Page 39 - Haematologica Atlas of Hematologic Cytology

CHAPTER 4 - Viral infections
B A AB CD
EF
Figure 1 Infec ous mononucleosis (IM) A young woman presented with fa gue arthralgia and and and myalgia nausea and and and and vomi ng ng low-grade fever Physical examina on on on revealed slight slight aundice cervical lymphadenomegalies and and and and mild hepatosplenomegaly Hematologic data showed slight slight thrombocytopenia and and and and and leukocytosis (white blood cell count 17 5x109/L) Hyperbilirubinemia and and and increased levels of transaminases alkaline phosphatase and and and lactate dehydro- genase were also found ( ( ) ) ) Peripheral blood blood smear Most white blood blood cells cells cells are are lymphoid cells cells cells with with polymorphic features They are are called reac reac ve or or atypical lymphocytes ( ( ( ) ) ) At higher magni ca ca ca on on note large cells cells cells with with with abundant strongly basophilic cytoplasm some mes with with with evident nucleolus similar to to immunoblasts ( ( ) ) The The nuclei of reac reac - ve lymphocytes are eccentrically placed they may be round oval reniform or or or or lobulated with with with loose or or or or moderately thickened chroma n n n n n n n n n n The The cytoplasm cytoplasm is is some some mes vacuolated or or or or or granular with with variable basophilia which in in some some cells is is limited to to to to the cytoplasmic borders (F) There are also plasmacytoid lymphocytes lymphocytes Immunophenotyping exclu- ded a a a a a a a a a a a a a a a a a a a a monoclonal B-cell popula on on on on on on while showing an an increase in in in in in in in ac ac vated T T lymphocytes lymphocytes Serological tes tes tes ng ng ng con- rmed the the the diagnosis of of Epstein-Barr virus infec on on on on on on suspected on on on on on on the the the basis of of the the the clinical and cytological features 26