Answer to Comment on the Editorial ‘Should hematologists put there microscopes on eBay?’

We are very happy with the reaction of Prof. Shaun McCann1 to our recent Editorial2 because it may initiate more thinking and discussion about the role of morphology in the diagnosis of hematologic malignancies. What’s more, we agree with most of his statements. Not, however, that our Spotlight was meant to state that clinical hematologists should abandon their microscopes (it should be noted that the headline of our small ‘finger exercise’ ended with a question mark).2 What we intended to say is that the role of morphology is changing from being only a diagnostic technique to becoming a first-line technique at the beginning of stepwise diverse diagnostic algorithms. The comparison with physical examination is very appropriate. You never can skip the physical examination, but a heart murmur will instigate an ultrasound examination rather than a discussion as to whether it is proto-diastolic or late systolic. The same is true for morphology, even for APL, because the quite distinct morphological features that need to be recognized and taught should initiate the next steps, such as FISH and PCR. Although in most cases you can be pretty sure about a diagnosis made only on the basis of morphological examination, you do need the confirmation of genetics to start or continue all trans-retinoic acid.

Thus, the clinical hematologist should have an even more important role in the diagnostic process in the molecular era. Morphological examination of blood films and bone marrows has to lead the way in this process.

To be prepared for this task, hematologists should not abandon their micro-scopes but should adapt their microscopy skills.