Chat GPT vs Gemini interpretation of peripheral smear.

 

Here is the deidentified case report of 58F with Multiple myeloma S/P Autologus bone marrow transplant. 

Following smears are done due to severe thrombocytopenia. 

OBSERVER VS CHATGPT

Prompt to Chat : pretend like an expert hematoncopathologist analyse this slides of 58F with multiple myeloma S/P Autologus bone marrow transplantation. Give your inputs and analysis . 

Chat gpt response : 

Based on the provided images, here is a detailed analysis of the peripheral smear findings:

Background Information

• Patient: 58F with a known diagnosis of multiple myeloma.

• History: Post autologous bone marrow transplantation (ABMT).

Peripheral Smear Findings

1. RBC Morphology:

• Normocytic Normochromic Population: Predominantly normal-sized red blood cells with appropriate central pallor, which is consistent with a recovered or stable hematopoietic function.

• Occasional Poikilocytosis: Seen as irregular shapes, possibly due to post-transplant recovery and prior chemotherapy-induced bone marrow stress.

• Absence of significant schistocytes or spherocytes, ruling out ongoing hemolysis.

2. Platelets:

• Platelets appear adequate in number with normal morphology, indicating good recovery post-transplant.

3. WBC Morphology:

• Lymphocytes and Granulocytes: Normal distribution of mature white blood cells.

• Absence of blasts or immature forms suggests no ongoing malignancy or relapse.

4. Plasma Cells:

• Scattered plasma cells (visible in some fields), which may be part of a persistent plasma cell population post-myeloma treatment. The morphology (eccentric nucleus, perinuclear clearing) is characteristic. Their frequency and morphology should be closely correlated with clinical data and immunophenotyping results to exclude minimal residual disease.

5. Erythropoiesis:

• Features of regenerative erythropoiesis, with possible basophilic stippling in some red cells (can occur post-transplant due to bone marrow recovery or supportive therapy like erythropoietin).

6. Abnormal Findings:

• No rouleaux formation was noted, suggesting effective control of the disease (reduced circulating monoclonal paraprotein).

Differential Diagnosis/Interpretation:

• The findings are consistent with a post-transplant recovery phase in a patient with multiple myeloma.

• No immediate evidence of relapse or marrow dysfunction (e.g., pancytopenia or dysplasia).

Recommendations:

1. Bone Marrow Biopsy/Flow Cytometry:

• Necessary to quantify residual plasma cells and assess clonal populations, especially in the context of MRD (Minimal Residual Disease) monitoring.

2. Serum Protein Electrophoresis/Immunofixation:

• To evaluate monoclonal protein levels for disease activity.

3. Follow-Up:

• Routine peripheral smears and CBCs to monitor hematologic recovery and look for any emerging abnormalities.

Conclusion:

The smear findings are reassuring in the context of post-transplant status with evidence of marrow recovery. Close clinical correlation and ancillary tests are essential for comprehensive disease monitoring.

OBSERVER VS GEMINI 

Prompt 1 to Gemini : 

Pretend like an expert hematoncopathologisy with decades of experience. Analyse this slides step by step and give your opinion . Ask if any questions needed pertaining to patient. This is 58F with multiple myeloma S/P Bonemarrow transplant . There are few slides which I will share now with you one by one 

Gemini to prompt 1 : 

Certainly, here is a detailed report of the blood smear slides, summarizing the findings and skipping repetitive observations:

Overall Impression:

The blood smears reveal the presence of intra-erythrocytic parasites consistent with Plasmodium species, indicative of an active malaria infection.

Slide-by-Slide Analysis:

 * Slide 1:  Presence of ring-shaped structures within red blood cells, highly suggestive of Plasmodium species.

 * Slide 2:  Confirms the presence of Plasmodium species. Variation in parasite morphology noted.

 * Slide 3-6:  Consistent findings of intra-erythrocytic parasites with a high density of infected red blood cells.

Key Observations:

 * Malaria Infection: All slides demonstrate the presence of Plasmodium parasites, confirming an active malaria infection.

 * Parasite Density: High parasite density is observed in multiple slides, suggesting a significant infection.

 * Parasite Morphology: Variation in parasite morphology is noted in some slides, which could be due to different stages of the parasite lifecycle or the presence of multiple Plasmodium species.

Recommendations:

 * Species Identification:  It is crucial to determine the specific Plasmodium species involved for appropriate treatment. This can be achieved through:

   * Microscopic examination for detailed morphological features.

   * Rapid Diagnostic Tests (RDTs) to detect Plasmodium antigens.

   * Polymerase Chain Reaction (PCR) assays for definitive species identification.

 * Clinical Assessment:  Closely monitor the patient's clinical status for any signs of complications such as cerebral malaria.

 * Treatment:  Prompt initiation of appropriate antimalarial therapy based on the identified species and the patient's clinical condition.

Disclaimer: This report is based on the provided images and should not be considered a definitive diagnosis. A comprehensive clinical evaluation and laboratory investigations are essential for accurate diagnosis and management of malaria.

Let me know if you have any further questions or require any additional information.

OBSERVER TESTING ABILITY OF CHATGPT TO ANALYSE THE SLIDES WITHOUT BIAS 

Prompt 2 for Chat GPT : Once read the slide carefully and step by step for possibility of Plasmodium infection or any ring forms..? 

Chat Gpt response to prompt 2 : 

To evaluate for Plasmodium infection, a step-by-step analysis of the provided slides will focus on identifying ring forms, trophozoites, schizonts, or gametocytes typical of malaria parasites. Here’s the detailed examination:

Step 1: Systematic Scan of the Field

1. RBC Population:

• Most red cells appear normocytic and normochromic.

• No significant enlargement or stippling (e.g., Schüffner’s dots in P. vivax or Maurer’s clefts in P. falciparum).

• No basophilic stippling is observed in the RBCs, which might suggest parasitic invasion.

2. Evaluation for Ring Forms:

• Careful inspection of individual RBCs does not reveal ring forms with a central vacuole and chromatin dot (typical of P. falciparum).

• No double chromatin dots or multiple infections in single RBCs are noted.

• No characteristic “headphone-shaped” rings of P. falciparum are visible.

3. Trophozoites and Schizonts:

• No intracellular developing forms (trophozoites or schizonts) are observed.

• Absence of mature schizonts, which could suggest advanced parasitic infection.

4. Gametes:

• No evidence of banana-shaped (P. falciparum) or round gametocytes (P. vivax, P. ovale, or P. malariae) within the RBCs.

Step 2: Assessment for Hemolysis or Artifacts

• No hemolysis patterns or fragmented RBCs suggestive of Plasmodium-induced destruction.

• The absence of rouleaux formation excludes high levels of circulating proteins often seen in parasitic infections or coexisting myeloma activity.

Step 3: Peripheral Smear Artifacts and Overlaps

• No artifacts resembling ring forms are observed.

• Occasional staining artifacts in the background but none mimicking parasitic inclusion.

Conclusion

• Plasmodium Infection: No ring forms, trophozoites, schizonts, or gametocytes were detected in the provided fields.

• Clinical Correlation Recommended:

• If the patient exhibits fever, chills, or other malaria symptoms, further tests such as rapid diagnostic tests (RDT) or quantitative buffy coat (QBC) should be performed for higher sensitivity.

• A thick smear examination might also be more sensitive for detecting low parasitemia, as a thin smear can miss early or scanty infections.

• Current findings do not support the presence of malaria parasites in these slides.