ISSUE24

ISSUE

April
2022

This issue
Last Month’s Slides P.1
Monthly Digital Case study P.1-2
Cell Quiz P.2
Malaria P2-3

Last Month’sSlides

Slide 1
Monomorphic
hyperlymphocytosis
associated with numerous
naked nuclei. Expert
comment: Aspect of CLL.

Slide 2
See case study on right.

Monthly Digital Case study
Presentation
Slide 2
Female (83 years old)

Slide 3

FBC Results

Intensive care unit. Lipaemic
sample. Anemia. Anisocytosis(++). Erythroblastosis.
Thrombocytopenia.
Hypergranulation ofneutrophils (+).

WBC 80.6 (10^3/mm3)
RBC 3.82 (10^6/mm3)
HGB 11.0 (g/dL)
HCT 25.6 (%)
MCV 93 (fL)
MCH 28.7 (pg)
MCHC 30.8 (g/dL)
PLT 186 (10^3/mm3)
Neutrophils 21.7 %Lymphocytes 72.9 %Monocytes 4.3 %Eosinophils 1.1 %Basophils 0.0 %Slide 4
Nothing to report.

Slide 5
Nothing to report.

Lymphocyte

Slide 6
Nothing to report.

Slide review
Clinical Haematology Department. Hyperleukocytosis. Anisocytosis (+).
Lymphomatous population with a high nucleo-cytoplasmic ratio, fine chromatin andsometimes cleaved nucleus, associated with very many smudge cells.
Immunophenotyping required of circulating lymphocytes.
Expert comment: appearance in favour of a lymphoproliferative
syndrome.

Cell Quiz:
What can be seen in the redcell?

Malaria-Part 1
Malaria is a worldwide disease, it is transmitted to humans via the Anopheles
Mosquito, through a bite. Malaria is found in tropical and subtropical regions ofthe world.
The mosquito bite introduces the parasite into the human’s blood via
sporozoites in the saliva. The parasites then migrate to the liver, where theymature and reproduce. This is known as the exoerythrocytic phase.

Last Month’s Cell
Quiz:
What is the feature within thered cell:

The organisms multiply in the liver in infected hepatocytes. These differentiate
into thousands of merozoites, which rupture the host cell, infiltrating the bloodand infecting red blood cells. This next stage is known as the erythrocytic stage ofthe life cycle. The parasite is able to leave the liver undetected as it envelopes
itself in the cell membrane of the infected host liver cell.

A) Howell Jolly Body
B) Ring form of P. FalciparumC) PlateletAnswer: B
Malaria is a global infectious
disease, which a major causeof morbidity and mortality
across the world. It istransmitted via the female
Anopheles Mosquito. The slide
shows ring form trophozoitesof P. falciparum (B) in the redcell (RBC). These are usually athin, delicate ring, about 1/5of the diameter of the RBC.
The ring can contain 1 or 2
chromatin dots and multiple
rings within one RBC arecommonly found in P.
falciparum. Rings seen in theperiphery of the RBC areknown as Accole or applique.

Types of Malaria
There are five known types of malaria parasite: Plasmodium falciparum,Plasmodium Vivax, Plasmodium Ovale, Plasmodium Malariae and Plasmodium
knowlesi. The most severe is P. falciparum and the lesser common is P. Knowlesi.
Plasmodium Falciparum: found mainly in Africa, it's the most common type ofmalaria parasite and is responsible for most malaria deaths worldwide, thoughtreatment does cure the infection.
Plasmodium Vivax: mainly found in Asia and South America, this parasite causes
milder symptoms, but it can stay in the liver for years which can result in
symptoms reoccurring if it isn’t treated properly.
Plasmodium Ovale: uncommon and usually found in West Africa.
Plasmodium Malariae: this is quite rare and usually only found in Africa.
Plasmodium Knowlesi: this is very rare and found in parts of southeast Asia.
These each have variations which help identification, see table below:

Size

Not enlarged

EnlargedNot enlarged

Enlarged

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To find out more, contact us.

ShapeRound,sometimes
crenated

Round or oval

Round

Round or oval,
often
fimbriatedBibliography

Normal, but
may becomedarker or may
have a purple
rimNormal topale

NormalMaurer’s
spots, appear
as large red
Differential Diagnosis
spots, loops
and clefts

Schuffner’sdots, appear
as small red
dots,
numerous

Ziemann’s
dots, few tiny
dots, rarely
detected

Pigment

Black or darkbrown

Seen as ahaze of finegolden brown
granulesscatteredthrough thecytoplasm

Black orbrown coarse
granules,scatteredIntermediate
between P.
Vivax and P.
Malariae

Trophozoite

Smallest,
delicate,sometimes
two chromatin
dots, multiple
rings
commonly
found

Relatively
large, one
chromatin dot,
sometimes
two, often tworings in one
cellCompact,one
chromatin
dot, single

Compact, one
chromatin dot,
singleSchizont

Medium size

Large

Small

Medium Size

Gametocyte

Crescent
shapedSpherical

Similar to P.
Vivax, but
smaller andless frequent

Like P. Vivax,
but smaller

Stippling

P. OvaleQSP 2.0

P. Falciparum

Colour

P. Vivax

P. Malariae

Observation(RBC)

https://www.ncbi.nlm.nih.gov/
books/NBK555962/

NormalEssential Haematology
A.V .Hoffbrand & J.E.Pettit

Schuffner’sdots (James’sdots).
Numerous
small red dots

Editorial Team
Kelly Duffy
Andrew Fisher

About us
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Northampton, UK
NN3 6FLHORIBA Medical
Parc Euromédecine, 390
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Francewww.horiba.com/medical

P.FALCIPARUM (shows Double dots)

Malaria

Testing for the diagnosis of malaria is confirmed by a microscopic (blood films) and nomicroscopic (FBC, rapid test) tests. See next newsletter.