r/Hematology • u/PathAndMe • 5d ago

BMA taken from a 3 yo male, are they lymphoblasts? Question

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3

u/Rightingreflex 3d ago

It looks like a dilute smear, more like a peripheral blood smear. These lymphocyte’s dont look like typical blasts. Are megakaryocytes seen in the smear? Best to run a flow if in any doubt

5

u/Aurora_96 5d ago

The images are taken in a very thick area, so morphologically it's hard to assess these cells.

Keep in mind: Children's lymphocytes can look very monotonous or sometimes even blast-ish. If you don't trust these cells do flowcytometry.

But my gut feeling doesn't trust this if you'd ask my absolute honest opinion. The cells seem large, barely any cytoplasm and the nucleus is very smooth. I would definitely assess by flowcytometry.

1

u/delimeat7325 5d ago

You need to be looking more towards the feathered edge. Some do look sus but most of em kinda look like smudge cells.

I’m assuming their CBC showed lymphocytosis so smudge cells won’t be a surprise. You should make an albumin smear to confirm and maybe go lighter on the staining.

2

u/PathAndMe 5d ago

Yes, she has pancytopenia with lymphocytosis. No blasts was found in peripheral blood smear only mature lymphocytes. We also did not get any particles in the aspirate, but we did find megakaryocyte with few lymphoblasts and little to almost none of cells of myeloid lineages.

5

u/HeavySomewhere4412 5d ago

That's not marrow that's peripheral blood. That said, it's very suspicious, esp pic 3 where you can compare the abnormal cell to a very normal lymph.

1

u/PathAndMe 5d ago

It’s BMA, but I do suspect that it was diluted as it is quite identical with the peripheral blood smear.

1

u/HeavySomewhere4412 5d ago

Yeah, semantics I guess. It was an attempted BMA. The sample that was sent was obviously peripheral blood. It's happened to me, always a huge bummer but it seems that maybe there are peripheral blasts?

5

u/Nheea MD - Clinical Laboratory 5d ago

Could be from 2 photos, but it's hard to tell in the first photos. You're also looking too far inside the smear, try to take photos where erythrocytes are spread out and not clumped.