ISSUE06

ISSUE

October
2020

This issue

Last Month’sSlides

Last Month’s Slides P.1
Monthly Case study P.1
Neutrophil Hypersegmentation P.2
Monthly Quiz P.2
QSP 2.0 Focus on Expert Reports P.3

September 2020 SlideSummaries
Slide 1Atypical Lymphocytes andoccasional blast cells seen. Some
Giant platelets. Crenated red cells

Monthly Digital Case study
September 2020 Slide 4
Presentation

Slide 2
Generally normal film – someplatelet aggregates

Male (44 years old)
Slide review requested by the physician, to confirm presence of erythroblasts.
Presence of erythroblasts, Neutrophilia and a Lymphopaenia.

Slide 3

FBC Results

Neutrophil toxic granulation,
eosinophilia

Leuco/erythroblastic picture,polychromasia and anisocytosis.
Neutrophilia

WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT

Slide 5Slide review

Acanthocytes, spherocytes, somebasophilic stippling.

Leuco/erythroblastic picture. Red cells show polychromasia and anisocytosis.
Neutrophilia and lymphopaenia. Some large platelets.

Slide 4

Slide 6Hypersegmented neutrophils

24 (109/L)
4.73 (1012/L)
141 (g/L)
0.424 (L/L)
90 (fL)29.8 (pg)333(g/L)
90 (109/L)

Neutrophils 88%
Lymphocytes 3.7%
Monocytes 7.4%
Eosinophil 0%
Basophils 0%

Diagnosis
No clinical details were provided, however the blood film is suggestive ofSepsis and/or an ICU patient.

Monthly Morphology
QuizHypersegmented
Neutrophils

What features can you

An overview of laboratory
findings

identify this cell/cells?:
Introduction

Neutrophils, in normal adults, make up for more than half of the body’s
circulating leucocytes. Their main function is to defend the body againstpyogenic bacterial infections. A normal neutrophil will be uniform in size, with asegmented nucleus, showing fine granulation when stained. Generally,neutrophils have 3 nuclear segments or lobes, connected by chromatin strands.

Hypersegmentation

What may this collection offeatures be known as/seenin?

The presence of hypersegmented neutrophils is an important diagnosticfeature. Neutrophil hypersegmentation can be defined as the presenceof neutrophils with five or more lobes or the presence of more than 3%of neutrophils with at least five lobes.
Hypersegmented neutrophils are also known as“right shifted” neutrophils. The presence ofhypersegmented neutrophils is an importantdiagnostic feature of megaloblastic anaemias.
Hypersegmentation can also be seen in otherconditions but with relatively less diagnostic
significance.

Megaloblastic Anaemia
Last month’s cells:

Neutrophil hypersegmentation is one of the earliest, most sensitive and specificindications of megaloblastic anaemia, due to vitamin B12 & folic acid deficiency.
In the severe form of this, one may also see red cell fragments and tear drop
poikilocytes in the blood film.
The presence of Megaloblastic anaemia when looking at a blood film may besuspected from the presence of oval macrocytic red cells, poikilocytes and, as
already mentioned, hypersegmented neutrophils with >5 nuclear lobes.
Other causes of Megaloblastic anaemia not due to hypovitaminosis may becaused by antimetabolites that poison DNA production directly, such as somechemotherapeutic or antimicrobial agents e.g. azathioprine or trimethoprim.

Other Indications
The cell is from a patient with
Hairy cell leukemia (HCL). HCL is arelatively rare B-celllymphoproliferative disease. It ischaracterised by abnormal large#lymphocytes with villous
cytoplasmic projections that givethem a distinctive 'hairyappearance.

Hypersegmented Nuetrophils can also be seen in:• Hereditary neutrophil hypersegmenation- usually >50% of neutrophils in theblood film are hypersegmented. Check family history also.
• Myelokathesis• MDS- the intermediate state between developing AML (10-20% blasts seenin film• Myeloproliferative disorders• Use of chemo/cytotoxic drugs
The presence of hypersegmented neutrophils, with five or more nuclear
segments, is an important morphological feature to observe in the blood film.
The existence of these cells can be therefore be viewed as an indication ofvarious different conditions mentioned above, and is a valuable
morphological feature when investigating a blood film.

QSP 2.0 News
Focus on the Expert report
Along with many improvements in QSP 2.0, the format of the expert report has been improved
to make it easier and quicker to follow the progress of users as they view slides.

Other NewsQSP 2.0
Available now!

The expert report, as the name implies, can only be created by a user with an Expert accesslevel and is the only report from which you can see the performance of multiple assistantusers.
The expert can quickly identify those users underperforming and see the reason for the user
underperforming e.g. misclassifying blasts, nucleated red cells, myelocytes etc.

Options for a single
operator or site
license which allows
up to 10 concurrent
users

The expert report is split into 3 sections, the first section gives an overview of the performanceof each user and details the number of incorrectly classified cells :Bibliography
QSP September 2020
Hoffbrand’s Essential
Haematology 7th edition
Wiley Blackwell

Accuracy is an indication of the number of misclassified cells, thus enabling the expert user toquickly see individual user’s overall performance.
The next section is a more detailed view of how the users performed in classifying individual
cell types:

Editorial Team
Kelly Duffy
Andrew Fisher
Shubham Rastogi

Sensitivity and precision is calculated using the true positive, false positive, true negative, false
negative figures where:• A value of 1 for sensitivity and precision means the user has not misclassified any cells• A value of less than 1 for sensitivity means that the user has classified one or more cells as acell type other than the correct one• A value of less than 1 for precision means that the user has classified one or more cells
incorrectly as that cell type.

Morphology Posters – Free of charge (UK only)

The final section shows a picture of every misclassified cell along with the name of every user
and what cell type the user classified that cell as. It is therefore easy to see if certain users arepersistently misclassifying the same cell types, e.g. nucleated red cells as lymphocytes, and if
there is a good reason why the cell may have been misclassified. Cells which several users havemisclassified could indicate that the cell was incorrectly classified by the expert as in the case ofcell 72 below where 3 assistant users classified the cell as a Monocyte and the Expert classified
it as a Lymphocyte.

About us
HORIBA UK Limited
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Moulton Park
Northampton, UKNN3 6FL
HORIBA MedicalParc Euromédecine,
390 Rue du Caducée,
34790, France
www.horiba.com/medicalThe expert report enables the performance of staff to be quickly evaluated and therefore time
can be spent on users who didn’t perform as well as expected. The report can then be used asa valuable training tool to explain to users the reasons why the cell is classified as it is.