Online morphology training
and competency assessment
A new initiative
Gillian Rozenberg
Online Morphology
 February 2016 marks the completion of ‘Online Morphology’, an online
haematology training and competency course. I have worked together with
three scientists, a haematologist, Elsevier Australia and the RCPAQAP.
‘Online Morphology’ has been developed as an educational tool in the field
of Haematology Morphology for both Medical Scientists and Haematology
Registrars.
 Using this program, members of the Australian Institute of Medical Scientists
(AIMS) will complete the Competency Questions and Answers to gain APACE
points. The RCPAQAP will use ‘Online Morphology’ as an educational tool as
well as a tool to assess competency. A certificate of completion can be
printed at the end of the 3 part course.
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Online Morphology
 ‘Online Morphology’ is comprised of three parts,
 Red Cells,
 White Cells and
 Platelets.
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Online Morphology
 Part 1: Red Cells, is divided into seven modules and an
introductory blood film review module:
 Blood film review
1. Erythropoiesis
2. Nomenclature
3. Red cell Inclusions
4. Microcytic and macrocytic anaemias
5. Thalassaemias and other haemoglobinopathies
6. Haemolysis
7. Red cell membrane disorders
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Online Morphology
 Part 2: White Cells, is also divided into seven modules:
1.
2.
3.
4.
5.
6.
7.
Leucocyte maturation
Review of morphological abnormalities
Myeloproliferative neoplasms
Acute leukaemia
Lymphoproliferative neoplasms
Reactive lymphocytes
Plasma cells
 Part 3: Platelets
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ICSH Nomenclature…
 Whilst working with my colleagues on ‘Online Morphology’ I was the
Australian representative working on the ‘ICSH recommendations for the
standardization of nomenclature and grading blood cell morphological
features’ which was published in the International Journal of Laboratory
Hematology in June 2015. One can link some of the ICSH changes suggested
in this document with ‘Online Morphology’.
 In general, when it comes to the red cells, there is not a lot of disagreement
between the nomenclature suggested by the ICSH and that used by the
RCPAQAP.
 The use of the term ‘Schistocyte’ to describe a red cell fragment seen in
microangiopathic haemolytic anaemia is still somewhat controversial in some
institutions.
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ICSH recommendation - red cell
 The ICSH list of synonyms for a schistocyte:
 burr cell,
 helmet cell,
 horn cell,
 keratoschistocyte,
 pincer cell,
 poikilocyte,
 prickle cell,
 red cell fragment,
 schizocyte,
 thorn cell and
 triangular cell.
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Nomenclature
Module (6.10)
Haemolysis
Module (4)
Case study (11)
ICSH recommendation – white cell
 The ICSH lists under ‘Qualitative abnormalities in lymphoid cells’:
 “Lymphocyte morphology is subject to wide variability due to various
immunological stimuli both in inflammatory and infectious diseases
(particularly viral) as well as in neoplastic disorders (leukaemias and
lymphomas), resulting in circulating lymphocytes with morphological
abnormalities in various quantities”.
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ICSH recommendation – white cell
 “Terminology for these lymphocytes has been varied and confused with
many different terms being used to describe the same thing including variant,
reactive, abnormal, activated and atypical lymphocytes, Downey cells, Türk
cells, immunoblasts and even combinations of cells, for example monocytoid
lymphocytes. This highlights the need to simplify the terminology”.
 “It is recommended that reactive lymphocyte is used to describe
lymphocytes with a benign aetiology and abnormal lymphocyte with an
accompanying description of the cells is used to describe lymphocytes with a
suspected malignant or clonal aetiology”.
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Reactive
lymphocytes
Module (4)
Lymphoproliferativ
e neoplasms
Module (2)
Case study (20)
ICSH recommendation – platelet
 “Platelet size is of diagnostic significance particularly when considered in
relation to the platelet count. Large platelets are roughly the diameter of a
normal sized red cell whilst giant platelets are larger than normal sized red
cells. In a normal person, usually less than 5% of the platelets appear large”.
 “Hypogranular platelets, exhibit little, if any, of the purple red granules found
in normal platelets. It is recommended that a comment about the presence
of hypogranular platelets be made if seen on the peripheral blood film”.
 In ‘Online Morphology’ the interpretation of the platelet histogram and the
importance of differentiating between the impedance platelet count and the
optical platelet count is emphasized.
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Platelet
Module
(3), (5), (6),
(8.2)
(8.3)
SUMMARY
 Each module consists of information and a quiz which the trainee should pass
before moving onto the next module. The pass mark is 100% and the trainee
is granted two attempts at each question. The reason for the high score is
because the authors believe in the importance of being able to differentiate,
for example, between a reactive lymphocyte and a blast cell.
 On completion of all three parts to this course – red cells, white cells and
platelets – and once the trainee has passed the accompanying quizzes, they
will be issued with a certificate of completion.
 ‘Online morphology’ includes case studies accompanied by virtual slides.
 To maintain continuing education, four case studies will be added to this
resource annually.
 ‘Online morphology’ has voice over recording.
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To follow in May:
 Paediatric morphology module
 Adjunct to the online morphology course
 Containing case studies and virtual images
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Acknowledgements
 Renee Segalla – Senior Scientist, Haematology, Pathology West (Westmead Hospital)
 Dorra Arvanitis – Scientist, Haematology, Pathology West (Westmead Hospital)
 Vanessa Li – Scientist, Haematology, Pathology West (Westmead Hospital)
 Charmaine Marsh- Senior Scientist, Flow Cytometry, SEALS Randwick (Prince of Wales Hospital)
 Pauline Dalzell- Senior Scientist, Cytogenetics, SEALS Randwick (Prince of Wales Hospital)
 Dr Lesley Survela – Haematologist, Haematology, Pathology West (Westmead Hospital)
 Melinda McEvoy – Publisher, Health Professions, Elsevier Australia
 Sybil Kesteven – Elsevier Australia
 Rochelle Deighton – Senior Project Manager, Elsevier Australia
 Rosemary McDonald - Senior Project Manager, Elsevier Australia
 Fifin Intan – Education and Training Coordinator, RCPA Quality Assurance Programs
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Reviewers
 The Late Professor Jerry Koutts – Haematologist, Pathology West (Westmead
Hospital)
 Dr John Giannoutsos – Haematologist, Pathology West (Nepean Hospital)
 Dr Katherine Marsden - Haematologist/Chairperson RCPAQAP Haematology
 Professor Richard Cohn – Paediatric Oncologist, SESIAHS (The Sydney
Children’s Hospital)
 Craig Williams – Chief Medical Scientist, Haematology, Sullivan Nicolaides
Pathology, Queensland
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Reviewers
 Dr Cathy Durkin – Haematology Trainer at Dorevitch Pathology, Melbourne
 Professor Gina Zini – Catholic University of Sacred Heart, Rome, Italy
 Professor Wendy Erber – University of Western Australia and PathWest
Laboratory Medicine, Perth
 Dr Anne Kornreich – Head Laboratory Medecine Department, Grand Hôpital
de Charleroi, Belgium
 Dr Carol Briggs – University College London Hospitals, London, UK
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COME AND HEAR MORE ABOUT:
Online Haematology Morphology
A training and competency assessment
program
at the
Elsevier Stand
with
GILLIAN ROZENBERG
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