ISSUE04

ISSUE

August2020

This issue

Last Month’s
SlidesJuly 2020 SlideSummaries
Slide 1

Mostly normal slide with someplatelet aggregates and giant
plateletSlide 2

Generally normal film

Slide 3Lymphoproliferative disorder,
probable CLL. Smear cells andabnormal lymphocytes

Slide 4

Myelodysplastic blood film withcirculating megakaryocytes, Blasts
Multiple cell abnormalities.
Erythroblasts, Cabot’s rings in RBCs
Basophilia

Slide 5Lymphoblasts, abnormal lymphoidcells. Probable ALL

Slide 6

Leukoerythroblastic blood film.
Myelodysplastic changes,approx.
50% blasts, auer rods, monocytoid
blasts. Probable M4 Acute
Myeloblastic leaukaemia

Last Month’s Slides P.1
Monthly Case study P.1
Platelet morphologyP.2-3
Monthly Quiz P.2
Top Tips P.3

Monthly Digital Case study
July 2020 Slide 5
Presentation

Child (5 years old)Presenting with weakness and jaundice

FBC Results
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT

2.63 (10^3/mm3)
2.37 (10^6/mm3)
65 (g/L)
20.3 (%)
85 (fL)27.4 (pg)32.1 (g/dL)
104 (10^3/mm3)

Neutrophils
Lymphocytes
Monocytes
Blasts7.6%
87.3%
1.7%3.4%

Slide review
Leukopaenia/neutropaenia confirmed
Small blasts present with minimal cytoplasm – lymphoid in appearance
Abnormal lymphoid cells (counted with lymphocytes) with cytoplasmic projections.
Almost certainly some of these abnormal cells are lymphoblasts making thedifferentiation between these abnormal cells and obvious blasts cells subjective

Diagnosis

Probable Acute lymphocytic
Leukaemia(immunophenotyping required
to complete the diagnosis)

Platelet
morphology inperipheral blood

Monthly Morphology
QuizLook closely at this redcell:

An overview of laboratoryfindings
Introduction

Platelets are cell fragments circulating in the peripheral that are involved insecondary haemostasis. Aggregated platelets, platelet polymorphism,
platelet satellitism and the presence of platelet precursors, megakaryocytes,
in the peripheral blood are useful indicators of a variety of conditions.

Platelet production

What is unusual about it
and what could thisPlatelets are produced in the bone marrow by fragmentation of the tips ofcytoplasmic extensions of cells called megakaryocytes. Each cell produces
approximately 1000 to 5000 platelets. They are released into the blood stream
through the endothelium of the vascular niches of the bone marrow.
There is a 10-day cycle for the production and release of platelets:

Indicate?

Last month’s cells:

The blood film shows
neutrophils with Dohle
bodies in the cytoplasm
These are remnants ofrough endothelial reticulum
and can accompany toxic
left-shift

Platelet aggregates

Platelet aggregates are very common and can give rise to falsely low platelet
counts and occasional interference with other parameters. They can be cause
by slow or difficult venepuncture but, in some individuals, platelets may besensitive to EDTA anticoagulant and invariably clump when blood samples aretaken. In these instances, a sample taken into tri-sodium citrate can give a
correct result after correction for anticoagulant dilution factor.

Platelet
morphology inperipheral blood
Continued from page 2
Platelet Satellitism

Platelet satellitism (illustration above)is a rare phenomenon in EDTA blood
where the platelets congregate around a white cell (usually a neutrophil). It is
generally considered to be an artifact, but it has been observed in someconditions including lymphoproliferative disorders, lupus, vasculitis and liverdisease but a cause has not been established.

Giant platelets

The presence of giant platelets may indicate that there is increased plateletproduction as younger platelets tend to be larger. It is also associated withIdiopathic thrombocytopaenic Purpura (ITP). In this case, the platelets may not
function correctly as they are unable to stick to the injured blood-vessel wall.
Giant platelets also occur in hereditary platelets disorders such as BernardSoulier Syndrome.

Megakaryocytes

Other NewsQSP 2.0Available now!
Options for a single
operator or site
license which allows
up to 10 concurrent
users

Bibliography
QSP July2020
Hoffbrand’s Essential
Haematology 7th edition
Wiley Blackwell

Editorial Team
Kelly Duffy
Mandy Campbell
Shubham Rastogi

Megakaryocytes are normally not seen in the peripheral blood and theirpresence is indicative of bone marrow such as Myelodysplastic Symdrome,
Myeloid Leukaemia, Polycythaemia Rubra Vera and myelofibrosis.
Megakaryocytes in the peripheral blood are often ‘bare’ – ie. with minimal
cytoplasm (illustrations of giant platelets and megakaryocyte from July 04slide).

About usThis Month’s Top Morphology Tip
The Hunt for Malaria

Common errors in looking for malaria in thin films are caused by platelets
overlying a red blood cell, if in doubt, rack in and out of focus on theparticular cell, if the platelet is on top of the red cell, it should come into
focus before the red cell, which will still be slightly blurred. If it is a malaria
parasite within the red cell, clear focus will be on the same plane.

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