Morphology – case 3 (summary)

Thanks for all of the comments on the case. Here are a few:

  • Reactive lymphocytes
  • Atypical lymphocytes
  • Consistent with infectious mononucleosis

The patient had been feeling unwell with viral-type symptoms and fevers and presented with left upper quadrant pain. Automated count shows: Hb 120g/L, WCC 16.3×10*9/L, lymphs 8.9×10*9/L, neuts 3.9×10*9/L, monos 2.2×10*9/L, PLT 160×10*9/L.  LFTs showed a transaminitis with raised ALT.  It is likely that the automated counter is counting some of the lymphoctes as MONOcytes as they often become vacuolated in infectious MONOnucleosis.  The film showed large volumous lymphocytes with deep blue cytoplasm and occasional vacuoles. The lymphocytes display erythroid scallopping and would be consistent with a viral infection, especially EBV.  This can be confirmed by performing a Monospot test, where IgM antibodies produced by the immune system in response to EBV agglutinate red cells from other species – so called heterophile antibodies (antibodies against an antigen produced in one species that react against antigens from other species). Horse and sheep red cells are commonly used.  Alternatively EBV IgM antibodies can be measured serologically.

Rarely splenic rupture can occur and this patient needs a thorough clinical assessment.

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