ISSUE27

ISSUE

July2022

This issue
Last Month’s Slides P.1
Monthly Digital Case Study P.1
Lymphocytes P.2-3
Cell Quiz P.2

Last Month’sSlides
Slide 1
See film review on the right.

Slide 2
No clinical context.
Immunophenotyping of
circulating lymphocytes
requested.

Slide 3Monthly Digital Case Study
Presentation July 2022, Slide 1
FBC Results

WBC 20.5* (10^3/mm3)
RBC 2.6* (10^6/mm3)
HGB 7.9* (g/dL)
HCT 23.7* (%)
MCV 93 (fL)
MCH 31.0 (pg)Slide 4Presence of macroplatelets MCHC 33.3 (g/dL)
PLT 27* (10^3/mm3)(PDW at 21 fL).
Expert comments: Nothing to Neutrophils 84.4 %Lymphocytes 0.8 %report.
Monocytes 3.4 %Eosinophils 0.0 %Basophils 0.0 %Polymorphic lymphocyte
appearance.

Normoblast/Erythroblast

Slide 5

Nothing to report.

Clinical Haematology unit.
Platelet count monitoring.
Large Platelets

Slide 6
Nothing to report.

Slide Review
Clinical Haematology unit.
Platelet count monitoring.
Anaemia. Anisocytosis (RDWsd at 56 fL).
Microcytes(+). Macrocytes(+).
Myelo-erythroblastic.
Thrombocytopenia.
Presence of macroplatelets.

Large Platelets

Anisocytosis

Cell Quiz:

Lymphocytes
The normal range for Lymphocytes is 1.0 to 4.0 x 109/L with an estimated 2 x
1012 lymphocytes in the human body which is comparable in cell mass to the liverand brain.

Morphology of normal lymphocytes
Lymphocytes are mononuclear cells with variable amounts of weakly basophilic
cytoplasm.

What is the parasite (Fieldstain)?

There are 2 main morphologically different types of Lymphocytes. Small
lymphocytes, which are approx. 10-12um in diameter have a round or indented
nucleus and very scanty cytoplasm. They account for about 90% of the circulating
lymphocytes.

a) P Ovale

Small Lymphocyte is approximately the same size as anormal red cell and the nucleus has condensedchromatin.

b) Babesia Divergensc) P Malariae

Last Month’s Cell
Quiz

Large Lymphocytes, have a diameter of approx. 12-16um, have more abundantcytoplasm, and the nuclear chromatin is less condensed and open.
Large lymphocytes may have an irregular outline
whereas small lymphocytes tend to have a circularoutline.

Occasionally a few small azurophilic granules may beseen in the cytoplasm and larger cells may have adozen, or so, granules. These cells are called Large
Granular Lymphocytes.

What term best describes theabove neutrophila) Hypersegmentedb) Hypogranularc) Pelger Huet form

Possible confusion

Answer:b) Hypogranular. The
Neutrophil shows a lack or
absence of granules, immature
myeloid cells can also be
hypogranular or evenagranular which can lead todifficulty in correctly
identifying the cells correctly.
Hypogranular and agranular
Neutrophils are associatedwith Myelodysplasia (MDS).

Monocyte

Nucleated red cell

Monocytes: are significantly larger than lymphocytes with an irregular, often
lobulated nucleus. The cytoplasm is greyish blue in appearance.
Nucleated red cells: the nucleus is pyknotic with condensed chromatin, thecolour of the cytoplasm is the same as in polychromatic red cells.

QSP 2.0
Lymphocyte development
There are 2 main subsets of Lymphocytes: B cells and T cells, depending uponwhere they develop. B cells develop in the bone marrow, while T cells in thethymus. B and T cells arise from the same pluripotential haemopoietic stem cell.
Non-activated B and T cells are morphologically indistinguishable from eachother. There is further lymphocyte, known as Natural Killer Cells or NK cell.

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Lymphocyte Function
Lymphocytes are essential in the bodies immune system to fight against cancer,
foreign viruses, and bacteria. The different types of lymphocytes have their own
role to play in the immune system.

B cells
B cells are responsible for the production of antibodies. They have receptors intheir surface specific for an individual antigen. When the B cell encounters thespecific antigen, it is bound onto the cell surface and activates the cell to either
differentiate into a Plasma cell which produces antibodies specific to that
antigen or change into memory cells. Plasma cells are larger than normal
lymphocytes (14 – 20 um).

Bibliography
Alberts B, Johnson A, Lewis J,
et al. Molecular Biology ofthe Cell. 4th edition. New
York: Garland Science; 2002.
Lymphocytes and the Cellular
Basis of Adaptive
Immunity. Available from:https://www.ncbi.nlm.nih.gov/books/NBK26921/

Plasma cell
Round or oval with copious amountsof deep blue cytoplasm. The nucleus
is often eccentrically placed withcoarse chromatin.

Editorial Team
Kelly Duffy
Andrew Fisher

T cells
Like B cells, T cells have specific receptors on the membrane of the cellwhich are antigen specific, but unlike B cells, they do not produce
antibodies.
There are 5 different types of T cells, each of which have their own role in
the immune system:
1) Cytotoxic T cells: are responsible for actively searching out anddestroying infected cells through the direct action of digestiveenzymes.
2) Helper T cells: are responsible for activation of Cytotoxic T cell,
macrophages, and stimulating B Cells to produce antibodies.
3) Regulatory T cells: suppress the action of B and T cells in order todecrease the immune response when no longer required4) Natural Killer T Cells: help in the fight against cancer cells5) Memory T cells: are responsible for ensuring that previouslyencountered antigens are recognised, enabling the immune system torespond more quickly.
NK Cells
NK Cells are the main cells in the innate immune system that are capable ofrecognising and directly destroying foreign cells e.g. virus or cancer cells.

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