ISSUE18

ISSUE

October
2021

This issue
Last Month’s Slides P.1
Monthly Case study P.1-2
Neutrophil P.2-3
Cell Quiz P.2
National Pathology Week P.3

LastMonth’sSlides
Slide 1
Neutrophilia. Discrete
myelemia. Anaemia.
Microcytic anisocytosis (+).
Spherocytes (+).
Hypochromia (+). Target
RBCs(+). Echinocyte.

Slide 2See Slide Review on Right

Slide 3
Oncology department.
Neutrophilia (oftenvacuolated neutrophils).
Anaemia.
Thrombocytopenia.
Myelemia. Monocytosis.
Expert comments: Very
atypical neutrophils:
abnormal nuclei.

Slide 4Presence of blastsimmature chromatin. ALL

Monthly Digital Case study
September 2021
PresentationMale, 69 years oldFBC Results
WBC 15.1 (10^3/mm3)
RBC 2.85 (10^6/mm3)
HGB 9.0 (g/dL)
HCT 25.7 (%)
MCV 90.0 (fL)
MCH 31.6 (pg)
MCMH 35.0 (g/dL)
PLT 41.0 (10^3/mm3)

Platelet clumping

Neutrophils 76.1%
Lymphocytes 7.1%
Monocytes 5.1%
Eosinophils 0.0%
Basophils 0.0%

Slide 5
Neutrophilia

Slide review

Slide 6

Neutrophilia. Anaemia. False thrombocytopenia due to aggregation ofplatelets (+++). Platelet control to be requested on citrate sample. Expert
comment: Need to check leukocyte results of the analyser (interference
possible with platelet aggregates).

Normal for neonatal casePlatelet Aggregation continued

Cell Quiz
Look at the slide below, can youname the cell? What possible
clinical details would this patient
likely have?

Choose from the below options:A) Glandular feverB) Nothing AbnormalC) Thalassaemia

Platelet clumping may be caused by the activation of platelets during a
traumatic venepuncture and EDTA antibodies reacting with platelet
glycoprotein IIb/IIIa. Platelet clumps are made up of a combination of
apparently intact platelets and degranulated, pale grey platelets (see images
above fig 1 & 2).
A low platelet count should always be investigated. Primarily check thesample for the presence of a clot. In its absence, it is essential to examine ablood film carefully for the presence of platelet aggregates, or a true low
platelet count.
The HORIBA Yumizen H1500/H2500 series of analysers can detect thepresence of platelet aggregates and exclude them from the reported whitecell count.
Fig. 1: typical Differential (LMNE) plot from a sample with platelet clumps
AbsorptionPlatelet clumps

Last Month’s Cell QuizCan you name the structure seenin the slide below? CLUE: Often
found in Myeloid Blast Cells during
acute myeloid leukaemia.

VolumeThe platelet clumps are detected in the area to the left of the lymphocyte
cloud which is also the area where Nucleated Red Blood Cells (NRBC) areenumerated. Platelet clumps may also be found in the noise area (cells ingrey) any events in the noise area are excluded from the White Cell Count(WBC). The absorption of platelet clumps and NRBC are different and cantherefore be discriminated, allowing the analyser to exclude the plateletclumps in this area, thereby giving a Total Nucleated Cell (TNC) which can becorrected for the presence of NRBC. Where platelet clumps are detected by
the analyser, the sample will be flagged accordingly.

Eosinophils
Auer rods
Answer: Auer rods.
Auer rods azurophilic, needle
shaped cytoplasmic inclusions.
They are made up of fusedlysosomes and are rich inlysosomal enzymes.
Auer rods are found in myeloid
blast cells of some cases of acute
AML, high grade myelodysplastic
syndromes and myeloproliferative
disorders.

Eosinophils were first described by Paul Ehrlich in 1879 due to theircharacteristic staining with acidophilic dyes and their increased presence inpatients with asthma and helminth infection. The normal adult value for
Eosinophils is 0.02 – 0.7 x 10^9/L (0.5 – 1%) . For approximately 100 years it
has been known that Eosinophils are associated with allergic disease. At thistime Eosinophils are known to be associated pathologically with asthma,
atopic dermatitis, allergic rhinitis, eosinophilic gastroenteritis, and certain
diseases of the eye.
Eosinophils are slightly larger than Neutrophils with a diameter of 12-17 um.
The nucleus is usually bilobed, but sometimes the nucleus may be trilobed.
Eosinophil granules are plentiful, pack the cytoplasm, spherical and a lotlarger than the granules found in Neutrophils.

On the HORIBA Yumizen series of analysers Eosinophils are counted in theLMNE flow cell and characteristically occupy the upper part of the LMNE plot.

Eosinophils

QSP 2.0
Available as a single use
license and a site
license which allows up
to 50 concurrent users.
To find out more,contact us.

Bibliography
Yumizen Clinical Case
Studies-HORIBA Medical
Eosinophils develop in the bone marrow and after about 8 days development
they enter the blood circulation. The major contributing factor in Eosinophil
development is Interleukin 5 (IL-5). Once in the blood stream, they transit totissues such as the lungs.
Eosinophils are major effector cells in the immune system and play a pivotal
role in the body's defence against nematode and other parasitic infections.
Hover Eosinophils can also be damaging as part of the inflammatory response
to allergic disease. Upon activation Eosinophils release highly toxic granuleproteins and free radicals, which can kill invading micro organisms and parasite
but can also cause significant tissue damage in allergic reactions. Activation of
Eosinophils also causes the synthesis of chemical mediators e.g prostaglandins,
leukotrienes and cytokines, thereby amplifying the inflammatory response byactivating epithelial cells and recruiting more Eosinophils and leukocytes.
Exposure to these activation products for an extended time period can damage
the tissue/organ directly.

Editorial Team
Kelly Duffy
Andrew Fisher

An increase in Eosinophils can be caused by the following:
Allergies and asthma, Drug Allergy, Infections (mostly parasitic), Autoimmune
disorders, Endocrine Disorders.
Prolonged Eosinophilia may induce tissue damage and is termed asHypereosinophilic Syndrome (HES), if the eosinophil count remains greaterthan 1.5 x 10^9/L for a period of 6 months. Any organ can be affected by HES
the most commonly affected being the heart, central nervous system, skin andrespiratory tract.

National Pathology Week 2021
From 1st to 7th of November we will celebrate the National
Pathology Week. A celebration to highlight the tremendous
contribution of pathologists to healthcare. This year’s theme is“All Together Now”.
At HORIBA we are proud to be supporting them with our broad range ofhaematology analysers that are used in patient diagnosis, monitoring and support
other healthcare procedures and treatments.

About us
HORIBA UK Limited
Kyoto Close
Moulton Park
Northampton, UKNN3 6FL
HORIBA Medical
Parc Euromédecine, 390Rue du Caducée, 34790,
Francewww.horiba.com/medical