Decision Making and Problem Solving

| 994 | haematologica | 2009; 94(7) Acknowledgments: we want to address our warm thanks to Kathy Heptinstall and to the MDS-Foundation for their technical support in the organization of meetings. We have special thanks for Alain Renault (University Hospital of Rennes) who provided assistance for statistical evaluation. Manuscript received on December 31, 2008. Revised version arrived on February 6, 2009. Manuscript accepted on February 23, 2009. Correspondence: Jean E. Goasguen MD, PhD, Campus Santé, Faculté de Médecine, Hématologie, 2 avenue du Pr Léon Bernard, 35043 Rennes Cedex, France. E-mail: [email protected] The monocyte is still the most difficult cell to identify with confidence in the peripheral blood or in the bone marrow in healthy individuals as well as in patients with infections, and in those with leukemic proliferations. The goal of this study was to establish morphological definitions so that monocytes, including immature monocytes, could be separated from the spectrum of monocyte precursors. Cells from peripheral blood or bone marrow were selected to provide a large panel of normal and leukemic cells at different maturational stages and were submitted to 5 experts, who had previously reached a consensus, on the basis of microscopy, in defining 4 subtypes: monoblast, promonocyte, immature monocyte, mature, monocyte. They achieved a good concordance rate of 76.6% and a high κ rate confirming that the criteria for defining the 4 subtypes could be applied consistently. It has now to be established whether these monocyte subtypes correlate with immunological or molecular markers and are clinically relevant.