ISSUE08

ISSUE

December
2020

This issue

Last Month’sSlides

November 2020 Slide
Summaries
Slide 1

Last Month’s Slides P.1
Monthly Case Study P.1
Using QSP to Assess Parasitemia P.2
Myeloproliferative Disorders-Part 2 P.2
QSP Christmas Crossword P.3

Monthly Digital Case study
November 2020 Slide 3
Presentation

Acute Myeloid Leukaemia

Male 38 years old, recent travel abroad, sore throat
and mild fever.

Slide 2

FBC

Normal Blood film

Slide 3
Malaria Falciparum

Slide 4
Normal Blood film

WBC
RBC
HGBHCTMCVMCH
MCHCPLT

5.8 (10^3/mm3 )4.96 (10^6/mm3)
15.2 (g/dL)
43.8 (%)
88 (fL)30.6 (pg)34.7 (g/dL)
209 (10^3/mm3 )Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

73.1 (%)
15.7 (%)
6/0 (%)
0.7 (%)

Figure 1

Slide 5
Normal Blood film

Slide 6
Normal Blood Film

Slide review
Emergency unit consultation for fever, after
return from a trip abroad. Parasitaemia
estimated at 3,5% of Plasmodium (ringstage) on RBC’s wall, accolé forms (Fig.2).
Red cells contain multiple parasites( (Fig. 1)
Figure 2

Diagnosis
Confirmation of Plasmodium Falciparum
following blood film examination, rapid test
kit and confirmation of malarial species
from reference centre.

Monthly Morphology
Quiz

Last month’s cells:

The film indicates a normalfilm, red blood cells arenormochromic andnormocytic, WBCmorphology normal, with anormal distribution ofplatelets. The film is from afemale, 43 yrs old: with thefollowing parameters:
WBC 7.82 (10^3/mm3)
RBC 4.92 (10^6/mm3)
HGB 15.3 ((g/dL)
MCV 94 fL
PLT 193 (10^3/mm3).
Nothing abnormal detected.
It is extremely valuable as amorphologist to be able toidentify a normal blood film.
This means that when you
observe something abnormal
in a blood film, you are able
to notice this instantly. You
may not know exactly what isgoing on, but you will know
the film is not normal, this isan essential step when
examining blood films.

Using QSP to assess parasitaemia
The number of red cells containing parasites (parasitaemia) is an important diagnostic
factor and is calculated by counting the number of parasitised red cells in 1000 red
cells in a thin blood film as per UK National External Quality Assessment Service(UKNEQAS). QSP can assist the laboratory in assessing user’s ability to countparasitaemia.
On installing the slide package into QSP the local expert can see the parasites counted
by the external expert by accessing the RBC tab and left clicking on the Parasites line,
all parasites detected will be identified by a blue crosshair
To add additional parasites, point to andright click on the parasite. To remove an
incorrectly identified parasite, point to theblue crosshair and right click, the crosshair
will disappear. The parasite count will beadjusted accordingly.

Assistant User
Navigate to the RBC tab, and use the zoom
option to magnify the cells.
Point to and click on the Parasite line in the morphology table and when a parasite isfound right click on the red cell , the blue crosshairs will be displayed and the parasite
will be counted in both absolute and percentage. Other red cell features e.g.
schistocytes, sickle cells can be counted in the same manner.

Myeloproliferative Disorders – Part Two
Essential Thrombocytosis
This is most indolent myeloproliferative disorder and is characterised by increased
platelet production (thrombocytosis) alone. Its complications include transientischemic attacks, ocular migraine, erythromelalgia (burning pains in the hands andfeet), bleeding or pseudohyperkalemia (falsely elevated blood potassium levels) due toextreme thrombocytosis, and occasionally, arterial or venous thrombosis, rarelysplenomegaly. In some patients, transformation to bone marrow failure, myelofibrosis
and acute leukaemia. Essential thrombocytosis is a diagnosis of exclusion because
isolated thrombocytosis is frequently the first manifestation of polycythaemia vera
and primary myelofibrosis as well. It is compatible with a normal life span.

Primary Myelofibrosis
This is least common and most aggressive myeloproliferative disorder. It
characteristically presents with bone marrow fibrosis, splenomegaly due toextramedullary haematopoiesis, anaemia, variable changes in the platelet andleukocyte counts, constitutional symptoms due to increased inflammatory protein
production and a progressive course with bone marrow failure, pulmonary
hypertension and transformation to acute leukaemia.

Systemic Mastocytosis
This is a rare disorder due to mutations that allow the increased production of an
uncommon blood cell, the mast cell. This is rich in proteins that destroy tissues, andother inflammatory mediators, such as histamine that cause severe allergic
reactions. Expansion of mutated mast cell population results in spleen and liverenlargement, bone marrow failure, skin lesions, marrow fibrosis, osteoporosis,
abdominal pain, peptic ulcer and diarrhoea, flushing of the skin anditching. Occasionally, systemic mastocytosis is complicated byanother myeloproliferative disorder such as polycythaemia vera.

Other NewsQSP 2.0
Available now!
Options for asingle PC license
or site license
which allows up
to 10 concurrent
users on multiple
PC’s

Bibliography
QSP December 2020

Season’s Greeting from theHORIBA UK Medical Teamand best wishes for a
happy 2021.

Hoffbrand’s
Essential
Haematology 7thedition
Wiley Blackwell
Crossword courtesyof EclipseCrossword

Editorial Team
Kelly Duffy
Andrew Fisher

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

Scroll down for our QSP Christmas crossword.

QSP Christmas crossword
Our last QSP newsletter for 2020 comes to you with a crossword. Download and print the crossword
and the questions. Answers to be announced in our next newsletter. Enjoy!

*if the answer contains more than one word, there is a space in between the words.

QSP Christmas crossword
Clues Across
1. Term to describe blood cell production in the body (11)
5. Red cell no longer a biconcave disc (10)8. Mature Neutrophil with only one or two lobes is called this (2 words 6-4) (11)
9. Red cells that are shaped like when you cry (2 words 4,4) (9)12. This type of malaria is very neat and have ring forms (10)15. What does the Q stand for in QSP (7)17. Be careful under the mistletoe you might catch this (2 words 9,5) (15)
19. What month is in the name of a stain and the name of a disorder characterised by large platelets (3)22. What species of insect is responsible for transmitting Malaria (9)25. Which company produces Quality Slide Program (6)26. You may aim for this cell (2 words 6,4) (11)29. This lens on a microscope is the closest lens to the slide (9)31. What white cell is the least common in normal blood (8)33. This cell can either be T or B (10)34. This cell may be Russian (6)35. Platelet pre cursor (13)36. If you are Iron deficient your red cells are (10)37. What cell has a normal volume of 9 -12 fl (8)38. Rare hereditary disease where the red cells may look like those from burn patients (18)

Clues Down
2. This disorder can give background stain on the blood film (7)3. Word to describe the changes in red cell shape (14)
4. You use this chamber to count cells manually (8)6. what festive period gives its name to a coagulation disorder (9)7. What feature can be seen in Neutrophils in infection (2 words 4,4) (10)
10. Not a bald cell (10)
11. A monocyte becomes one of these cells when it enters the tissue (10)
13. Immature red cells are characterised by showing this colour change (13)14. Another name for smear cells (6)16. Neutrophils from Females may show this appendage (9)18. A "happy" red cell inclusion 3 words (6,5,6) (19)20. A needle like structure found in blast cells (8)21. These red cell inclusion may be produced by bake bean manufacturers (2 words 5,6) (12)23. Red cells stacked like pennies (8)24. A "mouthy" cell (11)27. To describe difference in the size of red cells (12)28. Red cells you need a supravital stain to manually count (12)30. Most commonly found white cell in normal patients (10)31. What you might find on a castle but also describes the technique of navigating through the slide when performing
a differential (10)32. Term to describe red cells larger than normal and seen in B12 or Folate deficiency (10)