ISSUE30

ISSUE

November
2022

This issue
November Slides P.1
Monthly Digital Case study P.1
Blast cells .2-3
Blast or Lymphocyte? P.4

November Slides

Slide 1Polymorphic Lymphocytes

Monthly Digital Case Study
Presentation November 2022, Slide 4

Slide 2
Nothing to report

Slide 3
Nothing to report

Slide 4See case study on the right

Slide 5
Myeloproliferative
Syndrome (CML)

Rare erythroblasts

FBC Results
WBC 6.97* (10^3/mm3)
RBC 2.34* (10^6/mm3)
HGB 7.7 (g/dL)
HCT 24.7 (%)
MCV 105 (fL)
MCH 29.5 (pg)
MCHC 31.2 (g/dL)
PLT 59* (10^3/mm3)

Rare blasts

Slide review
Male age 66
Clinical Details
Myelofibrosis
Basocytes (+++)

Slide 6
Eosinophilia.

Macroplatelets (+++)

Monthly Morphology
Quiz
Look closely at the slide below:

How to spot a blast cell
Blast cells are precursor cells to mature circulating cells. These cells are usuallyfound in low numbers in the bone marrow and generally not in significant
numbers in circulating blood.
The ability to recognise a blast cell in a blood film is perhaps one of the mostimportant morphology skills.
Blast cells are seen in severe infections, medications (GCSF), bone marrowtransplants, and hematopoietic neoplasms.
Acute leukaemia's are the most important to spot, as these can rapidly lead todeath.

Spotting a blast cell
What do you think it is?

Last month’s cell Quiz:
Which of the below would you
associate with a film appearance
like this?

Unfortunately, there is no single characteristic that indicates a blast. In general,
blasts are cells that have a large nucleus, immature chromatin, a prominent
nucleolus, scant cytoplasm, and few or no cytoplasmic granules. Blasts may
have some, or all of these characteristics:• Cell size - blasts are often medium to large cells. They are usually larger thana lymphocyte and at least the size of a monocyte.
• Large nucleus - most of the cell is taken up by the nucleus - they have a highnuclear to cytoplasmic ratio.
• Immature chromatin - the nuclear chromatin looks as if it is made of finedots. Imagine chromatin as many tiny points made by the tip of a sharp
pencil on a piece of paper.
• Prominent nucleolus. Nucleolus or nucleoli are structures within the nucleus
which appear as round less stained areas. The presence of nucleoli can be
helpful in defining the specificity of the cell.
• Nuclear membrane- usually follows the shape of the cytoplasm membrane.

A) Sickle cell

Blast Cells

B) Hereditary ElliptocytosisC) Haemolysis
Right answer: BThe Quiz slide shows hereditaryelliptocytosis. You can see the redcells (RBC) appear elongated, oval,
or elliptically shaped on theperipheral blood smear. Hereditaryspherocytosis is characterised byhaemolysis of spheroidal RBCs andanaemia. This is a rare autosomal
dominant disorder. It is caused
because of a weakness in thehorizontal linkages found in theskeleton of the membrane. This iscaused when there is a defective
dimer-dimer interaction, or adefective spectrin-actin 4.1R
junction complex. Spectrin is themain component of the cells
membrane, crucial in maintaining
the shape and structure.

It is really important when assessing a blood film to pull all the available
information available together, this includes current results, plots from theinstrument, any clinical details or previous results.
The LMNE channel on all the Yumizen H analysers can be used to assess if
abnormal cells are present. The LMNE channel plots Cell Volume on the X axis
and Cell Absorption on the Y axis is a visual marker for abnormal cells. On theYumizen H analysers the blast cell flag is a multiparameter flag using
measurements from 2 different channels (the Baso and LMNE channel),
together with diff can be the first indication of presence of Blasts.
LMNE from normal patient

LMNE from AML patientLooking at the full blood count results carefully is essential when looking at
peripheral blood films, as they go hand-in-hand to give the technician as muchinformation as possible on the sample.
There are a lot of parameters, so try to focus on the white blood cell count(WBC), haemoglobin (Hb), and platelet count (PLT) initially.
Look at the strength of the signal on the instrument, flags (*****). The moreparameters that are abnormal, the more cause for concern.

The more an individual parameter is abnormal, the cause for concern. e.g only
mild anaemia (WBC normal, Hb slightly decreased, PLT normal; not too worried)vs. severe pancytopenia (WBC markedly decreased, Hb markedly decreased, PLTmarked decreased; worried).

Blast or Lymphocyte??
It is often difficult, especially to trainee morphologists (and sometimes those withvast experience) to distinguish between a lymphocyte and a blast cell. Here is a
guide to help differentiate blasts from lymphocytes:

FeatureReactive
Lymphocyte

Blast Cell

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
Malaysian J Pathol 2020;
42(1): 37 – 49
Is this a blast? An illustrated
practical review on peripheral
blood smear examination inthe paediatric patient Gary
ROSE1, Heidi REINHARD1,
Samir B. KAHWASH1,2
https://eclinpath.com/hemato
logy/morphologicfeatures/white-bloodcells/big-blue-cells/

Editorial Team
Kelly Duffy
Andrew Fisher
Size

Variable in size

Usually larger than alymphocyte

Chromatin

ClumpedFine

Nucleoli

AbsentMay be presentCytoplasm

Deep blue smoothGrainy

Shape

IrregularRound, may beindented

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