Professor Barbara J Bain covers some of the circumstances when blood films are vital.
The morphologist assessing a blood film in the context of a full blood count, with or without a relevant clinical history, can sometimes make a speedy diagnosis that contributes greatly to management of the patient. This is often of a specifically haematological disorder, but sometimes it is of a condition in which haematological abnormalities are just part of a broader clinical picture. The blood film that is being assessed may have been requested by a clinician or may be generated as a result of an abnormality in the full blood count or an instrument flag. Some of the medical emergencies in which a blood film can be crucial will be discussed.
Acute promyelocytic leukaemia
Acute promyelocytic leukaemia (APL) is a medical emergency because the associated disseminated intravascular coagulation and increased fibrinolysis can lead to fatal haemorrhage, particularly intracerebral haemorrhage, soon after presentation. These patients require not only replacement of platelets and deficient clotting factors, but also emergency treatment with all-trans-retinoic acid while awaiting molecular confirmation of the diagnosis. The blood film may be examined either because of a clinical suspicion or because the platelet count has been found to be low. Both hypergranular APL and the hypogranular/microgranular variant must be recognised. Once it is appreciated that a patient has some type of acute leukaemia the presence of thrombocytopenia that is disproportionate to the mild anaemia can be a clue to APL.
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