I updated my atlas with something I saw down the microscope yesterday. Click here, then click on loa loa
This is (supposed to be) a reflective diary by a (not very) anonymous biomedical scientist who works somewhere in the south of England. One day this diary may well be submitted to the Health and Care Professions Council as evidence of ongoing continual professional development....
Showing posts with label down my microscope. Show all posts
Showing posts with label down my microscope. Show all posts
28 January 2026 (Wednesday) - Levetiracetam
I saw an interesting case today. Clearly an iron-deficiency anaemia. They are quite common. But this one was in someone who was on Levetiracetam. It’s an anticonvulsant which whilst supposedly not causing iron deficiency, it is recommended that people on that medication should take iron supplements. I’ve updated my atlas to include this case, and here’s some expert opinion on the matter
13 January 2026 (Tuesday) - Pseudo Pelger Huet Anomaly
An interesting case today… a massive neutrophilia with some Pelger Huet
cells…
I’ve updated the page in my atlas – click here, and then look for “Pelger
Huet Anomaly” in the links on the left hand side…
30 December 2025 (Tuesday) - Basophilic Stippling
I saw some basophilic stippling down the microscope… so I took a photo
and updated the page on my atlas.
I really need to go through that atlas and re-format it…
30 April 2025 (Wednesday) - Iron Deficient H.E.
An interesting case… an iron-deficient
case of hereditary elliptocytosis. There’s more about it in my atlas…
13 November 2024 (Wednesday) - Spot the Difference
Had an interesting conversation today
which made me think. What *exactly* is the difference between a
myelocyte and a promyelocyte?
They can be rather tricky to tell apart…
So I’ve had a think and done some
Googling…
- Promyelocytes are bigger.
- Promyelocytes have prominent nucleoli and Golgi apparatus.
- Myelocytes do not have nucleoli and Golgi apparatus.
- Compared to the myelocyte, much more of the promyelocyte is nucleus
- Promyelocytes have huge, dark purple, primary (azurophilic) granules both in the cytoplasm and overlying the nucleus.
- Promyelocytes do NOT have secondary (specific,to neutrophil, eosinophil or basophil) granulation – not even the beginnings of it! If you see any of that secondary granulation (even just a little blush of it in the cytoplasm) then it’s a myelocyte. The promyelocytes of the three granulocytic lineages cannot be distinguished by routine light microscopy.
16 May 2024 (Thursday) - Updating My Atlas
If you look on-line there are many atlases of haematology; websites
showing all sorts of weird and wonderful things you see down the microscope. Some
are rather obscure and you rarely if ever see these things outside of an atlas.
Years ago I started one of my own. It’s nothing special, the photos are rather
dreadful, but it is all stuff that I have seen myself. You can see the atlas by clicking here (if you feel so
inclined).
I spent a little while this morning updating it with things
I’ve seen over the last couple of months.
- Basophilic stippling
- Howell Jolly bodies
- May-Hegglin Anomoly
- Mitotic figures
8 April 2024 (Monday) - A Mitotic Figure
Mitotic figures are rather obscure
things but I saw one today… apart from NEQAS and Google, this would be the
fourth I’ve ever seen. I’ve taken the opportunity of updating my atlas.
20 November 2023 (Monday) - Platelet Satellites
I saw some platelet satellites today. We
often see platelets clumping in EDTA (at least once every day, but seeing them
satellite around neutrophils is a relatively rare occurrence. Interestingly (and
something I didn’t realise) is that demonstrably the platelets don’t form
satellites around every neutrophil.
I wonder why not.
Anyway, here’s a couple of references on
the matter:
The second reference says “The
clinical importance of this phenomenon is that in some cases it may result in
spurious thrombocytopenia or pseudothrombocytopenia leading to further
unnecessary investigations. Thus, recognition of this in vitro phenomenon only
re-emphasizes the necessity of age old practice of peripheral blood film
examination".
Written by an old-timer like me!!!
11 October 2023 (Wednesday) - Storage Changes?
If I see something like this my initial
thought would be that this is artefactual; a change brought about by storage.
But not necessarily… Botryoid nuclei are
also seen in cases of feature of burns and of hyperthermia, and… (this is where
I learned something today) – in cases of abuse of cocaine or methamphetamine.
There’s an article about this that you can read by
clicking here
25 September 2023 (Monday) - Harlequin Cells
Here’s something I don’t
see every day… or every year come to that. A harlequin cell. This one was in
the blood film of a chap with CLL whose white cell count was over 100. I only
saw the one despite some serious searching for more.
Harlequin cells are
dysplastic eosinophils with large purple-violet granules resembling basophilic
granules. The literature would have me believe that they are commonly observed
in acute and chronic myeloid leukaemias… I probably have seen them before but I
can’t say I remember seeing one.
Here’s a few references
about the things:
28 October 2022 (Friday) - Batten's Disease
Whilst
sitting at the microscope looking at (seemingly) ten thousand blood films
I read an interesting diagnosis… “blood film for Batten’s disease”.
Well… what
was that supposed to mean?
I had a little
look on-line and came up
with a reference.
… Batten disease is a rare inherited lysosomal storage disorder. Lysosomes
are compartments within a cell that degrade substances that are no longer
needed. Lysosomes that are unable to degrade wastes as intended, as in Batten
disease, allow lipofuscins, fatty granular substances, to accumulate inside
cells. This can lead to the formation of abnormal and distinctive vacuoles…
… make a blood film. The slide is then viewed under a light
microscope. Large vacuoles can easily be detected …
I never
knew that… One lives and learns – which is entirely the point of doing CPD.
23 September 2022 (Friday) - Elliptocytosis
I found a new case of hereditary elliptocytosis today. Rather than going blah-blah-blah here reproducing that which you can look up on Wikipedia in minutes, I updated my Atlas of Haematolgy. Call it up by clicking here and click on elliptocytes…
28 July 2022 (Thursday) - Highest Wbc Ever (?)
Here’s a photo of something I saw today. This is a shot of a film made from the blood of a patient with the highest white cell count have ever seen in forty-one years of blood testing.
Wbc 842.0
It’s a case of CLL in a chap who is one hundred and three years old… smear cells, prolymphocytes...
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