APIH223885224 - CME/CMLE - Blood Cell ID #3: Peripheral Blood Cells in a Child-APIH223885224

APIH223885224 - Educational Activity

Pdf Summary

The educational commentary provided by Karen A. Brown, an adjunct professor at the University of Utah, outlines the morphologic features and significance of various peripheral blood cells in a young child. This commentary is part of the American Proficiency Institute's 2022 3rd Test Event and offers free CME/CMLE credits in collaboration with the American Society for Clinical Pathology (ASCP).<br /><br />The given context is about a toddler who presented with fussiness and fatigue. Initial lab findings appeared normal. The focus of the commentary is on different types of blood cells identified from the child's peripheral blood smear:<br /><br />1. <strong>Nucleated Red Blood Cells (NRBCs)</strong>: These are immature erythrocytes that still contain nuclei, commonly seen in newborns but unusual in children. NRBCs decrease in size and increase in maturity, culminating in expulsion of the nucleus. The chromatin structure and cytoplasm color indicate maturation, with immature cells having lighter chromatin and blue cytoplasm.<br /><br />2. <strong>Monocytes</strong>: These are the largest cells found in the peripheral blood, with varied nuclear shapes and fine chromatin. Monocytes have a blue-gray, often grainy cytoplasm, sometimes containing azurophilic granules and vacuoles.<br /><br />3. <strong>Basophils</strong>: Rare in peripheral blood smears, basophils are the smallest granulocytes with large, water-soluble granules that may obscure nuclear details. The cytoplasm has distinctive blue-black or deep purple granules.<br /><br />4. <strong>Segmented Neutrophils</strong>: Slightly larger than basophils, these cells have 2-5 nuclear lobes separated by thin chromatin threads. Their cytoplasm contains small granules that do not obscure the nucleus.<br /><br />5. <strong>Band Neutrophils</strong>: Precursor to segmented neutrophils, bands have U or C-shaped nuclei. They usually constitute 2-6% of leukocytes, featuring clumped chromatin and cytoplasm filled with granules similar to segmented neutrophils.<br /><br />The discussion concludes that further testing may be necessary to pinpoint the cause of the child's symptoms despite the normal initial laboratory findings.

Keywords

Karen A. Brown

University of Utah

peripheral blood cells

toddler

fussiness

fatigue

Nucleated Red Blood Cells

Monocytes

Basophils

Segmented Neutrophils