ISSUE26

ISSUE

June
2022

This issue
Last Month’s Slides P.1
Monthly Digital Case Study P.1-2
Cell Quiz P.2
Previous 12 Months’ Issues P.3

Last Month’sSlides

Slide 1
See Case Study

Slide 2
Nothing to report

Slide 3
Leukocytosis. Neutrophilia(hyposegmented,degranulated and highlyvacuolated neutrophils).
Myelemia (ImmatureGranular cellsdegranulated). Blastosis.
Expert's comments: AML
post MDS probable.
Difficult +++ for the cellulardifferential. Do not hesitate
to reclassify "atypical" cells
as blasts. Significant
dysgranulopoiesis

Monthly Digital Case Study
May 2022 Slide 1
Presentation
Haematology clinic patient.
Clinical haematology unit.
Deterioration of general condition.
Myelemia.
Reticulocytosis.

FBC Results

Nothing to report

WBC 27.0 * (10^3/mm3)
RBC 2.4*(10^6/mm3)
HGB 7.5*(g/dL)
HCT 23.9* (%)
MCV 100(fL)
MCH 31.2(pg)MCHC 31.3(g/dL)
PLT227(10^3/mm3)
RDW-SD 80fL
Reticulocytes 225 x10^9/L

Slide 5Slide review

Nothing to report

Anisocytosis(RDWsda70fL).
Microcytes(++).
Macrocyte(++).
Schistocytes(++).
Echinocytes(++).
Prescence of Schistocytes.
Check for Thrombotic Microangiopathy (TMA).

Slide 4

Slide 6
Nothing to report

Schistocytes

Echinocyte

Macrocytic
Polychromatic CellCell Quiz:
Slide 1 Continued
Schistocytes or schizocytes (from the Greek word schisto, broken or cleft,
corresponding verb schizo) are circulating fragments of red blood cells (RBC) orRBCs from which cytoplasmic fragments have been lost. Schistocytes are absent
in the blood film of normal healthy individuals. Schistocytes are formed by
extrinsic mechanical destruction caused by the passage of the TBC throughfibrin strand. Fibrin stands are formed at the site of damage to a blood vessel
and a clot begins to form.
What term best describes theabove neutrophilb) HypogranularSchistocytes are a very important prognostic marker for Thrombotic
Macroangiopathic Anaemia (TMA) and if present in a blood film, further
investigation must be performed, particularly if they are the dominant RBC
morphological feature. In 2011, ICSH published guidelines on the identification,
diagnostic value, and quantitation of schistocytes.

c) Pelger Huet form

A suggested flow chart from the SCH guidelines is detailed below:a) Hypersegmented

Last Month’s CellQuiz:
An elderly patient presentswith extensive red rash(erythroderma), enlarged
spleen and lymph nodes.
Blood film shows numbers ofabnormal lymphocytes like theone above. What condition
may be present?

a) Glandular Feverb) Sezary Syndromec) Allergic reaction

Answer:b) Sezary Syndrome. Sezary
Syndrome is a rare aggressive
form of cutaneous T cell
Lymphoma with patients often
presenting with a red severely
itchy rash (erythroderma).
Sezary Cells have a convolutedor cerebriform nucleus withtightly intertwined nuclearlobes.

TMA includes 2 major syndromes: Thrombotic Thrombocytopenia Purpura*(TTP) and Haemolytic Uraemic Syndrome (HUS) Schistocytes may also be foundin patients with malfunctioning prosthetic valves, HELLP syndrome, malignant
hypertension, and metastatic cancer. RBC fragments similar to Schistocytes canalso be found in genetic or acquired RBC disorders (RBC membrane defects,
thalassaemia, megaloblastic anaemia, primary myelofibrosis, and burns.
Schistocytes can be classified as Keratocyte, helmet,
Microspherocytes are also part of the schistocyte family in TMA.

ortriangle.

A schistocyte count should be performed on a well stained blood film with thenumber of schistocytes counted per 1000 RBC.

* For more information, please see QSP issue 9, January 2021.

The first issue of the QSP Newsletter was published in May
2020. To celebrate the 2nd anniversary we looked back to thelast 12 issues:
Issue 25 |May 2022:
Case Study - Slide 3, 27% Erythroblasts, Target Cells, Howell Jolly Bodies.
Article - Malaria testing

Issue 24 | April 2022:
Case Study - Slide 2, High WBC, smudge cells - lymphoproliferative syndrome
Article - Malaria overview
Issue 23 | March 2022:
Case Study - Slide 2, Blast Cells indicative of AML
Article - Rare Lymphoid Clonal Abnormalities (hairy cell leukaemia, SLVL)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
ICSH
recommendations foridentification,
diagnostic value, andquantitation ofschistocytes

Issue 22 | February 2022:
Case Study - Slide 3, Atypical Lymphocytes - Infectious Mononucleosis
Article - An interesting case of Thrombocytopenia (May-Hegglin Anomaly)
Issue 21 | January 2022:
Case Study - Slide 5, Rouleaux formation
Article - Red Cell Morphology terminology part 2 - Variation in shape

Editorial Team
Kelly Duffy
Andrew Fisher

Issue 20 | December 2021:
Case Study - Slide 6, Vacuolated and hypergranular Neutrophils Septic Shock
Article - Red Cell Morphology Part 1 – variation in size and colour
Issue 19 | November 2021:
Case Study - Slide 3, High WBC, RBC target cells, Howell Jolly Body, Cabot’s Ring
Article - Monocytes
Issue 18| October 2021:
Case Study – Slide 2, Low Platelet count due to Platelet aggregation
Article - Platelet aggregation detection on HORIBA Yumizen H1500/H2500,
Eosinophils
Issue 17| September 2021:
Case Study - Slide 2, Neutrophilia, Anisocytosis
Article – Basophils
Issue 16| August 2021:
Case Study - Slide 1, Burkitt’s Lymphoma
Article – Granulocyte Development
Issue 15| July 2021:
Case Study - Slide 3, Lymphoproliferative Sezary Syndrome
Article - Paroxysmal Nocturnal Haemoglobinuria
Issue 14| June 2021:
Case Study - Slide 1, target cells, spherocytes
Article - Platelets and counting methodology

To find a full list of QSP Newsletters visit our website.

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