Case B14. Pathological WBC counts. Pseudopelger cells

Transcription

1 Pathological counts Case B14 Pseudopelger cells Diagnosis: B-PLL An 86-year-old woman treated for breast cancer in 2008 with surgery and postoperative irradiation. Six years later she now consulted her general practitioner because of increasing fatigue and unspecific abdominal and back pain. Blood tests revealed leukocytosis ( count 44,9x10 9 /l), with 30% blast-like cells containing nucleoli, but also some pseudo Pelger-Huët and immature forms in the granulopoiesis, together with a very high LDH >79 µkat/l (ref <4 µkat/l). Clinical examination revealed palpable splenomegaly and an enlarged untender left axillary lymph node. CT-scan showed some moderately enlarged lymph nodes and confirmed slight splenomegaly. A bone marrow investigation showed massive infiltration of blast-like cells. Flow cytometry of bone marrow showed a monoclonal cell population expressing CD19 and the light chain lambda. These cells were positive for CD10, CD20, CD22, IgD, and IgM, but negative for nuclear TdT, CD5, CD23, CD200, and cyclin D1. FISH for the Philadelphia chromosome was negative. The diagnosis based on the bone marrow investigation was B-prolymphocytic leukemia (B-PLL). She received one course of cyclophosphamide and rithuximab treatment with transient cytopenia afterwards, but at this follow up the count had increased rapidly again. The histogram shows an abnormal shape that could indicate immature findings, DE-flag. : Anemia with increased RDW. : Increased numbers. Bands 6.74 x 10 9 /l Neutrophils* x10 9 /l Eosinophils 0.45 x 10 9 /l Lymphocytes 4.04 x 10 9 /l Monocytes 1.35 x 10 9 /l Blasts 2.65 x 10 9 /l Promyelocytes 0.90 x 10 9 /l Myelocytes 2.25 x 10 9 /l Metamyelocytes 0.45 x 10 9 /l *Pseudopelger forms are observed. Spherocytes are observed. A neutrophil with pseudopelgershaped nucleus can be seen. Few spherocytic erythrocytes can also be seen.

2 Pathological counts Case B15 Plasma cells Diagnosis: Plasma cell leukemia This woman was initially followed from 1997 without treatment for smouldering myeloma with M-protein IgA-kappa and Bence Jones proteinuria, while working in a prison ward. After disease progression she underwent her first autologous hematopoietic stem cell transplantation in 2001, and another one in 2007, on both occasions after conditioning with highdose melphalan, and followed by interferon maintenance. Progressing disease necessitated other treatments since 2011, including the immunomodulators thalidomide and lenalidomide, with neuropathy developing after the former. Now she developed plasma cell leukemia and problems with bleeding due to low platelet counts. Unfortunately her condition worsened despite bendamustine and prednisone treatment for the plasma cell leukemia, and she succumbed to the malignancy not much later. The histogram shows leukocytosis with an abnormal distribution in the Mid- and Gra-cells populations. The distribution requires a microscopic examination. : Anemia with increased RDW. : Severe thrombocytopenia. Neutrophils 8.68 x 10 9 /l Lymphocytes 3.86 x 10 9 /l Monocytes 0.48 x 10 9 /l Plasmacells x 10 9 /l Anisocytosis, Rouleaux formation. Few. Two plasma cells and erythrocytes with Rouleaux formation can be seen in the picture.

3 Infections Case C05 Variant lymphocytes Diagnosis: Tonsillitis mononucleosis A 5-year old boy with tonsillitis due to a primary EBV infection (EBV serology positive for IgG and IgM). Admitted to hospital due to problems with food and fluid intake. The blood film shows 17 % variant lymphocytes. The histogram shows a wider lymphocyte peak than normal. : : Bands 1.09 x 10 9 /l Neutrophils 2.99 x 10 9 /l Basophils 0.07 x 10 9 /l Lymphocytes 1.09 x 10 9 /l Monocytes 0.34 x 10 9 /l Var. lymphocytes 1.16 x 10 9 /l In the center of the picture, below the band, a variant lymphocyte, with its characteristic basophilic cytoplasm, is seen.

4 Erythrocyte case studies /Anemia Anemia Diagnosis: Sickle cell anemia Case D14 A 30-year old man who is a homozygote for sickle cell anemia. In 2003 he was treated for acute chest syndrome in the intensive care unit. A few days ago he again suddenly developed chest pain, fever and cough. A CT scan has shown unspecific pleuro-pulmonary infiltrates. He is treated with antibiotics (piperacillin / tazobactam) as a bacterial infection can not be excluded and due to his functional asplenia. Probable diagnosis is acute chest syndrome due to sickling problems, with sickle cells also seen in peripheral blood. His severe pain gradually resolved over the next days. Increased. No apparent clearing up zon between the different populations. DE-flagging. : Anemia with increased RDW. MCV normal. : Bands 0.19 x 10 9 /l Neutrophils 8.83 x 10 9 /l Eosinophils 0.19 x 10 9 /l Basophils 0.19 x 10 9 /l Lymphocytes 6.14 x 10 9 /l Monocytes 3.65 x 10 9 /l Anisocytosis, polychromasia, target cells, sickle cells 2.5 %. Single giant platelets observed. Below the neutrophil two sickle cells can be seen. Target cells and polychromasia are also noted.

5 Erythrocyte case studies /Anemia Microcytosis Case D18a Diagnosis: Anemia of iron deficiency Here is a male teenager (16 years of age) who has been healthy and engaged in sports besides going to school. He now experienced headache and deteriorating physical capacity during the last four weeks. He visited the general practitioner who found extreme anemia with Hgb 3.7 g/dl and low MCV 58.6 fl. A very low ferritin 1 µg/l (ref µg/l) was later documented. He admitted occasional blood on the stools. Reduced numbers. : Pronounced anemia with microcytosis and hypochromasia. : Neutrophils 1.48 x 10 9 /l Eosinophils 0.03 x 10 9 /l Basophils 0.05 x 10 9 /l Lymphocytes 0.91 x 10 9 /l Monocytes 0.10 x 10 9 /l : Anisocytosis, microcytosis, hypochromasia. Two neutrophils are shown. The erythrocytes are significantly hypochromic and microcytic. Teardrop cells and target cells are also seen.

6 Erythrocyte case studies /Anemia Case D18b Microcytosis, dimorphic picture (continued from previous case) Diagnosis: Anemia of iron deficiency He received three units of packed red cells and started oral iron supplementation at the pediatric ward one week before the first shown blood test, and intravenous iron was given the day before the second shown blood test. Ulcerative proctitis was later found by colonoscopy. Persistent slight leukopenia is seen, but there is no bone marrow investigation yet. Still reduced numbers. : : Anemia with microcytosis and hypochromasia. The -histogram shows a curve with two distinct peaks. The left peak represents the patient s microcytic and hypochromatic cells and the right peak the donor s normal rythrocytes. Neutrophils 1.03 x 10 9 /l Eosinophils 0.11x 10 9 /l Basophils 0.04 x 10 9 /l Lymphocytes 0.84 x 10 9 /l Monocytes 0.18 x 10 9 /l : Dimorphic picture, poikilocytosis, spherocytosis. A clear difference between the patient s hemoglobin dieficient erythrocytes and the donor s normal erythrocytes, dimorphic picture, can be seen. Spherocytosis is a common phenomenon after blood transfusion. In the lower right corner a basophil can be seen.

7 Erythrocyte case studies /Anemia Erythrocyte abnormalities Case D19 Diagnosis: Anemia of iron deficiency A 5-year old boy was admitted to hospital due to 3-4 days of low-grade fever and epigastric discomfort. There is intermittent nausea and he has vomited once. He has no diarrhea or overt gastrointestinal bleeding. He has had decreased appetite during the last few months before admission. He has had repeated nose bleeds. Microcytic anemia (Hgb 9.2 g/dl) with low ferritin and low reticulocytes is found. In the blood smear, erythrocyte abnormalities including anisocytosis, microcytosis, and elliptocytosis are noted, all probably due to iron deficiency. Tests for fecal occult blood are repeatedly negative. He will be given oral iron supplementation and the Hgb will be normalized. Transglutaminase IgA antibodies are not elevated. : Microcytic anemia. : Neutrophils 3.89 x 10 9 /l Eosinophils 0.08 x 10 9 /l Basophils 0.08 x 10 9 /l Lymphocytes 3.73 x 10 9 /l Monocytes 0.32 x 10 9 /l : Ovalocytosis, anisocytosis, microcytosis, teardrop cells, elliptocytosis, poikilocytosis. Anisocytosis. Microcytosis, ovalocytes, elliptocytes, poikilocytes can be seen.

8 Erythrocyte case studies /Anemia Ovalocytosis Case D20 Diagnosis: Secondary thrombocytosis and leukocytosis (carcinoid tumor) This 82-year-old woman was operated by hemicolectomy for an ileocecal carcinoid tumor in There are known metastases in the liver, left ovary, and mesenterial lymph nodes. She has ongoing treatment with sandostatin injections once per month to decrease symptoms of flush and diarrhea caused by peptides released from the neoplastic tissue. Now she is admitted to hospital due to neurological symptoms evaluated as a transitory ischemic attack (TIA). Elevated platelet counts are seen at least since 2012, probably secondary to the metastasized malignancy. No JAK2 V617F mutation has been detected, whereas other genetic markers of myeloproliferative neoplasms such as CALR and MPL were not investigated. She is given low-dose aspirin for prevention of further cerebrovascular events. Leukocytosis, neutrophilia. No flagging. : : Thrombocytosis. Bands 0.17 x 10 9 /l Neutrophils x 10 9 /l Eosinophils 0.17 x 10 9 /l Basophils 0.17 x 10 9 /l Lymphocytes 1.17 x 10 9 /l Monocytes 0.33 x 10 9 /l : Ovalocytosis, anisocytosis, poikilocytosis. Increased. Three neutrophils are shown. The red cells present poikilocytosis, ovalocytosis and anisocytosis. Thrombocytosis.

9 Erythrocyte case studies /Anemia Macrocytosis Case D21a Diagnosis: Anemia of folic acid deficiency This now 50-year-old man has abused alcohol periodically since his youth, but has been able to work and have a family. In 2010 he was treated for a deep venous thrombosis, at which time also anemia due to folic acid deficiency was diagnosed and broad substitution given. Now after several weeks of insufficient food intake he is admitted to hospital again due to anemia with Hgb 5.8 g/dl and moderate thrombocytopenia. Other features are very high MCV 132 fl and elevated bilirubin 40 µmol/l (ref <25 µmol/l) but low reticulocytes. Again, a very low serum folic acid level <2 nmol/l (ref >7 nmol/l) is found, and also serum B 12 is below the reference range, 135 pmol/l (ref pmol/l). : Anemia, macrocytosis. : Moderate thrombocytopenia. Neutrophils 5.29 x 10 9 /l Eosinophils 0.34 x 10 9 /l Lymphocytes 1.01 x 10 9 /l Monocytes 0.07 x 10 9 /l : Macrocytosis, anisocytosis, poikilocytosis. Two hypersegmented neutrophils can be seen. The erythrocytes show macrocytosis, anisocytosis and poikilocytosis.

10 Erythrocyte case studies /Anemia Macrocytosis, Dimorfic presence Case D21b Diagnosis: This case is a continuation of the previous case D21a He receives two units of packed red blood cells, and substitution with folic acid and B12 is restarted. Gastroscopy is normal, including a duodenal biopsy without signs of celiac disease. All blood counts soon normalize after the vitamin substitutions. This sample was collected 24 hours after the previous sample (D21a). : Anemia. The histogram shows a curve with two distinct peaks (dimorphic shape) due to the blood transfusion. : Moderate thrombocytopenia. Neutrophils 4.80 x 10 9 /l Eosinophils 0.38 x 10 9 /l Lymphocytes 1.22 x 10 9 /l : Dimorphic picture. Moderate thrombocytopenia. A dimorphic picture due to the blood transfusion can be seen.

11 Platelet case studies Thrombocytopenia Diagnosis: Immune thrombocytopenia, ITP Case E04 This man has experienced several episodes of immune thrombocytopenia (ITP) from 1981 when he was 27 years old. The latest episode was He has now again noted petechiae on lower extremities since a couple of days. Today, mouth blisters and extensive bleeding at shaving have ensued. He arrives for blood sampling which shows a very low Plt count of 5x10 9 /l. He gets treatment with oral prednisone 75 mg/day, leading to recovery to normal Plt numbers 269x10 9 /l after 10 days and 307x10 9 /l after 13 days. A dip to 129 x10 9 /l during tapering of the prednisone treatment was reversed after supplementation of vitamin C 2 g/day. : : Thrombocytopenia. Bands 0.22 x 10 9 /l Neutrophils 3.51 x 10 9 /l Eosinophils 0.16 x 10 9 /l Basophils 0.05 x 10 9 /l Lymphocytes 0.97 x 10 9 /l Monocytes 0.49 x 10 9 /l Giant platelet are observed. Few platelets were found. I the middle of the picture a giant platelet can bee seen.

12 Platelet case studies Case E05 Thrombocytosis Diagnosis: Anemia of iron deficiency (with thrombocytosis) A baby boy (8 months old) had gastroenteritis during the spring 2014 when blood tests revealed anemia with Hgb 8.5 g/dl. Twelve days later he has now recovered but is still anemic with Hgb 10.3 g/dl. MCV 64.2 fl, MCHC 36.7 g/dl, and has a thrombocytosis with Plt count 796 x10 9 /l. Ferritin is very low, demonstrating clear evidence for iron deficiency, and explaining both the anemia and the thrombocytosis. His mother will feed him with iron-rich food and a few months later the Hgb value will have normalized. Slight lymphocytosis : Microcytic anemia. : Thrombocytosis. Bands 0.11 x 10 9 /l Neutrophils 2.44 x 10 9 /l Eosinophils 0.11 x 10 9 /l Basophils 0.11 x 10 9 /l Lymphocytes 7.21 x 10 9 /l Monocytes 0.64 x 10 9 /l Microcytosis. Anisocytosis, giant findings. Microcytic red cell distribution and thrombocytosis. I the middle of the picture a lymphocyte is seen.

13 Acute Leukemias Acute leukemia Diagnosis: T lymphoblastic leukemia, T-ALL Case F04 A woman, 73 years of age, who lately was diagnosed with small vessel vasculitis. Symptoms were mainly muscular pain and the diagnosis was made after muscle biopsy. Steroid therapy was instituted, and at a visit to a rheumatologist for consultation, blood tests were taken showing blasts in the blood and thrombocytopenia. At the chosen blood sampling occasion, 21 % blasts were seen, and a parallel bone marrow sample showed 57 % blasts which were classified as T-lymphoblasts by flow cytometry due to expressions of CD2, CD4, CD5 and TdT. She later received chemotherapy adapted for elderly patients and achieved complete remission. : The histogram shows a wider lymphocyte peak than normal. The presence of immature cells can be suspected because of the wider Lym-peak and should always be followed-up by a microscopic examination of a blood film. : Reduced count. Bands 0.33 x 10 9 /l Neutrophils 2.38 x 10 9 /l Eosinophils 0.08 x 10 9 /l Lymphocytes 3.03 x 10 9 /l Monocytes 0.41 x 10 9 /l Blasts 1.89 x 10 9 /l Myelocytes 0.08 x 10 9 /l N/100 4 Anisocytosis, teardrop cells. Only few platelets were found. A neutrophil is seen to the left and to the right a blast cell. Two teardrop cells are seen just below and to the right of the blast.

14 Acute Leukemias Case F05 Acute leukemia Diagnosis: Acute monocytic leukemia A 62-year-old man who noted decreased physical capacity at the gym and experienced a sore throat during the last weeks. When seeking advice from the general practitioner blood tests showed slight anemia, moderate thrombocytopenia and slight leukocytosis with blasts enumerated to 27 % by light microscopy. Acute leukemia was confirmed by bone marrow investigations displaying 80 % immature monocytoid cells, thus the diagnosis became acute monocytic leukemia (AML M5). Cytogenetic and molecular genetic investigations showed no abnormalities. He achieved complete remission after the second chemotherapy course and after the third course he was accepted for allogeneic hematopoietic stem cell transplantation from an unrelated donor, with reduced intensity conditioning. The histogram shows a wider Grapopulation. : : Reduced numbers. Bands 0.24 x 10 9 /l Neutrophils 2.74 x 10 9 /l Eosinophils 0.24 x 10 9 /l Lymphocytes 2.14 x 10 9 /l Monocytes 2.86 x 10 9 /l Blasts 3.33 x 10 9 /l Myelocytes 0.12 x 10 9 /l Metamyelocytes 0.12 x 10 9 /l N/100 1 Few. At the top left a neutrophil can be seen and below it to the right a blast. Just below to the right a monocyte and to the right of the monocyte a large platelet is seen.

15 Acute Leukemias Case F06 Blasts Diagnosis: T lymphoblastic leukemia, T-ALL This serious case involves a 51-year-old man with a complicated background of ulcerative colitis and sclerosing cholangitis with liver cirrhosis. During the last weeks he has developed symptoms of headache, sore throat, icterus, and low-grade fever. An acute leukemia with leukocytosis ( count >100 x10 9 /l) is evident. Flow cytometry with expressions of TdT and intracytoplasmic CD3 among other markers give the diagnosis T-cell acute lymphoblastic leukemia (T-ALL), confirmed also by a presence of T-cell receptor rearrangements. Leukapheresis and chemotherapy are started promptly, but unfortunately complications will take his life within less than two months. The histogram shows a typical blast pattern. The presence of blasts can be suspected and this case will be followedup by microscopic examination x10 9 /l after dilution. : Moderate anemia. : Decreased. Neutrophils 1.39 x 10 9 /l Lymphocytes 8.33 x 10 9 /l Monocytes 1.39 x 10 9 /l Blasts x 10 9 /l Anisocytosis, macrocytosis, hypochromasia, target cells. Decreased. The blood film dominated of blast cells.

16 Chronich myeloproliferative diseases Leukocytosis Diagnosis: Chronic myelogenous leukemia, BCR-ABL1 positive, CML Case G05 A 46-year-old man who works with X-ray of horses. At a routine blood check-up, extreme leukocytosis with a count nearly 300 x10 9 /l is revealed, combined with moderate anemia but a normal platelet count. A huge spleen is palpable 18 cm below the costal margin and measures over 30 cm craniocaudally according to a CT scan. The blood contains immature myeloid cells of all differentiation stages at microscopy. A strong suspicion of chronic myeloid leukemia (CML) is forwarded. This diagnosis is confirmed by FISH analysis concerning the Philadelphia chromosome t(9;22)(q34;q11) and PCR for the BCR-ABL fusion transcript. He receives initial treatment with hydroxyurea, changed to the small molecule tyrosine kinase inhibitor imatinib after the final diagnosis is made, and his status and blood counts improve rapidly. Pronounced leukocytosis. With a typical CML-pattern, DE-flagging. After dilution x 10 9 /l. : Decreased. : Bands x 10 9 /l Neutrophils x 10 9 /l Eosinophils 8.09 x 10 9 /l Basophils 5.39 x 10 9 /l Lymphocytes x 10 9 /l Monocytes x 10 9 /l Blasts 2.70 x 10 9 /l Promyelocytes x 10 9 /l Myelocytes x 10 9 /l Metamyelocytes x 10 9 /l Amphophilic cells 2/100 Anisocytosis, poikilocytosis. Normal Two neutrophils and one amphophilic cell are shown. Amphophilic cell is a cell that stains readily with acid and basic dyes.

17 Lymphomas Case H07 Lymphocytosis Diagnosis: Chronic lymphocytic leukemia, CLL This 80-year-old lady was treated for chronic lymphocytic leukemia with four courses of fludarabine and cyclophosphamide in 2010 and achieved complete hematological remission. Her blood counts have now worsened again after 3 ½ years of drug holiday. Also she has a cervical lymph node measuring 6-7 cm. She experiences fatigue due to anemia and displays slight fever and is now admitted to hospital for retreatment. Pronounced leukocytosis with lymphocytosis. The majority of the cells are to be find in the Lym-population. DE-flagging. : Macrocytic anemia : Neutrophils 0.63 x 10 9 /l Lymphocytes* x 10 9 /l *Gumprechts nuclear shadows are seen frequently Anisocytosis, macrocytosis, poikilocytes. Three lymphocytes and two Gumprecht s nuclear shadows can be seen in the picture. The red cells present anisocytosis and macrocytosis..

18 Lymphomas Immature lymphocytes Diagnosis: Mantle cell lymphoma, blastoid variant Case H11 This 71-year-old cigarette smoker and former farmer had a deep venous thrombosis in Now he is admitted to the hospital with worsening symptoms of fatigue, nausea, shortness of breath, and low-grade fever. Physical examination reveals hepato-splenomegaly and a moderately enlarged lymph node in the left supraclavicular fossa. A CT scan shows left-sided pleural effusion 4 cm and multiple enlarged lymph nodes both in the thorax and abdomen, the largest abdominal conglomerate measuring 8 cm in diameter. Rapidly increasing count is seen, with a large proportion of cells with varying nuclear form, sparse cytoplasm, and often a nucleolus. Flow cytometry of a bone marrow aspirate reveals that these cells are positive for CD19, CD5, CD22, IgD, IgM, and monoclonal kappa chains, but negative for CD23, CD200, and CD10. FISH of bone marrow biopsy material shows presence of the translocation t(11:14)(q13:q32). The diagnosis is thereby Mantle cell lymphoma, blastoid variant. He receives treatment with R-CHOP and responds, but later has a CNS relapse with dismal outcome. : The histogram shows a wider Lym-peak and an increased Mid-cell peak. DE-flag ging. The presence of immature cells can be suspected and this case will be followed-up by microscopic examination. Anemia. : Bands 0.49 x 10 9 /l Neutrophils x 10 9 /l Lymphocytes* 9.70 x 10 9 /l Monocytes 0.97 x 10 9 /l Others* x 10 9 /l *Varying maturity. Most of them present a nucleus and irregular nucleus. Anisocytosis. To the left a lymphocyte with irregular nucleus can be seen and to the right an atypic monocyte..

19 Lymphomas Case H12 Prolymphocytes Diagnosis: B-prolymphocytic leukemia This now 77-year-old man was diagnosed with B-prolymphocytic leukemia in At disease progression in 2009 he received four courses of chemotherapy with fludarabine and cyclophosphamide. Due to lack of response with enlarging spleen to 18x16x8.5 cm, persistent dominance of prolymphocytes in the blood and thrombocytopenia he was splenectomized in Afterwards the disease stabilized with lower percentage of prolymphocytes, acceptable Hgb and normal platelet counts. No disease progression has been seen during the last 5 years without further treatment. The histogram shows an increased Mid-cell peak with DE-flagging. The presence of immature cells can be suspected and this case will be followedup by microscopic examination. : Decreased. : Bands 0.69 x 10 9 /l Neutrophils 8.59 x 10 9 /l Eosinophils 2.07 x 10 9 /l Basophils 0.69 x 10 9 /l Lymphocytes* x 10 9 /l Monocytes 1.38 x 10 9 /l Prolymphocytes 5.20 x 10 9 /l *Varying maturity. Anisocytosis, macrocytosis, poikilocytes. Anisocytosis. A prolymphocyte is shown. The erythrocytes shows macrocytosis, anisocytosis and poikilocytosis.

20 Lymphomas Lymphocytosis Diagnosis: Waldenström macroglobulinemia, WM Case H13 Here is a 56-year-old male car mechanic whose physical capacity has decreased dramatically during the last 6 months. He can no longer climb the stairs, and suffers from dyspnea. At presentation his blood tests display Hgb 5.2 g/dl, leukopenia, and thrombocytopenia. There is a relative lymphocytosis. He receives two units of packed red cells, with new blood counts after the transfusion shown here. Plasma electrophoresis reveals an M-protein of the IgM-kappa type of 12 g/l, and slight Bence Jones proteinuria of kappa chains 23 mg/l. A bone marrow investigation shows very high cellularity, and flow cytometry reveals a malignant clone positive for kappa chains, IgD, IgM, CD200, partly positive for CD19, CD23, and CD25, but negative for CD138, CD11c, and CD103. The results lead to exclusion of hairy cell leukemia and chronic lymphocytic leukemia, and a diagnosis of Waldenström macroglobulinemia is suggested, consistent with the M-protein type. He receives (until now) 5 chemotherapy courses of dexamethasone, rithuximab, and cyclophosphamide, with improvements of blood counts and a decreasing M-protein. The histogram shows leukopenia. : Normocytic anemia. : Thrombocytopenia. Bands 0.02 x 10 9 /l Neutrophils 0.81 x 10 9 /l Basophils 0.02 x 10 9 /l Lymphocytes* 1.28 x 10 9 /l Monocytes 0.07 x 10 9 /l *Most of them small and with scant cytoplasm. Anisocytosis, poikilocytosis ovalocytosis. Decreased numbers. The picture shows a lymphocyte with scant cytoplasm..

21 Referens values, Hematology parameters in Swelab cell counters Parameter Reference values Unit x10 12 /l MCV fl RDW% % HCT l/l x10 9 /l MPV fl HGB g/dl MCH pg MCHC g/dl x10 9 /l LYM%* % MID%* % GRAN%* % LYM abs x10 9 /l MID abs x10 9 /l GRAN abs x10 9 /l

22 Referens values, Hematology parameters at the Örebro University Hospital, Department of Laboratory medicin Analysis Children Female Male Unit B x10 9 /l 0 1 w x10 9 /l 1 w 1 m m m m 6 yrs yrs yrs B /l B-HBG g/dl 0 1 w g/dl 1 w 1 m m m m 7 yrs yrs yrs B-HCT m-7 yrs yrs yrs Erc-MCV fl Erc-MCH pg Erc-MCHC g/dl B w x10 9 /l 1 w 1 m m m m 6 yrs yrs yrs Reticulocytes ( %) x10 9 /l

23 B-cells 3-part differential Analysis Children Female Male Unit Granulocytes x10 9 /l (Neutr+Baso+Eos) 0 1 d d 1 w w 3 m m 1 yr yrs yrs yrs yrs Lymphocytes x10 9 /l 0 1 w w 3 m m 1 yr yrs yrs yrs yrs Midcells x10 9 /l 0 1 yr N/A 1 5 yr yrs yrs

24 B-cells; Microscopy, Adults Analysis % x10 9 /l Bands Neutrophils Eosinophils Basophils Lymphocytes Monocytes 3-8% 0,1-1,0 B-cells; Microscopy, Children Neutrophils 0 1 d d 1 w w 3 m m 1 yr yrs yrs yrs yrs Abbrevations Red Blood cell HCT Hematocrit MCV Mean Cell Volume RDW Red cell Distribution Width HGB Hemoglobin MCH Mean Cell Hemoglobin MCHC Mean Cell Hemoglobin Concentration Platelet MPV Mean Platelet Volume White Blood Cells LYM Lymphocytes MID Midcells GRA Granulocytes Fl femtolitre litre pg picogram gram Eosinophils 0 1 w w 1 yr yrs yrs Basophils 0 1 w N/A 1 w 1 yr N/A 1 10 yrs N/A yrs N/A Lymphocytes 0 1 w w 3 m m 1 yr yrs yrs yrs yrs Monocytes 0 1 yr N/A 1 5 yr yrs yrs