March 2024
Monthly Digital Case Study
March Slides
Case Study Slide 1 Continnued
Quiz
(PDF for print)
| WBC 48.8* (10^3/mm3) | Neutrophils 83.1% |
| RBC 2.38* (10^6/mm3) | Lymphocytes 1.5% |
| HGB 7.5* (g/dL) | Monocytes 2.9% |
| HCT 23.1 (%) | Promyelocytes 1.5% |
| MCV 97 (fL) | Muelocytes 5.1% |
| MCH 32.5 (pg) | Metamyelocytes 5.9% |
| MCHC 32.5 (g/dL) | Normoblasts, Erythroblasts 2 |
| PLT 270 (10^3/mm3) |
Male age 56, pulmonology unit, multiple alarms on leukocyte differential
Anemia. Leukocytosis. Neutrophilia. Hyposegmented neutrophils (band cells) / Immature granulocytes. Monocytosis. No Blastosis associated with myelemia. Presence of rare erythroblasts.
Expert's comments:
Diagnostic approach:
1/ First exclude a non-hematological cause (Splenomegaly).
2/ If hematological cause: atypical Myeloproliferative disorder? (CML not the initial diagnosis).
These cells show the specific granulation of mature neutrophils but the nucleus does the full segmentation of normal Neutrophil. Please also note the cytoplasmic vacuolation.
Slightly larger than a mature Neutrophil, indented nucleus, abundant specific granules rare azurophilic granules.
Similar size to Metamyelocyte, nucleus is round (no or little indentation) with no nucleolus, condensed chromatin. Has both specific granules and azurophilic granules.
Larger cell than any of the above and larger than Myeloblast. Nucleus has open chromatin with nucleoli may be present. Azurophilic granules only.
Can you name a condition where this red cell picture would be seen?
The blood film is taken from a patient with hemolytic anemia. This anemia is a condition wherein the RBCs are destroyed faster than the bone marrow is able to replace them. The film shows RBC fragments, Spherocytes and stomatocytes.
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