Art and Science of Laboratory Medicine

Art and Science of Laboratory Medicine

Sunday, December 27, 2015

Blood cell identification challenge

Case: 2 years old girl from Spain has been in fever over a week. She is very tired and crying a lot. In primary health care center basic blood count, peripheral blood smear and CRP was taken. CRP was 12 mg/L. In BBC leukocytes were: 17,0 x 10E3/μL, etytrocytes 4,2 x 10E6/μL and Hb 100 g/L. Blood smear was seent to central laboratory and the findings are in the image below. Those mononuclear cells covered 70% of all leukocytes in the smear.

Can you identify these mononuclear cells?

Correct answer is below the image.



CORRECT ANSWER: Monocyte (left) and lymphocyte, LGL (right). Both cells are mature and normal. Monocyte is a little bit activated. This little girl has a flu. CRP is just above the decision limit and basci blood count parameters within the reference ranges of 2 year baby.

15 comments:

Cindy said...

Lymphocyte on right. Atypical lymph on left; possibly immature lymph.

Rodolfo Aquino Cáceres said...

Both are lymphocytes. On the left, atypical lymphocyte is seen. On the right, lymphocyte shows some azurophile granules.

Lloyd Jason Papa said...

These WBC are both lymphocytes, left is an Atypical Lymphocyte. On the right is a normo lymphocyte... The Patient may have Mononucleosis.. Further tests to do are LiverFunctionTest, LDH and an EBV, CMV serology..

Rasha Tariq said...

Reactive or atypical lymphocyte seen in viral infection

anjela giorgadze said...

Mononuclear cell(left) and Lymphocyte (right).

Hev said...

Both lymphocytes. The left is activated. Girl has glandular fever more than likely.

Santiago P said...
This comment has been removed by the author.
Santiago P said...


Agree with Lloyd Jason, ask about lymph nodes. Additional test: if you dont have serology, increase of ALAT/GPT highly suggestive. Think in EBV (Paul-bunnell), others are CMV and Listeria , but the last is less possible at age 2

December 27, 2015 at 12:05 PM

Posted to Blood cell identification challenge

Unknown said...

It can be a c/o infectious mononucleosis as the left lymphocyte is large n reactive.

Ikechukwu Isiguzoro said...

Atypical or reactive lymphocytes seen on the left while a matured lymphocytes seen on they right.Viral infection most likely.

Ikechukwu Isiguzoro said...

Atypical or reactive lymphocytes seen on the left while a matured lymphocytes seen on they right.Viral infection most likely.

Jossan Borba said...
This comment has been removed by the author.
bzendra said...

on what basis is the left one monocyte? can you please enlighten? i can't find any resemblances with monocyte!

Fernando Vazquez said...

Mononucleosis by EBV

Abdooo Naeem said...

IMN for EBV IgM

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