Dr Joel Newman
Blood samples are obtained in a number of different scenarios, such as general practice (GP), district nurses, high street pharmacies, hospital outpatients departments or inpatient wards, and emergency departments.
Our first hypothetical patient is James, and he was referred by his GP to the Medical Assessment Unit with tiredness and shortness of breath.
This is a blood film (smear) made from James’ blood sample. It shows numerous white blood cells (those that are coloured light blue and purple), including immature cells that should not normally be found in the blood. This is consistent with chronic myeloid leukaemia (CML).
Chromosomes are packages containing all the cell’s DNA. It is densely packaged around scaffolding proteins.
Most humans have 23 pairs of chromosomes: 22 pairs of ‘autosomes’ and 1 pair of sex chromosomes – either XX (female) or XY (male)
In chronic myeloid leukaemia, the chromosomes in the abnormal cells demonstrate a swapping of information between chromosomes 9 and 22 – termed the Philadelphia chromosome after the city in which it was discovered.
Glivec (imatinib) was the first drug developed that directly targets the abnormality in CML, and has revolutionised its treatment.
Our second hypothetical patient, Olive, was reviewed at her GP surgery as part of her annual medication review. She was feeling generally well, but her blood results were abnormal. After being referred to the outpatients department, extra blood tests were requested to further investigate the cause of Olive’s raised white cell count. This is a blood film (smear) from Olive’s blood sample showing the high number of white cells, but this time most of them are small or medium sized round cells, typical of lymphocytes, along with smear/smudge cells. This is typical of chronic lymphocytic leukaemia (CLL).
These are results of a flow cytometry investigation where fluorescent tags are attached to different cell surface markers and passed through a laser beam to count the number of cells expressing the markers in question. The abnormal population here is expressing the signature markers compatible with a diagnosis of Chronic Lymphocytic Leukaemia (CLL). Olive came to the Outpatients Department, and her diagnosis of Chronic Lymphocytic Leukaemia was already available.
The next patient seen in the Department was Eleanor, our next hypothetical patient, who had recently been diagnosed with a deep vein thrombosis (DVT). The right leg here is clearly larger and redder than the left, consistent with DVT.
Our final patient, Luke, went to A&E with rapidly worsening shortness of breath, and blood tests showing significant anaemia. This is a blood film (smear) from Luke’s blood sample showing bite cells – red blood cells with bits taken out, hemi-ghosts, and polychromatic cells (blueish coloured), consistent with non-haemolytic anaemias such as G6PD deficiency (Glucose-6-Phosphate Dehydrogenase Deficiency).
© Dr Joel Newman, 2013