{"about":"Only Cells image library: every real blood film picture on onlycells.co.uk, stored once. Made by library/build_library.py from the Only Cells Photo Library; library/uses.py fills in \"used\". 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Reactive lymphocytes are large cells with plentiful cytoplasm that is often indented by, or spreads between, neighbouring red cells. The nucleus is indented, and the cytoplasm extends round the neighbouring red cells, making the cell outline irregular. The red cells around it lie in a good monolayer.","w":2400,"h":1800,"pxPerUm":11.664,"v":"3aa5185b66","files":{"field":"/assets/library/OC_IM_0001/field.webp?v=3aa5185b66","medium":"/assets/library/OC_IM_0001/field-1200.webp?v=3aa5185b66","thumb":"/assets/library/OC_IM_0001/thumb.webp?v=3aa5185b66","cell":"/assets/library/OC_IM_0001/cell-{k}.webp?v=3aa5185b66","view":"/assets/library/OC_IM_0001/view-{name}.webp?v=3aa5185b66"},"bytes":141202,"slots":["reactive"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":1318,"y":811,"r":112,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_IM_0002","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A reactive (atypical) lymphocyte from a patient with infectious mononucleosis. Reactive lymphocytes are large cells with plentiful cytoplasm that is often indented by, or spreads between, neighbouring red cells. This is the largest of the three cells. Its plentiful cytoplasm spreads out between the surrounding red cells, and its edges are indented where the red cells press against it. The red cells around it lie in a good monolayer.","w":2400,"h":1800,"pxPerUm":11.621,"v":"e98cbaeac7","files":{"field":"/assets/library/OC_IM_0002/field.webp?v=e98cbaeac7","medium":"/assets/library/OC_IM_0002/field-1200.webp?v=e98cbaeac7","thumb":"/assets/library/OC_IM_0002/thumb.webp?v=e98cbaeac7","cell":"/assets/library/OC_IM_0002/cell-{k}.webp?v=e98cbaeac7","view":"/assets/library/OC_IM_0002/view-{name}.webp?v=e98cbaeac7"},"bytes":147376,"slots":["reactive"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":986,"y":849,"r":151,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_IM_0003","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A reactive (atypical) lymphocyte from a patient with infectious mononucleosis. Reactive lymphocytes are large cells with plentiful cytoplasm that is often indented by, or spreads between, neighbouring red cells. The nucleus sits to one side, and a long pale skirt of cytoplasm flows out between the neighbouring red cells. The red cells around it lie in a good monolayer.","w":2400,"h":1800,"pxPerUm":11.602,"v":"7e47b23557","files":{"field":"/assets/library/OC_IM_0003/field.webp?v=7e47b23557","medium":"/assets/library/OC_IM_0003/field-1200.webp?v=7e47b23557","thumb":"/assets/library/OC_IM_0003/thumb.webp?v=7e47b23557","cell":"/assets/library/OC_IM_0003/cell-{k}.webp?v=7e47b23557","view":"/assets/library/OC_IM_0003/view-{name}.webp?v=7e47b23557"},"bytes":150572,"slots":["reactive"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":830,"y":901,"r":147,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_IM_0004","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"Two reactive (atypical) lymphocytes from a patient with infectious mononucleosis, showing how varied these cells can look. Cell 1 is large, and its cytoplasm spreads out between the neighbouring red cells. Cell 2 is smaller and rounder, with a rim of blue cytoplasm. This variety is typical of infectious mononucleosis.","w":2400,"h":1800,"pxPerUm":11.767,"v":"75befe422c","files":{"field":"/assets/library/OC_IM_0004/field.webp?v=75befe422c","medium":"/assets/library/OC_IM_0004/field-1200.webp?v=75befe422c","thumb":"/assets/library/OC_IM_0004/thumb.webp?v=75befe422c","cell":"/assets/library/OC_IM_0004/cell-{k}.webp?v=75befe422c","view":"/assets/library/OC_IM_0004/view-{name}.webp?v=75befe422c"},"bytes":171706,"slots":["reactive"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":1125,"y":541,"r":161,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Reactive (atypical) lymphocyte","x":1375,"y":1438,"r":107,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_IM_0005","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"Two reactive (atypical) lymphocytes from a patient with infectious mononucleosis. Both have plentiful cytoplasm moulded by the neighbouring red cells. Cell 2's cytoplasm is deeper blue towards its edge, a feature often seen in reactive lymphocytes.","w":2400,"h":1800,"pxPerUm":11.853,"v":"c73d18c7b4","files":{"field":"/assets/library/OC_IM_0005/field.webp?v=c73d18c7b4","medium":"/assets/library/OC_IM_0005/field-1200.webp?v=c73d18c7b4","thumb":"/assets/library/OC_IM_0005/thumb.webp?v=c73d18c7b4","cell":"/assets/library/OC_IM_0005/cell-{k}.webp?v=c73d18c7b4","view":"/assets/library/OC_IM_0005/view-{name}.webp?v=c73d18c7b4"},"bytes":171912,"slots":["reactive"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":1559,"y":188,"r":112,"um":40,"cx":50,"cy":39.7},{"n":2,"k":2,"t":"Reactive (atypical) lymphocyte","x":884,"y":1601,"r":105,"um":40,"cx":50,"cy":58.1}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_IM_0006","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A reactive (atypical) lymphocyte (2) from a patient with infectious mononucleosis, shown beside a band form neutrophil (1) and a segmented neutrophil (3) for comparison. The band form has a single curved nucleus that has not yet divided into lobes.","w":2400,"h":1800,"pxPerUm":11.948,"v":"4881021ce0","files":{"field":"/assets/library/OC_IM_0006/field.webp?v=4881021ce0","medium":"/assets/library/OC_IM_0006/field-1200.webp?v=4881021ce0","thumb":"/assets/library/OC_IM_0006/thumb.webp?v=4881021ce0","cell":"/assets/library/OC_IM_0006/cell-{k}.webp?v=4881021ce0","view":"/assets/library/OC_IM_0006/view-{name}.webp?v=4881021ce0"},"bytes":175136,"slots":["band","reactive","neutrophil"],"cells":[{"n":1,"k":1,"t":"Band form neutrophil","x":1207,"y":749,"r":122,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Reactive (atypical) lymphocyte","x":237,"y":1243,"r":103,"um":40,"cx":49.6,"cy":50},{"n":3,"k":3,"t":"Neutrophil","x":2263,"y":1166,"r":117,"um":40,"cx":71.3,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"},{"page":"/courses/oh-blast-morphology-beginner","what":"Oh blast! Morphology – Part 1: Beginner: Real film \"im6\" (3 rings)"}]},{"id":"OC_IM_0007","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"Two reactive (atypical) lymphocytes (1, 2) from a second patient with infectious mononucleosis, with a smear (smudge) cell (3). Both lymphocytes have plentiful blue cytoplasm moulded by the neighbouring red cells. Smear cells are lymphocytes that broke apart when the film was spread. They are seen in infectious mononucleosis as well as in chronic lymphocytic leukaemia.","w":2400,"h":1800,"pxPerUm":13.051,"v":"d9b014a11f","files":{"field":"/assets/library/OC_IM_0007/field.webp?v=d9b014a11f","medium":"/assets/library/OC_IM_0007/field-1200.webp?v=d9b014a11f","thumb":"/assets/library/OC_IM_0007/thumb.webp?v=d9b014a11f","cell":"/assets/library/OC_IM_0007/cell-{k}.webp?v=d9b014a11f","view":"/assets/library/OC_IM_0007/view-{name}.webp?v=d9b014a11f"},"bytes":143950,"slots":["reactive","smear"],"cells":[{"n":1,"k":1,"t":"Reactive (atypical) lymphocyte","x":262,"y":226,"r":122,"um":40,"cx":50,"cy":43.3},{"n":2,"k":2,"t":"Reactive (atypical) lymphocyte","x":267,"y":1532,"r":105,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Smear cell","x":2226,"y":603,"r":176,"um":52,"cx":74.4,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_IM_0008","kind":"film","series":"IM","condition":"Infectious mononucleosis (glandular fever)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"Four reactive (atypical) lymphocytes in one field from a patient with infectious mononucleosis. Their varied size and shape is typical of the condition: the cytoplasm ranges from a narrow rim to a wide skirt that spreads between the neighbouring red cells and is often deeper blue at the edge. A small platelet clump (5) is also present. 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Morphology – Part 1: Beginner: picture \"blast\" (cell 1)"}]},{"id":"OC_BALL_0002","kind":"film","series":"BALL","condition":"B-lymphoblastic leukaemia (B-ALL)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A blast from a patient with B-lymphoblastic leukaemia. The large nucleus fills most of the cell, leaving a thin crescent of pale cytoplasm on one side. The chromatin is finely speckled, and nucleoli show as paler areas within the nucleus. Morphology alone cannot tell the lineage of a blast; immunophenotyping (flow cytometry) confirms it as a B lymphoblast. Many of the red cells have small, regular spikes (crenation). This is usually a drying or storage artefact rather than a feature of the leukaemia.","w":2400,"h":1800,"pxPerUm":11.699,"v":"e1301afe58","files":{"field":"/assets/library/OC_BALL_0002/field.webp?v=e1301afe58","medium":"/assets/library/OC_BALL_0002/field-1200.webp?v=e1301afe58","thumb":"/assets/library/OC_BALL_0002/thumb.webp?v=e1301afe58","cell":"/assets/library/OC_BALL_0002/cell-{k}.webp?v=e1301afe58","view":"/assets/library/OC_BALL_0002/view-{name}.webp?v=e1301afe58"},"bytes":137408,"slots":["blast","lymphoblast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1332,"y":892,"r":95,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_BALL_0003","kind":"film","series":"BALL","condition":"B-lymphoblastic leukaemia (B-ALL)","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Microscope camera","caption":"A lower-power field from a patient with B-lymphoblastic leukaemia, showing how many blasts are circulating: 11 blasts in a single field. The blasts vary in size. They have a high nuclear-to-cytoplasmic ratio, scanty cytoplasm and finely dispersed chromatin; at this magnification nucleoli are hard to see. Two pairs of blasts lie touching (1 and 3, 10 and 11). A small dark blue fragment of stain deposit (12) is also present on the left. It should not be mistaken for a cell, a platelet clump or a parasite. 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The lymphocyte is smaller, with dense, dark chromatin. The blasts are larger and have finer, more open chromatin, a high nuclear-to-cytoplasmic ratio and scanty cytoplasm. Small lymphoblasts can look much like mature lymphocytes, so chromatin pattern matters as much as size. Blasts 3 and 4 lie touching. 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The blasts are large, with finely dispersed chromatin, a high nuclear-to-cytoplasmic ratio and only a thin rim of cytoplasm; blast 1 has a slightly irregular outline. The lymphocyte is smaller and rounder, with dense, dark chromatin. Blasts 2 and 3 lie touching. Morphology alone cannot tell the lineage of a blast; immunophenotyping (flow cytometry) confirms it as a B lymphoblast.","w":2400,"h":1800,"pxPerUm":11.415,"v":"5ebcff8e00","files":{"field":"/assets/library/OC_BALL_0005/field.webp?v=5ebcff8e00","medium":"/assets/library/OC_BALL_0005/field-1200.webp?v=5ebcff8e00","thumb":"/assets/library/OC_BALL_0005/thumb.webp?v=5ebcff8e00","cell":"/assets/library/OC_BALL_0005/cell-{k}.webp?v=5ebcff8e00","view":"/assets/library/OC_BALL_0005/view-{name}.webp?v=5ebcff8e00"},"bytes":183672,"slots":["blast","lymph","lymphoblast"],"cells":[{"n":1,"k":1,"t":"Blast","x":484,"y":943,"r":81,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Blast","x":1461,"y":818,"r":76,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Blast","x":1381,"y":925,"r":73,"um":40,"cx":50,"cy":50},{"n":4,"k":4,"t":"Lymphocyte","x":1793,"y":1002,"r":56,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"},{"page":"/courses/oh-blast-morphology-beginner","what":"Oh blast! 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Plasma cell leukaemia is now defined by 5% or more circulating plasma cells.","w":2400,"h":1800,"pxPerUm":13.722,"v":"a24fbc52e6","files":{"field":"/assets/library/OC_PCL_0001/field.webp?v=a24fbc52e6","medium":"/assets/library/OC_PCL_0001/field-1200.webp?v=a24fbc52e6","thumb":"/assets/library/OC_PCL_0001/thumb.webp?v=a24fbc52e6","cell":"/assets/library/OC_PCL_0001/cell-{k}.webp?v=a24fbc52e6","view":"/assets/library/OC_PCL_0001/view-{name}.webp?v=a24fbc52e6"},"bytes":117778,"slots":["plt_clump","neutrophil","plasma","rouleaux"],"cells":[{"n":1,"k":1,"t":"Platelet clump","x":276,"y":324,"r":103,"um":34,"cx":50,"cy":50},{"n":2,"k":2,"t":"Neutrophil","x":801,"y":363,"r":73,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Plasma cell","x":1212,"y":1152,"r":132,"um":40,"cx":50,"cy":50},{"n":4,"k":4,"t":"Plasma cell","x":2238,"y":1020,"r":83,"um":40,"cx":70.4,"cy":50},{"n":5,"k":5,"t":"Neutrophil","x":1662,"y":1458,"r":81,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"},{"page":"/courses/oh-blast-morphology-beginner","what":"Oh blast! 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The red cells in the background form rouleaux, stacked like coins (2, 3, 4), caused by the raised paraprotein.","w":2400,"h":1800,"pxPerUm":13.375,"v":"b27567e156","files":{"field":"/assets/library/OC_PCL_0002/field.webp?v=b27567e156","medium":"/assets/library/OC_PCL_0002/field-1200.webp?v=b27567e156","thumb":"/assets/library/OC_PCL_0002/thumb.webp?v=b27567e156","cell":"/assets/library/OC_PCL_0002/cell-{k}.webp?v=b27567e156","view":"/assets/library/OC_PCL_0002/view-{name}.webp?v=b27567e156"},"bytes":110116,"slots":["plasma","rouleaux"],"cells":[{"n":1,"k":1,"t":"Plasma cell","x":1674,"y":918,"r":122,"um":40,"cx":50,"cy":50},{"n":2,"k":3,"t":"Rouleaux","x":1137,"y":706,"r":64,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Rouleaux","x":1624,"y":514,"r":64,"um":32,"cx":50,"cy":50},{"n":4,"k":2,"t":"Rouleaux","x":1492,"y":1127,"r":64,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"},{"page":"/courses/oh-blast-morphology-beginner","what":"Oh blast! 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Each has an eccentric nucleus with clumped chromatin and abundant greyish-blue cytoplasm; plasma cell 1 has a few small cytoplasmic vacuoles.","w":2400,"h":1261,"pxPerUm":20.557,"v":"e28d556c2f","files":{"field":"/assets/library/OC_PCL_0003/field.webp?v=e28d556c2f","medium":"/assets/library/OC_PCL_0003/field-1200.webp?v=e28d556c2f","thumb":"/assets/library/OC_PCL_0003/thumb.webp?v=e28d556c2f","cell":"/assets/library/OC_PCL_0003/cell-{k}.webp?v=e28d556c2f","view":"/assets/library/OC_PCL_0003/view-{name}.webp?v=e28d556c2f"},"bytes":75700,"slots":["plasma"],"cells":[{"n":1,"k":1,"t":"Plasma cell","x":1036,"y":591,"r":196,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Plasma cell","x":1274,"y":679,"r":198,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_PCL_0004","kind":"film","series":"PCL","condition":"Plasma cell leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A circulating plasma cell (1) beside a nucleated red cell (2) in a patient with plasma cell leukaemia. The plasma cell has an eccentric nucleus with clumped chromatin, plentiful blue cytoplasm and a paler zone (hof) beside the nucleus. The nucleated red cell is a late (orthochromatic) normoblast: a small, dense, round nucleus in pinkish-grey cytoplasm. Nucleated red cells in the blood can reflect marrow infiltration crowding out normal haemopoiesis.","w":2400,"h":1800,"pxPerUm":13.375,"v":"d447134418","files":{"field":"/assets/library/OC_PCL_0004/field.webp?v=d447134418","medium":"/assets/library/OC_PCL_0004/field-1200.webp?v=d447134418","thumb":"/assets/library/OC_PCL_0004/thumb.webp?v=d447134418","cell":"/assets/library/OC_PCL_0004/cell-{k}.webp?v=d447134418","view":"/assets/library/OC_PCL_0004/view-{name}.webp?v=d447134418"},"bytes":91790,"slots":["plasma","nrbc_ortho"],"cells":[{"n":1,"k":1,"t":"Plasma cell","x":1500,"y":258,"r":127,"um":40,"cx":50,"cy":48.2},{"n":2,"k":2,"t":"Nucleated red cell","x":1056,"y":1224,"r":71,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_PCL_0005","kind":"film","series":"PCL","condition":"Plasma cell leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"Two circulating plasma cells (1 and 2) from a patient with plasma cell leukaemia. Plasma cell 1 has its nucleus pushed to one side and flattened against the cell edge, with abundant blue cytoplasm. Plasma cell 2 has a round, eccentric nucleus with clumped chromatin and a rim of blue cytoplasm with an irregular outline. 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The eosinophils are recognised by their cytoplasm packed with coarse orange-pink granules and their lobed nuclei (usually two lobes; eosinophil 1 shows three). 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Labelled are P. falciparum ring forms: fine rings of blue cytoplasm with a red chromatin dot, some flattened against the edge of the cell (appliqué forms); Maurer's clefts: coarse, irregular red-mauve dots and short streaks scattered through a red cell holding a larger, more solid trophozoite. Maurer's clefts are fewer, larger and more irregular than the fine Schüffner's dots of P. vivax and P. ovale, and the cells that carry them are not enlarged; they show best with Giemsa at pH 7.2.","w":2400,"h":1800,"pxPerUm":11.778,"v":"df1ccfe1fa","files":{"field":"/assets/library/OC_PFMC_0001/field.webp?v=df1ccfe1fa","medium":"/assets/library/OC_PFMC_0001/field-1200.webp?v=df1ccfe1fa","thumb":"/assets/library/OC_PFMC_0001/thumb.webp?v=df1ccfe1fa","cell":"/assets/library/OC_PFMC_0001/cell-{k}.webp?v=df1ccfe1fa","view":"/assets/library/OC_PFMC_0001/view-{name}.webp?v=df1ccfe1fa"},"bytes":259054,"slots":["ring_fal"],"cells":[{"n":1,"k":1,"t":"P. falciparum ring form","x":1461,"y":648,"r":57,"um":32,"cx":50,"cy":50},{"n":2,"k":4,"t":"P. falciparum ring form","x":2058,"y":1254,"r":57,"um":32,"cx":50,"cy":50},{"n":3,"k":2,"t":"Maurer's clefts","x":1796,"y":658,"r":57,"um":32,"cx":50,"cy":50},{"n":4,"k":3,"t":"Maurer's clefts","x":618,"y":1188,"r":57,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_PFMC_0002","kind":"film","series":"PFMC","condition":"Plasmodium falciparum malaria","stain":"Giemsa (pH 7.2)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field of Plasmodium falciparum malaria stained with Giemsa, showing three red cells with ring forms, three cells with Maurer's clefts and two platelets. Labelled are P. falciparum ring forms: fine rings of blue cytoplasm with a red chromatin dot, some flattened against the edge of the cell (appliqué forms); Maurer's clefts: coarse, irregular red-mauve dots and short streaks scattered through a red cell holding a larger, more solid trophozoite; and platelets, small purple fragments lying free between the red cells. Maurer's clefts are fewer, larger and more irregular than the fine Schüffner's dots of P. vivax and P. ovale, and the cells that carry them are not enlarged; they show best with Giemsa at pH 7.2.","w":2400,"h":1800,"pxPerUm":13.656,"v":"890b61e52a","files":{"field":"/assets/library/OC_PFMC_0002/field.webp?v=890b61e52a","medium":"/assets/library/OC_PFMC_0002/field-1200.webp?v=890b61e52a","thumb":"/assets/library/OC_PFMC_0002/thumb.webp?v=890b61e52a","cell":"/assets/library/OC_PFMC_0002/cell-{k}.webp?v=890b61e52a","view":"/assets/library/OC_PFMC_0002/view-{name}.webp?v=890b61e52a"},"bytes":238220,"slots":["ring_fal","platelet"],"cells":[{"n":1,"k":2,"t":"P. falciparum ring form","x":691,"y":292,"r":65,"um":32,"cx":50,"cy":50},{"n":2,"k":4,"t":"P. falciparum ring form","x":864,"y":1404,"r":65,"um":32,"cx":50,"cy":50},{"n":3,"k":6,"t":"P. falciparum ring form","x":1965,"y":1623,"r":65,"um":32,"cx":50,"cy":59.4},{"n":4,"k":1,"t":"Maurer's clefts","x":1320,"y":174,"r":65,"um":32,"cx":50,"cy":39.8},{"n":5,"k":3,"t":"Maurer's clefts","x":627,"y":714,"r":65,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Maurer's clefts","x":1302,"y":1452,"r":65,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Platelet","x":1526,"y":1158,"r":65,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":750,"y":1506,"r":65,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_PFMC_0003","kind":"film","series":"PFMC","condition":"Plasmodium falciparum malaria","stain":"Giemsa (pH 7.2)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field of Plasmodium falciparum malaria stained with Giemsa, showing three red cells with ring forms and two cells with Maurer's clefts. Labelled are P. falciparum ring forms: fine rings of blue cytoplasm with a red chromatin dot, some flattened against the edge of the cell (appliqué forms); Maurer's clefts: coarse, irregular red-mauve dots and short streaks scattered through a red cell holding a larger, more solid trophozoite. Maurer's clefts are fewer, larger and more irregular than the fine Schüffner's dots of P. vivax and P. ovale, and the cells that carry them are not enlarged; they show best with Giemsa at pH 7.2.","w":2400,"h":1800,"pxPerUm":12.357,"v":"0aefa7e705","files":{"field":"/assets/library/OC_PFMC_0003/field.webp?v=0aefa7e705","medium":"/assets/library/OC_PFMC_0003/field-1200.webp?v=0aefa7e705","thumb":"/assets/library/OC_PFMC_0003/thumb.webp?v=0aefa7e705","cell":"/assets/library/OC_PFMC_0003/cell-{k}.webp?v=0aefa7e705","view":"/assets/library/OC_PFMC_0003/view-{name}.webp?v=0aefa7e705"},"bytes":214124,"slots":["ring_fal"],"cells":[{"n":1,"k":3,"t":"P. falciparum ring form","x":742,"y":827,"r":60,"um":32,"cx":50,"cy":50},{"n":2,"k":4,"t":"P. falciparum ring form","x":942,"y":780,"r":60,"um":32,"cx":50,"cy":50},{"n":3,"k":5,"t":"P. falciparum ring form","x":1807,"y":1618,"r":60,"um":32,"cx":50,"cy":53.9},{"n":4,"k":1,"t":"Maurer's clefts","x":816,"y":216,"r":60,"um":32,"cx":50,"cy":50},{"n":5,"k":2,"t":"Maurer's clefts","x":1014,"y":366,"r":60,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_PFMC_0004","kind":"film","series":"PFMC","condition":"Plasmodium falciparum malaria","stain":"Giemsa (pH 7.2)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field of Plasmodium falciparum malaria stained with Giemsa, showing three red cells with ring forms, four cells with Maurer's clefts and two platelets. Labelled are P. falciparum ring forms: fine rings of blue cytoplasm with a red chromatin dot, some flattened against the edge of the cell (appliqué forms); Maurer's clefts: coarse, irregular red-mauve dots and short streaks scattered through a red cell holding a larger, more solid trophozoite; and platelets, small purple fragments lying free between the red cells. Maurer's clefts are fewer, larger and more irregular than the fine Schüffner's dots of P. vivax and P. ovale, and the cells that carry them are not enlarged; they show best with Giemsa at pH 7.2.","w":2400,"h":1800,"pxPerUm":17.614,"v":"5a0277cebe","files":{"field":"/assets/library/OC_PFMC_0004/field.webp?v=5a0277cebe","medium":"/assets/library/OC_PFMC_0004/field-1200.webp?v=5a0277cebe","thumb":"/assets/library/OC_PFMC_0004/thumb.webp?v=5a0277cebe","cell":"/assets/library/OC_PFMC_0004/cell-{k}.webp?v=5a0277cebe","view":"/assets/library/OC_PFMC_0004/view-{name}.webp?v=5a0277cebe"},"bytes":296706,"slots":["ring_fal","platelet"],"cells":[{"n":1,"k":2,"t":"P. falciparum ring form","x":1056,"y":229,"r":85,"um":32,"cx":50,"cy":40.7},{"n":2,"k":1,"t":"P. falciparum ring form","x":1896,"y":255,"r":85,"um":32,"cx":50,"cy":45.3},{"n":3,"k":3,"t":"P. falciparum ring form","x":1272,"y":858,"r":85,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Maurer's clefts","x":444,"y":1026,"r":85,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Maurer's clefts","x":1380,"y":786,"r":85,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Maurer's clefts","x":294,"y":1506,"r":85,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Maurer's clefts","x":1470,"y":1362,"r":85,"um":32,"cx":50,"cy":50},{"n":8,"k":9,"t":"Platelet","x":882,"y":1188,"r":85,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Platelet","x":2346,"y":1464,"r":85,"um":32,"cx":90.4,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_PFMC_0005","kind":"film","series":"PFMC","condition":"Plasmodium falciparum malaria","stain":"Giemsa (pH 7.2)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field of Plasmodium falciparum malaria stained with Giemsa, showing eight red cells with ring forms and two cells with Maurer's clefts. Labelled are P. falciparum ring forms: fine rings of blue cytoplasm with a red chromatin dot, some flattened against the edge of the cell (appliqué forms); Maurer's clefts: coarse, irregular red-mauve dots and short streaks scattered through a red cell holding a larger, more solid trophozoite. Maurer's clefts are fewer, larger and more irregular than the fine Schüffner's dots of P. vivax and P. ovale, and the cells that carry them are not enlarged; they show best with Giemsa at pH 7.2.","w":2400,"h":1800,"pxPerUm":13.196,"v":"007effa3cb","files":{"field":"/assets/library/OC_PFMC_0005/field.webp?v=007effa3cb","medium":"/assets/library/OC_PFMC_0005/field-1200.webp?v=007effa3cb","thumb":"/assets/library/OC_PFMC_0005/thumb.webp?v=007effa3cb","cell":"/assets/library/OC_PFMC_0005/cell-{k}.webp?v=007effa3cb","view":"/assets/library/OC_PFMC_0005/view-{name}.webp?v=007effa3cb"},"bytes":306330,"slots":["ring_fal"],"cells":[{"n":1,"k":10,"t":"P. falciparum ring form","x":382,"y":12,"r":63,"um":32,"cx":50,"cy":2.8},{"n":2,"k":1,"t":"P. falciparum ring form","x":809,"y":213,"r":63,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"P. falciparum ring form","x":1075,"y":542,"r":63,"um":32,"cx":50,"cy":50},{"n":4,"k":7,"t":"P. falciparum ring form","x":2188,"y":797,"r":63,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"P. falciparum ring form","x":546,"y":1277,"r":63,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"P. falciparum ring form","x":1039,"y":1315,"r":63,"um":32,"cx":50,"cy":50},{"n":7,"k":8,"t":"P. falciparum ring form","x":435,"y":1545,"r":63,"um":32,"cx":50,"cy":50},{"n":8,"k":9,"t":"P. falciparum ring form","x":1345,"y":1551,"r":63,"um":32,"cx":50,"cy":50},{"n":9,"k":2,"t":"Maurer's clefts","x":1872,"y":270,"r":63,"um":32,"cx":50,"cy":50},{"n":10,"k":3,"t":"Maurer's clefts","x":624,"y":654,"r":63,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 10 close-ups"}]},{"id":"OC_PVIV_0001","kind":"film","series":"PVIV","condition":"Plasmodium vivax malaria","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a 58-year-old man with Plasmodium vivax malaria, showing two enlarged red cells, each holding an amoeboid trophozoite, and platelets. Labelled are P. vivax trophozoites: irregular, amoeboid parasites with patchy blue cytoplasm spreading through the cell, a small red chromatin dot and fine golden-brown pigment, in red cells that are clearly larger and paler than their neighbours; and platelets, small purple fragments lying free between the red cells. In P. vivax the infected red cells are enlarged and often paler than uninfected cells, and all stages of the parasite can be seen in the blood.","w":2400,"h":1800,"pxPerUm":14.994,"v":"f72a712c65","files":{"field":"/assets/library/OC_PVIV_0001/field.webp?v=f72a712c65","medium":"/assets/library/OC_PVIV_0001/field-1200.webp?v=f72a712c65","thumb":"/assets/library/OC_PVIV_0001/thumb.webp?v=f72a712c65","cell":"/assets/library/OC_PVIV_0001/cell-{k}.webp?v=f72a712c65","view":"/assets/library/OC_PVIV_0001/view-{name}.webp?v=f72a712c65"},"bytes":184176,"slots":["vivax","platelet"],"cells":[{"n":1,"k":1,"t":"P. vivax trophozoite","x":1320,"y":906,"r":72,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"P. vivax trophozoite","x":1386,"y":1314,"r":72,"um":32,"cx":50,"cy":50},{"n":3,"k":5,"t":"Platelet","x":1245,"y":102,"r":72,"um":32,"cx":50,"cy":21.2},{"n":4,"k":6,"t":"Platelet","x":1788,"y":144,"r":72,"um":32,"cx":50,"cy":30},{"n":5,"k":4,"t":"Platelet","x":1389,"y":1116,"r":72,"um":32,"cx":50,"cy":50},{"n":6,"k":3,"t":"Platelet","x":612,"y":1518,"r":72,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_PVIV_0002","kind":"film","series":"PVIV","condition":"Plasmodium vivax malaria","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a 58-year-old man with Plasmodium vivax malaria, showing an amoeboid trophozoite, a gametocyte and platelets. Labelled are a P. vivax trophozoite: an irregular, amoeboid parasite with spreading blue cytoplasm and a red chromatin dot, in an enlarged red cell; a P. vivax gametocyte: a large round parasite that fills an enlarged cell, with even blue cytoplasm and scattered rods of golden-brown pigment; and platelets, small purple fragments lying free between the red cells. In P. vivax the infected red cells are enlarged and often paler than uninfected cells, and all stages of the parasite can be seen in the blood.","w":2400,"h":1800,"pxPerUm":15.849,"v":"535a8b0d4e","files":{"field":"/assets/library/OC_PVIV_0002/field.webp?v=535a8b0d4e","medium":"/assets/library/OC_PVIV_0002/field-1200.webp?v=535a8b0d4e","thumb":"/assets/library/OC_PVIV_0002/thumb.webp?v=535a8b0d4e","cell":"/assets/library/OC_PVIV_0002/cell-{k}.webp?v=535a8b0d4e","view":"/assets/library/OC_PVIV_0002/view-{name}.webp?v=535a8b0d4e"},"bytes":159912,"slots":["vivax","platelet"],"cells":[{"n":1,"k":1,"t":"P. vivax trophozoite","x":882,"y":1314,"r":76,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"P. vivax gametocyte","x":1704,"y":858,"r":76,"um":32,"cx":50,"cy":50},{"n":3,"k":5,"t":"Platelet","x":2322,"y":1026,"r":76,"um":32,"cx":84.6,"cy":50},{"n":4,"k":3,"t":"Platelet","x":1052,"y":1218,"r":76,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":1095,"y":1344,"r":76,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_PVIV_0003","kind":"film","series":"PVIV","condition":"Plasmodium vivax malaria","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a 58-year-old man with Plasmodium vivax malaria, showing a gametocyte and platelets. Labelled are a P. vivax gametocyte: a large round parasite that fills an enlarged red cell, with even blue cytoplasm and scattered rods of golden-brown pigment; and platelets, small purple fragments lying free between the red cells. In P. vivax the infected red cells are enlarged and often paler than uninfected cells, and all stages of the parasite can be seen in the blood.","w":2400,"h":1800,"pxPerUm":15.713,"v":"068e5a37d9","files":{"field":"/assets/library/OC_PVIV_0003/field.webp?v=068e5a37d9","medium":"/assets/library/OC_PVIV_0003/field-1200.webp?v=068e5a37d9","thumb":"/assets/library/OC_PVIV_0003/thumb.webp?v=068e5a37d9","cell":"/assets/library/OC_PVIV_0003/cell-{k}.webp?v=068e5a37d9","view":"/assets/library/OC_PVIV_0003/view-{name}.webp?v=068e5a37d9"},"bytes":161780,"slots":["vivax","platelet"],"cells":[{"n":1,"k":1,"t":"P. vivax gametocyte","x":1386,"y":1008,"r":76,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":1161,"y":708,"r":76,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":2379,"y":792,"r":76,"um":32,"cx":95.7,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_PMAL_0001","kind":"film","series":"PMAL","condition":"Plasmodium malariae malaria","stain":"Giemsa (pH 7.2)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a patient with Plasmodium malariae malaria, showing a mature schizont and two platelets. Labelled are a P. malariae schizont: the parasite fills the red cell, with about a dozen merozoites (dark purple chromatin dots) arranged round a central clump of golden-brown pigment, the rosette typical of this species (P. malariae schizonts hold 6 to 12 merozoites); and platelets, small purple fragments lying free between the red cells. In P. malariae infected red cells are normal-sized or slightly small, with no stippling, and the parasitaemia is usually low.","w":2400,"h":1256,"pxPerUm":25.034,"v":"03bef3fced","files":{"field":"/assets/library/OC_PMAL_0001/field.webp?v=03bef3fced","medium":"/assets/library/OC_PMAL_0001/field-1200.webp?v=03bef3fced","thumb":"/assets/library/OC_PMAL_0001/thumb.webp?v=03bef3fced","cell":"/assets/library/OC_PMAL_0001/cell-{k}.webp?v=03bef3fced","view":"/assets/library/OC_PMAL_0001/view-{name}.webp?v=03bef3fced"},"bytes":392246,"slots":["malariae","platelet"],"cells":[{"n":1,"k":1,"t":"P. malariae schizont","x":1150,"y":873,"r":120,"um":32,"cx":50,"cy":52.2},{"n":2,"k":2,"t":"Platelet","x":384,"y":116,"r":120,"um":32,"cx":48,"cy":14.4},{"n":3,"k":3,"t":"Platelet","x":1124,"y":496,"r":120,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_PMAL_0002","kind":"film","series":"PMAL","condition":"Plasmodium malariae malaria","stain":"Giemsa (pH 7.2)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a patient with Plasmodium malariae malaria, showing a band form trophozoite. Labelled is a P. malariae band form trophozoite: a compact parasite stretched right across the red cell as a thickened band, with a little dark pigment along it. The infected cell is normal-sized with no stippling. Band forms are typical of P. malariae, alongside neat, compact trophozoites, gametocytes that fill the red cell and schizonts with 6 to 12 merozoites round central golden-brown pigment.","w":2400,"h":1792,"pxPerUm":36.331,"v":"280c0d3a6e","files":{"field":"/assets/library/OC_PMAL_0002/field.webp?v=280c0d3a6e","medium":"/assets/library/OC_PMAL_0002/field-1200.webp?v=280c0d3a6e","thumb":"/assets/library/OC_PMAL_0002/thumb.webp?v=280c0d3a6e","cell":"/assets/library/OC_PMAL_0002/cell-{k}.webp?v=280c0d3a6e","view":"/assets/library/OC_PMAL_0002/view-{name}.webp?v=280c0d3a6e"},"bytes":247028,"slots":["malariae"],"cells":[{"n":1,"k":1,"t":"P. malariae band form trophozoite","x":1335,"y":1052,"r":174,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_PMAL_0003","kind":"film","series":"PMAL","condition":"Plasmodium malariae malaria","stain":"Giemsa (pH 7.2)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a patient with Plasmodium malariae malaria, showing a mature schizont and two platelets. Labelled are a P. malariae schizont: the parasite fills the red cell, with about a dozen merozoites (dark purple chromatin dots) arranged round a central clump of golden-brown pigment, the rosette typical of this species (P. malariae schizonts hold 6 to 12 merozoites); and platelets, small purple fragments lying free between the red cells. In P. malariae infected red cells are normal-sized or slightly small, with no stippling, and the parasitaemia is usually low.","w":2400,"h":1094,"pxPerUm":22.542,"v":"185e8f48b7","files":{"field":"/assets/library/OC_PMAL_0003/field.webp?v=185e8f48b7","medium":"/assets/library/OC_PMAL_0003/field-1200.webp?v=185e8f48b7","thumb":"/assets/library/OC_PMAL_0003/thumb.webp?v=185e8f48b7","cell":"/assets/library/OC_PMAL_0003/cell-{k}.webp?v=185e8f48b7","view":"/assets/library/OC_PMAL_0003/view-{name}.webp?v=185e8f48b7"},"bytes":160498,"slots":["malariae","platelet"],"cells":[{"n":1,"k":1,"t":"P. malariae schizont","x":970,"y":713,"r":108,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":306,"y":62,"r":108,"um":32,"cx":42.4,"cy":8.7},{"n":3,"k":3,"t":"Platelet","x":948,"y":388,"r":108,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_PMAL_0004","kind":"film","series":"PMAL","condition":"Plasmodium malariae malaria","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a second patient with Plasmodium malariae malaria, showing a mature schizont, platelets and a large platelet. Labelled are a P. malariae schizont: the parasite fills the red cell, with about ten merozoites (purple chromatin) spaced round a central clump of golden-brown pigment, the rosette pattern of this species (P. malariae schizonts hold 6 to 12 merozoites); platelets, small purple fragments lying free between the red cells; and a large platelet, about the size of a small red cell, with fine granules and no surrounding red cell to mistake it for a parasite. The surrounding red cells are normal-sized with no stippling, as expected in P. malariae.","w":2400,"h":1350,"pxPerUm":14.783,"v":"2f881327ac","files":{"field":"/assets/library/OC_PMAL_0004/field.webp?v=2f881327ac","medium":"/assets/library/OC_PMAL_0004/field-1200.webp?v=2f881327ac","thumb":"/assets/library/OC_PMAL_0004/thumb.webp?v=2f881327ac","cell":"/assets/library/OC_PMAL_0004/cell-{k}.webp?v=2f881327ac","view":"/assets/library/OC_PMAL_0004/view-{name}.webp?v=2f881327ac"},"bytes":139416,"slots":["malariae","platelet","giant_plt"],"cells":[{"n":1,"k":1,"t":"P. malariae schizont","x":1182,"y":658,"r":89,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":405,"y":602,"r":89,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Platelet","x":850,"y":948,"r":89,"um":32,"cx":50,"cy":50},{"n":4,"k":3,"t":"Platelet","x":1066,"y":826,"r":89,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Large platelet","x":2238,"y":693,"r":89,"um":32,"cx":65.7,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_POVA_0001","kind":"film","series":"POVA","condition":"Plasmodium ovale malaria","stain":"Giemsa (pH 7.2)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a patient with Plasmodium ovale malaria, showing a single infected red cell. Labelled is a P. ovale trophozoite: a neat, compact parasite with a dense red chromatin mass and thick blue cytoplasm that keeps a rounded, ring-like shape. The infected red cell is enlarged with a ragged, fimbriated edge, and is covered in coarse, evenly spread pink-red stippling (James's dots). Infected cells in P. ovale are slightly enlarged, and some are oval or have spiky edges; the stippling shows best with Giemsa at pH 7.2.","w":2400,"h":1547,"pxPerUm":26.502,"v":"2484c831a0","files":{"field":"/assets/library/OC_POVA_0001/field.webp?v=2484c831a0","medium":"/assets/library/OC_POVA_0001/field-1200.webp?v=2484c831a0","thumb":"/assets/library/OC_POVA_0001/thumb.webp?v=2484c831a0","cell":"/assets/library/OC_POVA_0001/cell-{k}.webp?v=2484c831a0","view":"/assets/library/OC_POVA_0001/view-{name}.webp?v=2484c831a0"},"bytes":265838,"slots":["ovale"],"cells":[{"n":1,"k":1,"t":"P. ovale trophozoite","x":1302,"y":780,"r":127,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_LOA_0001","kind":"film","series":"LOA","condition":"Loiasis (Loa loa)","stain":"Delafield's haematoxylin","objective":"×40","camera":"Phone camera on the microscope","caption":"A blood film from a patient with loiasis, showing a single Loa loa microfilaria with a monocyte, two lymphocytes, a neutrophil and a platelet for scale. Labelled are a Loa loa microfilaria: a long, sheathed larva, many times the length of a white cell, packed with dark-staining nuclei that run in an irregular column right to the tip of the tapering tail; its sheath: the pale, loose membrane that extends beyond the end of the body; and the white cells and platelet. A sheath, nuclei reaching the tail tip and a daytime blood sample (Loa loa microfilariae circulate by day) point to Loa loa rather than Wuchereria bancrofti, whose tail tip is free of nuclei. Haematoxylin stains the Loa loa sheath, which often stains poorly or not at all with Giemsa.","w":2400,"h":1200,"pxPerUm":11.126,"v":"5c1649a203","files":{"field":"/assets/library/OC_LOA_0001/field.webp?v=5c1649a203","medium":"/assets/library/OC_LOA_0001/field-1200.webp?v=5c1649a203","thumb":"/assets/library/OC_LOA_0001/thumb.webp?v=5c1649a203","cell":"/assets/library/OC_LOA_0001/cell-{k}.webp?v=5c1649a203","view":"/assets/library/OC_LOA_0001/view-{name}.webp?v=5c1649a203"},"bytes":259398,"slots":["mf_loa","monocyte","lymph","neutrophil","platelet"],"cells":[{"n":1,"k":1,"t":"Loa loa microfilaria","x":1596,"y":480,"r":54,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Microfilarial sheath","x":1152,"y":864,"r":54,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Monocyte","x":204,"y":102,"r":97,"um":40,"cx":45.9,"cy":22.9},{"n":4,"k":8,"t":"Neutrophil","x":2060,"y":594,"r":97,"um":40,"cx":50,"cy":50},{"n":5,"k":7,"t":"Platelet","x":254,"y":774,"r":54,"um":32,"cx":50,"cy":50},{"n":6,"k":9,"t":"Loa loa microfilaria","x":257,"y":865,"r":54,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_LOA_0002","kind":"film","series":"LOA","condition":"Loiasis (Loa loa)","stain":"Unstained wet preparation","objective":"×20","camera":"Phone camera on the microscope","caption":"A wet preparation of fresh blood, made to check quickly for platelet clumps; a live Loa loa microfilaria was found by chance among the unstained red cells, and the video clip shows it moving. Labelled is a Loa loa microfilaria: a long, slender, colourless larva, many times the length of a red cell, that thrashes and coils in place, pushing the red cells aside. A wet preparation is a quick way to find motile microfilariae before a stained film is made; the species is then confirmed on a stained film (sheath, and nuclei running to the tip of the tail in Loa loa). Loa loa microfilariae circulate by day, so blood is best taken around midday.","w":2400,"h":2400,"pxPerUm":45.391,"v":"43186e8d30","files":{"field":"/assets/library/OC_LOA_0002/field.webp?v=43186e8d30","medium":"/assets/library/OC_LOA_0002/field-1200.webp?v=43186e8d30","thumb":"/assets/library/OC_LOA_0002/thumb.webp?v=43186e8d30","cell":"/assets/library/OC_LOA_0002/cell-{k}.webp?v=43186e8d30","view":"/assets/library/OC_LOA_0002/view-{name}.webp?v=43186e8d30","clip":"/assets/library/OC_LOA_0002/clip.mp4?v=43186e8d30"},"bytes":790439,"slots":["mf_loa"],"cells":[{"n":1,"k":2,"t":"Loa loa microfilaria","x":1120,"y":1249,"r":311,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_PSAT_0001","kind":"film","series":"PSAT","condition":"Platelet satellitism","stain":"MGG","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"A field from an EDTA blood film. Labelled are three neutrophils ringed by platelets (marked Platelet satellitism), one of them band-shaped, and five free platelets. Platelet satellitism is platelets ringing (rosetting around) neutrophils, sometimes with platelets clinging to the cell surface. It happens in EDTA blood at room temperature, caused by antibodies that bind platelets to the neutrophil, and is not linked to any disease. The ringed platelets are not counted, so the platelet count can be falsely low (pseudothrombocytopenia). Check the film before reporting a low count; a fresh sample in citrate, or a film made straight from a finger-prick, usually shows no satellitism. Image kindly shared by Charlotte Pattison.","w":2400,"h":3199,"pxPerUm":34.678,"v":"99991ad6ac","files":{"field":"/assets/library/OC_PSAT_0001/field.webp?v=99991ad6ac","medium":"/assets/library/OC_PSAT_0001/field-1200.webp?v=99991ad6ac","thumb":"/assets/library/OC_PSAT_0001/thumb.webp?v=99991ad6ac","cell":"/assets/library/OC_PSAT_0001/cell-{k}.webp?v=99991ad6ac","view":"/assets/library/OC_PSAT_0001/view-{name}.webp?v=99991ad6ac"},"bytes":394150,"slots":["satellitism","platelet"],"cells":[{"n":1,"k":1,"t":"Platelet satellitism","x":1584,"y":768,"r":167,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet satellitism","x":544,"y":2143,"r":167,"um":32,"cx":49,"cy":50},{"n":3,"k":3,"t":"Platelet satellitism","x":1104,"y":2304,"r":167,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Platelet","x":456,"y":967,"r":167,"um":32,"cx":41.1,"cy":50},{"n":5,"k":5,"t":"Platelet","x":1808,"y":2352,"r":167,"um":32,"cx":50,"cy":50},{"n":6,"k":7,"t":"Platelet","x":795,"y":2855,"r":167,"um":32,"cx":50,"cy":69},{"n":7,"k":8,"t":"Platelet","x":908,"y":2848,"r":206,"um":32,"cx":50,"cy":68.3},{"n":8,"k":6,"t":"Platelet","x":2032,"y":2575,"r":167,"um":32,"cx":66.8,"cy":50},{"n":9,"k":11,"t":"Neutrophil","x":1529,"y":682,"r":342,"um":40,"cx":50,"cy":49.2},{"n":10,"k":9,"t":"Neutrophil","x":517,"y":2129,"r":342,"um":40,"cx":37.3,"cy":50},{"n":11,"k":10,"t":"Neutrophil","x":1032,"y":2283,"r":342,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 11 close-ups"}]},{"id":"OC_PSAT_0002","kind":"film","series":"PSAT","condition":"Platelet satellitism","stain":"MGG","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"A field from an EDTA blood film. Labelled are seven neutrophils ringed by platelets (marked Platelet satellitism), two of them lying together at the top right, two free platelets (one over a red cell) and a lymphocyte at the top left. Platelet satellitism is platelets ringing (rosetting around) neutrophils, sometimes with platelets clinging to the cell surface. It happens in EDTA blood at room temperature, caused by antibodies that bind platelets to the neutrophil, and is not linked to any disease. The ringed platelets are not counted, so the platelet count can be falsely low (pseudothrombocytopenia). Check the film before reporting a low count; a fresh sample in citrate, or a film made straight from a finger-prick, usually shows no satellitism. Image kindly shared by Charlotte Pattison.","w":2400,"h":3200,"pxPerUm":30.991,"v":"4b800f7345","files":{"field":"/assets/library/OC_PSAT_0002/field.webp?v=4b800f7345","medium":"/assets/library/OC_PSAT_0002/field-1200.webp?v=4b800f7345","thumb":"/assets/library/OC_PSAT_0002/thumb.webp?v=4b800f7345","cell":"/assets/library/OC_PSAT_0002/cell-{k}.webp?v=4b800f7345","view":"/assets/library/OC_PSAT_0002/view-{name}.webp?v=4b800f7345"},"bytes":426694,"slots":["satellitism","platelet","lymph"],"cells":[{"n":1,"k":6,"t":"Platelet satellitism","x":1693,"y":1282,"r":148,"um":32,"cx":50,"cy":50},{"n":2,"k":7,"t":"Platelet satellitism","x":2012,"y":1052,"r":148,"um":32,"cx":60.8,"cy":50},{"n":3,"k":1,"t":"Platelet satellitism","x":1167,"y":1533,"r":148,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet satellitism","x":2242,"y":1350,"r":148,"um":32,"cx":84,"cy":50},{"n":5,"k":2,"t":"Platelet satellitism","x":517,"y":2367,"r":148,"um":32,"cx":50,"cy":50},{"n":6,"k":4,"t":"Platelet satellitism","x":2108,"y":2333,"r":148,"um":32,"cx":70.6,"cy":50},{"n":7,"k":3,"t":"Platelet satellitism","x":1242,"y":2400,"r":148,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":1000,"y":658,"r":148,"um":32,"cx":50,"cy":50},{"n":9,"k":11,"t":"Platelet","x":1638,"y":1833,"r":148,"um":32,"cx":50,"cy":50},{"n":10,"k":12,"t":"Platelet","x":1898,"y":2213,"r":148,"um":32,"cx":50,"cy":50},{"n":11,"k":9,"t":"Platelet","x":1933,"y":2017,"r":148,"um":32,"cx":52.9,"cy":50},{"n":12,"k":10,"t":"Lymphocyte","x":317,"y":83,"r":217,"um":40,"cx":25.5,"cy":6.7},{"n":13,"k":18,"t":"Neutrophil","x":2015,"y":1067,"r":317,"um":40,"cx":68.9,"cy":50},{"n":14,"k":15,"t":"Neutrophil","x":1035,"y":1585,"r":317,"um":40,"cx":50,"cy":50},{"n":15,"k":17,"t":"Neutrophil","x":2307,"y":1373,"r":317,"um":40,"cx":92.5,"cy":50},{"n":16,"k":16,"t":"Neutrophil","x":2135,"y":2260,"r":317,"um":40,"cx":78.6,"cy":50},{"n":17,"k":14,"t":"Neutrophil","x":485,"y":2452,"r":317,"um":40,"cx":39.1,"cy":50},{"n":18,"k":13,"t":"Neutrophil","x":1280,"y":2463,"r":317,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 18 close-ups"}]},{"id":"OC_TRYP_0001","kind":"film","series":"TRYP","condition":"African trypanosomiasis (Trypanosoma brucei)","stain":"MGG","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a 52-year-old with fever, platelets of 58 × 10⁹/L and lymphopenia (0.42 × 10⁹/L), showing African trypanosomiasis. Labelled are six T. brucei trypomastigotes and a platelet. T. brucei trypomastigotes are slender, wavy, 15 to 30 µm long, with a central nucleus, a small dot-like kinetoplast near the blunt posterior end, an undulating membrane along the body and a free flagellum leaving the pointed front end. They lie between the red cells, never inside them. T. cruzi, the main look-alike, is C- or U-shaped with a large, bulging kinetoplast at the very end and is usually scanty. T. b. rhodesiense and T. b. gambiense look the same; the travel history tells them apart. Finding trypanosomes is an urgent result.","w":2400,"h":1800,"pxPerUm":9.863,"v":"fab4a581bc","files":{"field":"/assets/library/OC_TRYP_0001/field.webp?v=fab4a581bc","medium":"/assets/library/OC_TRYP_0001/field-1200.webp?v=fab4a581bc","thumb":"/assets/library/OC_TRYP_0001/thumb.webp?v=fab4a581bc","cell":"/assets/library/OC_TRYP_0001/cell-{k}.webp?v=fab4a581bc","view":"/assets/library/OC_TRYP_0001/view-{name}.webp?v=fab4a581bc"},"bytes":203628,"slots":["tryp_brucei","platelet"],"cells":[{"n":1,"k":2,"t":"T. brucei trypomastigote","x":1225,"y":396,"r":47,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"T. brucei trypomastigote","x":2307,"y":202,"r":47,"um":32,"cx":70.6,"cy":50},{"n":3,"k":4,"t":"T. brucei trypomastigote","x":1293,"y":729,"r":47,"um":32,"cx":50,"cy":50},{"n":4,"k":3,"t":"T. brucei trypomastigote","x":1295,"y":596,"r":47,"um":32,"cx":50,"cy":50},{"n":5,"k":6,"t":"T. brucei trypomastigote","x":265,"y":862,"r":47,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"T. brucei trypomastigote","x":1410,"y":849,"r":47,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Platelet","x":2078,"y":300,"r":47,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 7 close-ups"}]},{"id":"OC_TRYP_0002","kind":"film","series":"TRYP","condition":"African trypanosomiasis (Trypanosoma brucei)","stain":"MGG","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a 52-year-old with fever, platelets of 58 × 10⁹/L and lymphopenia (0.42 × 10⁹/L), showing African trypanosomiasis. Labelled are five T. brucei trypomastigotes, a neutrophil and three platelets; the platelets are few, in keeping with the low count. T. brucei trypomastigotes are slender, wavy, 15 to 30 µm long, with a central nucleus, a small dot-like kinetoplast near the blunt posterior end, an undulating membrane along the body and a free flagellum leaving the pointed front end. They lie between the red cells, never inside them. T. cruzi, the main look-alike, is C- or U-shaped with a large, bulging kinetoplast at the very end and is usually scanty. T. b. rhodesiense and T. b. gambiense look the same; the travel history tells them apart. Finding trypanosomes is an urgent result.","w":2400,"h":1800,"pxPerUm":14.342,"v":"2c42c8b084","files":{"field":"/assets/library/OC_TRYP_0002/field.webp?v=2c42c8b084","medium":"/assets/library/OC_TRYP_0002/field-1200.webp?v=2c42c8b084","thumb":"/assets/library/OC_TRYP_0002/thumb.webp?v=2c42c8b084","cell":"/assets/library/OC_TRYP_0002/cell-{k}.webp?v=2c42c8b084","view":"/assets/library/OC_TRYP_0002/view-{name}.webp?v=2c42c8b084"},"bytes":215770,"slots":["tryp_brucei","neutrophil","platelet"],"cells":[{"n":1,"k":1,"t":"T. brucei trypomastigote","x":377,"y":279,"r":69,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"T. brucei trypomastigote","x":1479,"y":540,"r":69,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"T. brucei trypomastigote","x":1797,"y":851,"r":69,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"T. brucei trypomastigote","x":978,"y":1354,"r":69,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"T. brucei trypomastigote","x":2085,"y":1698,"r":69,"um":32,"cx":50,"cy":77.7},{"n":6,"k":6,"t":"Neutrophil","x":457,"y":915,"r":125,"um":40,"cx":50,"cy":50},{"n":7,"k":9,"t":"Platelet","x":2160,"y":712,"r":69,"um":32,"cx":50,"cy":50},{"n":8,"k":7,"t":"Platelet","x":1173,"y":867,"r":69,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Platelet","x":1430,"y":1560,"r":69,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_TRYP_0003","kind":"film","series":"TRYP","condition":"African trypanosomiasis (Trypanosoma brucei)","stain":"MGG","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a 52-year-old with fever, platelets of 58 × 10⁹/L and lymphopenia (0.42 × 10⁹/L), showing African trypanosomiasis. Labelled are six T. brucei trypomastigotes, a monocyte, a lymphocyte, a neutrophil, a giant platelet and two platelets. T. brucei trypomastigotes are slender, wavy, 15 to 30 µm long, with a central nucleus, a small dot-like kinetoplast near the blunt posterior end, an undulating membrane along the body and a free flagellum leaving the pointed front end. They lie between the red cells, never inside them. T. cruzi, the main look-alike, is C- or U-shaped with a large, bulging kinetoplast at the very end and is usually scanty. T. b. rhodesiense and T. b. gambiense look the same; the travel history tells them apart. 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The red circles were drawn on the video by its maker. Labelled are four trypanosomes: small, colourless, corkscrewing organisms about two to three red cells long, which wriggle quickly and jostle the red cells around them. A wet preparation is a quick way to spot motile trypanosomes before a stained film is made; the species is then identified on a stained film. Video kindly shared by Cha Wei Lee.","w":2400,"h":4267,"pxPerUm":22.713,"v":"cf95f54190","files":{"field":"/assets/library/OC_TRYP_0004/field.webp?v=cf95f54190","medium":"/assets/library/OC_TRYP_0004/field-1200.webp?v=cf95f54190","thumb":"/assets/library/OC_TRYP_0004/thumb.webp?v=cf95f54190","cell":"/assets/library/OC_TRYP_0004/cell-{k}.webp?v=cf95f54190","view":"/assets/library/OC_TRYP_0004/view-{name}.webp?v=cf95f54190","clip":"/assets/library/OC_TRYP_0004/clip.mp4?v=cf95f54190"},"bytes":2198873,"slots":["tryp_brucei"],"cells":[{"n":1,"k":1,"t":"Trypanosome","x":467,"y":1378,"r":156,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Trypanosome","x":1189,"y":1889,"r":156,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Trypanosome","x":1482,"y":2511,"r":156,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Trypanosome","x":1989,"y":2922,"r":156,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_TRYP_0005","kind":"film","series":"TRYP","condition":"African trypanosomiasis (Trypanosoma brucei)","stain":"Giemsa","objective":"×100","camera":"Phone camera on the microscope","caption":"A field from a Giemsa-stained blood film showing African trypanosomiasis. Labelled are a T. brucei trypomastigote and seven platelets. At ×100 the parts of the trypanosome are easy to see: the deeply stained body with its nucleus, the small dot-like kinetoplast near the blunt posterior end, the undulating membrane running in loose folds along the whole body, and the free flagellum leaving the front end. This one is broader than the slender forms, which is typical of the intermediate and stumpy forms of T. brucei. T. cruzi, the main look-alike, has a large, bulging kinetoplast and a narrow membrane. Finding trypanosomes is an urgent result.","w":2400,"h":1094,"pxPerUm":13.745,"v":"06cddea0e7","files":{"field":"/assets/library/OC_TRYP_0005/field.webp?v=06cddea0e7","medium":"/assets/library/OC_TRYP_0005/field-1200.webp?v=06cddea0e7","thumb":"/assets/library/OC_TRYP_0005/thumb.webp?v=06cddea0e7","cell":"/assets/library/OC_TRYP_0005/cell-{k}.webp?v=06cddea0e7","view":"/assets/library/OC_TRYP_0005/view-{name}.webp?v=06cddea0e7"},"bytes":119020,"slots":["tryp_brucei","platelet"],"cells":[{"n":1,"k":1,"t":"T. brucei trypomastigote","x":1170,"y":828,"r":66,"um":32,"cx":50,"cy":50},{"n":2,"k":8,"t":"Platelet","x":428,"y":18,"r":66,"um":32,"cx":50,"cy":4.1},{"n":3,"k":7,"t":"Platelet","x":2046,"y":112,"r":66,"um":32,"cx":50,"cy":25.4},{"n":4,"k":6,"t":"Platelet","x":1746,"y":390,"r":66,"um":32,"cx":50,"cy":50},{"n":5,"k":2,"t":"Platelet","x":720,"y":750,"r":66,"um":32,"cx":50,"cy":50},{"n":6,"k":3,"t":"Platelet","x":1350,"y":654,"r":66,"um":32,"cx":50,"cy":50},{"n":7,"k":5,"t":"Platelet","x":884,"y":876,"r":66,"um":32,"cx":50,"cy":50.3},{"n":8,"k":4,"t":"Platelet","x":1428,"y":840,"r":66,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_TCRUZ_0001","kind":"film","series":"TCRUZ","condition":"Chagas disease (Trypanosoma cruzi)","stain":"Giemsa","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from a Giemsa-stained blood film showing Trypanosoma cruzi, the cause of Chagas disease (American trypanosomiasis). Labelled are two T. cruzi trypomastigotes and eight platelets. T. cruzi trypomastigotes are typically C- or U-shaped in stained films, about 20 µm long, with a central nucleus, a narrow undulating membrane, a free flagellum and a large, round kinetoplast at or near the pointed posterior end that bulges out of the body. They lie between the red cells and do not divide in the blood. T. brucei, the main look-alike, is slenderer and wavier, with a small dot-like kinetoplast. Trypomastigotes are seen in blood mainly in the acute phase of Chagas disease, or when chronic infection reactivates in someone who is immunosuppressed. 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Labelled are two T. cruzi trypomastigotes and 10 platelets. T. cruzi trypomastigotes are typically C- or U-shaped in stained films, about 20 µm long, with a central nucleus, a narrow undulating membrane, a free flagellum and a large, round kinetoplast at or near the pointed posterior end that bulges out of the body. They lie between the red cells and do not divide in the blood. T. brucei, the main look-alike, is slenderer and wavier, with a small dot-like kinetoplast. Trypomastigotes are seen in blood mainly in the acute phase of Chagas disease, or when chronic infection reactivates in someone who is immunosuppressed. 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Labelled are a T. cruzi trypomastigote and five platelets. T. cruzi trypomastigotes are typically C- or U-shaped in stained films, about 20 µm long, with a central nucleus, a narrow undulating membrane, a free flagellum and a large, round kinetoplast at or near the pointed posterior end that bulges out of the body. They lie between the red cells and do not divide in the blood. T. brucei, the main look-alike, is slenderer and wavier, with a small dot-like kinetoplast. Trypomastigotes are seen in blood mainly in the acute phase of Chagas disease, or when chronic infection reactivates in someone who is immunosuppressed. 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Labelled are two T. cruzi trypomastigotes, one curled into a C and one into a U, and six platelets. T. cruzi trypomastigotes are typically C- or U-shaped in stained films, about 20 µm long, with a central nucleus, a narrow undulating membrane, a free flagellum and a large, round kinetoplast at or near the pointed posterior end that bulges out of the body. They lie between the red cells and do not divide in the blood. T. brucei, the main look-alike, is slenderer and wavier, with a small dot-like kinetoplast. Trypomastigotes are seen in blood mainly in the acute phase of Chagas disease, or when chronic infection reactivates in someone who is immunosuppressed. 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Labelled are a T. cruzi trypomastigote, seven platelets and four large, pale platelets. T. cruzi trypomastigotes are typically C- or U-shaped in stained films, about 20 µm long, with a central nucleus, a narrow undulating membrane, a free flagellum and a large, round kinetoplast at or near the pointed posterior end that bulges out of the body. They lie between the red cells and do not divide in the blood. T. brucei, the main look-alike, is slenderer and wavier, with a small dot-like kinetoplast. Trypomastigotes are seen in blood mainly in the acute phase of Chagas disease, or when chronic infection reactivates in someone who is immunosuppressed. 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The film showed normal red cells, neutrophils with cytoplasmic inclusions and marked variation in platelet size with giant platelets, so the platelet count may slightly underestimate the true number. Labelled are three neutrophils, with the Döhle-like inclusions in two of them marked (May–Hegglin inclusion), two giant platelets, four large platelets, three platelets and two stain deposits. May–Hegglin anomaly is one of the inherited MYH9-related disorders. The neutrophils carry crisp, pale blue, often spindle-shaped inclusions near the edge of the cell that look like Döhle bodies, but there is no toxic granulation or vacuolation and no infection to explain them. Giant platelets, some as large as red cells, are missed or counted as red cells by the analyser, so the count is low and the mean platelet volume can look normal. Recognising the pattern on the film spares the patient treatment for immune thrombocytopenia (ITP).","w":2400,"h":1800,"pxPerUm":14.409,"v":"66acd3fb1f","files":{"field":"/assets/library/OC_MHA_0001/field.webp?v=66acd3fb1f","medium":"/assets/library/OC_MHA_0001/field-1200.webp?v=66acd3fb1f","thumb":"/assets/library/OC_MHA_0001/thumb.webp?v=66acd3fb1f","cell":"/assets/library/OC_MHA_0001/cell-{k}.webp?v=66acd3fb1f","view":"/assets/library/OC_MHA_0001/view-{name}.webp?v=66acd3fb1f"},"bytes":396418,"slots":["neutrophil","mayhegglin","giant_plt","platelet","stain"],"cells":[{"n":1,"k":1,"t":"Neutrophil","x":780,"y":265,"r":126,"um":40,"cx":50,"cy":46.1},{"n":2,"k":2,"t":"Neutrophil","x":1963,"y":1063,"r":126,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Neutrophil","x":257,"y":1492,"r":126,"um":40,"cx":44.6,"cy":50},{"n":4,"k":4,"t":"May–Hegglin inclusion","x":1939,"y":955,"r":69,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"May–Hegglin inclusion","x":170,"y":1486,"r":69,"um":32,"cx":36.8,"cy":50},{"n":6,"k":6,"t":"Giant platelet","x":506,"y":1183,"r":69,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Giant platelet","x":1903,"y":1671,"r":69,"um":32,"cx":50,"cy":72.1},{"n":8,"k":11,"t":"Large platelet","x":1865,"y":407,"r":69,"um":32,"cx":50,"cy":50},{"n":9,"k":10,"t":"Large platelet","x":1689,"y":857,"r":69,"um":32,"cx":50,"cy":50},{"n":10,"k":8,"t":"Large platelet","x":411,"y":1063,"r":69,"um":32,"cx":50,"cy":50},{"n":11,"k":9,"t":"Large platelet","x":94,"y":1406,"r":69,"um":32,"cx":20.4,"cy":50},{"n":12,"k":13,"t":"Platelet","x":935,"y":26,"r":69,"um":32,"cx":50,"cy":5.6},{"n":13,"k":14,"t":"Platelet","x":2211,"y":111,"r":69,"um":32,"cx":59.1,"cy":24.1},{"n":14,"k":12,"t":"Platelet","x":351,"y":286,"r":69,"um":32,"cx":50,"cy":50},{"n":15,"k":15,"t":"Stain deposit","x":2037,"y":364,"r":69,"um":32,"cx":50,"cy":50},{"n":16,"k":16,"t":"Stain deposit","x":257,"y":749,"r":69,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 16 close-ups"}]},{"id":"OC_MHA_0002","kind":"film","series":"MHA","condition":"May–Hegglin anomaly (MYH9-related disorder)","stain":"MGG","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a 94-year-old woman with May–Hegglin anomaly (white cells 8.8 × 10⁹/L, haemoglobin 128 g/L, MCV 93 fL, platelets 54 × 10⁹/L, PDW 17.6). The film showed normal red cells, neutrophils with cytoplasmic inclusions and marked variation in platelet size with giant platelets, so the platelet count may slightly underestimate the true number. Labelled are two neutrophils, each with its Döhle-like inclusion marked (May–Hegglin inclusion), a lymphocyte, two giant platelets, a large platelet, four platelets and two echinocytes. May–Hegglin anomaly is one of the inherited MYH9-related disorders. The neutrophils carry crisp, pale blue, often spindle-shaped inclusions near the edge of the cell that look like Döhle bodies, but there is no toxic granulation or vacuolation and no infection to explain them. Giant platelets, some as large as red cells, are missed or counted as red cells by the analyser, so the count is low and the mean platelet volume can look normal. Recognising the pattern on the film spares the patient treatment for immune thrombocytopenia (ITP).","w":2400,"h":1800,"pxPerUm":13.799,"v":"68a87244a6","files":{"field":"/assets/library/OC_MHA_0002/field.webp?v=68a87244a6","medium":"/assets/library/OC_MHA_0002/field-1200.webp?v=68a87244a6","thumb":"/assets/library/OC_MHA_0002/thumb.webp?v=68a87244a6","cell":"/assets/library/OC_MHA_0002/cell-{k}.webp?v=68a87244a6","view":"/assets/library/OC_MHA_0002/view-{name}.webp?v=68a87244a6"},"bytes":398494,"slots":["neutrophil","mayhegglin","lymph","giant_plt","platelet","echino"],"cells":[{"n":1,"k":1,"t":"Neutrophil","x":1080,"y":351,"r":120,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Neutrophil","x":368,"y":1568,"r":120,"um":40,"cx":50,"cy":58.1},{"n":3,"k":3,"t":"May–Hegglin inclusion","x":1123,"y":327,"r":66,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"May–Hegglin inclusion","x":421,"y":1562,"r":66,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Lymphocyte","x":489,"y":1389,"r":96,"um":40,"cx":50,"cy":50},{"n":6,"k":6,"t":"Giant platelet","x":1835,"y":308,"r":66,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Giant platelet","x":2229,"y":737,"r":66,"um":32,"cx":61.2,"cy":50},{"n":8,"k":8,"t":"Large platelet","x":2237,"y":943,"r":66,"um":32,"cx":63.1,"cy":50},{"n":9,"k":10,"t":"Platelet","x":411,"y":449,"r":66,"um":32,"cx":50,"cy":50},{"n":10,"k":9,"t":"Platelet","x":1311,"y":163,"r":66,"um":32,"cx":50,"cy":36.9},{"n":11,"k":11,"t":"Platelet","x":1303,"y":1186,"r":66,"um":32,"cx":50,"cy":50},{"n":12,"k":12,"t":"Platelet","x":1363,"y":1204,"r":66,"um":32,"cx":50,"cy":50},{"n":13,"k":13,"t":"Echinocyte","x":1286,"y":986,"r":66,"um":32,"cx":50,"cy":50},{"n":14,"k":14,"t":"Echinocyte","x":2151,"y":1097,"r":66,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 14 close-ups"}]},{"id":"OC_MHA_0003","kind":"film","series":"MHA","condition":"May–Hegglin anomaly (MYH9-related disorder)","stain":"MGG","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a 94-year-old woman with May–Hegglin anomaly (white cells 8.8 × 10⁹/L, haemoglobin 128 g/L, MCV 93 fL, platelets 54 × 10⁹/L, PDW 17.6). The film showed normal red cells, neutrophils with cytoplasmic inclusions and marked variation in platelet size with giant platelets, so the platelet count may slightly underestimate the true number. Labelled are two giant platelets, as large as the red cells around them, two large platelets, three platelets of normal size for comparison, two echinocytes and a stain deposit. May–Hegglin anomaly is one of the inherited MYH9-related disorders. The neutrophils carry crisp, pale blue, often spindle-shaped inclusions near the edge of the cell that look like Döhle bodies, but there is no toxic granulation or vacuolation and no infection to explain them. Giant platelets, some as large as red cells, are missed or counted as red cells by the analyser, so the count is low and the mean platelet volume can look normal. 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The film showed normal red cells, neutrophils with cytoplasmic inclusions and marked variation in platelet size with giant platelets, so the platelet count may slightly underestimate the true number. Labelled are three neutrophils, with the Döhle-like inclusions in two of them marked (May–Hegglin inclusion), four large platelets, three platelets and two echinocytes. May–Hegglin anomaly is one of the inherited MYH9-related disorders. The neutrophils carry crisp, pale blue, often spindle-shaped inclusions near the edge of the cell that look like Döhle bodies, but there is no toxic granulation or vacuolation and no infection to explain them. Giant platelets, some as large as red cells, are missed or counted as red cells by the analyser, so the count is low and the mean platelet volume can look normal. 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Labelled are 13 platelet clumps, from small groups to large sheets of many platelets, and four giant platelets lying free. Platelet clumps are groups of platelets stuck together, lying between the red cells; they are usually seen at the edges and in the tail of the film. Clumping makes the analyser count the clumps as one large particle or miss them, so the platelet count is falsely low (pseudothrombocytopenia), and big clumps can be counted as white cells. The usual cause is EDTA-dependent antibodies, or a poor or slow sample collection. 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The film showed 10–12 red cell fragments per ×100 field, anisopoikilocytosis, polychromasia, target cells and nucleated red cells, with slightly reduced platelets; she also had anaemia of chronic disease and iron deficiency. Labelled are 24 schistocytes, 11 echinocytes, four polychromatic cells, three neutrophils, fibrin strands, two large platelets and 13 platelets. Schistocytes are pieces of red cells torn by shear stress as blood is forced at high velocity through or around an abnormal valve, most often a leaking prosthetic valve. They take the form of helmet cells, triangles, small irregular fragments and keratocytes (cells with horn-like projections), and microspherocytes form as the torn membrane reseals. This is the same intravascular, DAT-negative picture as microangiopathic haemolysis, so thrombotic microangiopathy (TTP, HUS) and DIC must be excluded with the platelet count, clotting and the clinical setting; here the platelets are only slightly reduced. 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Labelled are two Borrelia, three platelets and a large platelet. Relapsing fever is caused by Borrelia spirochaetes: B. recurrentis is spread by the body louse and causes epidemic louse-borne relapsing fever, mainly in the Horn of Africa and among displaced people, while tick-borne species such as B. duttonii and B. hermsii cause endemic disease. The spirochaetes circulate in large numbers during febrile episodes, so a film taken while the patient is febrile is the standard way to make the diagnosis; a thick film is more sensitive. They are thin, helical, loosely and irregularly coiled threads about 10–30 µm long, lying free between the red cells, with no nucleus, kinetoplast or undulating membrane, which separates them from trypanosomes. Fibrin strands are straighter and do not coil regularly. Each relapse follows antigenic variation of the outer surface proteins. Thrombocytopenia is common, and treatment with a tetracycline, penicillin or macrolide often triggers a Jarisch–Herxheimer reaction. Borrelia burgdorferi, the cause of Lyme disease, is not seen on blood films. 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Labelled are three Borrelia and a neutrophil. Relapsing fever is caused by Borrelia spirochaetes: B. recurrentis is spread by the body louse and causes epidemic louse-borne relapsing fever, mainly in the Horn of Africa and among displaced people, while tick-borne species such as B. duttonii and B. hermsii cause endemic disease. The spirochaetes circulate in large numbers during febrile episodes, so a film taken while the patient is febrile is the standard way to make the diagnosis; a thick film is more sensitive. They are thin, helical, loosely and irregularly coiled threads about 10–30 µm long, lying free between the red cells, with no nucleus, kinetoplast or undulating membrane, which separates them from trypanosomes. Fibrin strands are straighter and do not coil regularly. Each relapse follows antigenic variation of the outer surface proteins. Thrombocytopenia is common, and treatment with a tetracycline, penicillin or macrolide often triggers a Jarisch–Herxheimer reaction. 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Labelled are a nucleated red cell, eight target cells, seven red cells with Pappenheimer bodies, four red cells with Howell–Jolly bodies, a tear-drop cell, two fragments, two microspherocytes, two echinocytes, a hypochromic red cell, 11 platelets and two platelets lying over red cells. The patient was a 34-year-old woman with Hb 92 g/L, RBC 3.90 × 10¹²/L, MCV 72.8 fL, MCH 23.6 pg, RDW 26.3%, reticulocytes 19.5% (761 × 10⁹/L), 102 nucleated red cells per 100 white cells, WBC 14.4 × 10⁹/L after correction for them, and platelets 816 × 10⁹/L. Thalassaemia intermedia describes thalassaemia that is clinically between trait and transfusion-dependent major: Hb is usually 70–100 g/L without regular transfusion, and causes include β+ thalassaemia homozygosity or compound heterozygosity, HbE/β thalassaemia, co-inherited α thalassaemia or HPFH, and HbH disease. The film is microcytic and hypochromic with marked anisopoikilocytosis: target cells, tear-drop cells, fragments and irregular cells, many nucleated red cells and a high reticulocyte count reflect ineffective erythropoiesis and haemolysis. Pappenheimer bodies (iron-containing granules) and Howell–Jolly bodies (nuclear remnants), together with the very high nucleated red cell count and thrombocytosis, are typical after splenectomy. 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The result is ineffective erythropoiesis with anisopoikilocytosis: target cells, elliptocytes, tear-drop cells and fragments, polychromasia, and nucleated red cells released into the blood. A nucleated red cell count this high, with Howell–Jolly and Pappenheimer bodies, is most often seen after splenectomy; the clinical details here do not say whether the patient has had one. Automated analysers count nucleated red cells as white cells unless corrected, so the corrected WBC is the one to use. 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A nucleated red cell count this high, with Howell–Jolly and Pappenheimer bodies, is most often seen after splenectomy; the clinical details here do not say whether the patient has had one. Automated analysers count nucleated red cells as white cells unless corrected, so the corrected WBC is the one to use. 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Labelled are eight cryoglobulin deposits, two neutrophils and nine platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. 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Labelled are 14 cryoglobulin deposits, a neutrophil, a monocyte and seven platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. 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Labelled are 11 cryoglobulin deposits, four neutrophils and six platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. These images have been colour-balanced and sharpened for clarity.","w":2400,"h":1800,"pxPerUm":13.47,"v":"ca9b65fed5","files":{"field":"/assets/library/OC_CRYO_0003/field.webp?v=ca9b65fed5","medium":"/assets/library/OC_CRYO_0003/field-1200.webp?v=ca9b65fed5","thumb":"/assets/library/OC_CRYO_0003/thumb.webp?v=ca9b65fed5","cell":"/assets/library/OC_CRYO_0003/cell-{k}.webp?v=ca9b65fed5","view":"/assets/library/OC_CRYO_0003/view-{name}.webp?v=ca9b65fed5"},"bytes":892380,"slots":["cryo","neutrophil","platelet"],"cells":[{"n":1,"k":21,"t":"Cryoglobulin deposit","x":1345,"y":47,"r":65,"um":32,"cx":50,"cy":10.9},{"n":2,"k":3,"t":"Cryoglobulin deposit","x":2016,"y":360,"r":65,"um":32,"cx":50,"cy":50},{"n":3,"k":19,"t":"Cryoglobulin deposit","x":322,"y":668,"r":65,"um":32,"cx":50,"cy":50},{"n":4,"k":20,"t":"Cryoglobulin deposit","x":494,"y":508,"r":65,"um":32,"cx":50,"cy":50},{"n":5,"k":8,"t":"Cryoglobulin deposit","x":1404,"y":504,"r":65,"um":32,"cx":50,"cy":50},{"n":6,"k":4,"t":"Cryoglobulin deposit","x":2064,"y":504,"r":65,"um":32,"cx":50,"cy":50},{"n":7,"k":1,"t":"Cryoglobulin deposit","x":996,"y":816,"r":65,"um":32,"cx":50,"cy":50},{"n":8,"k":2,"t":"Cryoglobulin deposit","x":1332,"y":912,"r":65,"um":32,"cx":50,"cy":50},{"n":9,"k":6,"t":"Cryoglobulin deposit","x":168,"y":1140,"r":65,"um":32,"cx":38.9,"cy":50},{"n":10,"k":5,"t":"Cryoglobulin deposit","x":732,"y":1164,"r":65,"um":32,"cx":50,"cy":50},{"n":11,"k":7,"t":"Cryoglobulin deposit","x":1428,"y":1458,"r":65,"um":32,"cx":50,"cy":50},{"n":12,"k":12,"t":"Neutrophil","x":1896,"y":246,"r":117,"um":40,"cx":50,"cy":45.6},{"n":13,"k":9,"t":"Neutrophil","x":1272,"y":1314,"r":117,"um":40,"cx":50,"cy":50},{"n":14,"k":10,"t":"Neutrophil","x":1968,"y":1332,"r":117,"um":40,"cx":50,"cy":50},{"n":15,"k":11,"t":"Neutrophil","x":276,"y":1638,"r":117,"um":40,"cx":50,"cy":70},{"n":16,"k":14,"t":"Platelet","x":1014,"y":396,"r":65,"um":32,"cx":50,"cy":50},{"n":17,"k":13,"t":"Platelet","x":1026,"y":318,"r":65,"um":32,"cx":50,"cy":50},{"n":18,"k":17,"t":"Platelet","x":1542,"y":690,"r":65,"um":32,"cx":50,"cy":50},{"n":19,"k":15,"t":"Platelet","x":732,"y":750,"r":65,"um":32,"cx":50,"cy":50},{"n":20,"k":16,"t":"Platelet","x":786,"y":816,"r":65,"um":32,"cx":50,"cy":50},{"n":21,"k":18,"t":"Platelet","x":2208,"y":1632,"r":65,"um":32,"cx":55.4,"cy":61.1}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 21 close-ups"}]},{"id":"OC_CRYO_0004","kind":"film","series":"CRYO","condition":"Cryoglobulinaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from a blood film with cryoglobulinaemia. Labelled are eight cryoglobulin deposits, a neutrophil and seven platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. These images have been colour-balanced and sharpened for clarity.","w":2400,"h":1800,"pxPerUm":12.776,"v":"b94bde3855","files":{"field":"/assets/library/OC_CRYO_0004/field.webp?v=b94bde3855","medium":"/assets/library/OC_CRYO_0004/field-1200.webp?v=b94bde3855","thumb":"/assets/library/OC_CRYO_0004/thumb.webp?v=b94bde3855","cell":"/assets/library/OC_CRYO_0004/cell-{k}.webp?v=b94bde3855","view":"/assets/library/OC_CRYO_0004/view-{name}.webp?v=b94bde3855"},"bytes":767996,"slots":["cryo","neutrophil","platelet"],"cells":[{"n":1,"k":13,"t":"Cryoglobulin deposit","x":2320,"y":117,"r":61,"um":32,"cx":80.5,"cy":28.5},{"n":2,"k":15,"t":"Cryoglobulin deposit","x":1704,"y":406,"r":61,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Cryoglobulin deposit","x":456,"y":696,"r":61,"um":32,"cx":50,"cy":50},{"n":4,"k":2,"t":"Cryoglobulin deposit","x":1728,"y":624,"r":61,"um":32,"cx":50,"cy":50},{"n":5,"k":14,"t":"Cryoglobulin deposit","x":542,"y":873,"r":61,"um":32,"cx":50,"cy":50},{"n":6,"k":1,"t":"Cryoglobulin deposit","x":1224,"y":828,"r":61,"um":32,"cx":50,"cy":50},{"n":7,"k":4,"t":"Cryoglobulin deposit","x":2004,"y":1032,"r":61,"um":32,"cx":50,"cy":50},{"n":8,"k":16,"t":"Cryoglobulin deposit","x":1596,"y":1327,"r":61,"um":32,"cx":50,"cy":50},{"n":9,"k":5,"t":"Neutrophil","x":1032,"y":984,"r":111,"um":40,"cx":50,"cy":50},{"n":10,"k":6,"t":"Platelet","x":1050,"y":264,"r":61,"um":32,"cx":50,"cy":50},{"n":11,"k":7,"t":"Platelet","x":180,"y":552,"r":61,"um":32,"cx":44,"cy":50},{"n":12,"k":8,"t":"Platelet","x":1956,"y":786,"r":61,"um":32,"cx":50,"cy":50},{"n":13,"k":11,"t":"Platelet","x":1722,"y":1230,"r":61,"um":32,"cx":50,"cy":50},{"n":14,"k":10,"t":"Platelet","x":822,"y":1422,"r":61,"um":32,"cx":50,"cy":50},{"n":15,"k":9,"t":"Platelet","x":1278,"y":1434,"r":61,"um":32,"cx":50,"cy":50},{"n":16,"k":12,"t":"Platelet","x":2358,"y":1608,"r":61,"um":32,"cx":89.7,"cy":53}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 16 close-ups"}]},{"id":"OC_CRYO_0005","kind":"film","series":"CRYO","condition":"Cryoglobulinaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from a blood film with cryoglobulinaemia. Labelled are seven cryoglobulin deposits, a neutrophil and eight platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. These images have been colour-balanced and sharpened for clarity.","w":2400,"h":1800,"pxPerUm":9.369,"v":"fb38584b76","files":{"field":"/assets/library/OC_CRYO_0005/field.webp?v=fb38584b76","medium":"/assets/library/OC_CRYO_0005/field-1200.webp?v=fb38584b76","thumb":"/assets/library/OC_CRYO_0005/thumb.webp?v=fb38584b76","cell":"/assets/library/OC_CRYO_0005/cell-{k}.webp?v=fb38584b76","view":"/assets/library/OC_CRYO_0005/view-{name}.webp?v=fb38584b76"},"bytes":792712,"slots":["cryo","neutrophil","platelet"],"cells":[{"n":1,"k":16,"t":"Cryoglobulin deposit","x":70,"y":79,"r":54,"um":32,"cx":23.2,"cy":26.4},{"n":2,"k":14,"t":"Cryoglobulin deposit","x":222,"y":583,"r":54,"um":32,"cx":50,"cy":50},{"n":3,"k":1,"t":"Cryoglobulin deposit","x":576,"y":1008,"r":54,"um":32,"cx":50,"cy":50},{"n":4,"k":2,"t":"Cryoglobulin deposit","x":156,"y":1212,"r":54,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Cryoglobulin deposit","x":1248,"y":1056,"r":54,"um":32,"cx":50,"cy":50},{"n":6,"k":15,"t":"Cryoglobulin deposit","x":1911,"y":1566,"r":54,"um":32,"cx":50,"cy":50},{"n":7,"k":3,"t":"Cryoglobulin deposit","x":1932,"y":1404,"r":54,"um":32,"cx":50,"cy":50},{"n":8,"k":5,"t":"Neutrophil","x":744,"y":852,"r":82,"um":40,"cx":50,"cy":50},{"n":9,"k":7,"t":"Platelet","x":918,"y":444,"r":54,"um":32,"cx":50,"cy":50},{"n":10,"k":13,"t":"Platelet","x":1854,"y":168,"r":54,"um":32,"cx":50,"cy":50},{"n":11,"k":6,"t":"Platelet","x":504,"y":456,"r":54,"um":32,"cx":50,"cy":50},{"n":12,"k":10,"t":"Platelet","x":2256,"y":1050,"r":54,"um":32,"cx":52,"cy":50},{"n":13,"k":8,"t":"Platelet","x":1530,"y":1182,"r":54,"um":32,"cx":50,"cy":50},{"n":14,"k":9,"t":"Platelet","x":1632,"y":1098,"r":54,"um":32,"cx":50,"cy":50},{"n":15,"k":12,"t":"Platelet","x":780,"y":1494,"r":54,"um":32,"cx":50,"cy":50},{"n":16,"k":11,"t":"Platelet","x":2268,"y":1584,"r":54,"um":32,"cx":55.9,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 16 close-ups"}]},{"id":"OC_CRYO_0006","kind":"film","series":"CRYO","condition":"Cryoglobulinaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from a blood film with cryoglobulinaemia. Labelled are 12 cryoglobulin deposits and 12 platelets. The cryoglobulin forms pale lilac-blue, amorphous, slightly granular or fluffy extracellular deposits of varying size, often with red cells pushed together or wrapped around their edges. Cryoglobulins are immunoglobulins that precipitate when blood cools below body temperature and redissolve on warming, so they appear when a sample cools before the film is made. They are easily mistaken for stain deposit, platelet clumps or a smudged cell; the clues are the pale blue, structureless material lying between the cells, its absence from films made from a sample kept at 37 °C, and that the deposits can also be seen inside neutrophils that have ingested them. Cryoglobulins can also upset the analyser, falsely raising the white cell and platelet counts when the precipitate is counted as particles, so a film is worth checking when the counts do not fit; rewarming the sample to 37 °C and repeating the count corrects this. Type I cryoglobulins are a single monoclonal immunoglobulin (myeloma, Waldenström macroglobulinaemia, MGUS); types II and III are mixed, with an IgM rheumatoid factor bound to polyclonal IgG, and are most often linked to hepatitis C, Sjögren's syndrome and SLE. Clinical features include purpura, Raynaud's phenomenon, arthralgia, peripheral neuropathy and glomerulonephritis, with low C4 in mixed cryoglobulinaemia. To test for cryoglobulins the sample must be taken and transported at 37 °C and allowed to clot warm before the serum is separated and kept at 4 °C to look for a precipitate. 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Labelled are eight abnormal promyelocytes, one small platelet clump and one platelet. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. A G6PD screen was equivocal here; G6PD status matters before rasburicase is given for tumour lysis because it can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency.","w":2400,"h":1800,"pxPerUm":13.401,"v":"b28e03d3e7","files":{"field":"/assets/library/OC_APML_0001/field.webp?v=b28e03d3e7","medium":"/assets/library/OC_APML_0001/field-1200.webp?v=b28e03d3e7","thumb":"/assets/library/OC_APML_0001/thumb.webp?v=b28e03d3e7","cell":"/assets/library/OC_APML_0001/cell-{k}.webp?v=b28e03d3e7","view":"/assets/library/OC_APML_0001/view-{name}.webp?v=b28e03d3e7"},"bytes":458212,"slots":["apl_micro","plt_clump","platelet"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":463,"y":265,"r":64,"um":32,"cx":50,"cy":50},{"n":2,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1149,"y":257,"r":64,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":1317,"y":380,"r":64,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1932,"y":403,"r":64,"um":32,"cx":50,"cy":50},{"n":5,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":446,"y":454,"r":64,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":965,"y":1217,"r":64,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Abnormal promyelocyte (microgranular APL)","x":1937,"y":1226,"r":64,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Abnormal promyelocyte (microgranular APL)","x":2135,"y":1277,"r":64,"um":32,"cx":50,"cy":50},{"n":9,"k":10,"t":"Platelet","x":2203,"y":1149,"r":64,"um":32,"cx":54.1,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_APML_0002","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the presenting blood film of a 43-year-old man with a new diagnosis of acute myeloid leukaemia, later confirmed as acute promyelocytic leukaemia (APL, APML). Labelled are six abnormal promyelocytes and two platelets. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. A G6PD screen was equivocal here; G6PD status matters before rasburicase is given for tumour lysis because it can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency.","w":2400,"h":1800,"pxPerUm":14.007,"v":"2d4732edde","files":{"field":"/assets/library/OC_APML_0002/field.webp?v=2d4732edde","medium":"/assets/library/OC_APML_0002/field-1200.webp?v=2d4732edde","thumb":"/assets/library/OC_APML_0002/thumb.webp?v=2d4732edde","cell":"/assets/library/OC_APML_0002/cell-{k}.webp?v=2d4732edde","view":"/assets/library/OC_APML_0002/view-{name}.webp?v=2d4732edde"},"bytes":422010,"slots":["apl_micro","platelet"],"cells":[{"n":1,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1111,"y":146,"r":67,"um":32,"cx":50,"cy":32.5},{"n":2,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":953,"y":249,"r":67,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":137,"y":720,"r":67,"um":32,"cx":30.5,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":651,"y":1063,"r":67,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1392,"y":1054,"r":67,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":1483,"y":1174,"r":67,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Platelet","x":1557,"y":699,"r":67,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":2105,"y":1320,"r":67,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_APML_0003","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the presenting blood film of a 43-year-old man with a new diagnosis of acute myeloid leukaemia, later confirmed as acute promyelocytic leukaemia (APL, APML). Labelled are ten abnormal promyelocytes, one smear cell and three platelets. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. A G6PD screen was equivocal here; G6PD status matters before rasburicase is given for tumour lysis because it can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency.","w":2400,"h":1800,"pxPerUm":13.795,"v":"a86497a2ef","files":{"field":"/assets/library/OC_APML_0003/field.webp?v=a86497a2ef","medium":"/assets/library/OC_APML_0003/field-1200.webp?v=a86497a2ef","thumb":"/assets/library/OC_APML_0003/thumb.webp?v=a86497a2ef","cell":"/assets/library/OC_APML_0003/cell-{k}.webp?v=a86497a2ef","view":"/assets/library/OC_APML_0003/view-{name}.webp?v=a86497a2ef"},"bytes":488156,"slots":["apl_micro","smear","platelet"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1971,"y":120,"r":66,"um":32,"cx":50,"cy":27.2},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1071,"y":703,"r":66,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1243,"y":711,"r":66,"um":32,"cx":50,"cy":50},{"n":4,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":935,"y":1029,"r":66,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":960,"y":832,"r":66,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1128,"y":900,"r":66,"um":32,"cx":50,"cy":50},{"n":7,"k":8,"t":"Abnormal promyelocyte (microgranular APL)","x":249,"y":1320,"r":66,"um":32,"cx":50,"cy":50},{"n":8,"k":7,"t":"Abnormal promyelocyte (microgranular APL)","x":1042,"y":1183,"r":66,"um":32,"cx":50,"cy":50},{"n":9,"k":9,"t":"Abnormal promyelocyte (microgranular APL)","x":171,"y":1508,"r":66,"um":32,"cx":38.8,"cy":50},{"n":10,"k":10,"t":"Abnormal promyelocyte (microgranular APL)","x":1954,"y":1414,"r":66,"um":32,"cx":50,"cy":50},{"n":11,"k":11,"t":"Smear cell","x":1385,"y":1311,"r":124,"um":52,"cx":50,"cy":50},{"n":12,"k":12,"t":"Platelet","x":343,"y":232,"r":66,"um":32,"cx":50,"cy":50},{"n":13,"k":13,"t":"Platelet","x":977,"y":223,"r":66,"um":32,"cx":50,"cy":50},{"n":14,"k":14,"t":"Platelet","x":1011,"y":249,"r":83,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 14 close-ups"}]},{"id":"OC_APML_0004","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the presenting blood film of a 43-year-old man with a new diagnosis of acute myeloid leukaemia, later confirmed as acute promyelocytic leukaemia (APL, APML). Labelled are six abnormal promyelocytes, one mature neutrophil, one smear cell and three platelets. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. A G6PD screen was equivocal here; G6PD status matters before rasburicase is given for tumour lysis because it can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency.","w":2400,"h":1800,"pxPerUm":13.876,"v":"aa2963e20c","files":{"field":"/assets/library/OC_APML_0004/field.webp?v=aa2963e20c","medium":"/assets/library/OC_APML_0004/field-1200.webp?v=aa2963e20c","thumb":"/assets/library/OC_APML_0004/thumb.webp?v=aa2963e20c","cell":"/assets/library/OC_APML_0004/cell-{k}.webp?v=aa2963e20c","view":"/assets/library/OC_APML_0004/view-{name}.webp?v=aa2963e20c"},"bytes":439166,"slots":["apl_micro","neutrophil","smear","platelet"],"cells":[{"n":1,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":1389,"y":677,"r":67,"um":32,"cx":50,"cy":50},{"n":2,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1560,"y":583,"r":67,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":660,"y":986,"r":67,"um":32,"cx":50,"cy":50},{"n":4,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":1243,"y":994,"r":67,"um":32,"cx":50,"cy":50},{"n":5,"k":7,"t":"Abnormal promyelocyte (microgranular APL)","x":1440,"y":1029,"r":67,"um":32,"cx":50,"cy":50},{"n":6,"k":8,"t":"Abnormal promyelocyte (microgranular APL)","x":1303,"y":1183,"r":67,"um":32,"cx":50,"cy":50},{"n":7,"k":1,"t":"Neutrophil","x":368,"y":94,"r":121,"um":40,"cx":50,"cy":16.9},{"n":8,"k":2,"t":"Smear cell","x":129,"y":608,"r":125,"um":52,"cx":17.8,"cy":50},{"n":9,"k":9,"t":"Platelet","x":2122,"y":429,"r":67,"um":32,"cx":50,"cy":50},{"n":10,"k":11,"t":"Platelet","x":626,"y":545,"r":67,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 10 close-ups"}]},{"id":"OC_APML_0005","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the presenting blood film of a 43-year-old man with a new diagnosis of acute myeloid leukaemia, later confirmed as acute promyelocytic leukaemia (APL, APML). Labelled are six abnormal promyelocytes and two smear cells. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. 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Labelled are seven abnormal promyelocytes, two platelets and fibrin strands. FBC: WBC 113.60 × 10⁹/L; Hb 78 g/L, RBC 2.51 × 10¹²/L, HCT 0.236, MCV 94.0 fL, MCH 31.1 pg, MCHC 331 g/L, RDW 15.6%; platelets 54 × 10⁹/L, MPV 12.1 fL; reticulocytes 0.92% (30.4 × 10⁹/L). Manual differential: blasts and abnormal promyelocytes 82% (93.15 × 10⁹/L), promyelocytes 10% (11.36), myelocytes 4% (4.54), metamyelocytes 1% (1.14), neutrophils 2% (2.27), lymphocytes 1% (1.14), no monocytes, eosinophils or basophils. When the differential is counted, the abnormal promyelocytes of APL are counted as blast equivalents, so they are added to the blasts (as in the 82% above) rather than counted with normal promyelocytes; with the PML::RARA fusion the diagnosis of APL does not depend on reaching any blast percentage. The film was reported as leucoerythroblastic, with large blasts of high nuclear to cytoplasmic ratio, prominent and sometimes multiple nucleoli, many bilobed forms and occasional Auer rods; red cells showed anisocytosis, mild polychromasia and occasional irregularly contracted cells, with marked thrombocytopenia; PML::RARA testing was awaited. The cells here are typical of the hypogranular variant of APL: the cytoplasm looks almost agranular or finely dusty by light microscopy, and the nucleus is folded, bilobed or reniform, often with two lobes pressed together in a 'butterfly' or 'bowtie' shape. Unlike classic hypergranular APL, the variant usually presents with a high white cell count and is easily mistaken for acute monocytic leukaemia; a strongly positive myeloperoxidase stain, CD34 and HLA-DR negativity and the PML::RARA fusion from t(15;17) settle it. Faggot cells (bundles of Auer rods) are fewer than in the hypergranular form, so a careful search helps. APL is a haematological emergency: disseminated intravascular coagulation and hyperfibrinolysis cause early deaths from bleeding, so all-trans retinoic acid (ATRA) should start as soon as the film suggests the diagnosis, without waiting for genetic confirmation, with platelet and fibrinogen support; ATRA with arsenic trioxide now cures most patients. A presenting white count above 10 × 10⁹/L puts the patient in the high-risk group, with more bleeding and a higher risk of differentiation syndrome. A G6PD screen was equivocal here; G6PD status matters before rasburicase is given for tumour lysis because it can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency.","w":2400,"h":1800,"pxPerUm":13.278,"v":"acb244859f","files":{"field":"/assets/library/OC_APML_0006/field.webp?v=acb244859f","medium":"/assets/library/OC_APML_0006/field-1200.webp?v=acb244859f","thumb":"/assets/library/OC_APML_0006/thumb.webp?v=acb244859f","cell":"/assets/library/OC_APML_0006/cell-{k}.webp?v=acb244859f","view":"/assets/library/OC_APML_0006/view-{name}.webp?v=acb244859f"},"bytes":484836,"slots":["apl_micro","platelet"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1397,"y":317,"r":64,"um":32,"cx":50,"cy":50},{"n":2,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1106,"y":643,"r":64,"um":32,"cx":50,"cy":50},{"n":3,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1294,"y":480,"r":64,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":720,"y":1183,"r":64,"um":32,"cx":50,"cy":50},{"n":5,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":1037,"y":1508,"r":64,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1114,"y":1371,"r":64,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Abnormal promyelocyte (microgranular APL)","x":1465,"y":1483,"r":64,"um":32,"cx":50,"cy":50},{"n":8,"k":9,"t":"Platelet","x":411,"y":1083,"r":64,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Platelet","x":1174,"y":1128,"r":64,"um":32,"cx":50,"cy":50},{"n":10,"k":10,"t":"Fibrin strands","x":555,"y":397,"r":64,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 10 close-ups"}]},{"id":"OC_APML_0007","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APML). Labelled are two blasts, three hypogranular myelocytes, a monocyte and a hypogranular neutrophil. The patient, a woman in her 20s with known acute promyelocytic leukaemia (APML), had been admitted for treatment. FBC: WBC 30.87 × 10⁹/L, Hb 96 g/L, RBC 3.26 × 10¹²/L, HCT 0.291, MCV 89.3 fL, MCH 29.4 pg, MCHC 330 g/L, RDW 16.8%, platelets 49 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 27%, lymphocytes 21%, monocytes 11%, myelocytes 33%, promyelocytes 1% and blasts 7%, with 1.2 nucleated red cells per 100 white cells. The film showed a marked left shift to the myelocyte stage, severely hypogranular mature neutrophils, occasional large blast-like cells with prominent nucleoli, red cell anisocytosis, polychromasia and a very occasional fragment; the low platelet count was genuine, with no clumps. Hypogranular, immature-looking granulocytes are typical of APML and of its treatment: all-trans retinoic acid (ATRA) and arsenic trioxide make the leukaemic promyelocytes mature, so the blood can fill with myelocytes and abnormal neutrophils and the white count can rise (differentiation syndrome is a recognised risk). Several cells here have folded nuclei and grey-blue cytoplasm and could be maturing abnormal promyelocytes, myelocytes or monocytes; those are marked \"not sure\" for review. PML::RARA testing (FISH or PCR) confirms APML and is used to follow the response.","w":2400,"h":1800,"pxPerUm":6.556,"v":"e777f48e88","files":{"field":"/assets/library/OC_APML_0007/field.webp?v=e777f48e88","medium":"/assets/library/OC_APML_0007/field-1200.webp?v=e777f48e88","thumb":"/assets/library/OC_APML_0007/thumb.webp?v=e777f48e88","cell":"/assets/library/OC_APML_0007/cell-{k}.webp?v=e777f48e88","view":"/assets/library/OC_APML_0007/view-{name}.webp?v=e777f48e88"},"bytes":437552,"slots":["blast","myelocyte","monocyte","neutrophil"],"cells":[{"n":1,"k":6,"t":"Neutrophil","x":2374,"y":1073,"r":57,"um":40,"cx":90,"cy":50},{"n":2,"k":3,"t":"Blast","x":1330,"y":912,"r":57,"um":40,"cx":50,"cy":50},{"n":3,"k":10,"t":"Blast","x":1529,"y":926,"r":57,"um":40,"cx":50,"cy":50},{"n":4,"k":7,"t":"Blast","x":875,"y":1140,"r":57,"um":40,"cx":50,"cy":50},{"n":5,"k":1,"t":"Myelocyte","x":599,"y":682,"r":42,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Myelocyte","x":979,"y":991,"r":42,"um":32,"cx":50,"cy":50},{"n":7,"k":9,"t":"Myelocyte","x":2143,"y":1668,"r":42,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Monocyte","x":1599,"y":1180,"r":57,"um":40,"cx":50,"cy":50},{"n":9,"k":11,"t":"Blast","x":1182,"y":876,"r":57,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_APML_0008","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APML). Labelled are two blasts, two hypogranular myelocytes, a monocyte, a hypogranular neutrophil and a lymphocyte. The patient, a woman in her 20s with known acute promyelocytic leukaemia (APML), had been admitted for treatment. FBC: WBC 30.87 × 10⁹/L, Hb 96 g/L, RBC 3.26 × 10¹²/L, HCT 0.291, MCV 89.3 fL, MCH 29.4 pg, MCHC 330 g/L, RDW 16.8%, platelets 49 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 27%, lymphocytes 21%, monocytes 11%, myelocytes 33%, promyelocytes 1% and blasts 7%, with 1.2 nucleated red cells per 100 white cells. The film showed a marked left shift to the myelocyte stage, severely hypogranular mature neutrophils, occasional large blast-like cells with prominent nucleoli, red cell anisocytosis, polychromasia and a very occasional fragment; the low platelet count was genuine, with no clumps. Hypogranular, immature-looking granulocytes are typical of APML and of its treatment: all-trans retinoic acid (ATRA) and arsenic trioxide make the leukaemic promyelocytes mature, so the blood can fill with myelocytes and abnormal neutrophils and the white count can rise (differentiation syndrome is a recognised risk). Several cells here have folded nuclei and grey-blue cytoplasm and could be maturing abnormal promyelocytes, myelocytes or monocytes; those are marked \"not sure\" for review. PML::RARA testing (FISH or PCR) confirms APML and is used to follow the response.","w":2400,"h":1800,"pxPerUm":6.438,"v":"c706e9e5f1","files":{"field":"/assets/library/OC_APML_0008/field.webp?v=c706e9e5f1","medium":"/assets/library/OC_APML_0008/field-1200.webp?v=c706e9e5f1","thumb":"/assets/library/OC_APML_0008/thumb.webp?v=c706e9e5f1","cell":"/assets/library/OC_APML_0008/cell-{k}.webp?v=c706e9e5f1","view":"/assets/library/OC_APML_0008/view-{name}.webp?v=c706e9e5f1"},"bytes":429200,"slots":["blast","myelocyte","monocyte","neutrophil","lymph"],"cells":[{"n":1,"k":2,"t":"Blast","x":1242,"y":382,"r":56,"um":40,"cx":50,"cy":50},{"n":2,"k":12,"t":"Blast","x":712,"y":671,"r":56,"um":40,"cx":50,"cy":50},{"n":3,"k":13,"t":"Blast","x":1549,"y":590,"r":56,"um":40,"cx":50,"cy":50},{"n":4,"k":6,"t":"Blast","x":977,"y":833,"r":56,"um":40,"cx":50,"cy":50},{"n":5,"k":10,"t":"Blast","x":1158,"y":950,"r":56,"um":40,"cx":50,"cy":50},{"n":6,"k":9,"t":"Myelocyte","x":1382,"y":1220,"r":42,"um":32,"cx":50,"cy":50},{"n":7,"k":1,"t":"Monocyte","x":1218,"y":95,"r":56,"um":40,"cx":50,"cy":36.8},{"n":8,"k":3,"t":"Lymphocyte","x":1423,"y":455,"r":45,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_APML_0009","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×20","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APML). Labelled are two blasts, two hypogranular myelocytes, two monocytes and a hypogranular neutrophil. The patient, a woman in her 20s with known acute promyelocytic leukaemia (APML), had been admitted for treatment. FBC: WBC 30.87 × 10⁹/L, Hb 96 g/L, RBC 3.26 × 10¹²/L, HCT 0.291, MCV 89.3 fL, MCH 29.4 pg, MCHC 330 g/L, RDW 16.8%, platelets 49 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 27%, lymphocytes 21%, monocytes 11%, myelocytes 33%, promyelocytes 1% and blasts 7%, with 1.2 nucleated red cells per 100 white cells. The film showed a marked left shift to the myelocyte stage, severely hypogranular mature neutrophils, occasional large blast-like cells with prominent nucleoli, red cell anisocytosis, polychromasia and a very occasional fragment; the low platelet count was genuine, with no clumps. Hypogranular, immature-looking granulocytes are typical of APML and of its treatment: all-trans retinoic acid (ATRA) and arsenic trioxide make the leukaemic promyelocytes mature, so the blood can fill with myelocytes and abnormal neutrophils and the white count can rise (differentiation syndrome is a recognised risk). Several cells here have folded nuclei and grey-blue cytoplasm and could be maturing abnormal promyelocytes, myelocytes or monocytes; those are marked \"not sure\" for review. PML::RARA testing (FISH or PCR) confirms APML and is used to follow the response.","w":2400,"h":1800,"pxPerUm":6.682,"v":"7a8cb202d3","files":{"field":"/assets/library/OC_APML_0009/field.webp?v=7a8cb202d3","medium":"/assets/library/OC_APML_0009/field-1200.webp?v=7a8cb202d3","thumb":"/assets/library/OC_APML_0009/thumb.webp?v=7a8cb202d3","cell":"/assets/library/OC_APML_0009/cell-{k}.webp?v=7a8cb202d3","view":"/assets/library/OC_APML_0009/view-{name}.webp?v=7a8cb202d3"},"bytes":421964,"slots":["blast","myelocyte","monocyte","neutrophil"],"cells":[{"n":1,"k":2,"t":"Blast","x":1204,"y":926,"r":58,"um":40,"cx":50,"cy":50},{"n":2,"k":8,"t":"Blast","x":907,"y":1676,"r":58,"um":40,"cx":50,"cy":53.7},{"n":3,"k":3,"t":"Myelocyte","x":1603,"y":995,"r":42,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Myelocyte","x":677,"y":1193,"r":42,"um":32,"cx":50,"cy":50},{"n":5,"k":6,"t":"Monocyte","x":321,"y":1337,"r":58,"um":40,"cx":50,"cy":50},{"n":6,"k":9,"t":"Blast","x":2259,"y":1432,"r":58,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_APML_0010","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are two abnormal promyelocytes and an Auer rod. The cell with a bundle of several Auer rods is a \"faggot cell\", which is almost only seen in APL. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. A small, very dark cell is marked \"not sure\": it may be a lymphocyte or a late nucleated red cell. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":14.176,"v":"a52842ae18","files":{"field":"/assets/library/OC_APML_0010/field.webp?v=a52842ae18","medium":"/assets/library/OC_APML_0010/field-1200.webp?v=a52842ae18","thumb":"/assets/library/OC_APML_0010/thumb.webp?v=a52842ae18","cell":"/assets/library/OC_APML_0010/cell-{k}.webp?v=a52842ae18","view":"/assets/library/OC_APML_0010/view-{name}.webp?v=a52842ae18"},"bytes":358310,"slots":["apl_micro","auer"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1992,"y":234,"r":68,"um":32,"cx":50,"cy":50},{"n":2,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1264,"y":864,"r":68,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Auer rod","x":1248,"y":763,"r":68,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_APML_0011","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are six abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":18.991,"v":"e1fafc6d55","files":{"field":"/assets/library/OC_APML_0011/field.webp?v=e1fafc6d55","medium":"/assets/library/OC_APML_0011/field-1200.webp?v=e1fafc6d55","thumb":"/assets/library/OC_APML_0011/thumb.webp?v=e1fafc6d55","cell":"/assets/library/OC_APML_0011/cell-{k}.webp?v=e1fafc6d55","view":"/assets/library/OC_APML_0011/view-{name}.webp?v=e1fafc6d55"},"bytes":410144,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":408,"y":672,"r":91,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":600,"y":736,"r":91,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":2028,"y":1306,"r":91,"um":32,"cx":50,"cy":50},{"n":4,"k":7,"t":"Abnormal promyelocyte (microgranular APL)","x":1166,"y":2225,"r":91,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1416,"y":2368,"r":91,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":1440,"y":2656,"r":91,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_APML_0012","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are two abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":18.658,"v":"7771f6397f","files":{"field":"/assets/library/OC_APML_0012/field.webp?v=7771f6397f","medium":"/assets/library/OC_APML_0012/field-1200.webp?v=7771f6397f","thumb":"/assets/library/OC_APML_0012/thumb.webp?v=7771f6397f","cell":"/assets/library/OC_APML_0012/cell-{k}.webp?v=7771f6397f","view":"/assets/library/OC_APML_0012/view-{name}.webp?v=7771f6397f"},"bytes":399428,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1344,"y":1632,"r":90,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1464,"y":1824,"r":90,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Keratocyte","x":1358,"y":2214,"r":90,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_APML_0013","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are two abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":19.351,"v":"df2e2ff49c","files":{"field":"/assets/library/OC_APML_0013/field.webp?v=df2e2ff49c","medium":"/assets/library/OC_APML_0013/field-1200.webp?v=df2e2ff49c","thumb":"/assets/library/OC_APML_0013/thumb.webp?v=df2e2ff49c","cell":"/assets/library/OC_APML_0013/cell-{k}.webp?v=df2e2ff49c","view":"/assets/library/OC_APML_0013/view-{name}.webp?v=df2e2ff49c"},"bytes":368368,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1922,"y":1139,"r":93,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":893,"y":1536,"r":93,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_APML_0014","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are three abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":16.469,"v":"867cabfd89","files":{"field":"/assets/library/OC_APML_0014/field.webp?v=867cabfd89","medium":"/assets/library/OC_APML_0014/field-1200.webp?v=867cabfd89","thumb":"/assets/library/OC_APML_0014/thumb.webp?v=867cabfd89","cell":"/assets/library/OC_APML_0014/cell-{k}.webp?v=867cabfd89","view":"/assets/library/OC_APML_0014/view-{name}.webp?v=867cabfd89"},"bytes":437480,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":202,"y":1334,"r":79,"um":32,"cx":38.3,"cy":50},{"n":2,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1356,"y":2032,"r":79,"um":32,"cx":50,"cy":50},{"n":3,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1440,"y":1872,"r":79,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Auer rod","x":1414,"y":1787,"r":79,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_APML_0015","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are five abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. A small, very dark cell is marked \"not sure\": it may be a lymphocyte or a late nucleated red cell. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":17.317,"v":"30489d4335","files":{"field":"/assets/library/OC_APML_0015/field.webp?v=30489d4335","medium":"/assets/library/OC_APML_0015/field-1200.webp?v=30489d4335","thumb":"/assets/library/OC_APML_0015/thumb.webp?v=30489d4335","cell":"/assets/library/OC_APML_0015/cell-{k}.webp?v=30489d4335","view":"/assets/library/OC_APML_0015/view-{name}.webp?v=30489d4335"},"bytes":463586,"slots":["apl_micro"],"cells":[{"n":1,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1409,"y":771,"r":83,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1085,"y":844,"r":83,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":881,"y":1683,"r":83,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":752,"y":2435,"r":83,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1505,"y":2448,"r":83,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_APML_0016","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are two abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":16.126,"v":"0411bada3d","files":{"field":"/assets/library/OC_APML_0016/field.webp?v=0411bada3d","medium":"/assets/library/OC_APML_0016/field-1200.webp?v=0411bada3d","thumb":"/assets/library/OC_APML_0016/thumb.webp?v=0411bada3d","cell":"/assets/library/OC_APML_0016/cell-{k}.webp?v=0411bada3d","view":"/assets/library/OC_APML_0016/view-{name}.webp?v=0411bada3d"},"bytes":415830,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1128,"y":1152,"r":78,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1308,"y":1312,"r":78,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_APML_0017","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are five abnormal promyelocytes. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":3200,"pxPerUm":17.864,"v":"d48155cb32","files":{"field":"/assets/library/OC_APML_0017/field.webp?v=d48155cb32","medium":"/assets/library/OC_APML_0017/field-1200.webp?v=d48155cb32","thumb":"/assets/library/OC_APML_0017/thumb.webp?v=d48155cb32","cell":"/assets/library/OC_APML_0017/cell-{k}.webp?v=d48155cb32","view":"/assets/library/OC_APML_0017/view-{name}.webp?v=d48155cb32"},"bytes":407558,"slots":["apl_micro"],"cells":[{"n":1,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":492,"y":463,"r":86,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":2100,"y":752,"r":86,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":540,"y":2128,"r":86,"um":32,"cx":50,"cy":50},{"n":4,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1440,"y":1872,"r":86,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1944,"y":3040,"r":86,"um":32,"cx":50,"cy":72}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_APML_0018","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are three abnormal promyelocytes and an Auer rod. The cell with a bundle of several Auer rods is a \"faggot cell\", which is almost only seen in APL. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":12.244,"v":"5e3bbbf8cd","files":{"field":"/assets/library/OC_APML_0018/field.webp?v=5e3bbbf8cd","medium":"/assets/library/OC_APML_0018/field-1200.webp?v=5e3bbbf8cd","thumb":"/assets/library/OC_APML_0018/thumb.webp?v=5e3bbbf8cd","cell":"/assets/library/OC_APML_0018/cell-{k}.webp?v=5e3bbbf8cd","view":"/assets/library/OC_APML_0018/view-{name}.webp?v=5e3bbbf8cd"},"bytes":303500,"slots":["apl_micro","auer"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1068,"y":540,"r":59,"um":32,"cx":50,"cy":50},{"n":2,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1644,"y":1260,"r":59,"um":32,"cx":50,"cy":50},{"n":3,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1704,"y":1134,"r":59,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Auer rod","x":1014,"y":598,"r":59,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Auer rod","x":1131,"y":612,"r":59,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Auer rod","x":1626,"y":1327,"r":59,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_APML_0019","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are an abnormal promyelocyte. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.929,"v":"e9aa18a03e","files":{"field":"/assets/library/OC_APML_0019/field.webp?v=e9aa18a03e","medium":"/assets/library/OC_APML_0019/field-1200.webp?v=e9aa18a03e","thumb":"/assets/library/OC_APML_0019/thumb.webp?v=e9aa18a03e","cell":"/assets/library/OC_APML_0019/cell-{k}.webp?v=e9aa18a03e","view":"/assets/library/OC_APML_0019/view-{name}.webp?v=e9aa18a03e"},"bytes":171762,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1248,"y":666,"r":57,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_APML_0020","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are three abnormal promyelocytes and an Auer rod. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. A smaller cell with a rounder nucleus is marked \"not sure\": it may be a less abnormal promyelocyte or a myelocyte. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.844,"v":"e82d69bad2","files":{"field":"/assets/library/OC_APML_0020/field.webp?v=e82d69bad2","medium":"/assets/library/OC_APML_0020/field-1200.webp?v=e82d69bad2","thumb":"/assets/library/OC_APML_0020/thumb.webp?v=e82d69bad2","cell":"/assets/library/OC_APML_0020/cell-{k}.webp?v=e82d69bad2","view":"/assets/library/OC_APML_0020/view-{name}.webp?v=e82d69bad2"},"bytes":175886,"slots":["apl_micro","auer"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1008,"y":558,"r":57,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":1128,"y":522,"r":57,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":468,"y":986,"r":57,"um":32,"cx":50,"cy":50},{"n":4,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":1254,"y":1425,"r":57,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Auer rod","x":1125,"y":421,"r":57,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_APML_0021","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are seven abnormal promyelocytes and an Auer rod. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.824,"v":"2c52078e22","files":{"field":"/assets/library/OC_APML_0021/field.webp?v=2c52078e22","medium":"/assets/library/OC_APML_0021/field-1200.webp?v=2c52078e22","thumb":"/assets/library/OC_APML_0021/thumb.webp?v=2c52078e22","cell":"/assets/library/OC_APML_0021/cell-{k}.webp?v=2c52078e22","view":"/assets/library/OC_APML_0021/view-{name}.webp?v=2c52078e22"},"bytes":275712,"slots":["apl_micro","auer"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":348,"y":396,"r":57,"um":32,"cx":50,"cy":50},{"n":2,"k":10,"t":"Abnormal promyelocyte (microgranular APL)","x":1008,"y":365,"r":57,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1116,"y":594,"r":57,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":1656,"y":684,"r":57,"um":32,"cx":50,"cy":50},{"n":5,"k":6,"t":"Abnormal promyelocyte (microgranular APL)","x":336,"y":891,"r":57,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":756,"y":774,"r":57,"um":32,"cx":50,"cy":50},{"n":7,"k":9,"t":"Abnormal promyelocyte (microgranular APL)","x":1008,"y":1631,"r":57,"um":32,"cx":50,"cy":55.4},{"n":8,"k":11,"t":"Auer bodies","x":1124,"y":528,"r":57,"um":32,"cx":50,"cy":50},{"n":9,"k":12,"t":"Auer bodies","x":696,"y":840,"r":57,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_APML_0022","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are five abnormal promyelocytes. A possible Auer rod at the edge of the top-left cell is marked \"not sure\". The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.479,"v":"0aaca34941","files":{"field":"/assets/library/OC_APML_0022/field.webp?v=0aaca34941","medium":"/assets/library/OC_APML_0022/field-1200.webp?v=0aaca34941","thumb":"/assets/library/OC_APML_0022/thumb.webp?v=0aaca34941","cell":"/assets/library/OC_APML_0022/cell-{k}.webp?v=0aaca34941","view":"/assets/library/OC_APML_0022/view-{name}.webp?v=0aaca34941"},"bytes":249500,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":816,"y":252,"r":55,"um":32,"cx":50,"cy":50},{"n":2,"k":9,"t":"Abnormal promyelocyte (microgranular APL)","x":1085,"y":321,"r":55,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1176,"y":648,"r":55,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":948,"y":1296,"r":55,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":684,"y":1674,"r":55,"um":32,"cx":50,"cy":65.7},{"n":6,"k":8,"t":"Auer rod","x":852,"y":300,"r":55,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Auer bodies","x":711,"y":1730,"r":55,"um":32,"cx":50,"cy":81}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 7 close-ups"}]},{"id":"OC_APML_0023","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are five abnormal promyelocytes and a lymphocyte. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.498,"v":"6e4179c646","files":{"field":"/assets/library/OC_APML_0023/field.webp?v=6e4179c646","medium":"/assets/library/OC_APML_0023/field-1200.webp?v=6e4179c646","thumb":"/assets/library/OC_APML_0023/thumb.webp?v=6e4179c646","cell":"/assets/library/OC_APML_0023/cell-{k}.webp?v=6e4179c646","view":"/assets/library/OC_APML_0023/view-{name}.webp?v=6e4179c646"},"bytes":242790,"slots":["apl_micro"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":396,"y":666,"r":55,"um":32,"cx":50,"cy":50},{"n":2,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1632,"y":594,"r":55,"um":32,"cx":50,"cy":50},{"n":3,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":612,"y":792,"r":55,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":804,"y":1296,"r":55,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Abnormal promyelocyte (microgranular APL)","x":1500,"y":1458,"r":55,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Lymphocyte","x":2172,"y":693,"r":81,"um":40,"cx":50.4,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_APML_0024","kind":"film","series":"APML","condition":"Acute promyelocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute promyelocytic leukaemia (APL, APML). Labelled are six abnormal promyelocytes and an Auer rod. The abnormal promyelocytes here have folded, bilobed or kidney-shaped nuclei, often with the two lobes pressed together, and pale to lilac cytoplasm with fine, dusty granules, as seen in the hypogranular (microgranular) variant; some show Auer rods, thin pink-purple needles made of fused granules. APL is a medical emergency because of its bleeding risk from disseminated intravascular coagulation (DIC), so a film suggesting it should be reported urgently and checked with clotting tests. The PML::RARA fusion from t(15;17), found by FISH or PCR, confirms the diagnosis, and treatment with all-trans retinoic acid (ATRA) and arsenic trioxide is started on suspicion.","w":2400,"h":1800,"pxPerUm":11.129,"v":"3b4aa98bd8","files":{"field":"/assets/library/OC_APML_0024/field.webp?v=3b4aa98bd8","medium":"/assets/library/OC_APML_0024/field-1200.webp?v=3b4aa98bd8","thumb":"/assets/library/OC_APML_0024/thumb.webp?v=3b4aa98bd8","cell":"/assets/library/OC_APML_0024/cell-{k}.webp?v=3b4aa98bd8","view":"/assets/library/OC_APML_0024/view-{name}.webp?v=3b4aa98bd8"},"bytes":240820,"slots":["apl_micro","auer"],"cells":[{"n":1,"k":1,"t":"Abnormal promyelocyte (microgranular APL)","x":1152,"y":324,"r":53,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Abnormal promyelocyte (microgranular APL)","x":936,"y":972,"r":53,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Abnormal promyelocyte (microgranular APL)","x":1044,"y":1278,"r":53,"um":32,"cx":50,"cy":50},{"n":4,"k":9,"t":"Abnormal promyelocyte (microgranular APL)","x":1517,"y":1323,"r":53,"um":32,"cx":50,"cy":50},{"n":5,"k":8,"t":"Abnormal promyelocyte (microgranular APL)","x":1808,"y":1172,"r":53,"um":32,"cx":50,"cy":50},{"n":6,"k":4,"t":"Abnormal promyelocyte (microgranular APL)","x":960,"y":1458,"r":53,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Auer rod","x":1210,"y":356,"r":53,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 7 close-ups"}]},{"id":"OC_CLL_0001","kind":"film","series":"CLL","condition":"Chronic lymphocytic leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Microscope camera","caption":"A field from the blood film of a man in his nineties with cellulitis on a background of chronic lymphocytic leukaemia (CLL), a B-cell lymphoproliferative disorder. 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Labelled are 135 lymphocytes, 33 smear cells and one neutrophil. FBC: WBC 823.81 × 10⁹/L (checked by dilution) with lymphocytes 99% (815.57 × 10⁹/L), neutrophils 1% (8.24 × 10⁹/L) and no monocytes; Hb 74 g/L (corrected for white cell interference), RBC 2.69 × 10¹²/L, HCT 0.281, MCV 104.5 fL, MCH 27.5 pg, MCHC 263 g/L; platelets 131 × 10⁹/L, MPV 11.3 fL. The film comment was: marked lymphocytosis with smear cells. Almost every nucleated cell is a small mature lymphocyte with a round nucleus, coarsely clumped 'soccer ball' chromatin and a thin rim of cytoplasm, and there are many smear cells, the crushed nuclei of these fragile cells; in CLL they are counted with the lymphocytes, and an albumin-treated film reduces them if a more accurate differential is needed. Counts this high cause analyser artefacts worth knowing: the turbidity of so many white cells falsely raises the measured haemoglobin, so it has to be corrected, and white cells counted in the red cell channel distort the RBC, HCT, MCV and MCHC, which is why the MCHC here is implausibly low; the white count itself may need dilution to fall within the analyser's range. Even at these counts symptomatic leucostasis is rare in CLL, unlike acute leukaemia, because the small mature cells are deformable, so the lymphocyte count alone is not an indication for treatment. Treatment is guided instead by progressive marrow failure (Hb below 100 g/L or platelets below 100 × 10⁹/L), bulky or symptomatic lymphadenopathy or splenomegaly, B symptoms, a lymphocyte doubling time under six months, or autoimmune cytopenias not responding to steroids; the anaemia here would meet the first criterion if it is not explained otherwise (for example by haemolysis, which a DAT and reticulocyte count would check). 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Blasts are few in chronic phase; under the WHO 5th edition, 20% or more blasts in blood or marrow (or extramedullary blast proliferation) defines blast phase, and a rising basophil count (20% or more), increasing blasts or new clonal abnormalities are high-risk features of progression. A reactive neutrophilia or leukaemoid reaction also shows a left shift, but usually without basophilia or a myelocyte peak, and with toxic granulation. Platelets are often normal or raised, and splenomegaly is common. Treatment is with tyrosine kinase inhibitors such as imatinib, dasatinib or nilotinib, with response monitored by quantitative BCR::ABL1 PCR. 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Blood count from the analyser: WBC 319.64 ×10⁹/L, RBC 4.51 ×10¹²/L, Hb 146 g/L, HCT 0.438, MCV 97.1 fL, MCH 32.4 pg, MCHC 333 g/L, platelets 205 ×10⁹/L, RDW-CV 18.8%, MPV 12.7 fL; the analyser could not give a differential (neutrophils, lymphocytes, monocytes and immature granulocytes not reported) but flagged basophils at 17.0% and eosinophils at 1.6%. A white count this high with a failed automated differential is common in CML because the analyser cannot classify the immature granulocytes, so a manual differential on the film is needed; a basophil count close to 20% should prompt a careful blast count and assessment for progression. 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Blasts are few in chronic phase; under the WHO 5th edition, 20% or more blasts in blood or marrow (or extramedullary blast proliferation) defines blast phase, and a rising basophil count (20% or more), increasing blasts or new clonal abnormalities are high-risk features of progression. A reactive neutrophilia or leukaemoid reaction also shows a left shift, but usually without basophilia or a myelocyte peak, and with toxic granulation. Platelets are often normal or raised, and splenomegaly is common. Treatment is with tyrosine kinase inhibitors such as imatinib, dasatinib or nilotinib, with response monitored by quantitative BCR::ABL1 PCR. Blood count from the analyser: WBC 319.64 ×10⁹/L, RBC 4.51 ×10¹²/L, Hb 146 g/L, HCT 0.438, MCV 97.1 fL, MCH 32.4 pg, MCHC 333 g/L, platelets 205 ×10⁹/L, RDW-CV 18.8%, MPV 12.7 fL; the analyser could not give a differential (neutrophils, lymphocytes, monocytes and immature granulocytes not reported) but flagged basophils at 17.0% and eosinophils at 1.6%. A white count this high with a failed automated differential is common in CML because the analyser cannot classify the immature granulocytes, so a manual differential on the film is needed; a basophil count close to 20% should prompt a careful blast count and assessment for progression. These images have been colour-balanced and sharpened for clarity.","w":2400,"h":1800,"pxPerUm":12.29,"v":"feab9fca8f","files":{"field":"/assets/library/OC_CML_0006/field.webp?v=feab9fca8f","medium":"/assets/library/OC_CML_0006/field-1200.webp?v=feab9fca8f","thumb":"/assets/library/OC_CML_0006/thumb.webp?v=feab9fca8f","cell":"/assets/library/OC_CML_0006/cell-{k}.webp?v=feab9fca8f","view":"/assets/library/OC_CML_0006/view-{name}.webp?v=feab9fca8f"},"bytes":809046,"slots":["myelocyte","basophil","neutrophil","metamyelocyte","band","promyelocyte","blast","eosinophil"],"cells":[{"n":1,"k":1,"t":"Myelocyte","x":60,"y":72,"r":59,"um":32,"cx":15.3,"cy":18.3},{"n":2,"k":2,"t":"Myelocyte","x":828,"y":60,"r":59,"um":32,"cx":50,"cy":15.3},{"n":3,"k":7,"t":"Myelocyte","x":780,"y":444,"r":59,"um":32,"cx":50,"cy":50},{"n":4,"k":8,"t":"Myelocyte","x":900,"y":384,"r":59,"um":32,"cx":50,"cy":50},{"n":5,"k":3,"t":"Myelocyte","x":1272,"y":240,"r":59,"um":32,"cx":50,"cy":50},{"n":6,"k":4,"t":"Myelocyte","x":1404,"y":312,"r":59,"um":32,"cx":50,"cy":50},{"n":7,"k":19,"t":"Myelocyte","x":1716,"y":324,"r":59,"um":32,"cx":50,"cy":50},{"n":8,"k":20,"t":"Myelocyte","x":2112,"y":324,"r":59,"um":32,"cx":50,"cy":50},{"n":9,"k":10,"t":"Myelocyte","x":552,"y":636,"r":59,"um":32,"cx":50,"cy":50},{"n":10,"k":11,"t":"Myelocyte","x":720,"y":576,"r":59,"um":32,"cx":50,"cy":50},{"n":11,"k":9,"t":"Myelocyte","x":1068,"y":516,"r":59,"um":32,"cx":50,"cy":50},{"n":12,"k":12,"t":"Myelocyte","x":636,"y":768,"r":59,"um":32,"cx":50,"cy":50},{"n":13,"k":14,"t":"Myelocyte","x":1032,"y":840,"r":59,"um":32,"cx":50,"cy":50},{"n":14,"k":15,"t":"Myelocyte","x":1092,"y":984,"r":59,"um":32,"cx":50,"cy":50},{"n":15,"k":25,"t":"Myelocyte","x":1836,"y":996,"r":59,"um":32,"cx":50,"cy":50},{"n":16,"k":16,"t":"Myelocyte","x":1212,"y":1056,"r":59,"um":32,"cx":50,"cy":50},{"n":17,"k":29,"t":"Myelocyte","x":1800,"y":1344,"r":59,"um":32,"cx":50,"cy":50},{"n":18,"k":27,"t":"Myelocyte","x":1872,"y":1152,"r":59,"um":32,"cx":50,"cy":50},{"n":19,"k":35,"t":"Myelocyte","x":108,"y":1404,"r":59,"um":32,"cx":27.5,"cy":50},{"n":20,"k":37,"t":"Myelocyte","x":456,"y":1620,"r":59,"um":32,"cx":50,"cy":54.3},{"n":21,"k":36,"t":"Myelocyte","x":588,"y":1548,"r":59,"um":32,"cx":50,"cy":50},{"n":22,"k":30,"t":"Myelocyte","x":1764,"y":1512,"r":59,"um":32,"cx":50,"cy":50},{"n":23,"k":31,"t":"Myelocyte","x":1896,"y":1500,"r":59,"um":32,"cx":50,"cy":50},{"n":24,"k":38,"t":"Myelocyte","x":576,"y":1692,"r":59,"um":32,"cx":50,"cy":72.5},{"n":25,"k":21,"t":"Metamyelocyte","x":2184,"y":216,"r":59,"um":32,"cx":50,"cy":50},{"n":26,"k":34,"t":"Metamyelocyte","x":972,"y":1344,"r":59,"um":32,"cx":50,"cy":50},{"n":27,"k":26,"t":"Metamyelocyte","x":1728,"y":1152,"r":59,"um":32,"cx":50,"cy":50},{"n":28,"k":17,"t":"Neutrophil","x":1032,"y":660,"r":107,"um":40,"cx":50,"cy":50},{"n":29,"k":6,"t":"Neutrophil","x":1416,"y":504,"r":107,"um":40,"cx":50,"cy":50},{"n":30,"k":18,"t":"Neutrophil","x":708,"y":996,"r":107,"um":40,"cx":50,"cy":50},{"n":31,"k":22,"t":"Neutrophil","x":1476,"y":852,"r":107,"um":40,"cx":50,"cy":50},{"n":32,"k":23,"t":"Neutrophil","x":1512,"y":1020,"r":107,"um":40,"cx":50,"cy":50},{"n":33,"k":28,"t":"Neutrophil","x":1956,"y":1260,"r":107,"um":40,"cx":50,"cy":50},{"n":34,"k":33,"t":"Neutrophil","x":1416,"y":1608,"r":107,"um":40,"cx":50,"cy":60.9},{"n":35,"k":24,"t":"Eosinophil","x":1416,"y":1152,"r":107,"um":40,"cx":50,"cy":50},{"n":36,"k":32,"t":"Eosinophil","x":1632,"y":1548,"r":107,"um":40,"cx":50,"cy":50},{"n":37,"k":41,"t":"Blast","x":1221,"y":399,"r":107,"um":40,"cx":50,"cy":50},{"n":38,"k":39,"t":"Myelocyte","x":867,"y":763,"r":59,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 38 close-ups"}]},{"id":"OC_WEIRD_0001","kind":"film","series":"WEIRD","condition":"Weird & wonderful","stain":"May–Grünwald–Giemsa (MGG)","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"Weird and wonderful: a giant platelet that looks just like Patrick Star from SpongeBob SquarePants, or a starfish. What it really is: a giant platelet, larger than the red cells around it, with a central purple granular area (the granulomere) and a paler blue, agranular rim (the hyalomere) drawn out into points. Giant platelets are seen when platelets are being made and used up quickly, in myeloproliferative neoplasms and in inherited macrothrombocytopenias; report them as giant platelets. The field also shows many tear-drop cells and elliptocytes, and a few small platelet clumps. Weird & wonderful names are nicknames for fun, not real terms: never use them in a report.","w":2400,"h":1632,"pxPerUm":19.378,"v":"923ba1ffe5","files":{"field":"/assets/library/OC_WEIRD_0001/field.webp?v=923ba1ffe5","medium":"/assets/library/OC_WEIRD_0001/field-1200.webp?v=923ba1ffe5","thumb":"/assets/library/OC_WEIRD_0001/thumb.webp?v=923ba1ffe5","cell":"/assets/library/OC_WEIRD_0001/cell-{k}.webp?v=923ba1ffe5","view":"/assets/library/OC_WEIRD_0001/view-{name}.webp?v=923ba1ffe5"},"bytes":179228,"slots":[],"cells":[{"n":1,"k":1,"t":"Patrick the starfish (giant platelet)","x":1194,"y":800,"r":112,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_WEIRD_0002","kind":"film","series":"WEIRD","condition":"Weird & wonderful","stain":"May–Grünwald–Giemsa (MGG)","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"Weird and wonderful: a rose made from a platelet clump on a stem of fibrin strands; a good Valentine's gift for a biomedical scientist. What it really is: a large platelet clump with pale fibrin strands running through and away from it. Platelet clumps and fibrin mean the platelets have aggregated or the sample has started to clot, so the analyser platelet count may be falsely low (pseudothrombocytopenia). Clumps are not always spread evenly and may collect in the tail of the film, so check there; if EDTA-dependent clumping is suspected, a fresh sample in another anticoagulant such as citrate usually gives a reliable count. Weird & wonderful names are nicknames for fun, not real terms: never use them in a report.","w":2400,"h":5307,"pxPerUm":42.215,"v":"c91251db18","files":{"field":"/assets/library/OC_WEIRD_0002/field.webp?v=c91251db18","medium":"/assets/library/OC_WEIRD_0002/field-1200.webp?v=c91251db18","thumb":"/assets/library/OC_WEIRD_0002/thumb.webp?v=c91251db18","cell":"/assets/library/OC_WEIRD_0002/cell-{k}.webp?v=c91251db18","view":"/assets/library/OC_WEIRD_0002/view-{name}.webp?v=c91251db18"},"bytes":288384,"slots":[],"cells":[{"n":1,"k":1,"t":"Platelet rose (platelet clump)","x":1068,"y":955,"r":293,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Rose stem (fibrin strands)","x":1202,"y":3397,"r":293,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_WEIRD_0003","kind":"film","series":"WEIRD","condition":"Weird & wonderful","stain":"May–Grünwald–Giemsa (MGG)","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"Weird and wonderful: a white cell whose nucleus is folded into a heart. What it really is: probably a metamyelocyte, with an indented, kidney-shaped nucleus and clumped chromatin, here folded into a heart. An indented nucleus is also seen in band forms and monocytes, so judge the chromatin and the cytoplasm as well as the outline of the nucleus. Its partner, the red heart, is in this section too. Weird & wonderful names are nicknames for fun, not real terms: never use them in a report.","w":2400,"h":1402,"pxPerUm":26.746,"v":"02599a1a9b","files":{"field":"/assets/library/OC_WEIRD_0003/field.webp?v=02599a1a9b","medium":"/assets/library/OC_WEIRD_0003/field-1200.webp?v=02599a1a9b","thumb":"/assets/library/OC_WEIRD_0003/thumb.webp?v=02599a1a9b","cell":"/assets/library/OC_WEIRD_0003/cell-{k}.webp?v=02599a1a9b","view":"/assets/library/OC_WEIRD_0003/view-{name}.webp?v=02599a1a9b"},"bytes":85480,"slots":[],"cells":[{"n":1,"k":1,"t":"Purple heart (metamyelocyte)","x":1176,"y":687,"r":128,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_WEIRD_0004","kind":"film","series":"WEIRD","condition":"Weird & wonderful","stain":"May–Grünwald–Giemsa (MGG)","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"Weird and wonderful: a heart-shaped red cell. What it really is: a small, misshapen red cell with no central pallor, most likely a red cell fragment (schistocyte); red cells can also be bent into odd shapes as the film is spread. One odd shape means little: fragments matter when there are many of them, and a diagnosis of microangiopathic haemolytic anaemia needs more than 1% schistocytes, counted on at least 1000 red cells. Its partner, the purple heart, is in this section too. Weird & wonderful names are nicknames for fun, not real terms: never use them in a report.","w":2400,"h":1521,"pxPerUm":66.868,"v":"c7e68ec717","files":{"field":"/assets/library/OC_WEIRD_0004/field.webp?v=c7e68ec717","medium":"/assets/library/OC_WEIRD_0004/field-1200.webp?v=c7e68ec717","thumb":"/assets/library/OC_WEIRD_0004/thumb.webp?v=c7e68ec717","cell":"/assets/library/OC_WEIRD_0004/cell-{k}.webp?v=c7e68ec717","view":"/assets/library/OC_WEIRD_0004/view-{name}.webp?v=c7e68ec717"},"bytes":87734,"slots":[],"cells":[{"n":1,"k":1,"t":"Red heart (schistocyte)","x":1200,"y":716,"r":321,"um":32,"cx":50,"cy":47}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_WEIRD_0005","kind":"film","series":"WEIRD","condition":"Weird & wonderful","stain":"May–Grünwald–Giemsa (MGG)","objective":"Not recorded","camera":"Phone camera on the microscope","caption":"Weird and wonderful: a smear cell shaped like a hand showing \"a little bit\", with thumb and finger almost touching. What it really is: a smear cell (smudge cell), the crushed nucleus of a fragile white cell, flattened as the film was spread, with the chromatin spread out in a net and no cytoplasm left. A few smear cells are seen in many films; large numbers are typical of chronic lymphocytic leukaemia, where they should be counted with the lymphocytes. Weird & wonderful names are nicknames for fun, not real terms: never use them in a report.","w":2400,"h":2058,"pxPerUm":78.067,"v":"9290e04c6a","files":{"field":"/assets/library/OC_WEIRD_0005/field.webp?v=9290e04c6a","medium":"/assets/library/OC_WEIRD_0005/field-1200.webp?v=9290e04c6a","thumb":"/assets/library/OC_WEIRD_0005/thumb.webp?v=9290e04c6a","cell":"/assets/library/OC_WEIRD_0005/cell-{k}.webp?v=9290e04c6a","view":"/assets/library/OC_WEIRD_0005/view-{name}.webp?v=9290e04c6a"},"bytes":72088,"slots":[],"cells":[{"n":1,"k":1,"t":"A little bit (smear cell)","x":1126,"y":1009,"r":373,"um":32,"cx":50,"cy":49.1}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_HBH_0001","kind":"film","series":"HBH","condition":"HbH inclusions (alpha thalassaemia)","stain":"Brilliant cresyl blue (HbH preparation)","objective":"×60","camera":"Microscope camera","caption":"A field from an HbH preparation. Labelled are 18 red cells with HbH inclusions (golf ball cells) and two reticulocytes. The sample was incubated with brilliant cresyl blue, a supravital stain that oxidises and precipitates the unstable haemoglobin H (β4 tetramers), so affected red cells fill with many small, evenly spaced, blue-green inclusions that give the classic 'golf ball' appearance; reticulocytes, by contrast, show a coarser, irregular network of precipitated RNA. FBC: Hb 102 g/L, RBC 5.69 × 10¹²/L, PCV 0.335, MCV 59 fL, MCH 18.0 pg, RDW 24.6%, WBC 7.4 × 10⁹/L, platelets 157 × 10⁹/L, no nucleated red cells. HPLC showed no common haemoglobin variant and no beta thalassaemia trait, with HbA2 0.9% (low) and HbF 3.6% (raised); because of the red cell indices the sample was sent for molecular analysis, and the HbH preparation showed numerous HbH bodies. Multiplex gap-PCR then showed the patient to be homozygous for α+ thalassaemia due to the 3.7 kb deletion (−α3.7/−α3.7). With two of the four α-globin genes lost this is α-thalassaemia trait, which usually gives microcytosis and hypochromia with a normal or near-normal haemoglobin and only occasional HbH bodies, so this many golf ball cells is more than expected and worth correlating with the iron status and the clinical picture; HbH disease, with three genes lost (−−/−α), typically shows HbH bodies in a large proportion of red cells. A normal or low HbA2 with microcytosis points towards α-thalassaemia or iron deficiency rather than β-thalassaemia trait, and α-thalassaemia cannot be confirmed by HPLC, so DNA analysis is needed; HbH bodies support the diagnosis but their absence does not exclude it. Identifying the deletion matters for genetic counselling: a partner who carries an α0 deletion (−−/αα), common in people of South-East Asian and Mediterranean origin, could have a child with HbH disease, and two α0 carriers risk haemoglobin Bart's hydrops fetalis. These images have been colour-balanced and sharpened to make the inclusions clearer.","w":2400,"h":1800,"pxPerUm":14.474,"v":"965970a69a","files":{"field":"/assets/library/OC_HBH_0001/field.webp?v=965970a69a","medium":"/assets/library/OC_HBH_0001/field-1200.webp?v=965970a69a","thumb":"/assets/library/OC_HBH_0001/thumb.webp?v=965970a69a","cell":"/assets/library/OC_HBH_0001/cell-{k}.webp?v=965970a69a","view":"/assets/library/OC_HBH_0001/view-{name}.webp?v=965970a69a"},"bytes":413622,"slots":["hbh"],"cells":[{"n":1,"k":2,"t":"HbH inclusions (golf ball cell)","x":474,"y":426,"r":69,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"HbH inclusions (golf ball cell)","x":564,"y":270,"r":69,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"HbH inclusions (golf ball cell)","x":1026,"y":414,"r":69,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"HbH inclusions (golf ball cell)","x":1878,"y":354,"r":69,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"HbH inclusions (golf ball cell)","x":1446,"y":582,"r":69,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"HbH inclusions (golf ball cell)","x":1710,"y":564,"r":69,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"HbH inclusions (golf ball cell)","x":1818,"y":636,"r":69,"um":32,"cx":50,"cy":50},{"n":8,"k":9,"t":"HbH inclusions (golf ball cell)","x":702,"y":918,"r":69,"um":32,"cx":50,"cy":50},{"n":9,"k":10,"t":"HbH inclusions (golf ball cell)","x":1158,"y":948,"r":69,"um":32,"cx":50,"cy":50},{"n":10,"k":8,"t":"HbH inclusions (golf ball cell)","x":1296,"y":810,"r":69,"um":32,"cx":50,"cy":50},{"n":11,"k":12,"t":"HbH inclusions (golf ball cell)","x":1884,"y":966,"r":69,"um":32,"cx":50,"cy":50},{"n":12,"k":11,"t":"HbH inclusions (golf ball cell)","x":2202,"y":768,"r":69,"um":32,"cx":57.3,"cy":50},{"n":13,"k":14,"t":"HbH inclusions (golf ball cell)","x":792,"y":1074,"r":69,"um":32,"cx":50,"cy":50},{"n":14,"k":13,"t":"HbH inclusions (golf ball cell)","x":1338,"y":1062,"r":69,"um":32,"cx":50,"cy":50},{"n":15,"k":16,"t":"HbH inclusions (golf ball cell)","x":1236,"y":1596,"r":69,"um":32,"cx":50,"cy":56},{"n":16,"k":15,"t":"HbH inclusions (golf ball cell)","x":1512,"y":1482,"r":69,"um":32,"cx":50,"cy":50},{"n":17,"k":17,"t":"HbH inclusions (golf ball cell)","x":1470,"y":1686,"r":69,"um":32,"cx":50,"cy":75.4},{"n":18,"k":18,"t":"HbH inclusions (golf ball cell)","x":1698,"y":1728,"r":69,"um":32,"cx":50,"cy":84.5},{"n":19,"k":19,"t":"Reticulocyte","x":2118,"y":486,"r":69,"um":32,"cx":50,"cy":50},{"n":20,"k":20,"t":"Reticulocyte","x":2310,"y":774,"r":69,"um":32,"cx":80.6,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 20 close-ups"}]},{"id":"OC_HBH_0002","kind":"film","series":"HBH","condition":"HbH inclusions (alpha thalassaemia)","stain":"Brilliant cresyl blue (HbH preparation)","objective":"×60","camera":"Microscope camera","caption":"A field from an HbH preparation. Labelled are 18 red cells with HbH inclusions (golf ball cells) and a reticulocyte. The sample was incubated with brilliant cresyl blue, a supravital stain that oxidises and precipitates the unstable haemoglobin H (β4 tetramers), so affected red cells fill with many small, evenly spaced, blue-green inclusions that give the classic 'golf ball' appearance; reticulocytes, by contrast, show a coarser, irregular network of precipitated RNA. FBC: Hb 102 g/L, RBC 5.69 × 10¹²/L, PCV 0.335, MCV 59 fL, MCH 18.0 pg, RDW 24.6%, WBC 7.4 × 10⁹/L, platelets 157 × 10⁹/L, no nucleated red cells. HPLC showed no common haemoglobin variant and no beta thalassaemia trait, with HbA2 0.9% (low) and HbF 3.6% (raised); because of the red cell indices the sample was sent for molecular analysis, and the HbH preparation showed numerous HbH bodies. Multiplex gap-PCR then showed the patient to be homozygous for α+ thalassaemia due to the 3.7 kb deletion (−α3.7/−α3.7). With two of the four α-globin genes lost this is α-thalassaemia trait, which usually gives microcytosis and hypochromia with a normal or near-normal haemoglobin and only occasional HbH bodies, so this many golf ball cells is more than expected and worth correlating with the iron status and the clinical picture; HbH disease, with three genes lost (−−/−α), typically shows HbH bodies in a large proportion of red cells. A normal or low HbA2 with microcytosis points towards α-thalassaemia or iron deficiency rather than β-thalassaemia trait, and α-thalassaemia cannot be confirmed by HPLC, so DNA analysis is needed; HbH bodies support the diagnosis but their absence does not exclude it. Identifying the deletion matters for genetic counselling: a partner who carries an α0 deletion (−−/αα), common in people of South-East Asian and Mediterranean origin, could have a child with HbH disease, and two α0 carriers risk haemoglobin Bart's hydrops fetalis. 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Labelled are seven spherocytes, 10 irregularly contracted cells, 15 polychromatic cells, two nucleated red cells, a tear-drop cell, two lymphocytes and seven platelets. The red cells show spherocytes, polychromasia, nucleated red cells and dense, irregularly contracted cells, the picture of brisk haemolysis with a marrow response. Red cell immunohaematology on a sample taken during the reaction showed a positive direct antiglobulin test (IgG 1+, C3d 1+), a newly detected anti-Fya by LISS IAT, and a pan-reactive autoantibody in both the plasma and an eluate made from the patient's red cells. Anti-C and anti-S had been reported before but could not be detected on this occasion, and the RhD type could not be determined because of the recent transfusion; the patient had previously been typed C+ c+ E− e+ K−. Units for future transfusion were to be ABO, D and K compatible, E−, S−, K− and Fya−, HbS-negative and crossmatched by IAT. A delayed haemolytic transfusion reaction (DHTR) usually appears 3 to 14 days after transfusion, when an antibody from an earlier pregnancy or transfusion that has fallen below detectable levels (evanescence, as with the anti-C and anti-S here) returns in an anamnestic response and destroys the transfused cells. It is a particular risk in sickle cell disease, where alloimmunisation is common, and the symptoms (pain, fever, dark urine and jaundice) can be mistaken for a sickle crisis; a falling HbA percentage on HPLC after transfusion is a useful sign that donor cells are being destroyed. In hyperhaemolysis the patient's own red cells are destroyed as well and the haemoglobin falls below the pre-transfusion level, often with a low reticulocyte count; further transfusion can make it worse, so it is avoided where possible and treatment with IVIG and steroids, or eculizumab, is considered. 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Labelled are five spherocytes, 10 irregularly contracted cells, six polychromatic cells, eight nucleated red cells, a schistocyte (red cell fragment), a neutrophil, a lymphocyte and 14 platelets. The red cells show spherocytes, polychromasia, nucleated red cells and dense, irregularly contracted cells, the picture of brisk haemolysis with a marrow response. Red cell immunohaematology on a sample taken during the reaction showed a positive direct antiglobulin test (IgG 1+, C3d 1+), a newly detected anti-Fya by LISS IAT, and a pan-reactive autoantibody in both the plasma and an eluate made from the patient's red cells. Anti-C and anti-S had been reported before but could not be detected on this occasion, and the RhD type could not be determined because of the recent transfusion; the patient had previously been typed C+ c+ E− e+ K−. Units for future transfusion were to be ABO, D and K compatible, E−, S−, K− and Fya−, HbS-negative and crossmatched by IAT. 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Labelled are three villous lymphocytes and four platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":16.775,"v":"e1b9104882","files":{"field":"/assets/library/OC_SMZL_0001/field.webp?v=e1b9104882","medium":"/assets/library/OC_SMZL_0001/field-1200.webp?v=e1b9104882","thumb":"/assets/library/OC_SMZL_0001/thumb.webp?v=e1b9104882","cell":"/assets/library/OC_SMZL_0001/cell-{k}.webp?v=e1b9104882","view":"/assets/library/OC_SMZL_0001/view-{name}.webp?v=e1b9104882"},"bytes":423798,"slots":["villous"],"cells":[{"n":1,"k":1,"t":"Villous lymphocyte","x":984,"y":708,"r":80,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Villous lymphocyte","x":1554,"y":990,"r":80,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Villous lymphocyte","x":1446,"y":1398,"r":80,"um":32,"cx":50,"cy":50},{"n":4,"k":8,"t":"Platelet","x":1153,"y":636,"r":80,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":489,"y":824,"r":80,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Platelet","x":2187,"y":1426,"r":80,"um":32,"cx":60.3,"cy":50},{"n":7,"k":5,"t":"Platelet","x":2256,"y":1350,"r":80,"um":32,"cx":73.2,"cy":50},{"n":8,"k":7,"t":"Platelet","x":1474,"y":1651,"r":80,"um":32,"cx":50,"cy":72.3}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_SMZL_0002","kind":"film","series":"SMZL","condition":"Splenic marginal zone lymphoma","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a blood film in splenic marginal zone lymphoma (SMZL). Labelled are three villous lymphocytes and five platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":16.556,"v":"8e9dfcd7d1","files":{"field":"/assets/library/OC_SMZL_0002/field.webp?v=8e9dfcd7d1","medium":"/assets/library/OC_SMZL_0002/field-1200.webp?v=8e9dfcd7d1","thumb":"/assets/library/OC_SMZL_0002/thumb.webp?v=8e9dfcd7d1","cell":"/assets/library/OC_SMZL_0002/cell-{k}.webp?v=8e9dfcd7d1","view":"/assets/library/OC_SMZL_0002/view-{name}.webp?v=8e9dfcd7d1"},"bytes":438896,"slots":["villous"],"cells":[{"n":1,"k":1,"t":"Villous lymphocyte","x":1518,"y":594,"r":80,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Villous lymphocyte","x":1668,"y":1260,"r":80,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Villous lymphocyte","x":1482,"y":1422,"r":80,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet","x":245,"y":227,"r":80,"um":32,"cx":46.3,"cy":42.9},{"n":5,"k":4,"t":"Platelet","x":1470,"y":225,"r":80,"um":32,"cx":50,"cy":42.5},{"n":6,"k":9,"t":"Platelet","x":2255,"y":286,"r":80,"um":32,"cx":72.7,"cy":50},{"n":7,"k":10,"t":"Platelet","x":1210,"y":777,"r":80,"um":32,"cx":50,"cy":50},{"n":8,"k":6,"t":"Platelet","x":1600,"y":1033,"r":80,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Platelet","x":29,"y":1532,"r":80,"um":32,"cx":5.4,"cy":50},{"n":10,"k":7,"t":"Platelet","x":1921,"y":1446,"r":80,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 10 close-ups"}]},{"id":"OC_SMZL_0003","kind":"film","series":"SMZL","condition":"Splenic marginal zone lymphoma","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a blood film in splenic marginal zone lymphoma (SMZL). Labelled are two villous lymphocytes and five platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":15.727,"v":"cd63a985a7","files":{"field":"/assets/library/OC_SMZL_0003/field.webp?v=cd63a985a7","medium":"/assets/library/OC_SMZL_0003/field-1200.webp?v=cd63a985a7","thumb":"/assets/library/OC_SMZL_0003/thumb.webp?v=cd63a985a7","cell":"/assets/library/OC_SMZL_0003/cell-{k}.webp?v=cd63a985a7","view":"/assets/library/OC_SMZL_0003/view-{name}.webp?v=cd63a985a7"},"bytes":487524,"slots":["villous"],"cells":[{"n":1,"k":1,"t":"Villous lymphocyte","x":978,"y":606,"r":76,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Villous lymphocyte","x":1914,"y":894,"r":76,"um":32,"cx":50,"cy":50},{"n":3,"k":8,"t":"Platelet","x":1229,"y":381,"r":76,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet","x":134,"y":794,"r":76,"um":32,"cx":26.6,"cy":50},{"n":5,"k":3,"t":"Platelet","x":731,"y":767,"r":76,"um":32,"cx":50,"cy":50},{"n":6,"k":10,"t":"Platelet","x":1476,"y":808,"r":76,"um":32,"cx":50,"cy":50},{"n":7,"k":4,"t":"Platelet","x":1827,"y":785,"r":76,"um":32,"cx":50,"cy":50},{"n":8,"k":6,"t":"Platelet","x":279,"y":1143,"r":76,"um":32,"cx":50,"cy":50},{"n":9,"k":7,"t":"Platelet","x":564,"y":1317,"r":76,"um":32,"cx":50,"cy":50},{"n":10,"k":13,"t":"Platelet","x":671,"y":1618,"r":76,"um":32,"cx":50,"cy":63.9},{"n":11,"k":14,"t":"Platelet","x":564,"y":1767,"r":76,"um":32,"cx":50,"cy":93.4},{"n":12,"k":9,"t":"Platelet over red cell","x":1752,"y":492,"r":76,"um":32,"cx":50,"cy":50},{"n":13,"k":11,"t":"Echinocyte","x":714,"y":967,"r":76,"um":32,"cx":50,"cy":50},{"n":14,"k":12,"t":"Echinocyte","x":1030,"y":1724,"r":76,"um":32,"cx":50,"cy":84.9}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 14 close-ups"}]},{"id":"OC_SMZL_0004","kind":"film","series":"SMZL","condition":"Splenic marginal zone lymphoma","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a blood film in splenic marginal zone lymphoma (SMZL). Labelled are a villous lymphocyte, a neutrophil and four platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":16.132,"v":"17529cc910","files":{"field":"/assets/library/OC_SMZL_0004/field.webp?v=17529cc910","medium":"/assets/library/OC_SMZL_0004/field-1200.webp?v=17529cc910","thumb":"/assets/library/OC_SMZL_0004/thumb.webp?v=17529cc910","cell":"/assets/library/OC_SMZL_0004/cell-{k}.webp?v=17529cc910","view":"/assets/library/OC_SMZL_0004/view-{name}.webp?v=17529cc910"},"bytes":425408,"slots":["villous","neutrophil"],"cells":[{"n":1,"k":2,"t":"Villous lymphocyte","x":1770,"y":1128,"r":77,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"Neutrophil","x":1164,"y":732,"r":140,"um":40,"cx":50,"cy":50},{"n":3,"k":4,"t":"Platelet","x":1595,"y":421,"r":77,"um":32,"cx":50,"cy":50},{"n":4,"k":3,"t":"Platelet","x":2026,"y":313,"r":77,"um":32,"cx":50,"cy":50},{"n":5,"k":7,"t":"Platelet","x":1131,"y":496,"r":77,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Platelet","x":2219,"y":537,"r":77,"um":32,"cx":64.9,"cy":50},{"n":7,"k":6,"t":"Platelet","x":829,"y":1115,"r":77,"um":32,"cx":50,"cy":50},{"n":8,"k":9,"t":"Echinocyte","x":971,"y":936,"r":77,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Echinocyte","x":1331,"y":1650,"r":77,"um":32,"cx":50,"cy":70.9}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_SMZL_0005","kind":"film","series":"SMZL","condition":"Splenic marginal zone lymphoma","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a blood film in splenic marginal zone lymphoma (SMZL). Labelled are two villous lymphocytes and eight platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":15.875,"v":"8e656e7781","files":{"field":"/assets/library/OC_SMZL_0005/field.webp?v=8e656e7781","medium":"/assets/library/OC_SMZL_0005/field-1200.webp?v=8e656e7781","thumb":"/assets/library/OC_SMZL_0005/thumb.webp?v=8e656e7781","cell":"/assets/library/OC_SMZL_0005/cell-{k}.webp?v=8e656e7781","view":"/assets/library/OC_SMZL_0005/view-{name}.webp?v=8e656e7781"},"bytes":450440,"slots":["villous"],"cells":[{"n":1,"k":1,"t":"Villous lymphocyte","x":1116,"y":822,"r":76,"um":32,"cx":50,"cy":50},{"n":2,"k":2,"t":"Villous lymphocyte","x":1452,"y":1176,"r":76,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":2304,"y":415,"r":76,"um":32,"cx":81,"cy":50},{"n":4,"k":4,"t":"Platelet","x":2200,"y":627,"r":76,"um":32,"cx":60.6,"cy":50},{"n":5,"k":5,"t":"Platelet","x":104,"y":982,"r":76,"um":32,"cx":20.4,"cy":50},{"n":6,"k":6,"t":"Platelet","x":1341,"y":1040,"r":76,"um":32,"cx":50,"cy":50},{"n":7,"k":7,"t":"Platelet","x":79,"y":1311,"r":76,"um":32,"cx":15.5,"cy":50},{"n":8,"k":9,"t":"Platelet","x":2310,"y":1547,"r":76,"um":32,"cx":82.3,"cy":50.2},{"n":9,"k":8,"t":"Platelet","x":2320,"y":1471,"r":76,"um":32,"cx":84.2,"cy":50},{"n":10,"k":10,"t":"Platelet","x":2238,"y":1692,"r":76,"um":32,"cx":68.1,"cy":78.8},{"n":11,"k":12,"t":"Echinocyte","x":663,"y":736,"r":76,"um":32,"cx":50,"cy":50},{"n":12,"k":11,"t":"Echinocyte","x":2016,"y":536,"r":76,"um":32,"cx":50,"cy":50},{"n":13,"k":14,"t":"Platelet over red cell","x":1438,"y":160,"r":76,"um":32,"cx":50,"cy":31.5},{"n":14,"k":13,"t":"Platelet over red cell","x":854,"y":1758,"r":76,"um":32,"cx":50,"cy":91.8}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 14 close-ups"}]},{"id":"OC_SMZL_0006","kind":"film","series":"SMZL","condition":"Splenic marginal zone lymphoma","stain":"May–Grünwald–Giemsa (MGG)","objective":"×50","camera":"Phone camera on the microscope","caption":"A field from a blood film in splenic marginal zone lymphoma (SMZL). Labelled are two villous lymphocytes and seven platelets. SMZL is a low-grade B-cell lymphoma of the spleen, bone marrow and blood, and typically presents with splenomegaly and a lymphocytosis of small to medium-sized lymphocytes. Villous lymphocytes have round nuclei with condensed chromatin and short, fine cytoplasmic projections, classically at one pole of the cell; on this film many show projections around much of the edge, so they need telling apart from hairy cells. Hairy cells have more abundant pale cytoplasm with projections all round, a more open chromatin pattern and an oval or bean-shaped nucleus, and hairy cell leukaemia usually comes with monocytopenia and pancytopenia rather than a high lymphocyte count. Villi are easily lost on thick or slowly dried films, so their absence does not exclude SMZL. FBC: WBC 48.35 × 10⁹/L, lymphocytes 75% (36.26 × 10⁹/L), neutrophils 24% (11.60 × 10⁹/L), monocytes 1% (0.48 × 10⁹/L), Hb 94 g/L, RBC 4.34 × 10¹²/L, HCT 0.310, MCV 71.4 fL, MCH 21.7 pg, MCHC 303 g/L, RDW 21.2%, platelets 185 × 10⁹/L, no nucleated red cells; the film also showed anisopoikilocytosis and slight hypochromia. Flow cytometry showed a mature B-cell population positive for CD19, CD20, CD22, CD11c, CD79b and strong surface IgM, and negative for CD5, CD10, CD23, CD25, CD103, CD123 and annexin A1: CD5 negativity argues against CLL and mantle cell lymphoma, CD23 negativity against CLL, and the lack of CD103, CD123 and annexin A1, which classical hairy cell leukaemia almost always expresses, argues strongly against it. Together with the splenomegaly this confirmed splenic marginal zone lymphoma. This patient was the Only Cells Morphology Monday case MM250707.","w":2400,"h":1800,"pxPerUm":15.505,"v":"7d07ba306e","files":{"field":"/assets/library/OC_SMZL_0006/field.webp?v=7d07ba306e","medium":"/assets/library/OC_SMZL_0006/field-1200.webp?v=7d07ba306e","thumb":"/assets/library/OC_SMZL_0006/thumb.webp?v=7d07ba306e","cell":"/assets/library/OC_SMZL_0006/cell-{k}.webp?v=7d07ba306e","view":"/assets/library/OC_SMZL_0006/view-{name}.webp?v=7d07ba306e"},"bytes":470270,"slots":["villous"],"cells":[{"n":1,"k":2,"t":"Villous lymphocyte","x":1704,"y":738,"r":74,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"Villous lymphocyte","x":636,"y":948,"r":74,"um":32,"cx":50,"cy":50},{"n":3,"k":12,"t":"Platelet","x":161,"y":162,"r":74,"um":32,"cx":32.5,"cy":32.6},{"n":4,"k":3,"t":"Platelet","x":623,"y":391,"r":74,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":121,"y":713,"r":74,"um":32,"cx":24.4,"cy":50},{"n":6,"k":5,"t":"Platelet","x":1177,"y":942,"r":74,"um":32,"cx":50,"cy":50},{"n":7,"k":6,"t":"Platelet","x":1339,"y":1001,"r":74,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":1779,"y":1297,"r":74,"um":32,"cx":50,"cy":50},{"n":9,"k":7,"t":"Platelet","x":1980,"y":1215,"r":74,"um":32,"cx":50,"cy":50},{"n":10,"k":9,"t":"Platelet","x":947,"y":1423,"r":74,"um":32,"cx":50,"cy":50},{"n":11,"k":13,"t":"Platelet","x":1418,"y":1436,"r":74,"um":32,"cx":50,"cy":50},{"n":12,"k":11,"t":"Echinocyte","x":2268,"y":332,"r":74,"um":32,"cx":73.5,"cy":50},{"n":13,"k":10,"t":"Echinocyte","x":1185,"y":670,"r":74,"um":32,"cx":50,"cy":50},{"n":14,"k":14,"t":"Echinocyte","x":2021,"y":992,"r":74,"um":32,"cx":50,"cy":50},{"n":15,"k":15,"t":"Echinocyte","x":1526,"y":1552,"r":74,"um":32,"cx":50,"cy":50.1}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 15 close-ups"}]},{"id":"OC_AML_0001","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, a neutrophil and four platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.133,"v":"4909a90485","files":{"field":"/assets/library/OC_AML_0001/field.webp?v=4909a90485","medium":"/assets/library/OC_AML_0001/field-1200.webp?v=4909a90485","thumb":"/assets/library/OC_AML_0001/thumb.webp?v=4909a90485","cell":"/assets/library/OC_AML_0001/cell-{k}.webp?v=4909a90485","view":"/assets/library/OC_AML_0001/view-{name}.webp?v=4909a90485"},"bytes":357722,"slots":["blast","neutrophil"],"cells":[{"n":1,"k":1,"t":"Blast","x":959,"y":695,"r":79,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Neutrophil","x":1660,"y":1213,"r":79,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":1958,"y":599,"r":44,"um":32,"cx":50,"cy":50},{"n":4,"k":6,"t":"Platelet","x":559,"y":1537,"r":44,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Platelet","x":1058,"y":1496,"r":44,"um":32,"cx":50,"cy":50},{"n":6,"k":4,"t":"Platelet","x":1716,"y":1460,"r":44,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_AML_0002","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are two neutrophils and a platelet. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.279,"v":"fe856639cd","files":{"field":"/assets/library/OC_AML_0002/field.webp?v=fe856639cd","medium":"/assets/library/OC_AML_0002/field-1200.webp?v=fe856639cd","thumb":"/assets/library/OC_AML_0002/thumb.webp?v=fe856639cd","cell":"/assets/library/OC_AML_0002/cell-{k}.webp?v=fe856639cd","view":"/assets/library/OC_AML_0002/view-{name}.webp?v=fe856639cd"},"bytes":347864,"slots":["neutrophil"],"cells":[{"n":1,"k":1,"t":"Neutrophil","x":264,"y":729,"r":81,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Neutrophil","x":2046,"y":1260,"r":81,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":608,"y":1138,"r":45,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Large platelet","x":1314,"y":229,"r":45,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Spherocyte","x":939,"y":207,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_AML_0003","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, a lymphocyte and three platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.334,"v":"1a5985a3af","files":{"field":"/assets/library/OC_AML_0003/field.webp?v=1a5985a3af","medium":"/assets/library/OC_AML_0003/field-1200.webp?v=1a5985a3af","thumb":"/assets/library/OC_AML_0003/thumb.webp?v=1a5985a3af","cell":"/assets/library/OC_AML_0003/cell-{k}.webp?v=1a5985a3af","view":"/assets/library/OC_AML_0003/view-{name}.webp?v=1a5985a3af"},"bytes":340488,"slots":["blast","lymph"],"cells":[{"n":1,"k":1,"t":"Blast","x":989,"y":660,"r":81,"um":40,"cx":50,"cy":50},{"n":2,"k":3,"t":"Platelet","x":530,"y":790,"r":45,"um":32,"cx":50,"cy":50},{"n":3,"k":4,"t":"Platelet","x":2130,"y":792,"r":45,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet","x":835,"y":1463,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_AML_0004","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast and a platelet. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.244,"v":"326e53d723","files":{"field":"/assets/library/OC_AML_0004/field.webp?v=326e53d723","medium":"/assets/library/OC_AML_0004/field-1200.webp?v=326e53d723","thumb":"/assets/library/OC_AML_0004/thumb.webp?v=326e53d723","cell":"/assets/library/OC_AML_0004/cell-{k}.webp?v=326e53d723","view":"/assets/library/OC_AML_0004/view-{name}.webp?v=326e53d723"},"bytes":319366,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1118,"y":711,"r":80,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":1056,"y":440,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_AML_0005","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, three neutrophils, a smear cell and three platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.41,"v":"e75287243f","files":{"field":"/assets/library/OC_AML_0005/field.webp?v=e75287243f","medium":"/assets/library/OC_AML_0005/field-1200.webp?v=e75287243f","thumb":"/assets/library/OC_AML_0005/thumb.webp?v=e75287243f","cell":"/assets/library/OC_AML_0005/cell-{k}.webp?v=e75287243f","view":"/assets/library/OC_AML_0005/view-{name}.webp?v=e75287243f"},"bytes":401448,"slots":["blast","neutrophil","smear"],"cells":[{"n":1,"k":2,"t":"Blast","x":1027,"y":936,"r":82,"um":40,"cx":50,"cy":50},{"n":2,"k":1,"t":"Neutrophil","x":526,"y":538,"r":82,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Neutrophil","x":2067,"y":989,"r":82,"um":40,"cx":50,"cy":50},{"n":4,"k":4,"t":"Neutrophil","x":1965,"y":1083,"r":82,"um":40,"cx":50,"cy":50},{"n":5,"k":5,"t":"Smear cell","x":611,"y":1102,"r":85,"um":52,"cx":50,"cy":50},{"n":6,"k":6,"t":"Platelet","x":1143,"y":84,"r":45,"um":32,"cx":50,"cy":27.9},{"n":7,"k":7,"t":"Platelet","x":986,"y":665,"r":45,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":1976,"y":1446,"r":45,"um":32,"cx":50,"cy":50},{"n":9,"k":10,"t":"Platelet","x":1313,"y":1361,"r":45,"um":32,"cx":50,"cy":50},{"n":10,"k":9,"t":"Platelet","x":883,"y":1704,"r":45,"um":32,"cx":50,"cy":68},{"n":11,"k":11,"t":"Spherocyte","x":1190,"y":1332,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 11 close-ups"}]},{"id":"OC_AML_0006","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, a neutrophil and four platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.272,"v":"9f14c1257f","files":{"field":"/assets/library/OC_AML_0006/field.webp?v=9f14c1257f","medium":"/assets/library/OC_AML_0006/field-1200.webp?v=9f14c1257f","thumb":"/assets/library/OC_AML_0006/thumb.webp?v=9f14c1257f","cell":"/assets/library/OC_AML_0006/cell-{k}.webp?v=9f14c1257f","view":"/assets/library/OC_AML_0006/view-{name}.webp?v=9f14c1257f"},"bytes":360408,"slots":["blast","neutrophil"],"cells":[{"n":1,"k":1,"t":"Blast","x":672,"y":836,"r":81,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Neutrophil","x":1186,"y":857,"r":81,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":875,"y":510,"r":45,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Platelet","x":2110,"y":993,"r":45,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Platelet","x":1401,"y":1299,"r":45,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Platelet","x":654,"y":1502,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_AML_0007","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, a smear cell and two platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.572,"v":"c857f15c2d","files":{"field":"/assets/library/OC_AML_0007/field.webp?v=c857f15c2d","medium":"/assets/library/OC_AML_0007/field-1200.webp?v=c857f15c2d","thumb":"/assets/library/OC_AML_0007/thumb.webp?v=c857f15c2d","cell":"/assets/library/OC_AML_0007/cell-{k}.webp?v=c857f15c2d","view":"/assets/library/OC_AML_0007/view-{name}.webp?v=c857f15c2d"},"bytes":333234,"slots":["blast","smear"],"cells":[{"n":1,"k":1,"t":"Blast","x":1299,"y":951,"r":83,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Smear cell","x":2135,"y":1273,"r":86,"um":52,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":2046,"y":946,"r":46,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Platelet","x":1299,"y":1549,"r":46,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_AML_0008","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast, a neutrophil and three platelets. A manual 100-cell differential counted about 34% blasts. FBC: WBC 28.74 × 10⁹/L (neutrophils 12.07, lymphocytes 1.72, monocytes 2.87, eosinophils 0.57, basophils 0.86, myelocytes 0.86 and blasts 9.77 × 10⁹/L), Hb 115 g/L, RBC 3.97 × 10¹²/L, HCT 0.331, MCV 83.4 fL, MCH 29.0 pg, MCHC 347 g/L, RDW 15.9%, platelets 83 × 10⁹/L and nucleated red cells 0.11 × 10⁹/L. The blasts are large cells with a high nuclear to cytoplasmic ratio, finely dispersed chromatin and a narrow rim of basophilic cytoplasm; no granules or Auer rods are seen in these fields. Without granules or Auer rods, morphology alone cannot reliably tell a myeloblast from a lymphoblast, so flow cytometry (for example CD34, CD117, CD13, CD33 and myeloperoxidase), cytogenetics and molecular tests confirm the lineage and classify the leukaemia. At least 20% blasts in the blood or marrow is diagnostic of AML, and some recurrent genetic abnormalities define AML at lower blast counts. The low platelet count reflects marrow failure as the leukaemia crowds out normal haemopoiesis. Smear cells are fragile cells, often blasts, broken while the film was spread; they are not counted in the differential, but a high number of them can make the blast count an underestimate.","w":2400,"h":1800,"pxPerUm":9.545,"v":"ba249deb8e","files":{"field":"/assets/library/OC_AML_0008/field.webp?v=ba249deb8e","medium":"/assets/library/OC_AML_0008/field-1200.webp?v=ba249deb8e","thumb":"/assets/library/OC_AML_0008/thumb.webp?v=ba249deb8e","cell":"/assets/library/OC_AML_0008/cell-{k}.webp?v=ba249deb8e","view":"/assets/library/OC_AML_0008/view-{name}.webp?v=ba249deb8e"},"bytes":336268,"slots":["blast","neutrophil"],"cells":[{"n":1,"k":2,"t":"Blast","x":1261,"y":1271,"r":83,"um":40,"cx":50,"cy":50},{"n":2,"k":1,"t":"Neutrophil","x":702,"y":799,"r":83,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":1520,"y":948,"r":46,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Platelet","x":1557,"y":1104,"r":46,"um":32,"cx":50,"cy":50},{"n":5,"k":5,"t":"Platelet","x":2145,"y":1662,"r":46,"um":32,"cx":50,"cy":54.8}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_AML_0009","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast and four platelets. The appearances suggest acute monocytic leukaemia (FAB M5), not yet confirmed. The blasts are large cells with a round to slightly indented nucleus, fine lacy chromatin and a moderate amount of grey-blue cytoplasm, some with a few vacuoles; no Auer rods are seen in these fields. In monocytic leukaemias the blasts are monoblasts and promonocytes: monoblasts are large with round nuclei, prominent nucleoli and plentiful basophilic cytoplasm, while promonocytes have folded nuclei and greyer, finely granular cytoplasm. Morphology suggests monocytic differentiation but cannot confirm it: non-specific esterase cytochemistry and flow cytometry (CD14, CD64, CD11b, CD36 with CD33 and HLA-DR, often CD34-negative) show the lineage, and cytogenetic and molecular tests (for example KMT2A rearrangements) classify the leukaemia. At least 20% blasts (counting promonocytes) in the blood or marrow is diagnostic of AML.","w":2400,"h":1800,"pxPerUm":14.284,"v":"801be76fe9","files":{"field":"/assets/library/OC_AML_0009/field.webp?v=801be76fe9","medium":"/assets/library/OC_AML_0009/field-1200.webp?v=801be76fe9","thumb":"/assets/library/OC_AML_0009/thumb.webp?v=801be76fe9","cell":"/assets/library/OC_AML_0009/cell-{k}.webp?v=801be76fe9","view":"/assets/library/OC_AML_0009/view-{name}.webp?v=801be76fe9"},"bytes":246924,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1343,"y":754,"r":124,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":1685,"y":676,"r":68,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":744,"y":757,"r":68,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet","x":515,"y":1517,"r":68,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":1913,"y":1487,"r":68,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 5 close-ups"}]},{"id":"OC_AML_0010","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are five platelets; the nucleated cell is still to be identified. The appearances suggest acute monocytic leukaemia (FAB M5), not yet confirmed. The blasts are large cells with a round to slightly indented nucleus, fine lacy chromatin and a moderate amount of grey-blue cytoplasm, some with a few vacuoles; no Auer rods are seen in these fields. In monocytic leukaemias the blasts are monoblasts and promonocytes: monoblasts are large with round nuclei, prominent nucleoli and plentiful basophilic cytoplasm, while promonocytes have folded nuclei and greyer, finely granular cytoplasm. Morphology suggests monocytic differentiation but cannot confirm it: non-specific esterase cytochemistry and flow cytometry (CD14, CD64, CD11b, CD36 with CD33 and HLA-DR, often CD34-negative) show the lineage, and cytogenetic and molecular tests (for example KMT2A rearrangements) classify the leukaemia. At least 20% blasts (counting promonocytes) in the blood or marrow is diagnostic of AML.","w":2400,"h":1800,"pxPerUm":15.162,"v":"f50d27df20","files":{"field":"/assets/library/OC_AML_0010/field.webp?v=f50d27df20","medium":"/assets/library/OC_AML_0010/field-1200.webp?v=f50d27df20","thumb":"/assets/library/OC_AML_0010/thumb.webp?v=f50d27df20","cell":"/assets/library/OC_AML_0010/cell-{k}.webp?v=f50d27df20","view":"/assets/library/OC_AML_0010/view-{name}.webp?v=f50d27df20"},"bytes":250784,"slots":["blast"],"cells":[{"n":1,"k":7,"t":"Platelet","x":132,"y":343,"r":73,"um":32,"cx":27.2,"cy":50},{"n":2,"k":2,"t":"Platelet","x":795,"y":936,"r":73,"um":32,"cx":50,"cy":50},{"n":3,"k":8,"t":"Platelet","x":1305,"y":1170,"r":73,"um":32,"cx":50,"cy":50},{"n":4,"k":5,"t":"Platelet","x":1886,"y":1335,"r":73,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":2297,"y":1179,"r":73,"um":32,"cx":78.8,"cy":50},{"n":6,"k":6,"t":"Platelet","x":1504,"y":1435,"r":73,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_AML_0011","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast and four platelets. The appearances suggest acute monocytic leukaemia (FAB M5), not yet confirmed. The blasts are large cells with a round to slightly indented nucleus, fine lacy chromatin and a moderate amount of grey-blue cytoplasm, some with a few vacuoles; no Auer rods are seen in these fields. In monocytic leukaemias the blasts are monoblasts and promonocytes: monoblasts are large with round nuclei, prominent nucleoli and plentiful basophilic cytoplasm, while promonocytes have folded nuclei and greyer, finely granular cytoplasm. Morphology suggests monocytic differentiation but cannot confirm it: non-specific esterase cytochemistry and flow cytometry (CD14, CD64, CD11b, CD36 with CD33 and HLA-DR, often CD34-negative) show the lineage, and cytogenetic and molecular tests (for example KMT2A rearrangements) classify the leukaemia. At least 20% blasts (counting promonocytes) in the blood or marrow is diagnostic of AML.","w":2400,"h":1800,"pxPerUm":14.582,"v":"7d2075fcd7","files":{"field":"/assets/library/OC_AML_0011/field.webp?v=7d2075fcd7","medium":"/assets/library/OC_AML_0011/field-1200.webp?v=7d2075fcd7","thumb":"/assets/library/OC_AML_0011/thumb.webp?v=7d2075fcd7","cell":"/assets/library/OC_AML_0011/cell-{k}.webp?v=7d2075fcd7","view":"/assets/library/OC_AML_0011/view-{name}.webp?v=7d2075fcd7"},"bytes":260228,"slots":["blast"],"cells":[{"n":1,"k":7,"t":"Blast","x":1826,"y":780,"r":127,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Blast","x":595,"y":1205,"r":127,"um":40,"cx":50,"cy":50},{"n":3,"k":4,"t":"Platelet","x":83,"y":402,"r":70,"um":32,"cx":17.7,"cy":50},{"n":4,"k":3,"t":"Platelet","x":801,"y":321,"r":70,"um":32,"cx":50,"cy":50},{"n":5,"k":6,"t":"Platelet","x":1610,"y":564,"r":70,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Platelet","x":2203,"y":517,"r":70,"um":32,"cx":57.8,"cy":50},{"n":7,"k":8,"t":"Large platelet","x":1432,"y":1532,"r":70,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 7 close-ups"}]},{"id":"OC_AML_0012","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast and three platelets. The appearances suggest acute monocytic leukaemia (FAB M5), not yet confirmed. The blasts are large cells with a round to slightly indented nucleus, fine lacy chromatin and a moderate amount of grey-blue cytoplasm, some with a few vacuoles; no Auer rods are seen in these fields. In monocytic leukaemias the blasts are monoblasts and promonocytes: monoblasts are large with round nuclei, prominent nucleoli and plentiful basophilic cytoplasm, while promonocytes have folded nuclei and greyer, finely granular cytoplasm. Morphology suggests monocytic differentiation but cannot confirm it: non-specific esterase cytochemistry and flow cytometry (CD14, CD64, CD11b, CD36 with CD33 and HLA-DR, often CD34-negative) show the lineage, and cytogenetic and molecular tests (for example KMT2A rearrangements) classify the leukaemia. At least 20% blasts (counting promonocytes) in the blood or marrow is diagnostic of AML.","w":2400,"h":1800,"pxPerUm":14.373,"v":"b9c96b545b","files":{"field":"/assets/library/OC_AML_0012/field.webp?v=b9c96b545b","medium":"/assets/library/OC_AML_0012/field-1200.webp?v=b9c96b545b","thumb":"/assets/library/OC_AML_0012/thumb.webp?v=b9c96b545b","cell":"/assets/library/OC_AML_0012/cell-{k}.webp?v=b9c96b545b","view":"/assets/library/OC_AML_0012/view-{name}.webp?v=b9c96b545b"},"bytes":258282,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1164,"y":946,"r":125,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":60,"y":232,"r":69,"um":32,"cx":13.1,"cy":50},{"n":3,"k":3,"t":"Platelet","x":2257,"y":695,"r":69,"um":32,"cx":68.9,"cy":50},{"n":4,"k":5,"t":"Platelet","x":486,"y":815,"r":69,"um":32,"cx":50,"cy":50},{"n":5,"k":4,"t":"Platelet","x":1969,"y":1434,"r":69,"um":32,"cx":50,"cy":50},{"n":6,"k":6,"t":"Platelet","x":621,"y":1686,"r":69,"um":32,"cx":50,"cy":75.2}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 6 close-ups"}]},{"id":"OC_AML_0013","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are two blasts and four platelets. The appearances suggest acute monocytic leukaemia (FAB M5), not yet confirmed. The blasts are large cells with a round to slightly indented nucleus, fine lacy chromatin and a moderate amount of grey-blue cytoplasm, some with a few vacuoles; no Auer rods are seen in these fields. In monocytic leukaemias the blasts are monoblasts and promonocytes: monoblasts are large with round nuclei, prominent nucleoli and plentiful basophilic cytoplasm, while promonocytes have folded nuclei and greyer, finely granular cytoplasm. Morphology suggests monocytic differentiation but cannot confirm it: non-specific esterase cytochemistry and flow cytometry (CD14, CD64, CD11b, CD36 with CD33 and HLA-DR, often CD34-negative) show the lineage, and cytogenetic and molecular tests (for example KMT2A rearrangements) classify the leukaemia. At least 20% blasts (counting promonocytes) in the blood or marrow is diagnostic of AML.","w":2400,"h":1800,"pxPerUm":14.612,"v":"4c29515ba9","files":{"field":"/assets/library/OC_AML_0013/field.webp?v=4c29515ba9","medium":"/assets/library/OC_AML_0013/field-1200.webp?v=4c29515ba9","thumb":"/assets/library/OC_AML_0013/thumb.webp?v=4c29515ba9","cell":"/assets/library/OC_AML_0013/cell-{k}.webp?v=4c29515ba9","view":"/assets/library/OC_AML_0013/view-{name}.webp?v=4c29515ba9"},"bytes":291960,"slots":["blast"],"cells":[{"n":1,"k":2,"t":"Blast","x":984,"y":980,"r":127,"um":40,"cx":50,"cy":50},{"n":2,"k":1,"t":"Blast","x":1496,"y":843,"r":127,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":633,"y":325,"r":70,"um":32,"cx":50,"cy":50},{"n":4,"k":4,"t":"Platelet","x":1123,"y":596,"r":70,"um":32,"cx":50,"cy":50},{"n":5,"k":7,"t":"Platelet","x":671,"y":1025,"r":70,"um":32,"cx":50,"cy":50},{"n":6,"k":5,"t":"Platelet","x":294,"y":1151,"r":70,"um":32,"cx":50,"cy":50},{"n":7,"k":6,"t":"Platelet","x":965,"y":1350,"r":70,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 7 close-ups"}]},{"id":"OC_AML_0014","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are ten blasts and a smear cell. The patient, a man in his 40s with AML, had a temperature spike when the sample was taken. FBC: WBC 61.84 × 10⁹/L, Hb 95 g/L, RBC 3.34 × 10¹²/L, HCT 0.291, MCV 87.1 fL, MCH 28.4 pg, MCHC 326 g/L, RDW 15.7%, platelets 14 × 10⁹/L (MPV 10.1 fL). Manual differential: blasts 97% (59.98 × 10⁹/L), neutrophils 1% (0.62 × 10⁹/L), lymphocytes 2% (1.24 × 10⁹/L) and no monocytes, with 0.1 nucleated red cells per 100 white cells. Almost every white cell is a blast, so the neutrophils are very low and the platelets are severely reduced, which is why infection and bleeding are the main dangers. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, nucleoli in some, and a rim of grey-blue cytoplasm that holds a few vacuoles or fine granules in some cells; no Auer rods are seen in these fields. Many lie in tight clusters, pressed against each other. Smear cells (broken white cells spread thin when the film is made) are common when the white count is this high. A small, very dense round cell with almost no cytoplasm is marked \"not sure\": it could be a late nucleated red cell or a small lymphocyte. Morphology alone cannot give the type of AML: flow cytometry shows the lineage (for example CD34, CD117, CD13, CD33, MPO), and cytogenetic and molecular tests classify it and guide treatment. At least 20% blasts in the blood or marrow is diagnostic of AML.","w":2400,"h":1931,"pxPerUm":7.454,"v":"f2d6cc2874","files":{"field":"/assets/library/OC_AML_0014/field.webp?v=f2d6cc2874","medium":"/assets/library/OC_AML_0014/field-1200.webp?v=f2d6cc2874","thumb":"/assets/library/OC_AML_0014/thumb.webp?v=f2d6cc2874","cell":"/assets/library/OC_AML_0014/cell-{k}.webp?v=f2d6cc2874","view":"/assets/library/OC_AML_0014/view-{name}.webp?v=f2d6cc2874"},"bytes":373818,"slots":["blast"],"cells":[{"n":1,"k":2,"t":"Blast","x":252,"y":303,"r":65,"um":40,"cx":50,"cy":50},{"n":2,"k":1,"t":"Blast","x":509,"y":234,"r":65,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Blast","x":1569,"y":469,"r":65,"um":40,"cx":50,"cy":50},{"n":4,"k":5,"t":"Blast","x":1152,"y":621,"r":65,"um":40,"cx":50,"cy":50},{"n":5,"k":4,"t":"Blast","x":1624,"y":565,"r":65,"um":40,"cx":50,"cy":50},{"n":6,"k":6,"t":"Blast","x":1195,"y":890,"r":65,"um":40,"cx":50,"cy":50},{"n":7,"k":7,"t":"Blast","x":1380,"y":977,"r":65,"um":40,"cx":50,"cy":50},{"n":8,"k":9,"t":"Blast","x":1950,"y":1028,"r":65,"um":40,"cx":50,"cy":50},{"n":9,"k":10,"t":"Blast","x":2025,"y":1087,"r":65,"um":40,"cx":50,"cy":50},{"n":10,"k":8,"t":"Blast","x":1422,"y":1334,"r":65,"um":40,"cx":50,"cy":50},{"n":11,"k":12,"t":"Smear cell","x":2322,"y":193,"r":67,"um":52,"cx":79.9,"cy":49.8},{"n":12,"k":13,"t":"Howell–Jolly body","x":572,"y":256,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 12 close-ups"}]},{"id":"OC_AML_0015","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are five blasts and two smear cells. The patient, a man in his 40s with AML, had a temperature spike when the sample was taken. FBC: WBC 61.84 × 10⁹/L, Hb 95 g/L, RBC 3.34 × 10¹²/L, HCT 0.291, MCV 87.1 fL, MCH 28.4 pg, MCHC 326 g/L, RDW 15.7%, platelets 14 × 10⁹/L (MPV 10.1 fL). Manual differential: blasts 97% (59.98 × 10⁹/L), neutrophils 1% (0.62 × 10⁹/L), lymphocytes 2% (1.24 × 10⁹/L) and no monocytes, with 0.1 nucleated red cells per 100 white cells. Almost every white cell is a blast, so the neutrophils are very low and the platelets are severely reduced, which is why infection and bleeding are the main dangers. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, nucleoli in some, and a rim of grey-blue cytoplasm that holds a few vacuoles or fine granules in some cells; no Auer rods are seen in these fields. Many lie in tight clusters, pressed against each other. Smear cells (broken white cells spread thin when the film is made) are common when the white count is this high. Morphology alone cannot give the type of AML: flow cytometry shows the lineage (for example CD34, CD117, CD13, CD33, MPO), and cytogenetic and molecular tests classify it and guide treatment. At least 20% blasts in the blood or marrow is diagnostic of AML.","w":2400,"h":1936,"pxPerUm":7.372,"v":"d7dbc71de7","files":{"field":"/assets/library/OC_AML_0015/field.webp?v=d7dbc71de7","medium":"/assets/library/OC_AML_0015/field-1200.webp?v=d7dbc71de7","thumb":"/assets/library/OC_AML_0015/thumb.webp?v=d7dbc71de7","cell":"/assets/library/OC_AML_0015/cell-{k}.webp?v=d7dbc71de7","view":"/assets/library/OC_AML_0015/view-{name}.webp?v=d7dbc71de7"},"bytes":328672,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1846,"y":33,"r":64,"um":40,"cx":50,"cy":11.3},{"n":2,"k":2,"t":"Blast","x":1954,"y":33,"r":64,"um":40,"cx":50,"cy":11.3},{"n":3,"k":4,"t":"Blast","x":978,"y":918,"r":64,"um":40,"cx":50,"cy":50},{"n":4,"k":3,"t":"Blast","x":1048,"y":852,"r":64,"um":40,"cx":50,"cy":50},{"n":5,"k":5,"t":"Blast","x":1048,"y":973,"r":64,"um":40,"cx":50,"cy":50},{"n":6,"k":6,"t":"Smear cell","x":204,"y":847,"r":67,"um":52,"cx":50,"cy":50},{"n":7,"k":7,"t":"Smear cell","x":1380,"y":1585,"r":67,"um":52,"cx":50,"cy":50},{"n":8,"k":9,"t":"Platelet","x":873,"y":457,"r":45,"um":32,"cx":50,"cy":50},{"n":9,"k":8,"t":"Platelet","x":987,"y":276,"r":45,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_AML_0016","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are six blasts. The patient, a man in his 40s with AML, had a temperature spike when the sample was taken. FBC: WBC 61.84 × 10⁹/L, Hb 95 g/L, RBC 3.34 × 10¹²/L, HCT 0.291, MCV 87.1 fL, MCH 28.4 pg, MCHC 326 g/L, RDW 15.7%, platelets 14 × 10⁹/L (MPV 10.1 fL). Manual differential: blasts 97% (59.98 × 10⁹/L), neutrophils 1% (0.62 × 10⁹/L), lymphocytes 2% (1.24 × 10⁹/L) and no monocytes, with 0.1 nucleated red cells per 100 white cells. Almost every white cell is a blast, so the neutrophils are very low and the platelets are severely reduced, which is why infection and bleeding are the main dangers. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, nucleoli in some, and a rim of grey-blue cytoplasm that holds a few vacuoles or fine granules in some cells; no Auer rods are seen in these fields. Many lie in tight clusters, pressed against each other. Smear cells (broken white cells spread thin when the film is made) are common when the white count is this high. Morphology alone cannot give the type of AML: flow cytometry shows the lineage (for example CD34, CD117, CD13, CD33, MPO), and cytogenetic and molecular tests classify it and guide treatment. At least 20% blasts in the blood or marrow is diagnostic of AML.","w":2400,"h":1920,"pxPerUm":7.381,"v":"354836aa7d","files":{"field":"/assets/library/OC_AML_0016/field.webp?v=354836aa7d","medium":"/assets/library/OC_AML_0016/field-1200.webp?v=354836aa7d","thumb":"/assets/library/OC_AML_0016/thumb.webp?v=354836aa7d","cell":"/assets/library/OC_AML_0016/cell-{k}.webp?v=354836aa7d","view":"/assets/library/OC_AML_0016/view-{name}.webp?v=354836aa7d"},"bytes":378762,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":762,"y":469,"r":64,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Blast","x":2118,"y":657,"r":64,"um":40,"cx":50,"cy":50},{"n":3,"k":4,"t":"Blast","x":992,"y":1043,"r":64,"um":40,"cx":50,"cy":50},{"n":4,"k":3,"t":"Blast","x":1790,"y":861,"r":64,"um":40,"cx":50,"cy":50},{"n":5,"k":6,"t":"Blast","x":963,"y":1195,"r":64,"um":40,"cx":50,"cy":50},{"n":6,"k":5,"t":"Blast","x":1025,"y":1138,"r":64,"um":40,"cx":50,"cy":50},{"n":7,"k":7,"t":"Platelet","x":1762,"y":413,"r":44,"um":32,"cx":50,"cy":50},{"n":8,"k":8,"t":"Platelet","x":944,"y":1803,"r":44,"um":32,"cx":50,"cy":50.5}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 8 close-ups"}]},{"id":"OC_AML_0017","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are fourteen blasts and a smear cell. The patient, a man in his 40s with AML, had a temperature spike when the sample was taken. FBC: WBC 61.84 × 10⁹/L, Hb 95 g/L, RBC 3.34 × 10¹²/L, HCT 0.291, MCV 87.1 fL, MCH 28.4 pg, MCHC 326 g/L, RDW 15.7%, platelets 14 × 10⁹/L (MPV 10.1 fL). Manual differential: blasts 97% (59.98 × 10⁹/L), neutrophils 1% (0.62 × 10⁹/L), lymphocytes 2% (1.24 × 10⁹/L) and no monocytes, with 0.1 nucleated red cells per 100 white cells. Almost every white cell is a blast, so the neutrophils are very low and the platelets are severely reduced, which is why infection and bleeding are the main dangers. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, nucleoli in some, and a rim of grey-blue cytoplasm that holds a few vacuoles or fine granules in some cells; no Auer rods are seen in these fields. Many lie in tight clusters, pressed against each other. Smear cells (broken white cells spread thin when the film is made) are common when the white count is this high. Morphology alone cannot give the type of AML: flow cytometry shows the lineage (for example CD34, CD117, CD13, CD33, MPO), and cytogenetic and molecular tests classify it and guide treatment. At least 20% blasts in the blood or marrow is diagnostic of AML.","w":2400,"h":1904,"pxPerUm":7.399,"v":"a5090d9b65","files":{"field":"/assets/library/OC_AML_0017/field.webp?v=a5090d9b65","medium":"/assets/library/OC_AML_0017/field-1200.webp?v=a5090d9b65","thumb":"/assets/library/OC_AML_0017/thumb.webp?v=a5090d9b65","cell":"/assets/library/OC_AML_0017/cell-{k}.webp?v=a5090d9b65","view":"/assets/library/OC_AML_0017/view-{name}.webp?v=a5090d9b65"},"bytes":507580,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":317,"y":152,"r":65,"um":40,"cx":50,"cy":50},{"n":2,"k":13,"t":"Blast","x":1078,"y":25,"r":65,"um":40,"cx":50,"cy":8.4},{"n":3,"k":14,"t":"Blast","x":1193,"y":33,"r":65,"um":40,"cx":50,"cy":11.1},{"n":4,"k":2,"t":"Blast","x":2018,"y":254,"r":65,"um":40,"cx":50,"cy":50},{"n":5,"k":3,"t":"Blast","x":1125,"y":689,"r":65,"um":40,"cx":50,"cy":50},{"n":6,"k":4,"t":"Blast","x":77,"y":879,"r":65,"um":40,"cx":25.9,"cy":50},{"n":7,"k":6,"t":"Blast","x":444,"y":942,"r":65,"um":40,"cx":50,"cy":50},{"n":8,"k":5,"t":"Blast","x":790,"y":941,"r":65,"um":40,"cx":50,"cy":50},{"n":9,"k":12,"t":"Blast","x":1298,"y":1024,"r":65,"um":40,"cx":50,"cy":50},{"n":10,"k":11,"t":"Blast","x":1331,"y":933,"r":65,"um":40,"cx":50,"cy":50},{"n":11,"k":9,"t":"Blast","x":1076,"y":1371,"r":65,"um":40,"cx":50,"cy":50},{"n":12,"k":7,"t":"Blast","x":1215,"y":1347,"r":65,"um":40,"cx":50,"cy":50},{"n":13,"k":10,"t":"Blast","x":1838,"y":1382,"r":65,"um":40,"cx":50,"cy":50},{"n":14,"k":8,"t":"Blast","x":2207,"y":1366,"r":65,"um":40,"cx":50,"cy":50},{"n":15,"k":15,"t":"Smear cell","x":2346,"y":666,"r":67,"um":52,"cx":86,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 15 close-ups"}]},{"id":"OC_AML_0018","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×40","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are seven blasts, a nucleated red cell, a neutrophil and a smear cell. The patient, a man in his 40s with AML, had a temperature spike when the sample was taken. FBC: WBC 61.84 × 10⁹/L, Hb 95 g/L, RBC 3.34 × 10¹²/L, HCT 0.291, MCV 87.1 fL, MCH 28.4 pg, MCHC 326 g/L, RDW 15.7%, platelets 14 × 10⁹/L (MPV 10.1 fL). Manual differential: blasts 97% (59.98 × 10⁹/L), neutrophils 1% (0.62 × 10⁹/L), lymphocytes 2% (1.24 × 10⁹/L) and no monocytes, with 0.1 nucleated red cells per 100 white cells. Almost every white cell is a blast, so the neutrophils are very low and the platelets are severely reduced, which is why infection and bleeding are the main dangers. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, nucleoli in some, and a rim of grey-blue cytoplasm that holds a few vacuoles or fine granules in some cells; no Auer rods are seen in these fields. Many lie in tight clusters, pressed against each other. Smear cells (broken white cells spread thin when the film is made) are common when the white count is this high. Morphology alone cannot give the type of AML: flow cytometry shows the lineage (for example CD34, CD117, CD13, CD33, MPO), and cytogenetic and molecular tests classify it and guide treatment. At least 20% blasts in the blood or marrow is diagnostic of AML.","w":2400,"h":1923,"pxPerUm":7.452,"v":"b90d7902af","files":{"field":"/assets/library/OC_AML_0018/field.webp?v=b90d7902af","medium":"/assets/library/OC_AML_0018/field-1200.webp?v=b90d7902af","thumb":"/assets/library/OC_AML_0018/thumb.webp?v=b90d7902af","cell":"/assets/library/OC_AML_0018/cell-{k}.webp?v=b90d7902af","view":"/assets/library/OC_AML_0018/view-{name}.webp?v=b90d7902af"},"bytes":408872,"slots":["blast"],"cells":[{"n":1,"k":5,"t":"Blast","x":2063,"y":452,"r":65,"um":40,"cx":50,"cy":50},{"n":2,"k":7,"t":"Blast","x":1393,"y":553,"r":65,"um":40,"cx":50,"cy":50},{"n":3,"k":6,"t":"Blast","x":2013,"y":544,"r":65,"um":40,"cx":50,"cy":50},{"n":4,"k":1,"t":"Blast","x":101,"y":828,"r":65,"um":40,"cx":33.7,"cy":50},{"n":5,"k":2,"t":"Blast","x":1308,"y":1027,"r":65,"um":40,"cx":50,"cy":50},{"n":6,"k":3,"t":"Blast","x":1716,"y":1185,"r":65,"um":40,"cx":50,"cy":50},{"n":7,"k":4,"t":"Blast","x":1180,"y":1693,"r":65,"um":40,"cx":50,"cy":50},{"n":8,"k":8,"t":"Nucleated red cell","x":1477,"y":553,"r":45,"um":32,"cx":50,"cy":50},{"n":9,"k":9,"t":"Neutrophil","x":1461,"y":1774,"r":65,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 9 close-ups"}]},{"id":"OC_AML_0019","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast. The blasts are medium to large cells with a high nuclear to cytoplasmic ratio, loose chromatin, one or more prominent nucleoli and basophilic cytoplasm holding fine azurophilic (purple-red) granules, sometimes with vacuoles; no Auer rods were seen. The patient was a woman in her 60s with AML. FBC (2021): WBC 9.11 × 10⁹/L, Hb 73 g/L, RBC 2.39 × 10¹²/L, HCT 0.221, MCV 92.5 fL, MCH 30.5 pg, MCHC 330 g/L, RDW 21.2%, platelets 33 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 39%, lymphocytes 14%, monocytes 10%, eosinophils 5%, basophils 16%, myelocytes 1% and blasts 15%, with 1.9 nucleated red cells per 100 white cells. The haematology film report on the same sample described a population of medium to large monomorphic cells (about 30% of the white cells) with high nuclear to cytoplasmic ratio, loose chromatin, prominent and sometimes multiple nucleoli, and basophilic cytoplasm with azurophilic granules and some vacuoles but no Auer rods; platelets markedly reduced with variation in size; reactive monocytes; neutrophils with toxic granulation and a left shift with band forms; and polychromasia with occasional nucleated red cells. It concluded that the film was highly suggestive of acute leukaemia, with toxic changes pointing to an underlying infection. Granules in the blasts point to a myeloid lineage, but flow cytometry (for example MPO, CD13, CD33, CD117, CD34) confirms it. A marked basophilia is uncommon in AML and raises possibilities such as AML with t(6;9) (DEK::NUP214) or a BCR::ABL1 rearrangement, including blast phase of chronic myeloid leukaemia, which cytogenetic and molecular tests sort out.","w":2400,"h":1800,"pxPerUm":13.132,"v":"db9befc420","files":{"field":"/assets/library/OC_AML_0019/field.webp?v=db9befc420","medium":"/assets/library/OC_AML_0019/field-1200.webp?v=db9befc420","thumb":"/assets/library/OC_AML_0019/thumb.webp?v=db9befc420","cell":"/assets/library/OC_AML_0019/cell-{k}.webp?v=db9befc420","view":"/assets/library/OC_AML_0019/view-{name}.webp?v=db9befc420"},"bytes":309982,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1176,"y":954,"r":114,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Auer rod","x":1159,"y":1016,"r":63,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_AML_0020","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are two blasts and a platelet. The blasts are medium to large cells with a high nuclear to cytoplasmic ratio, loose chromatin, one or more prominent nucleoli and basophilic cytoplasm holding fine azurophilic (purple-red) granules, sometimes with vacuoles; no Auer rods were seen. The patient was a woman in her 60s with AML. FBC (2021): WBC 9.11 × 10⁹/L, Hb 73 g/L, RBC 2.39 × 10¹²/L, HCT 0.221, MCV 92.5 fL, MCH 30.5 pg, MCHC 330 g/L, RDW 21.2%, platelets 33 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 39%, lymphocytes 14%, monocytes 10%, eosinophils 5%, basophils 16%, myelocytes 1% and blasts 15%, with 1.9 nucleated red cells per 100 white cells. The haematology film report on the same sample described a population of medium to large monomorphic cells (about 30% of the white cells) with high nuclear to cytoplasmic ratio, loose chromatin, prominent and sometimes multiple nucleoli, and basophilic cytoplasm with azurophilic granules and some vacuoles but no Auer rods; platelets markedly reduced with variation in size; reactive monocytes; neutrophils with toxic granulation and a left shift with band forms; and polychromasia with occasional nucleated red cells. It concluded that the film was highly suggestive of acute leukaemia, with toxic changes pointing to an underlying infection. Granules in the blasts point to a myeloid lineage, but flow cytometry (for example MPO, CD13, CD33, CD117, CD34) confirms it. A marked basophilia is uncommon in AML and raises possibilities such as AML with t(6;9) (DEK::NUP214) or a BCR::ABL1 rearrangement, including blast phase of chronic myeloid leukaemia, which cytogenetic and molecular tests sort out.","w":2400,"h":1800,"pxPerUm":14.936,"v":"4035548597","files":{"field":"/assets/library/OC_AML_0020/field.webp?v=4035548597","medium":"/assets/library/OC_AML_0020/field-1200.webp?v=4035548597","thumb":"/assets/library/OC_AML_0020/thumb.webp?v=4035548597","cell":"/assets/library/OC_AML_0020/cell-{k}.webp?v=4035548597","view":"/assets/library/OC_AML_0020/view-{name}.webp?v=4035548597"},"bytes":305194,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":828,"y":828,"r":130,"um":40,"cx":50,"cy":50},{"n":2,"k":5,"t":"Blast","x":1829,"y":836,"r":130,"um":40,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":711,"y":521,"r":71,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 3 close-ups"}]},{"id":"OC_AML_0021","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a band form neutrophil and a platelet. The band form has a curved, unsegmented nucleus with clumped chromatin; band forms and toxic granulation in the neutrophils were reported, fitting an infection alongside the leukaemia. The patient was a woman in her 60s with AML. FBC (2021): WBC 9.11 × 10⁹/L, Hb 73 g/L, RBC 2.39 × 10¹²/L, HCT 0.221, MCV 92.5 fL, MCH 30.5 pg, MCHC 330 g/L, RDW 21.2%, platelets 33 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 39%, lymphocytes 14%, monocytes 10%, eosinophils 5%, basophils 16%, myelocytes 1% and blasts 15%, with 1.9 nucleated red cells per 100 white cells. The haematology film report on the same sample described a population of medium to large monomorphic cells (about 30% of the white cells) with high nuclear to cytoplasmic ratio, loose chromatin, prominent and sometimes multiple nucleoli, and basophilic cytoplasm with azurophilic granules and some vacuoles but no Auer rods; platelets markedly reduced with variation in size; reactive monocytes; neutrophils with toxic granulation and a left shift with band forms; and polychromasia with occasional nucleated red cells. It concluded that the film was highly suggestive of acute leukaemia, with toxic changes pointing to an underlying infection. Granules in the blasts point to a myeloid lineage, but flow cytometry (for example MPO, CD13, CD33, CD117, CD34) confirms it. A marked basophilia is uncommon in AML and raises possibilities such as AML with t(6;9) (DEK::NUP214) or a BCR::ABL1 rearrangement, including blast phase of chronic myeloid leukaemia, which cytogenetic and molecular tests sort out.","w":2400,"h":1800,"pxPerUm":17.037,"v":"c6b2a63f1e","files":{"field":"/assets/library/OC_AML_0021/field.webp?v=c6b2a63f1e","medium":"/assets/library/OC_AML_0021/field-1200.webp?v=c6b2a63f1e","thumb":"/assets/library/OC_AML_0021/thumb.webp?v=c6b2a63f1e","cell":"/assets/library/OC_AML_0021/cell-{k}.webp?v=c6b2a63f1e","view":"/assets/library/OC_AML_0021/view-{name}.webp?v=c6b2a63f1e"},"bytes":244748,"slots":["band"],"cells":[{"n":1,"k":2,"t":"Platelet","x":798,"y":1044,"r":82,"um":32,"cx":50,"cy":50},{"n":2,"k":1,"t":"Band form neutrophil","x":1050,"y":942,"r":148,"um":40,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 2 close-ups"}]},{"id":"OC_AML_0022","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a basophil. The basophil is packed with coarse, dark purple-black granules that cover the nucleus. Basophils were strikingly raised (16% in the differential), which is unusual in AML. The patient was a woman in her 60s with AML. FBC (2021): WBC 9.11 × 10⁹/L, Hb 73 g/L, RBC 2.39 × 10¹²/L, HCT 0.221, MCV 92.5 fL, MCH 30.5 pg, MCHC 330 g/L, RDW 21.2%, platelets 33 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 39%, lymphocytes 14%, monocytes 10%, eosinophils 5%, basophils 16%, myelocytes 1% and blasts 15%, with 1.9 nucleated red cells per 100 white cells. The haematology film report on the same sample described a population of medium to large monomorphic cells (about 30% of the white cells) with high nuclear to cytoplasmic ratio, loose chromatin, prominent and sometimes multiple nucleoli, and basophilic cytoplasm with azurophilic granules and some vacuoles but no Auer rods; platelets markedly reduced with variation in size; reactive monocytes; neutrophils with toxic granulation and a left shift with band forms; and polychromasia with occasional nucleated red cells. It concluded that the film was highly suggestive of acute leukaemia, with toxic changes pointing to an underlying infection. Granules in the blasts point to a myeloid lineage, but flow cytometry (for example MPO, CD13, CD33, CD117, CD34) confirms it. A marked basophilia is uncommon in AML and raises possibilities such as AML with t(6;9) (DEK::NUP214) or a BCR::ABL1 rearrangement, including blast phase of chronic myeloid leukaemia, which cytogenetic and molecular tests sort out.","w":2400,"h":1800,"pxPerUm":16.687,"v":"d32d410ab6","files":{"field":"/assets/library/OC_AML_0022/field.webp?v=d32d410ab6","medium":"/assets/library/OC_AML_0022/field-1200.webp?v=d32d410ab6","thumb":"/assets/library/OC_AML_0022/thumb.webp?v=d32d410ab6","cell":"/assets/library/OC_AML_0022/cell-{k}.webp?v=d32d410ab6","view":"/assets/library/OC_AML_0022/view-{name}.webp?v=d32d410ab6"},"bytes":254060,"slots":["basophil"],"cells":[{"n":1,"k":1,"t":"Basophil","x":1140,"y":1014,"r":80,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 1 close-up"}]},{"id":"OC_AML_0023","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Phone camera on the microscope","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML). Labelled are a blast and two platelets. The blasts are medium to large cells with a high nuclear to cytoplasmic ratio, loose chromatin, one or more prominent nucleoli and basophilic cytoplasm holding fine azurophilic (purple-red) granules, sometimes with vacuoles; no Auer rods were seen. The patient was a woman in her 60s with AML. FBC (2021): WBC 9.11 × 10⁹/L, Hb 73 g/L, RBC 2.39 × 10¹²/L, HCT 0.221, MCV 92.5 fL, MCH 30.5 pg, MCHC 330 g/L, RDW 21.2%, platelets 33 × 10⁹/L (MPV 13.2 fL). Manual differential: neutrophils 39%, lymphocytes 14%, monocytes 10%, eosinophils 5%, basophils 16%, myelocytes 1% and blasts 15%, with 1.9 nucleated red cells per 100 white cells. The haematology film report on the same sample described a population of medium to large monomorphic cells (about 30% of the white cells) with high nuclear to cytoplasmic ratio, loose chromatin, prominent and sometimes multiple nucleoli, and basophilic cytoplasm with azurophilic granules and some vacuoles but no Auer rods; platelets markedly reduced with variation in size; reactive monocytes; neutrophils with toxic granulation and a left shift with band forms; and polychromasia with occasional nucleated red cells. It concluded that the film was highly suggestive of acute leukaemia, with toxic changes pointing to an underlying infection. Granules in the blasts point to a myeloid lineage, but flow cytometry (for example MPO, CD13, CD33, CD117, CD34) confirms it. A marked basophilia is uncommon in AML and raises possibilities such as AML with t(6;9) (DEK::NUP214) or a BCR::ABL1 rearrangement, including blast phase of chronic myeloid leukaemia, which cytogenetic and molecular tests sort out.","w":2400,"h":1800,"pxPerUm":16.75,"v":"f9ff6029c6","files":{"field":"/assets/library/OC_AML_0023/field.webp?v=f9ff6029c6","medium":"/assets/library/OC_AML_0023/field-1200.webp?v=f9ff6029c6","thumb":"/assets/library/OC_AML_0023/thumb.webp?v=f9ff6029c6","cell":"/assets/library/OC_AML_0023/cell-{k}.webp?v=f9ff6029c6","view":"/assets/library/OC_AML_0023/view-{name}.webp?v=f9ff6029c6"},"bytes":293310,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1032,"y":972,"r":146,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Platelet","x":492,"y":324,"r":80,"um":32,"cx":50,"cy":50},{"n":3,"k":3,"t":"Platelet","x":2295,"y":1566,"r":80,"um":32,"cx":80.3,"cy":56.4},{"n":4,"k":4,"t":"Auer rod","x":1051,"y":1065,"r":80,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 4 close-ups"}]},{"id":"OC_AML_0024","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML), labelled as acute myelomonocytic leukaemia (FAB M4). 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Telling monoblasts and promonocytes from myeloblasts by eye is hard, so the split here is a first pass; non-specific esterase cytochemistry and flow cytometry (monocytic markers such as CD14, CD64, CD11b and CD36 alongside CD13, CD33 and CD117) confirm the lineage, and cytogenetic and molecular tests classify the leukaemia, for example inv(16) or t(16;16) (CBFB::MYH11) in the variant with abnormal eosinophils.","w":2400,"h":1800,"pxPerUm":12.592,"v":"d3e46d40f5","files":{"field":"/assets/library/OC_AML_0024/field.webp?v=d3e46d40f5","medium":"/assets/library/OC_AML_0024/field-1200.webp?v=d3e46d40f5","thumb":"/assets/library/OC_AML_0024/thumb.webp?v=d3e46d40f5","cell":"/assets/library/OC_AML_0024/cell-{k}.webp?v=d3e46d40f5","view":"/assets/library/OC_AML_0024/view-{name}.webp?v=d3e46d40f5"},"bytes":404518,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":332,"y":332,"r":109,"um":40,"cx":50,"cy":50},{"n":2,"k":2,"t":"Blast","x":479,"y":332,"r":109,"um":40,"cx":50,"cy":50},{"n":3,"k":4,"t":"Blast","x":1515,"y":244,"r":109,"um":40,"cx":50,"cy":48.5},{"n":4,"k":6,"t":"Blast","x":1603,"y":371,"r":109,"um":40,"cx":50,"cy":50},{"n":5,"k":5,"t":"Blast","x":1661,"y":225,"r":109,"um":40,"cx":50,"cy":44.6},{"n":6,"k":3,"t":"Blast","x":420,"y":469,"r":109,"um":40,"cx":50,"cy":50},{"n":7,"k":12,"t":"Blast","x":1143,"y":954,"r":109,"um":40,"cx":50,"cy":50},{"n":8,"k":15,"t":"Blast","x":1886,"y":938,"r":109,"um":40,"cx":50,"cy":50},{"n":9,"k":7,"t":"Blast","x":211,"y":1196,"r":109,"um":40,"cx":41.9,"cy":50},{"n":10,"k":10,"t":"Blast","x":274,"y":1349,"r":109,"um":40,"cx":50,"cy":50},{"n":11,"k":8,"t":"Blast","x":352,"y":1202,"r":109,"um":40,"cx":50,"cy":50},{"n":12,"k":9,"t":"Blast","x":498,"y":1212,"r":109,"um":40,"cx":50,"cy":50},{"n":13,"k":13,"t":"Blast","x":1007,"y":1065,"r":109,"um":40,"cx":50,"cy":50},{"n":14,"k":14,"t":"Blast","x":1173,"y":1130,"r":109,"um":40,"cx":50,"cy":50},{"n":15,"k":18,"t":"Blast","x":1876,"y":1221,"r":109,"um":40,"cx":50,"cy":50},{"n":16,"k":19,"t":"Blast","x":1984,"y":1300,"r":109,"um":40,"cx":50,"cy":50},{"n":17,"k":17,"t":"Blast","x":2003,"y":1085,"r":109,"um":40,"cx":50,"cy":50},{"n":18,"k":11,"t":"Blast","x":362,"y":1388,"r":109,"um":40,"cx":50,"cy":50},{"n":19,"k":20,"t":"Blast","x":1808,"y":1378,"r":109,"um":40,"cx":50,"cy":50},{"n":20,"k":16,"t":"Promonocyte","x":1749,"y":1075,"r":61,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 20 close-ups"}]},{"id":"OC_AML_0025","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML), labelled as acute myelomonocytic leukaemia (FAB M4). Labelled are 11 blasts and 11 promonocytes. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, one or more nucleoli and a rim of basophilic to grey-blue cytoplasm; no Auer rods are seen in these fields. Promonocytes have a folded, indented or kidney-shaped nucleus with fine chromatin, sometimes a small nucleolus, and more plentiful grey-blue cytoplasm that may hold fine granules or a few vacuoles. The small dark cell with a knobbly outline at the lower left is marked as an unknown cell for review. No blood count was available for these pictures. In acute myelomonocytic leukaemia both neutrophil and monocyte lines are involved: blasts (myeloblasts, monoblasts and promonocytes, which count as blast equivalents) make up at least 20% of cells, and monocytes and their precursors at least 20% of the marrow cells. 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Labelled are 14 blasts, three promonocytes and a lymphocyte. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, one or more nucleoli and a rim of basophilic to grey-blue cytoplasm; no Auer rods are seen in these fields. Promonocytes have a folded, indented or kidney-shaped nucleus with fine chromatin, sometimes a small nucleolus, and more plentiful grey-blue cytoplasm that may hold fine granules or a few vacuoles. The small dark cell at the lower left is a lymphocyte, for size comparison. No blood count was available for these pictures. In acute myelomonocytic leukaemia both neutrophil and monocyte lines are involved: blasts (myeloblasts, monoblasts and promonocytes, which count as blast equivalents) make up at least 20% of cells, and monocytes and their precursors at least 20% of the marrow cells. 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Labelled are 12 blasts and a promonocyte. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, one or more nucleoli and a rim of basophilic to grey-blue cytoplasm; no Auer rods are seen in these fields. Promonocytes have a folded, indented or kidney-shaped nucleus with fine chromatin, sometimes a small nucleolus, and more plentiful grey-blue cytoplasm that may hold fine granules or a few vacuoles. No blood count was available for these pictures. In acute myelomonocytic leukaemia both neutrophil and monocyte lines are involved: blasts (myeloblasts, monoblasts and promonocytes, which count as blast equivalents) make up at least 20% of cells, and monocytes and their precursors at least 20% of the marrow cells. Telling monoblasts and promonocytes from myeloblasts by eye is hard, so the split here is a first pass; non-specific esterase cytochemistry and flow cytometry (monocytic markers such as CD14, CD64, CD11b and CD36 alongside CD13, CD33 and CD117) confirm the lineage, and cytogenetic and molecular tests classify the leukaemia, for example inv(16) or t(16;16) (CBFB::MYH11) in the variant with abnormal eosinophils.","w":2400,"h":1800,"pxPerUm":12.615,"v":"b6f126b7ed","files":{"field":"/assets/library/OC_AML_0027/field.webp?v=b6f126b7ed","medium":"/assets/library/OC_AML_0027/field-1200.webp?v=b6f126b7ed","thumb":"/assets/library/OC_AML_0027/thumb.webp?v=b6f126b7ed","cell":"/assets/library/OC_AML_0027/cell-{k}.webp?v=b6f126b7ed","view":"/assets/library/OC_AML_0027/view-{name}.webp?v=b6f126b7ed"},"bytes":362334,"slots":["blast"],"cells":[{"n":1,"k":1,"t":"Blast","x":1036,"y":707,"r":110,"um":40,"cx":50,"cy":50},{"n":2,"k":3,"t":"Blast","x":1261,"y":700,"r":110,"um":40,"cx":50,"cy":50},{"n":3,"k":4,"t":"Blast","x":1470,"y":670,"r":110,"um":40,"cx":50,"cy":50},{"n":4,"k":11,"t":"Blast","x":786,"y":954,"r":110,"um":40,"cx":50,"cy":50},{"n":5,"k":10,"t":"Blast","x":909,"y":1032,"r":110,"um":40,"cx":50,"cy":50},{"n":6,"k":2,"t":"Blast","x":950,"y":821,"r":110,"um":40,"cx":50,"cy":50},{"n":7,"k":5,"t":"Blast","x":1583,"y":778,"r":110,"um":40,"cx":50,"cy":50},{"n":8,"k":8,"t":"Blast","x":1593,"y":934,"r":110,"um":40,"cx":50,"cy":50},{"n":9,"k":6,"t":"Blast","x":1759,"y":840,"r":110,"um":40,"cx":50,"cy":50},{"n":10,"k":9,"t":"Blast","x":1765,"y":958,"r":110,"um":40,"cx":50,"cy":50},{"n":11,"k":7,"t":"Blast","x":2023,"y":782,"r":110,"um":40,"cx":50,"cy":50},{"n":12,"k":13,"t":"Blast","x":2042,"y":1476,"r":110,"um":40,"cx":50,"cy":50},{"n":13,"k":12,"t":"Promonocyte","x":739,"y":1116,"r":61,"um":32,"cx":50,"cy":50}],"views":[],"used":[{"page":"/toolkit/cell-identifier","what":"whole field, thumbnail and 13 close-ups"}]},{"id":"OC_AML_0028","kind":"film","series":"AML","condition":"Acute myeloid leukaemia","stain":"May–Grünwald–Giemsa (MGG)","objective":"×60","camera":"Microscope camera","caption":"A field from the blood film of a patient with acute myeloid leukaemia (AML), labelled as acute myelomonocytic leukaemia (FAB M4). Labelled are 11 blasts, two promonocytes, a neutrophil, a lymphocyte and a large platelet. The blasts are large cells with a high nuclear to cytoplasmic ratio, fine open chromatin, one or more nucleoli and a rim of basophilic to grey-blue cytoplasm; no Auer rods are seen in these fields. Promonocytes have a folded, indented or kidney-shaped nucleus with fine chromatin, sometimes a small nucleolus, and more plentiful grey-blue cytoplasm that may hold fine granules or a few vacuoles. The neutrophil at the top right, with its curved, partly segmented nucleus and pale granular cytoplasm, gives a useful size comparison. The small dark cell squeezed between the blasts at the lower right is marked as a possible lymphocyte (not sure). The large pink-purple body at the right is a large platelet. No blood count was available for these pictures. 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