Comment on: ‘Should clinical hematologists put their microscopes on eBay?’

I read the Editorial by van’t Veer and Haferlach with interest.1 I disagree with their premise that clinical hematologists should abandon their microscopes. Whereas undoubtedly there have been many very useful technological advances which have shed light on the pathogenesis of hematologic malignancies the etiology of most of which remains obscure, I and many others believe that examination of a well-made blood film is an important part of the history and physical examination.

Relying on sophisticated technology without looking at the tissue to be examined is fraught with danger. The diagnosis of acute promyelocytic leukemia (APL) can be made within minutes by examination of peripheral blood and bone marrow, and appropriate and sometimes life-saving treatment initiated long before the results of molecular tests become available. Likewise, how many of us have seen the result of a lymph node biopsy stating the diagnosis as that of ‘a well differentiated lymphocytic lymphoma’, when examination of a blood film could have made the diagnosis of chronic lymphocytic leukemia and avoided the discomfort of a biopsy? Once the skill of microscopy has been lost by hematologists it will never return.

Incidentally, the authors might like to know that some clinical hematologists are female and that sentences beginning with ‘He’ to describe clinical hematologists are inappropriate!