Can You Trust Frozen Hematology Foundation Models under Acquisition Shift?

Frozen hematology foundation-model (FM) embeddings reach near-saturated in-domain white-blood-cell (WBC) accuracy, but clinical deployment demands reliability across scanners, sites, stains and preparation pipelines. We audit 15 frozen encoders (hematology, pathology, and general vision) across four public single-cell acquisition domains along two axes: accuracy robustness and calibration. In-domain linear-probe macro-F1 is saturated (0.98-0.997), yet cross-dataset macro-F1 drops 34-72% and rankings re-order: DinoBloom-L, the in-domain best, falls to 10th of 15 on the most-shifted target (MLL23) at the benchmark's shared 224-px input, behind RedDino and several general and pathology encoders. Rank transfer is probe-dependent: 1-NN retrieval is more stable on average than a source-fitted linear head (median $ρ$ 0.65 vs 0.45), but neither probe universally predicts target robustness. Calibration also collapses: source-trained probes are nearly calibrated in-domain (expected calibration error, ECE, 0.004) but confidently wrong off-domain (ECE 0.35), and source-fitted temperature scaling transfers poorly. We further audit pretraining exposure and identify MLL23 as DinoBloom's internal cohort; because DinoBloom's only held-out dataset is also our source domain, this benchmark cannot isolate exposure from scanner-associated shift. Label-free adaptation and marginal-entropy-based model selection appear safe under balanced evaluation but fail under realistic WBC class-prior shift. Class-Balanced Re-standardization (CBR), a training-free pseudo-label-balanced feature normalization, improves all evaluated target-prior scenario means and partially improves calibration, although encoder-level exceptions and residual miscalibration remain. Hematology FM benchmarks must therefore jointly audit accuracy, calibration, exposure, and class-prior robustness.

Multilingual Hematology Visual Question Answering Dataset

Vision Language Models (VLMs) have shown promising capabilities in medical image analysis by jointly understanding visual and textual information for tasks such as Visual Question Answering. However, existing hematology vision-language resources remain predominantly English centric, limiting their applicability in multilingual healthcare environments. This challenge is releveant generally to South Asia and specifically to Pakistan, where Urdu is widely used despite healthcare information and digital medical systems being largely dependent on English. To investigate this gap, we conducted a survey among healthcare professionals, which revealed substantial language mismatches between clinical documentation and patient communication, emphasizing the need for multilingual healthcare technologies. To address this limitation, we introduce WBCMor VQA, a clinically validated bilingual English, Urdu morphology aware VQA benchmark for leukemia and normal white blood cell analysis. The benchmark is constructed using morphology-aware annotations from LeukemiaAttri and WBCAtt datasets and supported by a domain specific Urdu hematology dictionary to ensure linguistic consistency and clinical correctness. The final benchmark contains 110K bilingual question answer pairs serving as VQA annotations for 20K leukemic and normal single-cell images. Furthermore, we establish baseline performance by evaluating multiple open-source VLMs on the proposed benchmark. The proposed resource aims to facilitate the development of accessible and clinically relevant AI systems for multilingual healthcare environments.