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Reflection caused by only 0.5% of slit nucleus lymphocytes seen in bone marrow

 Last Update: 2022-05-19
 Source: Internet
 Author: User

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foreword

Laboratory personnel are the eyes of clinicians, especially morphologically, an abnormal cell is likely to be an important clue for disease diagnosis

case after

A 3-month-old female patient.

The outpatient was admitted to the hospital with "severe pneumonia"

Figure 1 Blood routine results

The blood routine results showed that the white blood cell was 119.

The proliferation of nucleated cells in the bone marrow was significantly active, the granulocyte: vigorous proliferation (72%), accompanied by toxic changes (poisoned granules can be seen, indicated by the red arrow in the figure); erythroid: the proportion of cells decreased (12%); megakaryocytic : hyperplasia; mature lymphocytes accounted for 15.

Figure 2 Bone marrow cell smear, Wright-Giemsa staining (×1000)

blood film observation

Manual classification is dominated by neutrophils accounting for 60%, of which rod-shaped granulocytes are more than 5%, middle and late myelocytes (green arrows) can be seen in 6%, and toxic granules can be seen in the cytoplasm of mature granulocytes (blue arrows).

Figure 3 Wright-Giemsa staining of peripheral blood cell smear (×1000)

Figure 3 Wright-Giemsa staining of peripheral blood cell smear (×1000) 3 Wright-Giemsa staining of peripheral blood cell smear (×1000)

After seeing the slit nucleus lymphocytes in the bone marrow and peripheral blood, the first thing that comes to mind is pertussis, and the clinician should be contacted as soon as possible

Figure 4 Infection indicators

Figure 5 Detection of related pathogens

Figure 6 Sputum culture

Figure 7 Blood culture

Figure 8 Fungal Detection

Three days later, the results of genetic testing of respiratory pathogens showed that Bacillus pertussis, Haemophilus influenzae, and Streptococcus pneumoniae were positive

Pertussis, Haemophilus influenzae, and Streptococcus pneumoniae were positive

Figure 9 Gene detection results of respiratory pathogens

The patient's peripheral blood leukocytes were significantly increased, and slit lymphocytes were seen in the bone marrow and peripheral blood.

case analysis

Pertussis is an acute respiratory infectious disease caused by Bacillus pertussis (Bordetella pertussis, BP) infection.

^{[1, 2]}^[3]

The clinical manifestations and blood routine of some children are not typical, which is easy to be missed and misdiagnosed, resulting in serious complications and even death ^[4-5] .

^[4-5]

After being transferred to our hospital, the detection of pertussis and other pathogens in the respiratory tract was completed.

In recent years, more and more literatures at home and abroad have reported that the slit nucleus lymphocytes in peripheral blood are of great significance in the diagnosis of whooping cough ^[6]

^[6]^[7]

Therefore, slit nucleus lymphocytes cannot be used as a specific indicator of whooping cough.

^[8]

Summary

The typical peripheral blood of whooping cough is dominated by lymphocytes, while this child is dominated by neutrophils, and the infection index is significantly increased.

Every blood film or bone marrow film is the hope of the patient to find the cause.
When a cell appears in front of your eyes, you must observe it carefully, because every abnormal cell has its meaning and value
.
As an inspection worker, facing each specimen, you need to have a sense of responsibility.
At the same time, you need to continue to learn, strive to improve your professional knowledge and ability, and apply the knowledge you have learned to your work to better serve the clinic
.

[references]

[1] Duan Lina, Liu Gang, Kong Dongfeng, et al.
Epidemiological characteristics of pertussis rebound in Shenzhen from 2005 to 2016 [J].
Journal of Tropical Medicine, 2019, 19(1): 92-94.

[2] Liu Na, Zhu Yiheng, Luan Lin, et al.
Epidemiological characteristics and case reporting of pertussis cases reported in Suzhou from 2012 to 2017 [J].
Modern Preventive Medicine, 2019, 46(2): 356-359+ 372.

[3] Hu Yunge, Liu Quanbo.
Clinical characteristics and risk factors of severe pertussis in 247 children with pertussis [J].
Chinese Journal of Pediatrics, 2015, 53(9): 684-689.

[4]wamyGK, Wheeler SM.
Neonatal pertussis, cocooning and maternalimmunization[J].
Expert Rev Vaccines, 2014, 13(9): 1107-1114.

[5] Wu DX, Chen Q, Yao KH, et al.
Pertussis detection in children with cough of any duration[J].
BMC Pediatr, 2019, 19(1): 236.

[6] Gonzalez, Hugo, Maloum, Karim, Remy, Florence, et al.
Cleaved lymphocytes inchronic lymphocytic leukemia: a detailed retrospective analysis of diagnostic features.
Leuk Lymphoma.
2003;43(3):555-564.

[7] TongJ, Buikema A, Horstman T.
Epidemiology and disease burden of pertussis in the United States among individuals aged.

0-64over a 10-year period (2006-2015)[J].
Curr Med Res Opin, 2020, 36(1): 127-137.

[8] Wu Jinqian, Huang Daolian, Cui Jinghe, et al.
Study on the diagnostic value of peripheral blood fissure lymphocyte count for pertussis [J].
Experimental and Laboratory Medicine, 2020, 05: 872-875.

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