ISSUE

19

ISSUE

November
2021

This issue
Last Month’s Slides P.1
Monthly Case study P.1
Monocytes P.2-3
Cell Quiz P.2
QSP 2.0 P.3

LastMonth’sSlides
Side 1
Presence of a blastoid cell
population, Immaturechromatin, High nuclearcytoplasmic ratio. Discreetly
nucleolated nuclei, Basophilic
cytoplasm rarely with a few
vacuoles.
Immunophenotyping of blasts
requested.
Expert comment: Dysplastic
PMNs. Appearance in favourof an AML.

Monthly Digital Case study

Slide 2WBC 51.0 (10^3/mm3)
RBC 2.35 (10^6/mm3)
HGB 8.6 (g/dL)
HCT 24.4 (%)
MCV 104 (fL)
MCH 36.4 (pg)
MCMH 35.1 (g/dL)
PLT
166 (10^3/mm3)
Neutrophils 76.3 %Lymphocytes 9.0 %Monocytes
3.4 %Eosinophils 0.0 %Basophils
0.0%Hyperlymphocytosis
associated with "smudge"
cells.
Atypical lymphoid population
identified with a cleaved
nucleus.
Phenotyping of circulating
lymphocytes requested.
Expert comment: Leukaemia
phase of small cell NHL.

Slide 3See Slide Review

October 2021 Slide 3
Presentation
Male (77 years old)

FBC Results

Slide 416% eosinophils (0.77 G / L).
Rare target RBCs (+).

Slide 5
Anemia. Patient in intensive
care unit. Anisocytosis (+).
Reticulocytes: 190x10^ 9 /L. Regenerative anemia.

Slide 6Anemia. Anisocytosis (++).
Hypochromasia (++)

Cabot ring

Large Platelet

Slide review
Leukocytosis. Myelemia (9%) + erythroblastosis (17%).
Anemia. Anisocytosis ++ (RDWsd at 95 fL).
Target RBCs (++).
Presence of Howell-Jolly bodies (++).A Cabot's ring is visible on the RBC wall
(picture n° 13).Expert comment: Platelet abnormalities, inclusions inerythroblasts.
Rare Pelger PMN.
Medullary study is desirable. Platelet anisocytosis (MPV at 37).

Cell Quiz

Monocytes

What test would you perform if
you saw a number of these cells ina young adult presenting withswollen lymph nodes, tiredness,sore throat:

Monocytes are the largest normal peripheral blood cells with a diameter ofbetween 12 – 20 um with a Nuclear to Cytoplasm (N:C) ratio of approximately
3:1. The monocyte nucleus is irregular and often lobulated, cytoplasm isabundant with a blue-gray colouration containing many fine lilac granules which
often give the cytoplasm a “ground glass” appearance, vacuoles may be present.
Note the difference in size of the monocyte, the lobulated nucleus, and thecytoplasmic vacuolation (Fig. 1 monocyte alongside a neutrophil).
.

Monocyte

Neutrophil
Figure 1A) Ham’s testB) Infectious Mononucleosis test
(Monospot)C) Malarial parasites
D) COVID-19 Lateral Flow test

Last Month’s 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
Answer:C) Thalassaemia

Figure 2: Figures above showing normal monocytes

The normal range for the monocyte count is 0.2 – 0.6 x 109/L. Monocyte
counts are usually slightly higher in males than females.
An increase in the monocyte can be caused by various chronic
inflammatory processes or infection e.g tuberculosis, Subacute Bacterial
Endocarditis (SBE), Systemic Lupus Erythematosus (SLE), rheumatoid
arthritis, temporal arteritis, or as part of a malignant neoplasm (CMML,MDS, M5 leukaemia).
Monocytes originate in the bone marrow from pluripotent stem cells
which develop into monoblasts, promonocyte and then finally themature monocyte. Mature monocyte only remain in the bone marrow
for about a day before they are released into the circulation wherethen either enter a circulating or a marginating pool (approx. 50:50
split). Monocytes and their tissue specific mature counterparts,
macrophages are key components in the mononuclear phagocyte
system involved in ingestion of microorganisms and foreign material invarious tissues
Monocytes contribute to the innate immune response as well as theadaptive immune response through phagocytosis, antigen presentationand cytokine production. Due to the phagocytic nature of monocytes,
they are occasionally found to have ingested red cell, cryoglobulin,
micro organisms and malarial pigment. Monocytes usually develop into
macrophages in the blood but occasionally macrophages may be foundon a blood film, they may be slightly larger than a monocyte or may bevery large and multinucleated with the cytoplasm containing cellular oramorphous debris.

Phagocytosis occurs when the cell is attracted to an area of high concentration offoreign particle/cells or molecules (chemotaxis).
The macrophage then binds to the surface of the particle via its surface receptors
e.g Toll-Like receptors (bacteria, fungi, viruses) Antibodies, Opsonin receptors(molecules that possess immunoglobulin G. The type of receptor binding
influences the appropriate response by the phagocyte.
The phagocyte starts expanding as it surrounds the molecule. A vacuole, orvesicle is subsequently formed around the molecule as it is completely ingested.
Enzymes in the vacuole/vesicle break down the molecule into simpler
components which can either be used or removed from the cell.

Virtual International
Symposium onHaematology 2021
HORIBA Medical sponsors theVirtual International
Symposium of Haematology
2021, hosted on 16th ofDecember by University
Hospital of Nimes andUniversity of Montpellier inFrance. Register here.

QSP 2.0 : Affordable digital morphology skill evaluation tool
Bibliography
Blood Cells – A Practicle
Guide , Barabara J Bain
Role of monocytes andmacrophages in regulating
immune response following
lung transplantation, Chiuand Bharat, Curr Opin Organ
Transplant , 2016, Jun, 21(3):239 - 245

Editorial Team
Kelly Duffy
Andrew Fisher

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