Book Review

Interactive Haematology Imagebank

N Engl J Med 2000; 343:1201-1202October 19, 2000

Article

Interactive Haematology Imagebank
CD-ROM. By Barbara J. Bain. System needed: Windows 95, 98, or NT. Malden, Mass., Blackwell Science, 1999. $195. ISBN: 0-632-05321-6

I once knew a hematologist who could recognize a patient from the blood smear — the teardrop cells, giant platelets, and nucleated red cells signaled the presence in the waiting room of the woman with myelofibrosis. Back then, hematologists examined the blood smear of virtually every patient they saw in consultation. Looking at the blood smear and bone marrow aspirate gave them a vivid connection to the patient and was as essential as the physical examination. Today, regrettably, many hematologists have little time to practice the art of examining the blood smear. Instead, they look at a ticket printed by a machine that produces numerical values and a histogram depicting measurements of any cell in the blood. I have not made a study of the reasons for the shift from the microscope to the ticket, but time and money are surely important. In the United States, hematologists receive no payment for the time and skill required to examine and interpret a blood smear. Cardiologists, by contrast, do receive a fee for interpreting an electrocardiogram. Moreover, the pressures on specialty trainees to become experts in both hematology and oncology have reduced the time available for the intensive study of blood smears and bone marrow preparations. Instead of doing the looking themselves, they depend on technicians, many of whom are superb morphologists, but without the vital connection with the patient.

Now, with the Interactive Haematology Imagebank, a splendid example of the educational power of the computer, every trainee and experienced hematologist has the opportunity to sit at leisure for personal lessons from a master teacher. The images on my screen are superb, and the accompanying commentaries are succinct and informative. A zoom feature magnifies the image for close inspection. Another useful tool is “Compare,” which allows the user to look simultaneously at two images — the blasts of acute lymphoblastic leukemia and those of M0 acute myelogenous leukemia, for example.

The program displays on command almost every morphologic aspect of blood and bone marrow cells. Three sections, for medical students, laboratory scientists, and hematologists, present the material from an elementary to an advanced level. One can proceed systematically, browse, or search. For me, the best feature is “Test,” which consists of hundreds of questions at increasingly difficult levels of knowledge. After choosing a question, the user is shown a photograph of a blood or bone marrow smear (or a biopsy specimen), a clinical finding (e.g., a mass in the neck), or some other image, plus a multiple-choice question, usually in the form, “What is the diagnosis?” A challenging teacher, “Test” will surely humble even the most sophisticated hematologist. My weaknesses in identifying parasites and interpreting karyotypes were quickly revealed.

There is more here than morphology. Another part of the program, “Learn,” shows the main clinical features of numerous hematologic conditions. Under sickle cell anemia, for example, the program displays radiographic images of osteonecrosis, gallstones, and the acute chest syndrome; a magnetic resonance image of cerebral infarction; and electrophoretic patterns of normal and abnormal hemoglobins. In the section on chronic lymphocytic leukemia, one finds demonstrations of immunophenotyping and two complications of the disease, autoimmune hemolytic anemia and herpes zoster. Clicking on “More” brings up a brief, instructive commentary on the image. The lack of a way to print the useful tables and definitions of oncogenes and CD numbers for later reference is one of the program's few shortcomings.

The Interactive Haematology Imagebank is not only an atlas. It is also an easily searched, clinically oriented catalogue of pithy commentary and concise definitions. It is not meant to replace the standard textbooks of hematology but is surely more flexible, challenging, and pleasurable to use than old-fashioned print. This CD-ROM will conveniently test and teach any student, trainee, or physician — even a board-certified hematologist.

Robert S. Schwartz, M.D.