Difficultés de détection et d'interprétation de cellules anormales circulantes

Total blood count with white blood cell differential is now a fully automated procedure. Its result can be validated in absence of flags or quantitative abnormalities. In all other situations, after having eliminated preanalytical or technical problems, a blood smear is mandatory to look for abnormal circulating cells. The smear and staining quality is a prerequisite for an optimal analysis of the slide. In a number of cases, the cytological examination, after a careful analysis of cells, will allow a definite diagnosis. Sometimes, the cytology will remain ambiguous and immunophenotyping will be necessary to distinguish mainly atypical forms of non-Hodgkin lymphomas from acute leukemias, or, more rarely, from a reactive process. Peripheral blood smear interpretation of abnormal circulating cells is a specialized cytology which requires expert clinical pathologists in private as well as in hospital practice.