laboratory Science of Tehran University of Medical Science

Differential



Neutrophils

Neutrophils are so named because they are not well stained by either eosin, a red acidic stain, nor by methylene blue, a basic or alkaline stain. Neutrophils, are also known as "segs", "PMNs" or "polys" (polymorphonuclears). They are the body's primary defense against bacterial infection and physiologic stress. Normally, most of the neutrophils circulating in the bloodstream are in a mature form, with the nucleus of the cell being divided or segmented. Because of the segmented appearance of the nucleus, neutrophils are sometimes referred to as "segs." The nucleus of less mature neutrophils is not segmented, but has a band or rod-like shape. Less mature neutrophils - those that have recently been released from the bone marrow into the bloodstream - are known as "bands" or "stabs". Stab is a German term for rod.

Increased neutrophil count

An increased need for neutrophils, as with an acute bacterial infection, will cause an increase in both the total number of mature neutrophils and the less mature bands or stabs to respond to the infection. The term "shift to the left" is often used when determining if a patient has an inflammatory process such as acute appendicitis or cholecystitis. This term is a holdover from days in which lab reports were written by hand. Bands or stabs, the less mature neutrophil forms, were written first on the left-hand side of the laboratory report. Today, the term "shift to the left" means that the bands or stabs have increased, indicating an infection in progress.

For example, a patient with acute appendicitis might have a "WBC count of 15,000 with 65% of the cells being mature neutrophils and an increase in stabs or band cells to 10%". This report is typical of a "shift to the left", and will be taken into consideration along with history and physical findings, to determine how the patient's appendicitis will be treated.


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Stabs or band cells are normally about 10% of the total leukocyte count.
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In addition to bacterial infections, neutrophil counts are increased in many inflammatory processes, during physical stress, or with tissue necrosis that might occur after a severe burn or a myocardial infarction. Neutrophils are also increased in granulocytic leukemia.

Decreased neutrophil count

A decrease in neutrophils is known as neutropenia. Although most bacterial infections stimulate an increase in neutrophils, some bacterial infections such as typhoid fever and brucelosis and many viral diseases, including hepatitis, influenza, rubella, rubeola, and mumps, decrease the neutrophil count. An overwhelming infection can also deplete the bone marrow of neutrophils and produce neutropenia. Many antineoplastic drugs used to treat cancer produce bone marrow depression and can significantly lower the neutrophil count. Types of drugs that can produce neutropenia include some antibiotics, the psychotropic drug lithium, phenothiazines, and tricyclic antidepressants.


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A patient with an acute viral infection may have a decreased neutrophil count.
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Eosinophils

Eosinophils are associated with antigen-antibody reactions. The most common reasons for an increase in the eosinophil count are allergic reactions such as hay fever, asthma, or drug hypersensitivity. Decreases in the eosinophil count may be seen when a patient is receiving corticosteroid drugs.

Basophils

The purpose of basophils is not completely understood. Basophils are phagocytes and contain heparin, histamines, and serotonin. Tissue basophils are also called"mast cells." Similar to blood basophils, they produce and store heparin, histamine, and serotonin. Basophil counts are used to analyze allergic reactions. An alteration in bone marrow function such as leukemia or Hodgkin's disease may cause an increase in basophils. Corticosteroid drugs, allergic reactions, and acute infections may cause the body's small basophil numbers to decrease.

Lymphocytes

Lymphocytes are the primary components of the body's immune system. They are the source of serum immunoglobulins and of cellular immune response. As a result, they play an important role in immunologic reactions. All lymphocytes are produced in the bone marrow. The B-cell lymphocyte also matures in the bone marrow; the T-cell lymphocyte matures in the thymus gland. The B cells control the antigen-antibody response that is specific to an offending antigen. The T cells are the master immune cells of the body, consisting of T-4 helper cells, killer cells, cytotoxic cells, and suppressor T-8 cells. The majority of lymphocytes that circulate in the blood are T-lymphocytes, rather than B-lymphocytes. To help diagnose immune system deficiencies such as AIDS, the lab does specialized tests of T-lymphocytes. In the WBC, T and B-lymphocytes are reported together. In adults, lymphocytes are the second most common WBC type after neutrophils. In young children under age 8, lymphocytes are more common than neutrophils.

Lymphocytes increase in many viral infections and with tuberculosis. A common reason for significant lymphocytosis is lymphocytic leukemia. The majority of both acute and chronic forms of leukemia affect lymphocytes.

Due to research on HIV infection, a virus that affects T-lymphocytes, much more is now known about lymphocytes and their functions. HIV causes a reduction in the total number of lymphocytes as well as changes in the ratios of the types of T-lymphocytes. Corticosteroids and other immunosuppressive drugs also cause lymphopenia. A decreased lymphocyte count of less than 500 places a patient at very high risk of infection, particularly viral infections. It is important when the lymphocyte count is low to implement measures to protect the patient from infection.


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T lymphocytes are the body's master immune cells.
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Monocytes

Monocytes are the largest cells in normal blood. They act as phagocytes in some inflammatory diseases and are the body's second line of defense against infection. Phagocytic monocytes produce the antiviral substance interferon. Diseases that cause a monocytosis include tuberculosis, malaria, Rocky Mountain spotted fever, monocytic leukemia, chronic ulcerative colitis and regional enteritis

+ نوشته شده در  چهارشنبه بیست و نهم آبان 1387ساعت 20:52  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 

lstums

 

 

Happy Birthday LSTUMS

 

 

اولین سالگرد شروع بکار وبلاگ علوم

 

آزمایشگاهی دانشگاه علوم پزشکی

 

تهران را تبریک عرض مینماییم.

 

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برخود میدانیم از تمامی دوستان و عزیزان بخصوص همکلاسی های عزیزمان که در این یکسال ما را با نظرات خود در پیشرفت هرچه بیشتر این بلاگ کمک کرده اند کمال تشکر و قدر دانی را داشته باشیم.

به امید پیشرفت روز افزون.

                                   جمعی از نویسندگان

+ نوشته شده در  دوشنبه بیستم آبان 1387ساعت 17:47  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



These two cells are atypical or reactive lymphocytes. They are typically seen in infectious mononuclei. Atypical lymphs have abundant cytoplasm. The cell on the left has cytoplasm extending between the red cells; where it touches a red cell, it is darker on the edge. The nuclear chromatin is finer than that seen in normal lymphocytes. The cytoplasm may contain small vacuoles. The cell on the right has a kidney-shaped nucleus. This is commonly seen in atypical lymphs. The cytoplasm is moderately basophilic. Atypical lymphs may be seen in patients with viral infections (especially infectious hepatitis) but the greatest numbers are seen in patients with infectious mononucleosis.


 

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This atypical lymph is large with abundant cytoplasm. Azurophilic granules are present in the cytoplasmonly seen in atypical lymphs. The cytoplasm is moderately basophilic. Atypical lymphs may be seen in patients with viral infections (especially infectious hepatitis) but the greatest numbers are seen in patients with infectious mononucleosis.


 

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Lymphocyte



This lymphocyte is slightly atypical due to its large size and abundant cytoplasm

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The cells indicated by the arrows are (left to right) an orthochromic normoblast, a basophilic normoblast and a polychromatophilic normoblast. The cell in the center appears to be a white blood cell blast and the cell on the lower right is a monocyte.


 

http://www.academic.marist.edu/~jzmz/HematologyI/NRBC41.html

+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:21  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



This Wright's stained peripheral blood smear demonstrates normal mature red blood cells approximately 7.2 micrometers in diameter with an area of central pallor less than 1/3 the volume of the cell. The normal red cell count for adults is between 4 and 5 million per microliter of blood.

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When a peripheral blood smear is stained with new methylene blue, a supravital stain, reticular material is visable. Reticulocytes can be counted. A normal reticulocyte count is 0.5 - 1.5% (1000 red cells are counted and the percent of reticulocytes is reported). If this field represents the whole smear, this patient would have an elevated reticulocyte count. Approximately seven reticulocytes are present out of 42 red blood cells. This would represent a reticulocyte count of about sixteen percent. This is extremely elevated.
+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:19  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



The cell indicated by the arrow on this Wrigt's stained blood smear is a reticulocyte. It is larger than the mature red cells and has a slight blusih tinge. If a Wright's stained blood smear has reticulocyte present, polychromasia is noted.
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The arrows point to orthochromic normoblasts with pyknotic nuclei. At this stage, the small dense nucleus is extruded from the red cell and the remaining cell is known as a reticulocyte. The large cell in the center is a pronormoblast. The cell to the left of the pronormoblast is a late basophilic normoblast.
+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:17  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



The cell indicated by the arrow is an orthochromic normoblast. It is about 8 - 10 micrometers in diameter. It is the last stage of red cell maturation with a nucleus. The nucleus is small and dense. The cytoplasm is mostly pink due to its high hemoglobin content. The cell below the nucleated red blood cell is a lymphocyte. The lymphocte chromatin is smoother and the cytoplasm is bluer.


 

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The cell indicated by the arrow is a polychromatophilic normoblast. It is about 8 - 12 micrometers in diameter. The cell is getting smaller as it matures. The nucleus is denser and dark purple in color. The cyptoplasm is staining light purple due to the presence of both RNA and beginning hemoglobin production. The cell on the lower left is an early orthochromic normoblast.

+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:15  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



The two large cells in the center are basophilic normoblasts. They are generally smaller (about 10 - 15 micrometers in diameter) than pronormoblasts. The cytoplasm is basophilic due to its high RNA content. The nucleii are red in color and beginning to condense. The cell on the right is a polychromatophilic normoblast. The cell is getting smaller (8 - 12 micrometers in diameter) as it matures. The nucleus is dense and dark purple in color. The cytoplasm is staining light purple due to the presence of both RNA and beginning hemoglobin production. The cell on the lower left is an early orthochromic normoblast.


 

+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:14  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 



The cell indicated by the arrow is a pronormoblast. It is the youngest recognizable red cell. The cell is large (14 - 20 micrometers in diameter). The cytoplasm is bright blue with a prominent light spot representing the golgi apparatus. The large, round nucleus is red in color and has fine lacy chromatin. It may contain 1 - 2 nucleoli. Also, pictured here (starting at 12 o'clock and going counter clockwise) is a lymphocyte, an orthochromic normoblast, a polychromatophilic normoblast and a stab.

+ نوشته شده در  سه شنبه چهاردهم آبان 1387ساعت 22:13  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 

Table of Contents
Results

 
Follicular Hodgkin Lymphoma

Results

Clinical Information

Seven males and 6 females (median age, 38 years; range, 12-64 years) had FHL in lymph nodes of the neck (6 patients), axilla (3 patients), groin (2 patients), and mediastinum (1 patient) and in the nasopharynx (1 patient). Detailed clinical information was available for the 4 patients with FHL treated at the University of Michigan, with follow-up ranging from 8 months to 10 years.

Case 1. In a 43-year-old woman with a left-sided neck mass, a computed tomography scan revealed 2 lymph nodes measuring 2.2 and 1.2 cm (stage IB). She was given multi-agent chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD] for 6 cycles), leading to a complete response; follow-up 1 year later showed no evidence of disease.

Case 2. A 28-year-old woman with a 2-cm supraclavicular mass and small ipsilateral infraclavicular lymph nodes sought care at 28 weeks of pregnancy. Staging revealed a 4 4 3-cm mass in the left supraclavicular region and anterior mediastinum, with 2 small suspicious lesions in the spleen (at least stage IIA, possibly IIIs). The disease responded to chemotherapy (ABVD for 6 cycles), and, at last follow-up, the patient had been in remission for 8 months.

Case 3. A 38-year-old man had stage IIB nodular sclerosis Hodgkin disease at initial examination, diagnosed following an inguinal lymph node biopsy. The disease recurred 1 year after treatment (chemotherapy, ABVD for 6 cycles; and radiation) as FHL in axillary lymph nodes, which responded to high-dose cyclophosphamide and a peripheral stem cell transplant.

Case 4. A 31-year-old woman with axillary and epitrochlear lymphadenopathy originally was given a diagnosis of lymphocyte predominance Hodgkin disease (subsequently reclassified as FHL). Staging at this time did not reveal evidence of disease in the spleen, liver, bone marrow, or iliac lymph nodes (stage II, probably A). Six years after radiation therapy, the disease recurred as FHL in iliac and periaortic lymph nodes, with involvement of bone marrow. She then received chemotherapy (ABVD for 6 cycles) and, at last follow-up, had been in remission for 9 years.

Histopathologic and Immunohistochemical Findings

All FHL cases showed a prominent follicular architecture, usually composed of small to intermediate-sized follicles (Figure 1a). The characteristic feature, seen in all cases, was the presence of follicles with expanded mantle zones, occasionally with small, well-defined, often eccentric, germinal centers (Figure 1b). Scattered classic Reed-Sternberg cells and variants (usually lacunar, occasionally mononuclear or mummified) were found within these mantle zones. Hyperplastic reactive follicles were noted in 5 of 13 cases (Figure 2). and apparent primary follicles in 13 cases. Classic Reed-Sternberg cells or variants were identified in the mantle zones of all these follicles. Mild capsular thickening was observed in the absence of intranodal fibrosis. In 11 of 13 cases, a vessel was noted to penetrate occasional follicles with expanded mantle zones, with the histologic appearance reminiscent of follicles in angiofollicular hyperplasia.[9]

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Figure 1a. (click image to zoom) (A), Lymph node showing follicles with expanded mantle zones and an occasional small germinal center (arrow) (H&E, x25).

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Figure 1b. (click image to zoom) (B), Follicle in A showing characteristic small, eccentric germinal center and expanded mantle zone with scattered large cells (arrow) (H&E, x50).

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Figure 2. (click image to zoom) Reactive follicle with scattered Reed-Sternberg cells (arrows) in expanded mantle zone (H&E, x150).

Immunoperoxidase stains for B- and T-cell markers showed a characteristic immunoarchitecture even at low magnification. The B-cell markers highlighted the follicles, with presence of nonstaining holes within expanded mantle zones (Figure 3a), while a corresponding CD3epsilon stain outlined the nodular architecture and rosettes of CD3epsilon+ cells within the mantle zones (Figure 3c). Higher magnification showed these holes to contain a classic Reed-Sternberg cell or variant, with the expected immunophenotype (CD30+, CD15 ±) (Figure 4), surrounded by a rosette of small T lymphocytes (Figure 3b) and (Figure 3d). These T-cell rosettes were CD3epsilon+ CD57 in 11 of 13 cases and CD3epsilon+ CD57+ in 2 of 13 cases. In 6 of 13 cases, the Reed-Sternberg cells showed heterogeneous positivity for a B-cell antigen by immunoperoxidase staining. Stains for CD23 highlighted well-defined germinal centers and the dendritic reticulum meshwork within the follicles.[10] A summary of the clinicopathologic features of all 13 cases of FHL is presented in Table 2.

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Figure 3a. (click image to zoom) (A), Follicles with presence of nonstaining holes (arrows) within expanded mantle zones (CD79alpha, x50).

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Figure 3b. (click image to zoom) (B), A hole in (A) (x1,000) with CD79alpha Reed-Sternberg cell surrounded by rosette of CD79alpha lymphocytes within mantle zone.

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Figure 3c. (click image to zoom) (C), Corresponding CD3epsilon stain (x250), showing germinal center and rosettes of CD3epsilon+ cells surrounding Reed-Sternberg cells within expanded mantle zone.

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Figure 3d. (click image to zoom) (D), Two CD3epsilon+ rosettes in C (x1,000) surrounding Reed-Sternberg cells.

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Figure 4. (click image to zoom) Follicle with germinal center and scattered CD15+ Reed-Sternberg cells within expanded mantle zone (x250).

In general, cases of NLPHL showed effacement of nodal architecture by large, often back-to-back nodules, occasionally with a rim of benign, uninvolved nodal tissue, consistent with our current understanding of the morphologic features of NLPHL. The neoplastic nodules were composed predominantly of small B lymphocytes with scattered Reed-Sternberg variants cytologically consistent with lymphocytic and histiocytic (L&H) cells. Well-defined germinal centers were not identified. Immunoperoxidase stains for B-cell markers decorated the nodules, with a disrupted dendritic reticulum meshwork highlighted by CD23. Immunophenotypically, the L&H cells showed reactivity for B-cell markers in the absence of CD15 or CD30. Occasionally, rosettes of CD3epsilon+ T cells surrounding the L&H cells also were CD57+.

+ نوشته شده در  چهارشنبه هشتم آبان 1387ساعت 8:57  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 


Microscopic view of a typical neuroblastoma with rosette formation (Credit: NCI)

+ نوشته شده در  چهارشنبه هشتم آبان 1387ساعت 8:54  توسط دانشجویان علوم آزمایشگاهی دانشگاه تهران  | 

a rosette of Leishmania promastigotes and some unattached promastigotes close to phagocytic cells (macrophages, the host cell that they infect)

Description: The photo represents a rosette of Leishmania promastigotes and some unattached promastigotes close to phagocytic cells (macrophages, the host cell that they infect).

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 The name of referred object is immunology00353-0154-b.jpg
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 The name of referred object is immunology00353-0153-b.jpg The name of referred object is immunology00353-0154-a.jpg
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 The name of referred object is immunology00353-0153-a.jpg

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