Reading the Blood Film: White Cells

What this deck covers

Reading the Blood Film: White Cells in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Counting the lobes
2. The granules have changed
3. Pale patches at the edge
4. Two lobes, in almost all
5. Not yet segmented
6. Lymphocytes that look busy
7. Cells with nothing around them
8. Holes in the cytoplasm
9. How a differential is made
10. Percentage against number
11. Counted as white cells
12. The line that gets written

What this deck teaches

• Count the lobes. More than five separate lobes is a finding with a number behind it, and the number is what makes it reproducible between readers.
• Describe the cytoplasm as well as the nucleus. Coarse granules, pale blue patches, clear round holes: three findings that live outside the nucleus and are missed by looking only at shape.
• A proportion can turn an appearance into a different finding. A few two-lobed neutrophils mean little. Nearly every neutrophil two-lobed is a different report, and only counting tells them apart.
• The differential is a count. A hundred cells, counted. An impression of the field is not a differential and cannot be compared with the last one.
• Percentage and absolute number answer different questions. A neutrophil percentage falls when lymphocytes rise. Whether the neutrophils are low is answered by their own number.
• Not everything with a nucleus is a white cell. Nucleated red cells are counted as white cells by most analysers, and the film is where that is caught.

Exam pearls from this deck

• Count them. A number is reproducible and an impression is not.
• The nucleus can be normal while the cytoplasm carries the finding.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all haematology illustrated case decks · haematology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.