Generative Artificial Intelligence in Peripheral Blood Morphology: Synthetic Image Creation and Digital Stain Normalization

The morphological analysis of peripheral blood cells is increasingly adopting deep learning, mainly for the automatic recognition of the variety of normal and abnormal cell classes. However, its clinical application is limited by the scarcity of annotated datasets for rare diseases and the high variability of staining protocols between laboratories. This paper provides an overview of how Generative Artificial Intelligence methods can help overcome these obstacles. Firsts, some basic concepts are presented, distinguishing between discriminative AI and generative AI, specifically generative adversarial networks (GANs) and diffusion models. The core of the paper addresses two problems: (1) the automatic generation of artificial blood cell images and (2) the digital artificial staining to reduce inter-laboratory differences. In these two cases, three sections are included: underlying concepts, a literature review and practical examples. These show how high-quality images of blood cells with realistic morphological characteristics are created, which strengthen the classifier's training. In multicenter tests, the examples illustrate that normalizing the staining allows a classifier trained on abnormal blood cell images from a single hospital to accurately recognize abnormal cells obtained in other laboratories, significantly improving performance without distorting cell morphology. A final section concludes the paper with observations and future perspectives on how generative tools can assist clinical pathologists as decision support systems that can operate consistently across diverse clinical settings.