Taking "Cellfies": Blood Morphology in the Era of Smartphones

Background: Microscopic examination of blood and marrow smears by hematologists is an essential clinical skill at risk of extinction in this high-tech era. This skill is on the decline being replaced by the reliance on flow cytometry, FISH, and molecular diagnostics. Five years ago, we observed that photographs of the oil-immersion field (OIF) in focus could be taken by positioning the smartphone camera lens close to either eyepiece. The captured image could be viewed on the smartphone, swiped to view detail, stored, and shared. We coined the term "Cellfie" for this smartphone image of the OIF. Cellfies can be taken with any smartphone at any microscope, with most learners taking a few minutes for their first Cellfie, and experts able to take Cellfies in a few seconds. Since 2012, we have taught fellows to use Cellfies at the microscope in the hospital and in clinic, and we present the experience of our hematology fellows using Cellfies.

Methods: We surveyed past and current hematology fellows (Class of 2015-to Class of 2019) regarding their experience with Cellfies.

Results: Nineteen of the twenty fellows invited to participate in the survey responded (95%). Two were PGY IV, 4 were PGY V, and 6 were PGY-VI. Four were fellows who graduated and in practice for one year (3 fellows did not provide level of training). Fifteen of 19 fellows (79%) had taken a Cellfie at some point during their training. Five took <10 Cellfies, 4 took 10-20 Cellfies, and one fellow had taken 50 or more Cellfies. Eight (53%) fellows rated the technique as 'easy', and 6 as 'difficult' (40%); one patient found the technique 'very difficult'. Cellfies were commonly used for consultation (80% of responders) and morphology teaching or use in conferences (67%). Only 2 responders had ever used Cellfies to paste in the electronic medical record (EMR). Overall, 80% of the responders thought Cellfies as a very useful tool in their everyday hematology practice.

Conclusion: Cellfie use by hematology fellows has resurrected this essential clinical skill of expertise in blood morphology. We have found a way to rekindle a passion for morphology and renew enthusiasm amongst hematology fellows, residents, and students to use information from microscopy as an essential component of their clinical skills. Taking and sharing Cellfies has the potential to put microscope skills back at the bedside, enable rapid diagnosis and treatment, shorten time to intervention in emergencies (acute promyelocytic leukemia, microangiopathy syndromes for example), expedite consultation after-hours and weekends, improve the quality of documentation in EMRs, create a portfolio of stored images for review, and teaching, and enhance patient-care.