormalities?’ Fill in results.

5. First choose Main group→ Finding→ Scale. When pressing the + sign at the right side of the page you get another new result menu. Save the respondent identification. Save as draft in you want to return to change the findings later.

6. Move always forward by pressing the green Next- button. After that you will reach the sample S002.

7. Repeat with every sample and finally press Accept the results and send to Labquality. Tip! Always use the Save & Next button, this will take you through the process easily.

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2020-06-01 INSTRUCTIONS

Product no. 4180

LQ711920011-012/FI

Subcontracting:

Sample preparation

____________________________

The results should be

reported no later than

June 22, 2020. _________________________

Inquiries

EQA Coordinator

Pirjo Makkonen

[email protected]

Labquality

Kumpulantie 15

FI-00520 HELSINKI

Finland

Tel. + 358 9 8566 8200

Fax + 358 9 8566 8280

[email protected]

www.labquality.fi

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Leucocyte Differential Count Results should be expressed as percentages without decimals. Please check that the total sum is 100%. This is not done automatically.

• Do not include erythroblasts in the leucocyte differential count. Please report them as nucleated red cells.

• Do not include smeared, disrupted nuclear remnants of leucocytes (”Gumbrecht´s shadows”) in the differential count.

Evaluation of Blood Cell Morphology First you have to answer the question if the blood film is normal or not: Normal blood film, no abnormalities? Enter abnormal findings and describe the changes using a scale as below:

• Slight change (scarcely discernible)

• Clear change (e.g. the platelet count clearly decreased)

• Strong change (e.g. plenty of spherocytes)

Leucocyte differential count and evaluation of blood cellmorphology, virtual microscopy, May, 1-2020

Copyright © Labquality Oy

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Erythrocytes

Slight Clear StrongAltered grouping Rouleaux 2 2 0Cell maturation Nucleated red cells 1 0 0

Polychromatophilia 22 1 0Inclusion bodies Basophilic stipling 2 1 0

Howell-Jolly bodies 4 0 0Pappenheimer bodies 1 0 0

Size/shape/Hb-concentration Achantocytes 1 1 0Anisocytosis 53 7 1

Echinocytes/Burr-cells 3 0 0Hypochromic microcytes 8 1 0Macro-ovalocytes 8 2 0Ovalocytes/elliptocytes 5 1 0Pencil shaped cells 1 0 0Poikilocytosis 21 2 0Round macrocytes 7 2 0Schiztocytes/fragm.cells 8 1 0Spherocytes 42 24 5

Target-cells 3 0 0Tear drop shaped cells 4 1 0

Leucocytes

Slight Clear StrongAltered amount of cells Leucocytosis 34 2 0Granulocyte morphology Hypersegmentation 12 0 0

Hypogranulation 1 1 0Irregularly shaped lobi 3 1 0Pelger-Hüet anomaly 1 0 0Toxic granulation 29 20 6

Lymphocyte morphology Atypical lymphocytes 48 30 2Plasma cells 11 1 0Prolymphocytes 5 0 0

Monocyte morphology Atypical monocytes 4 1 0Promonocytes/monoblasts 3 0 0

Proportions of cells Blasts 2 0 1Eosinophilia 1 0 0Lymphocytosis 7 0 0Lymphopenia 2 0 0Monocytosis 4 0 0Neutrophilia 0 1 0

Platelets

Slight Clear StrongAltered amount of cells Thrombocytosis 34 4 0

Case S001|02550

xxxxx



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Erythrocytes

Slight Clear StrongAltered grouping Agglutination 2 0 0

Rouleaux 7 4 0Cell maturation Nucleated red cells 49 2 0

Polychromatophilia 64 45 5

Inclusion bodies Basophilic stipling 2 0 0Howell-Jolly bodies 3 1 0

Size/shape/Hb-concentration Achantocytes 2 0 0Anisocytosis 63 54 6

Echinocytes/Burr-cells 1 0 0Hypochromic microcytes 22 16 1Macro-ovalocytes 29 12 1Ovalocytes/elliptocytes 27 4 0Pencil shaped cells 5 1 0Poikilocytosis 49 17 4Round macrocytes 16 9 0Schiztocytes/fragm.cells 31 6 0

Spherocytes 34 11 1

Target-cells 9 1 1Tear drop shaped cells 51 12 0

Leucocytes

Slight Clear StrongAltered amount of cells Leucocytosis 51 67 8

Granulocyte morphology Auer rods / bodies 3 1 0Hypersegmentation 0 2 0Hypogranulation 2 0 1Irregularly shaped lobi 12 6 2Pelger-Hüet anomaly 14 3 0Toxic granulation 26 23 4

Lymphocyte morphology Atypical lymphocytes 14 5 0Plasma cells 2 0 0Prolymphocytes 1 0 0

Monocyte morphology Atypical monocytes 3 0 0Promonocytes/monoblasts 1 0 0

Proportions of cells Blasts 36 9 1Left shift 10 70 51

Lymphopenia 24 10 4Monocytosis 1 0 0Neutrophilia 7 16 11

Platelets

Slight Clear StrongAltered amount of cells Thrombocytopenia 1 0 0

Thrombocytosis 88 30 0

Case S002|02550

xxxxx



29.06.2020 1/22

Case S001 histogram summaries in LabScala| Blasts, %|



29.06.2020 2/22

Case S001 histogram summaries in LabScala| Promyelocytes, %|



29.06.2020 3/22

Case S001 histogram summaries in LabScala| Myelocytes, %|



29.06.2020 4/22

Case S001 histogram summaries in LabScala| Metamyelocytes, %|



29.06.2020 5/22

Case S001 histogram summaries in LabScala| Band forms, %|



29.06.2020 6/22

Case S001 histogram summaries in LabScala| Neutrophils, %|



29.06.2020 7/22

Case S001 histogram summaries in LabScala| Eosinophils, %|



29.06.2020 8/22

Case S001 histogram summaries in LabScala| Basophils, %|



29.06.2020 9/22

Case S001 histogram summaries in LabScala| Lymphocytes, %|



29.06.2020 10/22

Case S001 histogram summaries in LabScala| Monocytes, %|



29.06.2020 11/22

Case S001 histogram summaries in LabScala| Others, %|



29.06.2020 12/22

Case S002 histogram summaries in LabScala| Blasts, %|



29.06.2020 13/22

Case S002 histogram summaries in LabScala| Promyelocytes, %|



29.06.2020 14/22

Case S002 histogram summaries in LabScala| Myelocytes, %|



29.06.2020 15/22

Case S002 histogram summaries in LabScala| Metamyelocytes, %|



29.06.2020 16/22

Case S002 histogram summaries in LabScala| Band forms, %|



29.06.2020 17/22

Case S002 histogram summaries in LabScala| Neutrophils, %|



29.06.2020 18/22

Case S002 histogram summaries in LabScala| Eosinophils, %|



29.06.2020 19/22

Case S002 histogram summaries in LabScala| Basophils, %|



29.06.2020 20/22

Case S002 histogram summaries in LabScala| Lymphocytes, %|



29.06.2020 21/22

Case S002 histogram summaries in LabScala| Monocytes, %|



29.06.2020 22/22

Case S002 histogram summaries in LabScala| Others, %|

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External Quality Assessment Scheme

Leucocyte Differential Count and Evaluation of Blood Cell Morphology Round 1, 2020 Specimens Sample S001 (LQ711920011) and Sample S002 (LQ711920012) were virtual images in Labscala. Report info The report includes findings, diagnoses, red cell indices, automated cell counts (WBC, PLT) and automated differential count. In leucocyte differential count the percentages are shown in histograms, where laboratory’s own result is marked with an orange dot. Intervals between some classes have been chosen to correspond to reference ranges for different cell types. Separate histograms are produced for each cell type. All evaluated results of blood cell morphology are shown in a table. Laboratory’s own result is marked with a radio button and the green colour indicates the consensus of the expert and at least five out of seven haematologists. Comments – Expert It is important to read the Final report first, because it contains important information of the samples and results in each round. Sample S001 Red blood cells: Red blood cells are normocytic and normochromic, occasional deformed cells, e.g. keratocytes. No increased polychromasia. No nucleated red blood cells. White blood cells: Mild leucocytosis. Neutrophils mainly with segmented nuclei, mild left shift, occasional myelocytes. Lymphocyte morphology mainly normal, occasional cells with strongly basophilic cytoplasm, reactive lymphocytes? No blast cells. Thrombocytes: Mild thrombocytosis, normal thrombocyte morphology. Conclusions: Mild, mainly reactive findings. If the changes are of reactive nature, they should comply with the clinical condition. Differential cell counts: An automated differential count was not possible. The differential count was achieved by manual microscopy. Diagnosis: Mild leucocytosis and thrombocytosis. Reactive changes? The patient has a chronic neurological illness for which she receives immunological therapy.

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2020-06-29 FINAL REPORT

Product no. 4180 Subcontracting: Sample preparation, Digital image services Samples sent 2020-06-01 Round closed 2020-06-22 Final report 2020-06-29 Request for correction Typing errors in laboratory’s result forms are on laboratory’s responsibility. Labquality accepts responsibility only for result processing. Requests must be notified by writing within three weeks from the date of this letter. Authorized by EQA Coordinator Pirjo Makkonen [email protected] Expert Anri Tienhaara, M.D., Ph.D.,Specialist in laboratory hematology, Turku University Central Hospital Labquality Oy Kumpulantie 15 FI-00520 HELSINKI Finland Tel. + 358 9 8566 8200 Fax + 358 9 8566 8280 [email protected] www.labquality.fi

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Copyright © Labquality Oy Labquality does not permit any reproduction for commercial purposes of any portion of the material subject to this copyright. Labquality prohibits any use of its name, or reference to Labquality EQA program, or material in this report in any advertising, brochures or other commercial publications. Labquality EQA data do not necessarily indicate the superiority of instruments, reagents, testing equipments or materials used by participating laboratories. Use of Labquality EQA data to suggest superiority or inferiority of equipments or materials may be deceptive and misleading. Proficiency test results are handled confidentially. Labquality will not issue any statements to third parties of the performance of laboratories in external quality assessment schemes unless otherwise agreed. 2 / 2

Sample S002 Red blood cells: Red blood cells mildly microcytic, mainly normochromic, partly hypochromic. Occasional tear drop poikilocytes, schistocytes. Blue polychromatic cells, occasional nucleated red blood cells. White blood cells: Leucocytosis, neutrophilia, monocytosis. Left shift mainly up to myelocyte level, also occasional blast cells. Normal monocyte and lymphocyte morphology. Thrombocytes: Thrombocytosis, normal thrombocyte morphology. Conclusions: Neutrophilia, left shift, monocytosis, thrombocytosis and a mild leucoerytroblastic finding match with bone marrow recovery after cytostatic treatment, backed up with granulocyte growth factor. Differential cell counts: Neutrophils 79% (14.3 x 109/l), Lymphocytes 10% (1.8 x 109/l), Monocytes 10% (1.8 x 109/l), Eosinophils 0.2%, Basophils 0.5% Diagnosis: The patient was diagnosed with a malignant tumour and cytostatic treatment was started. The findings in the blood sample reflect bone marrow recovery after cytostatic treatment, backed up with granulocyte growth factor. End of report

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Blood cell morphology round, 1/2020DiagnosesSpecimen S001: Mild leucocytosis and thrombocytosis. Reactive changes? The patient has a chronic neurological illness for which she receives immunological therapy.

Specimen S002: The patient was diagnosed with a malignant tumour and cytostatic treatment was started. The findings in the blood sample reflect bone marrow recovery after cytostatic treatment, backed up with granulocyte growth factor.

Labquality | Kumpulantie 15, FI-00520 Helsinki, Finland | Tel. +358 9 8566 8200 | VAT FI01100791 | www.labquality.fi | [email protected]

S002: A monocyte, a myelocyte and a neutrophil S002: A monocyte, a lymphocyte and a neutrophil

S001: One eosinophil and neutrophil S001: One monocyte and neutrophil

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Leucocyte Differential Count and Evaluation of Blood Cell