Proposed PBS review consensus statements
| Curricular considerations | |
| 1 | Education across the fellowship should incorporate both slides derived from patients under the care of the fellow as well as slides from formal slide libraries of high yield morphologies |
| 2 | Trainees should be well versed in the description of normal and pathologic nuclear and cytoplasmic characteristics |
| 3 | Curricula should include education on how PBS review can augment, or potentially eliminate the need for, more advanced testing |
| 4 | Discussions of the practical use of PBS review should occur within the context of the medical system as a whole with specific attention devoted to discussions of:(a)Avoiding clinically relevant delays in diagnosis and treatment(b)Providing care in resource limited settings(c)Cost of care and financial toxicity of advanced diagnostic testing |
| 5 | Trainees should be aware of and familiar with intracellular parasites (malaria, babesia, ehrlichia/anaplasma) regardless of their geographic location of training |
| Method of review | |
| 1 | Trainees should be taught to systematically review a PBS. This includes specific education on identification of the monolayer, use of various magnifications, switching between magnification, and systematic review of each cell line |
| 2 | Learners should be competent in the personal use of a compound light microscope, and should receive hands on training throughout fellowship |
| 3 | Learners should be made aware of limitations associated with the use of digital and remote microscopy use |
| Morphology | |
| 1 | Emphasis should be placed on(a)Disorders where correct and timely diagnosis is paramount to avoiding significant patient morbidity, acute decompensation, or death(b)Commonly encountered diagnoses |
| 2 | Trainees should be able to identify features of normal PBSs |
| 3 | Specific curricular emphasis should be placed on the morphologic presentation of acute leukemias and hemolytic anemias, including TMA |
| Disorders of white blood cells | |
| Trainees should be able to: | |
| 1 | Distinguish reactive leukocytosis from malignant processes |
| 2 | Identify blasts and myeloid precursors |
| 3 | Recognize evidence of myeloid dysplasia in peripheral blood |
| 4 | Identify the following cells on a PBS: atypical (reactive) lymphocytes, large granular lymphocytes, mature lymphocytes, mature myeloid cells, and immature myeloid precursors |
| 5 | Identify circulating promyelocytes, specifically in the context of suspected acute promyelocytic leukemia |
| Disorders of red blood cells | |
| Trainees should be able to: | |
| 1 | Readily identify peripheral smear evidence of TMA, with specific emphasis on identification of schistocytes |
| 2 | Hypothesize the mechanism of hemolytic anemia based upon red blood cell morphology and the presence of poikilocytes |
| 3 | Identify sickle cell morphology |
| 4 | Identify morphologic findings seen in thalassemias, specifically in the absence of other clinical data such as family history, hemoglobin electrophoresis, and genetic testing |
| Disorders of platelets | |
| Trainees should be able to: | |
| 1 | Identify platelet clumping (satellitism) |
| 2 | Recognize variation in platelet size |
| 3 | Identify relative thrombocytosis or thrombocytopenia |
| All statements had unanimous consensus and exceeded the prespecified threshold (>70%) for strong consensus. | |
| Curricular considerations | |
| 1 | Education across the fellowship should incorporate both slides derived from patients under the care of the fellow as well as slides from formal slide libraries of high yield morphologies |
| 2 | Trainees should be well versed in the description of normal and pathologic nuclear and cytoplasmic characteristics |
| 3 | Curricula should include education on how PBS review can augment, or potentially eliminate the need for, more advanced testing |
| 4 | Discussions of the practical use of PBS review should occur within the context of the medical system as a whole with specific attention devoted to discussions of:(a)Avoiding clinically relevant delays in diagnosis and treatment(b)Providing care in resource limited settings(c)Cost of care and financial toxicity of advanced diagnostic testing |
| 5 | Trainees should be aware of and familiar with intracellular parasites (malaria, babesia, ehrlichia/anaplasma) regardless of their geographic location of training |
| Method of review | |
| 1 | Trainees should be taught to systematically review a PBS. This includes specific education on identification of the monolayer, use of various magnifications, switching between magnification, and systematic review of each cell line |
| 2 | Learners should be competent in the personal use of a compound light microscope, and should receive hands on training throughout fellowship |
| 3 | Learners should be made aware of limitations associated with the use of digital and remote microscopy use |
| Morphology | |
| 1 | Emphasis should be placed on(a)Disorders where correct and timely diagnosis is paramount to avoiding significant patient morbidity, acute decompensation, or death(b)Commonly encountered diagnoses |
| 2 | Trainees should be able to identify features of normal PBSs |
| 3 | Specific curricular emphasis should be placed on the morphologic presentation of acute leukemias and hemolytic anemias, including TMA |
| Disorders of white blood cells | |
| Trainees should be able to: | |
| 1 | Distinguish reactive leukocytosis from malignant processes |
| 2 | Identify blasts and myeloid precursors |
| 3 | Recognize evidence of myeloid dysplasia in peripheral blood |
| 4 | Identify the following cells on a PBS: atypical (reactive) lymphocytes, large granular lymphocytes, mature lymphocytes, mature myeloid cells, and immature myeloid precursors |
| 5 | Identify circulating promyelocytes, specifically in the context of suspected acute promyelocytic leukemia |
| Disorders of red blood cells | |
| Trainees should be able to: | |
| 1 | Readily identify peripheral smear evidence of TMA, with specific emphasis on identification of schistocytes |
| 2 | Hypothesize the mechanism of hemolytic anemia based upon red blood cell morphology and the presence of poikilocytes |
| 3 | Identify sickle cell morphology |
| 4 | Identify morphologic findings seen in thalassemias, specifically in the absence of other clinical data such as family history, hemoglobin electrophoresis, and genetic testing |
| Disorders of platelets | |
| Trainees should be able to: | |
| 1 | Identify platelet clumping (satellitism) |
| 2 | Recognize variation in platelet size |
| 3 | Identify relative thrombocytosis or thrombocytopenia |
| All statements had unanimous consensus and exceeded the prespecified threshold (>70%) for strong consensus. | |