Morphology

While we would like to put a lot more than we do in this section but this is tricky because of copyright, and nothing unfortunately replaces regularly looking at morphology slides under a microscope. We can however give some advice about what to do in the exam (top 10 tips courtesy of Dr David Cummins, consultant haematologist, Royal Brompton and Harefield Hospitals); lists of features which become part of pattern recognition; and some advice about interpreting trephines:

Top ten tips during the morphology exam:

1. Don't get flustered if you don't know what's going on... remember your technique in reviewing blood films (platelets first; then red cells and white cells etc.)
2. Ensure you examine the 'correct' part of the film - in order to pick up the pathology. Often the tendency is to examine too thick a part of the film (or in the case of possible parasites, not examining sufficiently at low power).
3. Check for normal features (that everything you expect to be there is actually there!).
4. There may be cases where the diagnosis is not clear - especially in the long cases. Be prepared to come up with a list of differential diagnoses.
5. DO NOT run out of time! You should get through all of the exam questions even if you don't answer all of the subquestions.
6. Don't use loaded terms (e.g. blue polychromasia if not myelofibrosis; or 'Sputnik cells' if not pyruvate kinase deficiency post splenectomy) unless you are convinced of the diagnosis
7. Learn all your basic immunophenotyping markers - if you memorise them a few days before the exam you may not need to remember them again!
8. If you've found the diagnosis - make sure you check for associated features and a second pathology (e.g. if you note CLL check for autoimmune haemolysis or features suggestive of ITP). One NEQAS film had CML with concomitant Plasmodium falciparum!
9. Put the features down on the answer sheet in order of the most salient terms diagnostically. Do not use woolly terms such as anisopoikilocytosis!
10. Treat it seriously - but try to think of it as any other mock exam or group study session that you had in the past.

Microscope

Ensure you identify a microscope that you are able to take to the exam with a couple of months to go, and start practising with it well before the time comes. The exam centre will probably have a microscope for you to use if you ask in advance but anything that is going to have you flustered with the morphology paper is not ideal! Most tertiary hospitals you work at will have a number of microscopes, but if not your DGH may have one if you ask the pathology manager for one to borrow.

Bring with you:

• spare bulb and immersion oil (oil divides candidates - some will say you have enough time to use oil and some disagree; if you are well practised with it and time yourself with practice slides then it is extremely useful to have to hand for clarity and confirmation of pathology). The pathology will be obvious at x40 objective.
• Objective lenses: x10, x40 and x100 as a minimum; an extra x40 would be nice (in case you get oil on your first x40) plus a x4 (to look at trephines)

Rarer cases of blood film morphology >>

Bone marrow trephines >>