15 January 2018 (Monday) - Look at that !!!!

An interesting finding on an admission to the A&E department


K0123456            Burnham MICHAEL             01.02.03  M  Accident & Emer
Specimen R,18.0006197.A      Clin dets  fall, tender left hip and l3-l5 fracture
Collected 15.01.18   NK      A.Diag 
-------------- high intensity test code => unauthorised result -------------
PT           11.5         |RDW        + 29.5         |
APTT         29.0         |Neuts        NA           |NRBC's       2.5
FIB        + 6.99         |Lymphs       NA           |NUCA         0.27
Hb         - 82           |Monos        NA           |
WBC        + 10.66        |Eosin        NA           |
Plts         327          |Baso         NA           |
Hct        - 0.288        |FILM         Film Made    |
RBC        - 2.79         |MNEUT      + 9.63a        |
MCV        + 103.2        |MLYMP      - 0.69a        |
MCH          29.4         |MMONO        0.34a        |
MCHC       - 285          |                          |



Turns out the patient has had a splenectomy in the past. To quote an on-line source:

In our consult experience misinterpretation of the blood smear findings in the splenectomized patient is a cause of significant misdiagnosis.The blood changes following splenectomy are relatively predictable and knowing these changes can obviate a wrong diagnosis and therapy in your patient.

How true…

12 January 2018 (Friday) - Accole



Whilst getting the information together for the last few write-ups I learned a new phrase: “accole malarial forms”.

I’ve always known that trophozoites of P falciparum can be found on the edge of the red blood cells. I didn’t know that these are known as accole forms.
There’s three distinct types:

1. Common

The single chromatin bead lies on the edge of the cell with most of the cytoplasm
extended along the edge on both sides of the bead.

2.Rim

The complete parasite lies in a thichened line along the edge of the cell with no evidence of ring formation.

3.Displaced

The parasites are displaced beyond the edge of the host cell.  All degrees of displacement may occur, from partial to marked displacement with most of the parasite lying beyond the cell margin.

One lives and learns…

12 January 2018 (Friday) - December's Digital Morphology



While I’m at it – the December 2017 digital morphology exercise


CPD Report






Participant: Me !!


CPD Date: 2017-10-19 10:27:16


Total Number of Participants: 1098


Case Identifier: 1705DM








Consensus of Morphological features recorded:


Your Observations:

Rank
Morphological Feature
Participants who selected this feature
1
Lymphocytosis neoplastic appearance
38.5%
2
Smear/smudge cells
42%
3
Tear drop poikilocytes
5.6%
4
Thrombocytopenia
5%
5
Macrocytic platelets
6.3%

Other participants' Observations

Rank
Morphological Feature
Participants who selected this feature
1
Rouleaux
52.4%
2
Smear/smudge cells
42%
3
Lymphocytosis
41.6%
4
Lymphocytosis neoplastic ..
38.5%
5
Lymphoblasts
27.4%

What diagnostic category do you think best fits these appearances?
A mature lymphoid neoplasm: lymphoma/lymphoproliferative disorder

If you had to suggest a more precise diagnosis what condition would you choose?




Actual pathological diagnosis:
mantle cell lymphoma































At first sight not too good… but then again, what’s in a name?
I’m pleased with that !!