QSP Blood Cell Morphology Newsletter

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Side 1

See Review opposite.

Slide 2

Geriatrics unit.

Anaemia, Anisocytosis(++).

Neutrophilia (Degranulated/agranulated neutrophils).

Myelemia Degranulated) immature granular cells).

Thrombocytopenia. MDS/MPS?

Expert's comments: Atypical CML?

Slide 3

Monomorphic hyperlymphocytosis associated with numerous smudge cells compatible with a lymphoproliferative syndrome (CLL type?).

The diagnostic approach must be completed by a request of blood lymphocyte immunophenotyping by flow cytometry, with establishment of the Matutes scoring and cytogenetic analysis.

Note the presence of macro-platelets (see giant platelets) as well as numerous platelet aggregates: DO NOT REPORT platelets result.

Add a comment e.g.: "underestimation of platelets count: PLT cluster".

Expert's comment:

Count "smudge" cells in lymphocyte count (if lymphocyte count to be reported by manual method).

Slide 4

Composite type major sickle cell syndrome

(beta-thalassemia/haemoglobin S).

Slide 5

Recommendation: Platelets result to be checked on a citrate sample

Expert's comments:

"Difficult patient to sample?”

Slide 6

Presence of rare macroplatelets and rare platelet clusters.

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Monthly Digital Case study

December 2023, Slide 1

Presentation

Male 80 years old.

Deterioration of

health state.

Hyperleukocytosis+

thrombocytopenia

Leucocyte differential with alarm.

Additional information

Highly degranulated/agranulated

Neutrophil. Thrombocytopenia.

Majority population of mostly

granular blasts (estimated at 80%

of leucocytes, in favour of Acute

Myeloid Leukaemia.

Expert’s comment: AML probably AML 1/2.

Last month's quiz:

What morphological

features can be seen in the cell from a Romanowsky stained blood film?

a) Heinz Bodies

b) HbH

c) Basophilic Stippling

Right answer:

c) Basophilic Stippling

Basophilic stippling is a frequent manifestation of haematologic disease in the peripheral blood. Fine basophilic stippling is associated with increased red cell production and is commonly seen when there is increased polychromatophilia. Coarse basophilic stippling is seen in megaloblastic anaemia and other forms of severe anaemia, lead poisoning, and thalassemia.

Slide 1 Review Continued

The term AML, M1 or M2 relates to the French-American-British (FAB) groups classification of Acute Leukaemia's and Myelodysplastic Syndromes. The FAB classification was developed in the 1970’s firstly as an aid to differentiate Acute Lymphoid from Acute Myeloid Leukaemia, classification is based solely on the cytochemical morphology of cells to elucidate their lineage and maturation. In the 1980’s further development of the FAB classification sub divided the Acute Myeloid Leukaemia's into 8 categories based upon the morphological features of the cells:

M0 – AML with minimal evidence of differentiation

M1 – Poorly differentiated no Myeloid maturation

M2 – Myeloblastic with some Myeloid maturation

M3 and M3v – Promyelocytic Leukaemia

M4 – Acute Myelomonocytic Leukaemia

M5a and M5b – Monoblastic Leukaemia

M6 – Erythroblastic Leukaemia

M7 – Megakaryoblastic Leukaemia

With the development of techniques such as cytogenetics and immunophenotyping, the World Health Organisation (WHO) proposed a new classification which was based on the genetic, immunophenotypic, biological and clinical features of patients to better define specific disease entities.

The WHO classification of AML (briefly)

AML with myelodysplastic syndrome, therapy related.

AML with recurrent genetic abnormalities e.g. AML with t(8;21)(q22;q22), AML1(CBFA)-ETO fusion gene, Acute Promyelocytic Leukaemia (AML with t(15;17)(q22;q11-12) and PML-RARA fusion gene or variants with RARA.

AML with multilineage myelodysplasia.

AML Not Otherwise Categorised. In such cases the FAB classification is used.

Christmas Quiz

Let’s see what we remember for the previous cell quiz questions and morphology articles.

1) What word describes changes in Red Blood Cell shape?

2) What cell can either be T or B?

3) Can you identify this white cell?