Automated Digital Morphometry of Peripheral Blood Smears Detects Both Infrequent Events and Cellular Population Patterns in Myelodysplastic Syndrome

Background: Complete Blood Count (CBC) analytical capacity is falling short of recognizing informative RBC morphology or WBC dysplastic morphological changes. Current morphologic peripheral blood smear (PBS) analysis is performed manually using a semi-quantitative scale on a limited number of cells introducing high degree of subjectivity and low sensitivity. The novel Full-Field Morphology (FFM) technology developed by Scopio Labs performs PBS analysis on a significantly larger scale of 1000 fields of 100X view in a routine manner, allowing a precise and highly sensitive automated quantification of cellular and sub-cellular morphological parameters. Current diagnosis of myelodysplastic syndrome (MDS) is based on invasive bone marrow aspirate, followed by subjective morphological analysis. In this study, we applied this digital morphometric approach to compare PBS morphology of MDS patients with age-matched controls. Methods: 32 MDS (average age 80+10, [range 41-97] y, F:M ratio 14:18) and 30 age-matched control (average age 79+9, [range 65-100] y, F:M ratio 13:17) PBS were scanned by the Scopio Labs system, and evaluated according to three distinct morphological features with known significance in MDS: blast percentage per 100 or 1000 WBC; neutrophil cytoplasmic granulation per 1000 neutrophils; RBC morphology of at least 150,000 RBC. Quantitative determination of neutrophils granulation, was measured by Granulation Index (GI, between 0-1) and GI Distribution Width (GIDW, between 0-1). RBC measurements included the quantitative measurements of RBC size, namely macro- and microcytosis, and RBC contour changes (deformation), i.e. the percent of RBC that deviate from normal RBC shape. Results: The mean GI of MDS samples was 0.36+0.15, [range 0.14-0.63] (Fig. 1A middle, Fig. 1E), significantly (p