ISSUE11ISSUEMarch2021

This issue

Last Month’s Slides P.1
Monthly Case study P.1
Yumizen Case Study - Basophilia P.2
Morphology Quiz P.2
Basophil Channel P.3
Morphology Tip P.3

Last Month’sSlides
February 2021 Slide
Summaries
Side 1

Relapse of diffuse large B-cells
lymphoma. Expert comment:
Leukaemia phase of high-grade
non-Hodgkin's lymphoma.

Slide 2

Exploration of
hyperlymphocytosis.
Monomorphic
hyperlymphocytosis with thepresence of numerous"smudge”: probable CLL.

Monthly Digital Case study
Slide 2Presentation

2021 Male (72 years old)

FBC Results
WBCRBCHGB
HCTMCV
MCH
MCHC
PLT

42.3(10^3/mm3)
4.84 (10^6/mm3)
144 (g/L)
43.3 (%)
90(fL)
28.9 (pg)32.3 (g/dL)
253 (10^3/mm3)

Neutrophils 11.2 %Lymphocytes 85.4 %Monocytes 3.4 %Eosinophils 0 %Basophils0%

Lymphocyte

Slide review

Slide 3

Nothing abnormal to report.

Slide 4

Nothing abnormal to report.

Slide 5

Nothing abnormal to report.

Slide 6

Nothing abnormal to report.

Exploration of hyperlymphocytosis.
Monomorphic hyperlymphocytosis with thepresence of numerous "smudge":
Some platelet aggregates.
Probable CLL. To be compared with theimmunophenotyping results of circulating
lymphocyte (Matutes scoring).

Diagnosis

Probable CLL.

Nuclei ShadowMonthly Morphology
Quiz:
A female patient has thefollowing parameters Hb 72(g/L), MCV 57 (fl), MCH
14.5(pg), Platelets
219 (10^3/mm3)
Which of the slides below
would represent these results,
A or B ?

Case Study

Slide 5 August 2020
Basophilia with increase in myeloid precursors
TheHORIBA
Yumizen
H1500/H2500
analysers
utilise3
different chambers/channels to enumerate White Cells: 1) LMNE channel,2) Baso/TNC2 Channel, and 3) TNC/HGB Channel. We will explain thechanges seen two channels on the graphical displays on theHORIBA Yumizen H1500/H2500 series of analysers in the above patient.

LMNE Channel

Simultaneous measurement of volume and optical extinction occurs in thededicated LMNE flowcell. The optical extinction is related to the complexityof the cell in terms of nuclear structure and degree of cytoplasmic
granulation. The reagent Nucedif is used to lyse the red cells and stabilise thewhite cells.

Normal displayOpticalextinction

Slide A

Immature Granulocytes

Immature Monocytes
Immature Lymphocytes

Eosinophils – Orange
Neutrophils – Green
Monocytes – Purple
Lymphocytes – Blue
Large Immature Cells (LIC)– shaded orange section

VolumeLMNE display from patient Slide 5 August 2020 including cell images:
Slide B

Last month’s Quiz:
What is the name for the cell in
the red box and what condition
may you see them in?

The cells highlighted are known
as smear cells, smudge cells orbasket cells and are commonly
found in Chronic Lymphocytic
Leukaemia (CLL).

Flags would be generated indicating an increase in LIC (6.1% ,normal < 3.5%)
and an excess of cells in the Right Neutrophil and Right Monocyte area which
would indicate the possible presence of immature myeloid cells.
The difference between a normal LMNE plot and an abnormal plot LMNE is easily
identifiable, and the user can perform further tests e.g., blood film.

QSP 2.0

Basophil channel
The Basophil channel works on the principle that non basophil white cells
when they are incubated with the reagent Basolyse are stripped of theircytoplasm whilst Basophils retain the cytoplasm and therefore can beseparated based on size. The resulting dilution is then analysed using
aperture impedance and a cell size distribution curve is generated.

Available as a single
use license and asite license whichallows up to 10
concurrent users.
To find out more,contact us.

Bibliography
Number ofcells withthat volume

Non Basophils

Blood Cells A practicalguide – Barbara Bain
Case Study from HORIBA
MedicalVolumeEditorial Team

Basophil Channel from patient slide 5 August 2020:

Kelly Duffy
Andrew Fisher

An abnormal looking Basophil plot is a good indicator of the presence ofabnormal cells which needs further investigation.

About usThis Month’s Top Morphology Tip
How to read a blood smear
When looking at a blood film, it is important to be methodical. It is a goodidea to begin with red cells, then platelets and finally white cells. This way
you will not miss any important features from each cell type.
Whichever order you decide to look at each cell type, it is important toexamine films routinely in this order, this ensures a thorough, accurate
morphology examination every time.

HORIBA UK Limited
Kyoto Close
Moulton Park
Northampton, UK
NN3 6FLHORIBA Medical
Parc Euromédecine,
390 Rue du Caducée,
34790, France
www.horiba.com/medical