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I'm a busy Mum and a Biomedical Scientist in Haematology. My particular interest is in blood cell morphology and parasitology, where I never stop learning.

Wednesday, 17 March 2021

Hypogranular neutrophils picked up on an XN10 plot

This is a good example of how the differential plots must be reviewed when interpreting Full Blood Count results.

The X axis on the Sysmex XNs shows an increase in cell complexity from left to right ( i.e granules and nuclear lobulation). Eosinophils are therefore far right because of their heavy granulation and nuclear lobulation and neutrophils are just left of these.  The monocytes are to the left of the neutrophils as they are less complex , but higher up on the Y axis due to an increased DNA/ RNA content. Lymphocytes are far left.

Look at this plot. The neutrophil population is partly too far left illustrating that whatever these cells are, they are far less complex. My thinking was that there could be dysplasia, either dysplastic nuclei or hypogranular neutrophils which both make the neutrophils less complex and therefore appear left of the expected plot position.



The blood film did indeed show some hypogranular netrophils. Other neutrophils however showed toxic granulation The clinical details were bilary sepsis so features of infection/ inflammation would be consistent 





Reading up on the mechanism behind neutrophils lacking granules, it could be defective granule formation or excessive degranulation during development.

The significance of this feature could be that this is a myelodysplasia or myeloproliferative disorder. 

The Full Blood Count results were not remarkable and the film would not have been made if the plot wasn't viewed.  Therefore very important!

Monday, 22 February 2021

UK NEQAS Digital Morphology Instagram page

Just started following UK NEQAS Digital Morphology Instagram account. Take a look! https://www.instagram.com/haematography/

Sunday, 10 January 2021

Digital Morphology case 2006DM

10th January 2021 Digital Morphology case 2006DM 

This was a good P.Vivax film showing different trophozoite stages and how the level of red cell distortion increases as the trophozoite matures. 

The initial phase, red cell enlarged but still round with cytoplasmic dots.
This is compared to  how a later trophozoite stage greatly distorts and enlarges red cells . It also highlights how later stages cause red cells to become pale as the parasite metabolises haemoglobin.
I found this very useful as I would typically associate P. Vivax with the second picture, a very amoeboid trophozoite and greatly distorted red cell. It is worth remembering how different the trophozoite can appear in all species, depending on it’s maturity. 

Circulating schizoints and gametocytes are often seen in this species, although not in this particular case. 

The case narrative also gives some useful links to training aids. I will be using these for Malaria speciation training. 

https://haematologyetc.co.uk/Malaria_stage_recognition https://haematologyetc.co.uk/Malaria_species_recognition

Monday, 9 November 2020

Survey 2004RD: Rapid Diagnostic Techniques for Malaria

Survey 2004RD: Rapid Diagnostic Techniques for Malaria Date 9/11/20 

The November 2020, RDT survey directs partcipants to read the Malaria rapid diagnostic test performance. Results of WHO product testing of malaria RDTs: round 8 (2016-2018). This can be found at https://www.who.int/malaria/publications/atoz/9789241514965/en/ 

The document gives an overview of findings from rounds 5-8 of Malaria RDT product testing. This is a good guide for laboratories on choosing an RDT kit that is likely to perform to a high a standard The document gives in detail how these RDT kits were evaluated. A simple summary is given in this flowchart.
Kits were assessed based on the following: -sensitivity, to detect nearly all clinically significant cases of malaria; - specificity, to accurately discriminate non-malarial febrile illness from malaria in order to ensure appropriate management and accurate disease monitoring; - stability, to maintain accuracy after transport and storage in ambient conditions; and - ease of use and adequate labelling and instructions for use to ensure safe, correct preparation and accurate interpretation of results.

The results are too extensive to document here, but I will be looking at my own laboratory kit and comparing it’s performance to others on the market, based on these findings.

Friday, 16 October 2020

A Rare One!

Quite a rare one here... I had to look it up! Pearson’s Syndrome.. it’s a Congenital Sideroblastic anaemia and Pancreatic dysfunction. I was trying to work out why this patient had macrocytic red cells and thrombocytopenia. Reading around this, it seems that these features are consistent with this form of sideroblastic anaemia. I usually associate sideroblastic anaemia with microcytes and dimorphic red cells and hadn’t appreciated that mainly macrocytes could be a feature and how many different types of sideroblastic anaemia there actually were. Reading about this, it seems that a good starting point in searching for the cause of sideroblastic anaemia is to look at the MCV. So MCV is important! Bottomley, S. Leung L. Tirnauer, JS. (2020) Causes and the Pathophysiology of the Sideroblastic Anaemias
I also saw these. Pappenheimer bodies, which are blue iron containing inclusions in the red cell, and often found near the edge , I usually scan for these when I have a patient with an unexplained anaemia and dimorphic red cells. A lot learnt today! I’ll be using this blood film in morphology training to demonstrate the diversity of red cell size in the Sideroblastic Anaemias.

Wednesday, 14 October 2020

Malaria Parasitaemias

Dr Samuel Boadi who led Monday’s UK NEQAS Blood Parasitology course, made a very good suggestion for speeding up the calculation of Malaria percentage parasitaemias, in a busy laboratory. The laboratory should establish it’s own average number of red cells per field when using a x100 objective. This average number can be used every time, rather than the microscopist calculating it separately on every occasion. I’m going to ask number of different colleagues to count how many red cells they see on a film using a x100 objective, and take an average. I’ll fill out a quality improvement notice and see if this could be used and added to our SOP, as it will significantly improve turn around times!  

Monday, 12 October 2020

WORMS!!!!

I took a photo of this Microfilaria on last months Parasitology NEQAS. It was indeed Loa Loa. I find this species the easier one to diagnose, mainly because the sheath gives just a halo impression when stained with Giemsa (requires haematoxylin to be seen) and that the nuclei extend right to the tip of the tail. This coincided nicely with today’s UK NEQAS yearly parasitology course, which I attended online. Dr Samuel Boadi, gave a simple breakdown of the features of the tail, in three Filariasis species.
I’ll remember this now, Wucheria Bancrofti- nuclei do not extend to the tip of the tail, whereas Loa Loa, they do. Brugia Malayi is quite distinct with two nuclei separated from one another. Interesting on the NEQAS expert comment, it was suggested that Filaria can be seen macroscopically on a slide. My colleague described it as almost looking like an eyelash. I’m going to have another look, see if I can spot them!