1 This virus shares genomic and clinical similarities with the other highly pathogenic coronaviruses, namely severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), which caused fatal epidemics in 20 respectively. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus disease 2019 (COVID-19) pandemic, is a highly contagious enveloped single-stranded RNA virus that belongs to the family of Betacoronaviruses. Plasmacytoid lymphocytes are more common in COVID-19 cases. A spectrum of variant lymphocytes is seen in COVID-19 cases, albeit constituting less than 10% of lymphocytes in most cases.Acquired Pelger-Huët anomaly with monolobate neutrophils is significantly more common in COVID-19 patients compared to the control group. Absolute lymphopenia is not specific to COVID-19.This is the first study where a detailed qualitative and quantitative examination of peripheral smear findings in COVID-19 patients was performed and compared against a control group.Kristine Krafts, MD, is an Assistant Professor of Pathology at the University of Minnesota School of Medicine and School of Dentistry and the founder of the educational website Pathology Student. Finally, some parasitic infections present with an eosinophilia (but not a neutrophilia). Viral infection often presents with a lymphocytosis, sometimes with reactive changes in the lymphocytes. In addition, a basophilia is almost always present. In CML, however, the neutrophil count is usually quite high, and there is a marked left shift, with a particularly large number of myelocytes. In AML, at least 20% of the nucleated cells in the blood or bone marrow must be composed of blast or blast equivalents.Ĭhronic myeloid leukemia (CML) is often a consideration in patients with an elevated neutrophil count and a left shift. The normal red cell and platelet count, as well as the lack of a significant number of very immature myeloid cells, rules out the presence of acute myeloid leukemia (AML). As a result, the azurophilic granules are not diluted among daughter cells, but retained in the maturing neutrophil, the end result being a mature neutrophil with many more azurophilic granules than usual. If there is an urgent need for increased numbers of neutrophils, like there is in a severe bacterial infection, promyelocytes may opt to simply mature, rather than divide. Normally, as promyelocytes divide, their azurophilic granules are dispersed into daughter cells, the end result being a mature neutrophil with few azurophilic granules. Promyelocytes are the last dividing stage of the neutrophil series (once a cell reaches the myelocyte stage, it can no longer divide, but only mature). Toxic granulation is thought to be a result of the bone marrow’s response to the need for neutrophils in the peripheral tissues. The elevated neutrophil count with a left shift supports the diagnosis of bacterial infection. The cell shown in the photo is a slightly immature neutrophil showing toxic granulation (heavy, dark azurophilic cytoplasmic granules), a morphologic sign seen most commonly in severe bacterial infections. The answer in this case is C, bacterial infection. Which of the following is the most likely diagnosis? Several cells similar to the one shown below are noted. Platelet count 320 x 10 9/L (normal = 150 – 450 x 10 9/L)Ī review of the blood smear shows a slight left shift in the neutrophil series, with occasional metamyelocytes and rare myelocytes present. A 42-year-old male presents with fever and fatigue.
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