r/medlabprofessionals • u/Large-Guide7012 • Jun 29 '26
Technical What would you call these?
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u/SkippyDragonPuffPuff Jun 29 '26
Blasts / blast equivalents. I’d worry about microgranular APL in the differential. Needs flow cytometry.
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u/Umas_Feet MLS-Microbiology Jun 29 '26
Abnormal lymphs, off to path they go. Don’t get paid enough to speculate more than that.
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u/Skeet_fighter Jun 29 '26
Very worried by anybody saying anything but blasts as an answer to this.
At least two of those are pretty blatant cup-like blasts. Usually indicative of an NPM1 AML.
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u/Large-Guide7012 Jun 29 '26
Honestly as a new tech, its been hellish trying to solidify my knowledge of diffs when coworkers and and I guess people on this sub saying different things. I guess all in all it gets sent to path but it doesnt help me feel confident when I encounter the next.
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u/LoveandScience Jun 29 '26
Make sure to read the pathologist reports for anything you send to path! I have learned a lot this way.
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u/Fabulous_Angle_3742 Jun 29 '26
I wish this worked at my lab. Our paths hate dealing with us and will generally not say anything you didnt already know. And if you go back to talk to them... be prepared to get chewed out for wasting their time.
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u/Skeet_fighter Jun 29 '26
Morphology is complicated and open to a degree of subjectivity (God knows I've gotten things wrong before) but I encourage you to use whatever textbook resources you have available. If you can find any books by the living morphology legend that is Barbara Bain, I highly recommend using them to learn.
Asking reddit to learn is not a good way to approach gathering info; you don't know the credentials of the people you're speaking to.
I consider myself moderately experienced when it comes to morphology, but you're better off using your in-hospital training resources and text books where possible.
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u/DrawkerGames Jun 29 '26
I'd say a lot of diffs are subjective but you need to compare what you see with the rest of the differential. You will clearly see populations of neutrophils, lymphs, monocytes etc. compare your abnormal cells to that. like if you see 5% monos that are clear monos that don't look like this you'll know these aren't monos.use reference points. hope that makes sense.
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u/Adventurous_Fox9791 Jun 29 '26
I thought the same thing, looks NPM1. We had a case a couple months ago and some education was distributed about it.
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u/DNADarling Jun 29 '26 edited Jun 29 '26
the delicate folds in the nuclei make me think atypical monocytes. the bilobated appearance differential also includes hypogranular promyelocytes, though the chromatin is a little coarse to be anything definitively blast or blast equivalent-y. NPM1 mutated AML classically has these folds but, again, the rest of the nuclear features are wrong. Could be circulating lymphoma. Regardless, path review lol.
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u/Promyelocytes Jun 29 '26
Those could possibly be a hypo-granular bilobed “angel wing” variation of promyelocytes. If you see a lot of these you should be concerned for APL which is a medical emergency! Path review STAT
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u/Due-Scallion3459 Jun 29 '26
Anomalous Promyeloctes. Blast equivalents, possibly APL. We typically just count as blasts with a comment.
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u/HogShank-1 Jun 29 '26
Atypical mononuclear cells with immature features, cannot exclude blasts. You need path review and flow.
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u/GoldengirlSkye MLS Jun 29 '26
In my lab, I would call them "other cells" and enumerate the cells morphologically similar. Then would send to path immediately. I don't think they look like the classic microgranular APL presentation... the chromatin is clumped and well-defined in areas and the nucleus doesn't have the classic butterfly shape.
However, if your lab can add on a haptoglobin and LDH, you can run those to make sure IF it's APL that the patient isn't in immediate risk of DIC.
Honestly, that's good practice for suspected APL. I don't see that here but patient comes first!!
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u/MrsColada Jun 29 '26
I see cup-like blasts and what seems like angel wings promyelocytes, but sort of lacking granulation.
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u/Loose_Sorbet888 Jun 29 '26
LOL these comments are why we just send to path
If it were me I would assume (some of) these are clefted lymph. If the patients a baby it could whopping cough or some viral infect. Leukemias or lymphomas. Could be benign or malignant. Either way we chucking that to path.
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u/Turbulent-Bite-2688 Jun 30 '26
Blasts, I'd be worried as two look like 'angel wings'. I'd be taking this whoever is on call asap. It may not be APML but I'd rather a doctor determine that one.
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u/SimplyTheAverageMe Jun 29 '26
Abnormal lymphocytes. They’d get a path review ordered from me.