MYELODYSPLASTIC SYNDROME NOT OTHERWISE CLASSIFIED. DO AUTOMATIC METHODS CORRELATE WITH THE MICROSCOPIC METHOD OF BLOOD SMEAR ASSESSMENT?

Background
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal malignancies of the hematopoietic system, characterized by ineffective hematopoiesis with peripheral cytopenias. The aim of the study was to detect differences between automatic leukocyte separation and microscopic evaluation of a blood smear in a patient with MDS.

Material and methods
A 68-year-old patient with a history of MDS pancytopenia and vascular bleeding diathesis was admitted to the Department of Internal Diseases and Endocrinology of the University Clinical Centre of the Medical University of Warsaw. The patient was diagnosed with metabolic alkalosis, renal failure and hyperparathyroidism. Morphological examinations showed persistent pancytopenia. The microscopic evaluation of the blood smear showed features of dysplasia, e.g. asynchrony of nucleus/cytoplasm maturation, hypogranulation of the granulocyte cytoplasm, unequal distribution of granules in the cytoplasm, and hyposegmentation in neutrophils.

Results
omplete blood count and blood smear are presented as percentages obtained from automatic leukocyte separation and microscopic smear evaluation of three consecutive patient examinations, respectively. The largest discrepancies were in the proportion of eosinophils (0.6%/1.3%/0% vs. 29.5%/26.0%/9.0%), neutrophils (49.7%/41.7%/32.4% vs 26.0%/ 13.6%/22.0%) and atypical lymphocytes (4.4%/2.9% vs 2.4%/5.0%). Microscopic analysis also showed the presence of eosinophils at various stages of maturation (eosinophilic myelocytes).

Conclusions
Automatic blood smear analysis compared to manual analysis can show significantly different results. To diagnose diseases of the hematopoietic system, it is recommended to verify the results of the tests using the microscopic method. Bone marrow cytogenetic and molecular tests can also be performed as an auxiliary.