Next-generation morphology, a novel multilayer morphometric digital analysis, reveals both the basic topology and new trends of myelodysplasia of peripheral blood specimens.

Traditional microscopy compromises between resolution and field of view, limiting its diagnostic sensitivity. We present here next-generation morphology (NGM), a novel five-layer analytical approach leveraging a physical solution that enables high-resolution, large-field digital imaging, data mining and analysis of blood specimens. To test NGM performance, peripheral blood smears (PBS) from 37 myelodysplastic syndrome (MDS) patients and 30 age-matched controls were analysed. PBS topology was mapped to identify regions optimal for analysis. Red blood cells (RBCs) displayed a gradient distribution with a narrow zone suitable for accurate morphological assessment. NGM facilitated direct morphometric measurements of individual red and white blood cells (RBCs and WBCs), which were correlated with clinical variables. Significant morphometric differences were found between MDS and controls, particularly in RBC size, shape and neutrophil granularity and subpopulations profile. WBC differentials based on 1000 WBC significantly elevated blasts detection compared to conventional 100-WBC counts. Multivariate analysis linked RBC morphometrics with high-risk MDS. In summary, NGM overcomes traditional microscopy limitations, offering high-resolution, large-field imaging for sensitive digital morphometry of PBS. This technology can enhance the detection and quantitative characterization of haematological abnormalities, thereby contributing to the understanding of MDS physiology, and may support early detection of dysplasia in PBS.