Cracking the CBC code: Basics of CBC testing and unmasking leukemia, anemia, and mimics through smear sleuthing 

3.0 ACCENT credits / 3.0 CME credits
Sunday, July 27, 2025
Morning course | 9 a.m. – 12 p.m. US Central Time
McCormick Place Chicago

Description

This course covers the basics of CBC-D testing, regulatory and quality components of automated testing, and peripheral blood smear review indications. Blood smear review requires a broad knowledge base, pattern-recognition skills, and data integration to appropriately pursue follow-up testing for diagnosis. We will focus on CBC with smear review interpretation to distinguish reactive from neoplastic cell populations, appropriate flagging of critical findings such as hemolytic anemia, and confirmation of CBC results. The course will be a mixture of didactics with audience polling and guided-inquiry learning (facilitated group activities including virtual slide review) by speakers with expertise in medical laboratory science, hematopathology, and clinical chemistry. The intended audience are medical technologists with an interest in hematology and new-in-practice laboratory supervisors and faculty directors who may have little to no prior experience in laboratory hematology.

Target audience

This activity is designed for lab supervisors, lab directors (and/or assistant directors), lab managers (supervisory and/or non-supervisory), medical technologists, and in-training individuals.

Presentation level

Basic

Prerequisite knowledge

General knowledge regarding the following items will be helpful, but not required:

• Peripheral blood cellular composition in healthy and disease states
• Automated hematology analyzer methodology basics
• Regulatory aspects of the clinical laboratory

What to bring

A laptop or personal device for notetaking and audience participation.

Learning objectives

After participating in this course, participants will be able to:

• Recognize the basic principles of automated complete blood count (CBC) analyzers and appropriate correction of spurious results, as well as essential regulatory and quality requirements in the clinical hematology laboratory.
• Distinguish reactive from neoplastic populations in peripheral blood smear review, develop a differential diagnosis, and understand the clinical scenarios in which flow cytometry should be considered.
• Recognize critical blood smear findings that must trigger notification to clinical providers, including diagnostic red blood cell findings for hemolytic anemia due to oxidant insults and blood-borne infectious organisms (such as parasitemia, fungemia).

Skills you will gain

After participating in this course, participants will be able to:

• Interpret an automated differential for a complete blood count
• Interpret a peripheral blood smear
• Formulate a differential diagnosis including additional testing required from abnormal hematology results

Faculty

Mark Girton, MD, ABPath, DABCC | University of Michigan

David Maciak, MHA, MLS(ASCP)CM | St. Luke's Hospital

Nam Ku, MD, ABPath | University of California, Los Angeles

Maria (Ria) Vergara-Lluri, MD, ABPath | University of Southern California, Los Angeles

Course outline

1. (30 min) Introduction: Basics of hematology (David Maciak)
   This section covers fundamental hematology concepts, including CBC instrumentation, regulatory components, and lab accreditation checklist items such as quality control automation, alternative procedures, and ways to ensure reproducibility. It also explores automated results,and manual workflow and blood smear review triggers, including discussion on erroneous results and flags that can prompt manual intervention. Audience polling will be used throughout.
   
   
2. (30 min) Focus on leukocytes (Mark Girton)
   In this section, Dr. Ku will focus on leukocytes in the clinical laboratory with practical guides in leukocyte recognition, Dr. Ku will focus on signs of neoplasia, including cytoses and cytopenias. We will also explore the differences in leukemia subtypes – chronic versus acute and myeloid versus lymphoid leukemia. Audience polling will be used throughout.
   
   (10 min) Break
   
   
3. (30 min) RBCs, platelets/anisopoikilocytosis, and other big words (Ria Vergara-Lluri)
   Dr. Ria Vergara-Lluri will cover essential diagnoses related to red blood cells (RBCs) and platelets. Topics include critical RBC abnormalities, platelet disorders, anisopoikilocytosis, and recognizing infectious organisms in blood smears.
   
   
4. (30 min) Virtual slide review: Myeloid and lymphoid proliferations
   Faculty will lead a facilitated discussion using patient cases and virtual slide review to provide participants hands-on opportunities to practice identification of myeloid and lymphoid related proliferations. Participants will be guided through paired examples of benign and malignant profilerations in the following:
   Myeloid proliferations (benign vs malignant)
   • Leukemoid reaction
   • Acute myeloid leukemia (AML)
   • Chronic myeloid leukemia (CML)
   Lymphoid proliferations (benign vs malignant)
   • Reactive lymphocytosis including infectious mononucleosis
   • Chronic lymphocytic leukemia (CLL)
   • B and T lymphoblastic/leukemia/lymphoma
   
   
5. (30 min) Virtual slide review: RBCs and platelets
   Faculty will lead a facilitated discussion using patient cases and virtual slide review to provide participants hands-on opportunities to practice diagnosis  of RBC and platelet abnormalities that include critical RBC abnormalities, platelet artifacts and mimics, and others.
   
   
6. (10 min) Group wrap-up
   
   
7. (10 min) Pearls and pitfalls (Mark Girton)
   Faculty will review key take-home messages, actionable practice changes, and resources. Faculty will address potential pitfalls in practice and open the room for audience questions that were not already addressed in prior course sections.