Back issues
All the QSP Newsletters published before are available here.
July 2024
Monthly Digital Case Study
Quiz
(PDF for print)
WBC 32.5* (10^3/mm3) | Large Platelets 2 |
RBC 3.55 (10^6/mm3) | Neutrophils 61.1% |
HGB 10.6 (g/dL) | Lymphocytes 7.6% |
HCT 30.8 (%) | Monocytes -% |
MCV 86.8 (fL) | Eosinophils 0.8% |
MCH 30.0 (pg) | Blasts 17.6% |
MCHC 34.5 (g/dL) | Myelocytes 7.6% |
PLT 88* (10^3/mm3) | Metamyelocytes 5.3% |
Erythroblasts 3 |
Male age 63, Emergency Unit
Thrombocytopenia.
Leukocytosis.
Neutrophilia.
Monocytosis: Monocytes/promonocytes/monoblasts?
Search for acute leukemia.
Neutrophils sometimes degranulated.
Myelemia+erythroblastosis.
Promonocytes(++).
Presence of macroplatelets.
For the attention of the expert: AML (4/5)?
In the context of AML with a monocytic component, should promonocytes always be classified with (mono) blasts: WHO criteria.
Blastosis estimated in this case at 5 G/L (15% of leukocytes).
Expert comment: Appearence compatible with (monoblastic) AML5
Monoblast or Promonocyte?
In the paper ‘Morphological evaluation of monocytes and their precursors' published 2009 in the journal Hematologica, a guide to identify the monocyte subtypes was presented. The article separated monocyte into 4 types, Monoblast (the precursor cell), Promonocyte, Immature Monocyte and Monocyte, with the following characteristics.
Cell | Nuclear Shape | Chromatin | Cytoplasm | Comments |
---|---|---|---|---|
Monoblast | Round/Oval | Delicate/ lace like. Nucleolus prominent | Basophilic. Rare azurophilic granule | Large 20 – 40 um |
Promonocyte | Convoluted/indented | Delicate/ lace like. Nucleolus prominent | Variably basophilic. Variable azurophilic granules | Except for nuclear shape, very similar to monoblast |
Immature Monocyte | Convoluted/indented | More condensed, Rare nucleolus | Less basophilic than promonocyte or blast but more basophilic than mature monocyte | Resemble monocyte but less mature and smaller |
Monocyte | Lobulated/Indented | Condensed no visible nucleolus | Gray. Occasional azurophilic granules. Occasional vacuole | Large 20 – 25 um |
Using the above table, we can identify the following cells in the slide.
Monoblast | Promonocyte | Monocyte (different slide) |
It is important to be able to differentiate between Promonocytes and immature/mature monocytes as in the WHO classification, Promonocytes are included with Monoblasts.
WHO Classification of Acute Myelomonocytic and Acute Monocytic Leukemia
Acute Myelomonocytic Leukemia | ≥ 20% monocytes and their precursors |
Acute Monocytic Leukemia | ≥ 80% monocytes and/or their precursors (monoblasts and/or promonocytes) |
Bibliography
Morphological evaluation of monocytes and their precursors
Haematologica. 2009 Jul; 94(7): 994–997.
As some of you may already know, Quality Slide Program (QSP) is scheduled to be discontinued at the end of this year. Therefore, this month’s issue will be the final edition. Starting in October, we will introduce a new name for the newsletter and continue to provide educational content focused on cell morphology. We plan to incorporate feedback from our subscribers’ surveys into the content.
We would like to express our heartfelt gratitude to all of you who have been loyal readers of the QSP Newsletter over the past four years. We remain committed to delivering valuable information in the future.
QSP Newsletter Editorials
Sie haben Fragen oder Wünsche? Nutzen Sie dieses Formular, um mit unseren Spezialisten in Kontakt zu treten.