ISSUE16

ISSUE

August2021

This issue
Last Month’s Slides P.1
Monthly Case study P.1-2
Granulocyte Development P.2-3
Cell Quiz P.2
Haematopoiesis P.3

LastMonth’sSlides
Monthly Digital Case study
Side 1

July 2021
Atypical Lymphocytes

See case study on right

Slide 2
Patient in intensive careunit.
Neutrophilia. Anaemia.
Thrombocytopenia.
Expert comment: Presenceof vacuoles in neutrophil +echinocyte: Septic shock?

Slide 3Lymphopenia.
Aniso-poikilocytosis (++).
anisochromia (++).
Elliptocyte (++).
Echinocyte (++).

Slide 4
NormalSlide 5Emergency, Lymphopenia(0.49 G / L).

Slide 6
NormalPresentation
Female (81 years old)

FBC ResultsWBC
26.2 (10^3/mm3)RBC
4.05 (10^6/mm3)
HGB
12.2 (g/dL)
HCT
36.5(%)MCV
90 (fL)
MCH
30.1 (pg)
MCMH 33.4 (g/dL)
PLT
38 (10^3/mm3)
Neutrophils 31. 9%
Lymphocytes 13.3 %Monocytes 5.2%
Eosinophils 1.5%
Basophils 0.7%

Slide review
Patient hospitalised in Clinical Haematology
unit. Analyser alarms: WBC (Blasts / Abn Lympho?).
Clinician comment : EMERGENCY (+++).
Diagnosis: Burkitt's lymphoma. Read a case of Burkitt’s Lymphoma here.

Burkitt lymphoma (BL) is a rare type of non-Hodgkin lymphoma (NHL). BL
develops when B-cells become abnormal (cancerous). B-cells are white blood
cells that normally help fight infection.
They are sometimes called B-lymphocytes.

Cell Quiz
This cell is characterised byabundant granular cytoplasm
with predominance of specific
granules, kidney-shaped orindented nucleus, coarser
chromatin, and lack of distinct
nucleoli. Name the cell:slide review continued
There are different types of BL:• Sporadic BL – this is the most common type of BL. It usually develops in thetummy (abdomen), where it may form a large tumour. It can also affect otherparts of the body
• Immunodeficiency-related BL – this type develops in people who have aweakened immune system• Endemic BL – this type mainly affects children in Africa and is very rare in
the symptoms
BL generally develops in the tummy area (abdomen). Symptoms include:• Tummy pain
• Swelling of your tummy caused by a build-up of fluid (ascites)• Feeling sick (nausea)• Diarrhoea

Last Month’s Cell Quiz
From the following choose thedescription to best describe theprominent feature in thedisplayed Neutrophil:Answer:Neutrophil Toxic Granulation.
Toxic granulation refers to thedark course granules found in
granulocytes, especiallyneutrophils.
The presence of this granulation
in a peripheral blood film issuggestive of an inflammatory
process. Toxic granulation iscommonly found in patients withbacterial infections & sepsis,
although it’s findings can be nonspecific.
Patients receiving chemotherapy
or CSF may often show toxic
granulation.

BL may also cause painless swellings in the neck, armpit or groin. This happens
due to lymphoma cells building up in the lymph nodes, which makes thembigger. Often lymph nodes in more than one part of the body are affected.
The symptoms of BL can often develop very quickly.

Granulocyte Development
Myelopoiesis occurs in the bone marrow and is a regulated process.
Approximately 108 to 109 cells are produced per hour in order to keep thenecessary number of circulating cells at normal levels. Haematopoieticgrowth factors, such as Stem Cell factor (SCF), interleukin (IL-3), granulocytemacrophage colony stimulating factor (GM-CSF), and granulocyte colony
stimulation factor (G-CSF) play an important role in the amplification of theprogenitor cells. G-CSF is essential for the amplification and terminal
differentiation of neutrophil progenitors and precursors.
Myeloblast
The Myeloblast is the earliest morphological identifiable cell. Myeloblasts are
10 – 20 um in diameter. There is little cytoplasm which is basophilic in colour
and may contain fine azurophilic granules, nucleus: cytoplasm ratio (N:Cratio) approx. 4:1. The nucleus is round to oval and situated either centrally or
to one side of the cell and has loose open reddish purple stained chromatin
and may contain 1 – 5 nucleoli. Occasionally, Auer rods may be seen in
Myeloblasts, Auer rods are distinctive needle like crystals that are specific andvirtually diagnostic for Myeloid leukaemia. The crystals are composed ofperoxidase proteins.

Myeloblast

Myeloblast with Auer rodAuer RodQSP 2.0

Promyelocyte
The Promyelocyte is larger than a Myeloblast(diameter 15-25 um) with more abundantcytoplasm and abundant azurophilic primary
granules. The N:C is approx. 3:1 With more
cytoplasm present than in a Myeloblast and isslightly less basophilic.

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Myelocyte
Myelocytes are smaller than the earlier precursors,(diameter 10 -20 um) the cytoplasm is eosinophilic
and the predominant feature is the presence of finesecondary granules (N:C ratio 2:1). The nucleus hascoarse chromatin with no prominent nucleoli. Themyelocyte is the last stage where the cell undergoes
mitosis. A myelocyte can be identified as
Neutrophilic Eosinophilic and Basophilic based upon
the characteristics of its granules.

Metamyelocyte

Bibliography
Burkitt Lymphoma:
Diagnosis, Prognosis,Symptoms, and ...
https://www.webmd.com
Chase the Case, HORIBA
MedicalThe Metamyelocyte measures 10-12 um indiameter, the nucleus is indented or U shaped(kidney bean shaped). The cytoplasm is filled withprimary, secondary and tertiary granules.

Editorial Team

Band Form
The Band Form or Stab cell is the final stage prior
to a mature Neutrophil and is characterised by anindented, unsegmented C or S shaped nucleus.

Kelly Duffy
Andrew Fisher

Mature Neutrophil
Most prevalent white cell in normal adults. 12-15
um in diameter, cytoplasm contains numerous finegranules. The nucleus is divided into 2 to 5 distinct
lobes.

Haematopoiesis

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Haematopoiesis comes from the Greek meaning "blood" and "to make". This process France
is the formation of blood cellular components. Every cellular component originatesfrom haematopoietic stem cells. As the stem cell multiplies, some cells transform into www.horiba.com/medical
the precursor cells. These are destined to become a particular type of blood cell. They
will divide and mature into blood components, such as white cells, red cells andplatelets. Haematopoiesis occurs within the haematopoietic system, which includes
organs, such as the bone marrow, liver and the spleen.
A free copy of our haematopoiesis poster suitable for your lab is available fordownload on our web.