Aaron Goodman: The 4 most important blood smears for medical students for the USMLE and for life!

Aaron Goodman shared a post on his X/Twitter page:

“The 4 most important blood smears for medical students for the USMLE and for life! A short tweetorial/smearorial of 4 blood smears.

1. Fevers, Altered mental status (AMS), hemolytic anaemia, thrombocytopenia. It is Thrombotic thrombocytopenic purpura (TTP) with ADAMTS13 deficiency. Treatment with plasmapheresis. Smear with schistocytes and thrombocytopenia.

2. 25 year old with bleeding, thrombocytopenia and low fibrinogen. It is disseminated intravascular coagulation (DIC). Smear with large promyelocytes with granules, blasts with Auer rods, schistocytes can be present from DIC with Acute Promyelocytic Leukemia (APL) with t(15;17). Treatment with All-trans retinoic acid (ATRA). [ASH IMAGE BANK]

3. 50 year old asymptomatic with neutrophilic leukocytosis, basophilia, splenomegaly. Smear with leukocytosis rare blasts, myelocytes, sets, mature polymorphonuclear neutrophils, basophils. Note: WBCs with many different shapes and sizes unlike acute leukemia (blasts all big). Chronic myelogenous leukemia (CML) with t(9;22) and BCR-ABL1. Treatment with imatinib.

4. 75 year old asymptomatic gets routine CBC with WBC 150,000, almost all lymphocytes. Smear with numerous small lymphocytes with condensed nucleus and smudge cells. It is Chronic lymphocytic leukemia (CLL). Treatment is observervation. [ASH IMAGE BANK]”

Source: Aaron Goodman/X

Aaron Goodman is a Hematologist/ Oncologist and an Associate Professor of Medicine at the University of California, San Diego. He is a member of the National Comprehensive Cancer Network (NCCN) guideline committee for both cutaneous NHLs and T-cell NHLs. Dr. Goodman is a well-known physician-scientist, educator, advocate, and social media influencer.