On 2013 Jul 01, Dita Gratzinger commented:

This important study evaluates the performance characteristics of morphologic classification of myelodysplastic syndromes (MDS) according to the currently-used World Health Organization (WHO) 2008 criteria. Importantly, while moderate agreement was observed overall, significant areas of poor concordance included erythroid dysplasia and percentage of circulating blasts. The latter is particularly important given the impact of small changes in peripheral blood blast percentage on MDS category as per WHO 2008 criteria: a hypothetical patient with 3% bone marrow blasts and multilineage dysplasia would be classified as refractory cytopenia with multilineage dysplasia if she had 0.5% circulating blasts, myelodysplastic syndrome-unclassified if she had 1% circulating blasts, and refractory anemia with excess blasts-1 if she had 1.5% circulating blasts. It is possible that a 500 cell, rather than 200 cell, differential count would be helpful in increasing concordance in instances where circulating blasts are present, although even a low rate of miscalls could still result in discordance when such small changes in percentage result in reclassification.

On 2013 Jul 01, Dita Gratzinger commented:

This important study evaluates the performance characteristics of morphologic classification of myelodysplastic syndromes (MDS) according to the currently-used World Health Organization (WHO) 2008 criteria. Importantly, while moderate agreement was observed overall, significant areas of poor concordance included erythroid dysplasia and percentage of circulating blasts. The latter is particularly important given the impact of small changes in peripheral blood blast percentage on MDS category as per WHO 2008 criteria: a hypothetical patient with 3% bone marrow blasts and multilineage dysplasia would be classified as refractory cytopenia with multilineage dysplasia if she had 0.5% circulating blasts, myelodysplastic syndrome-unclassified if she had 1% circulating blasts, and refractory anemia with excess blasts-1 if she had 1.5% circulating blasts. It is possible that a 500 cell, rather than 200 cell, differential count would be helpful in increasing concordance in instances where circulating blasts are present, although even a low rate of miscalls could still result in discordance when such small changes in percentage result in reclassification.