Page 625 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 29 ■ Body Fluid Analysis 609

TABLE 29.18 Papanicolaou-Stained Morphology

Cell Type Nucleus Cytoplasm

Neutrophils (mature) Multilobulated; hyperchromatic Green or pink; granules not evident

Neutrophils (immature) Green or pink; primary granules not vis-

ible; secondary granules present

Lymphocytes Round with nely granular chromatin; no nucleolus Green; absent or scanty

visible

Lymphocytes (reactive) Oval to cleaved; nely granular with evenly Green; moderate amount

distributed chromatin; small chromocenter

Monocyte (usually macro- Lacy Some color; moderate amount; slightly

phages in pleural uid) vacuolated

Macrophage Lacy chromatin pattern; irregular shape Green; degenerating cell may be pink.

Mesothelial cell Size variable (may occupy up to 50% of the cell); Deep pink or green; homogeneous distri-

round to oval; usually central; well-de ned mem- bution; may be more densely stained in

brane; evenly distributed granular chromatin; small center of the cell and around the nucleus;

nucleoli may be present; multinucleated pale cytoplasmic vacuoles may be seen.

Ependymal cells Round; central dense chromatin; may be grainy or Green or pink; may have “brush” bor-

possible nucleoli ders; generous amount

Choroidal cells Round; central, smooth, dense chromatin Pale green; moderate amount

Plasma cells Round to oval; eccentrically located; clumped Dense and green; abundant; paranuclear
chromatin area present; may contain small vacu-

oles (e.g., Russell’s bodies, “grape cells”)

Basophils Granules do not stain

that the amniotic f uid be breathed into the lungs by the etus negative FN can reduce unnecessary hospitalizations and

in order or the lungs to develop normally. drug therapies. High levels can be due to causes other than

T e analysis o amniotic f uid, tapped rom the mother’s risk o preterm delivery. T e American College o Obstetrics

abdomen, is called amniocentesis. T e f uid contains etal and Gynecology currently does not recommend routine FN

cells that can be examined or genetic de ects, and chemi- screening o pregnant women, as its use has not been shown

cal analysis, or example, bronectin, and other assays can to be clinically e ective in predicting preterm labor in low-

determine etal lung maturity. Fetoplacental unction can be risk, asymptomatic pregnancies.

assessed by analyzing the lecithin/sphingomyelin ratio. Lamellar body counts (LBCs) in amniotic f uid are

Fetal bronectin ( FN) is a protein produced during preg- another assessment o etal lung maturity and the associ-

nancy and unctions as a biological glue, attaching the etal ated risk o developing respiratory stress syndrome in a

sac to the uterine lining. FN is per ormed i a woman is 26 to premature in ant. Respiratory distress syndrome is caused

34 weeks pregnant and having symptoms o premature labor. by insu cient sur actant in a newborn’s lungs. T e number

T e goal then is to intervene to prevent the potentially seri- o lamellar bodies present in the amniotic f uid is propor-

ous health complications o a preterm baby. tional to amount o available sur actant. Lamellar bodies

A cervical or vaginal f uid sample is collected and analyzed have concentrated layers o phospholipid secreted by type

or FN. During the rst trimester and or about hal o the sec- II alveolar cells and act as storage packets or sur actants in

ond trimester (up to 22 weeks o gestation), FN is normally amniotic f uid. Lamellar bodies can be counted using

present in the cervicovaginal secretions o pregnant women. platelet channels in automated instrumentation (see

In most pregnancies, a er 22 weeks, this protein is no lon- Chapter 30). Fetal lung maturity cuto values can be estab-

ger detected until the end o the last trimester (1 to 3 weeks lished by three methods according to CLSI document

be ore labor). T e presence o FN during weeks 24 to 34 o a C58-A (2011).

high-risk pregnancy, along with symptoms o labor, suggests

that the “glue” may be disintegrating ahead o schedule and

alerts doctors to a possibility o preterm delivery.

A negative FN result is highly predictive that preterm NOTE: This is a good time to complete end of chapter

delivery will not occur within the next 7 to 14 days. A Review Questions.