Blood Film Morphology in the Diagnosis of Haematological Malignancies at Ekiti State University Teaching Hospital, South West Nigeria

Peripheral blood film examination by an experienced haematologist or medical laboratory scientist remains a valuable, cost-effective, and rapid technique for diagnosing and classifying haematological malignancies in resource-limited settings. This study evaluated the role of blood film morphology in the diagnosis of haematological malignancies at Ekiti State University Teaching Hospital, Ado-Ekiti, South West Nigeria. A cross-sectional retrospective study reviewed blood film and bone marrow records of 120 patients diagnosed with haematological malignancies over a four-year period. Films were re-examined by two independent senior scientists, and morphological findings were correlated with final diagnoses, immunophenotyping results where available, and clinical outcomes. Acute leukaemias accounted for 48.3% of diagnoses, with ALL more common than AML. Chronic leukaemias represented 27.5%, lymphomas 16.7%, and multiple myeloma 7.5%. Blast percentage on film correlated well with bone marrow blast count in acute leukaemias. Morphological clues including Auer rods, smudge cells, rouleaux formation, and Reed-Sternberg-like cells directed provisional diagnoses subsequently confirmed by other methods. Immunophenotyping was available in only 38.3% of cases, limiting final subclassification. The study affirms the indispensable diagnostic role of expert blood film morphology in settings with limited immunophenotyping access and recommends investment in flow cytometry infrastructure at teaching hospitals in South West Nigeria to enhance haematological malignancy classification. Keywords: blood film morphology, haematological malignancies, leukaemia, bone marrow, Ekiti State