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Sysmex XN-module scattergrams performed by white cell differential (WDF), white progenitor cell (WPC) and white cell nucleated (WNR) channels and peripheral blood (PB) microphotographs (May-Grunwald Giemsa stain at 1000 ×) by Sysmex DI-60 on PB of a healthy adult subject (from A to E), a 65-year-old patient with hairy cell leukemia (HCL: from F to L) and an adult patient with B-cell splenic marginal zone lymphoma (SMZL: from M to Q). Healthy adult subject: (A) WDF scattergram: the different leukocyte classes are represented by different color clusters as follows: lymphocytes (pink), monocytes (green), neutrophils (light blue) and eosinophils (red). Normal distribution of WBC clusters; (B) WNR scattergram: regular pattern; (C) WPC scattergram: regular pattern; (D) a normal monocyte; (E) a normal lymphocyte, HCL: (F) WDF scattergram: an abnormal monocyte cluster (as pointed by the arrow) spreads over the lymphocyte zone; (G) WNR scattergram: it is clearly evident the presence of an abnormal lymphocyte double-cluster (indicated by the two arrows) and the lack of monocyte cluster; (H) WPC scattergram: a complete lack of the monocyte cluster (i.e. the upper white area pointed out by the arrow indicates the zone in which it should be visible); (I) a medium-sized lymphocyte with abundant cytoplasm and circumferential projections (hairy cell); (L) another hairy cell, splenic marginal zone lymphoma (SMZL): (M) WDF scattergram: an abnormal monocyte cluster (blue arrow) spreads over the pathological double-lymphocyte cluster (indicated by the red arrow); (N) WNR scattergram: the monocyte cluster is clearly evident, as pointed out, with a regular pattern; (O) WPC scattergram: same as above; (P) villous lymphocyte: it showed abundant cytoplasm, spongy chromatin and absent nucleoli; (Q) two atypical lymphocytes with basophil cytoplasm and, one of them, with evident nucleolus.
Contexts in source publication
Context 1
... OM review showed a complete lack of mono- cytes and the presence of some hairy cells (3%) ( Figure 1I, L). The clinical and laboratory data prompted clini- cians to proceed with a bone marrow aspiration, which showed (a) reduced representation of both erythroid, granulocytic and megakaryocytes series, with mature megakaryocytes and (b) diffused infiltrate of small and medium-sized lymphoid elements (80%-90%) exhib- iting a typical morphological pattern characteristic of hairy cells. ...
Context 2
... typical case of SMZL in an adult patient is depicted in Figure 1M-Q. The scattergrams and images were taken from PB analysis on XN-module and OM smear review of a patient with a B-cell SMZL confirmed by bone marrow biopsy and immunophenotyping (CD5−, CD23−). ...
Context 3
... the PB analysis on XN-module showed a normal CBC, except for the thrombocytopenia, and the alarm flag "Atypical Lympho?" (Table 1). The compari- son of XN-module WDF, WNR and WPC scattergrams ( Figure 1M-O) in the SMZL patient vs. a healthy adult subject ( Figure 1A-C) and the HCL patient ( Figure 1F-H) showed some important variations in the cell clusters distribution. In the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. ...
Context 4
... the PB analysis on XN-module showed a normal CBC, except for the thrombocytopenia, and the alarm flag "Atypical Lympho?" (Table 1). The compari- son of XN-module WDF, WNR and WPC scattergrams ( Figure 1M-O) in the SMZL patient vs. a healthy adult subject ( Figure 1A-C) and the HCL patient ( Figure 1F-H) showed some important variations in the cell clusters distribution. In the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. ...
Context 5
... the PB analysis on XN-module showed a normal CBC, except for the thrombocytopenia, and the alarm flag "Atypical Lympho?" (Table 1). The compari- son of XN-module WDF, WNR and WPC scattergrams ( Figure 1M-O) in the SMZL patient vs. a healthy adult subject ( Figure 1A-C) and the HCL patient ( Figure 1F-H) showed some important variations in the cell clusters distribution. In the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. ...
Context 6
... compari- son of XN-module WDF, WNR and WPC scattergrams ( Figure 1M-O) in the SMZL patient vs. a healthy adult subject ( Figure 1A-C) and the HCL patient ( Figure 1F-H) showed some important variations in the cell clusters distribution. In the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. The PB smear review by OM revealed an equal presence of atypical (3%) and villous lymphocytes (3%), as in Figure 1P and Q. ...
Context 7
... compari- son of XN-module WDF, WNR and WPC scattergrams ( Figure 1M-O) in the SMZL patient vs. a healthy adult subject ( Figure 1A-C) and the HCL patient ( Figure 1F-H) showed some important variations in the cell clusters distribution. In the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. The PB smear review by OM revealed an equal presence of atypical (3%) and villous lymphocytes (3%), as in Figure 1P and Q. ...
Context 8
... the SMZL case, the WDF scattergram ( Figure 1M) displayed an abnormal lymphocyte double cluster (colored in pink and indicated by the red arrow), whereas the WNR and WPC scattergrams exhibited the presence of the monocyte cluster (colored in green in the WDF scattergram) ( Figure 1N and O), as pointed out by the black arrows. The PB smear review by OM revealed an equal presence of atypical (3%) and villous lymphocytes (3%), as in Figure 1P and Q. As for the HCL case, it is noteworthy to mention that all the altera- tions we previously evidenced in the WDF, WNR and WPC scattergrams were shown in eight other HCL cases that were diagnosed at our hospital facility during the last year. ...
Citations
... -Lymphocytosis is uncommon [73]. -Unlike HCL-like disorders, monocytopenia is often present in HCL: it can be masked by automated hematology analyzers, which frequently identify HCs as monocytes [74]. - ...
Introduction: Hairy-cell leukemia (HCL) is a rare B-cell chronic lymphoproliferative disorder (B-CLPD), whose favorable prognosis has changed with the use of purine nucleoside analogs (PNAs), such as cladribine (CDA) or pentostatin (P). However, some patients eventually relapse and over time HCL becomes resistant to chemotherapy. Many discoveries have been made in the pathophysiology of HCL during the last decade, especially in genomics, with the identification of the BRAFV600E mutation and cellular biology, including the importance of signaling pathways as well as tumor microenvironment. All of these new developments led to targeted treatments, especially BRAF inhibitors (BRAFis), MEK inhibitors (MEKis), Bruton’s tyrosine kinase (BTK) inhibitors (BTKis) and recombinant anti-CD22 immunoconjugates. Results: The following major changes or additions were introduced in these updated guidelines: the clinical relevance of the changes in the classification of splenic B-cell lymphomas and leukemias; the increasingly important diagnostic role of BRAFV600E mutation; and the prognostic role of the immunoglobulin (IG) variable (V) heavy chain (H) (IGHV) mutational status and repertory. We also wish to insist on the specific involvement of bones, skin, brain and/or cerebrospinal fluid (CSF) of the disease at diagnosis or during the follow-up, the novel targeted drugs (BRAFi and MEKi) used for HCL treatment, and the increasing role of minimal residual disease (MRD) assessment. Conclusion: Here we present recommendations for the diagnosis of HCL, treatment in first line and in relapsed/refractory patients as well as for HCL-like disorders including HCL variant (HCL-V)/splenic B-cell lymphomas/leukemias with prominent nucleoli (SBLPN) and splenic diffuse red pulp lymphoma (SDRPL).
... Not surprisingly, papers on hematology analyzers are the most frequent in this category, approximately 80%, and the number of papers roughly represent the market shares of the main manufacturers. Some papers are of direct practical interest for the journal's readers: early evaluation reports of newly released analyzer models [103][104][105], sideby-side comparison studies of various analyzers [84,[106][107][108] and case reports on interfering factors that compromise the accuracy of reported results [98,[109][110][111][112]. A critical paper on unreliable basophil counts reported by hematology analyzers belongs to this group, too [113]. ...
On the occasion of the 60th anniversary of Clinical Chemistry and Laboratory Medicine ( CCLM ) we present a review of recent developments in the discipline of laboratory hematology as these are reflected by papers published in CCLM in the period 2012–2022. Since data on CCLM publications from 1963 to 2012 are also available, we were able to make a comparison between the two periods. This interestingly revealed that the share of laboratory hematology papers has steadily increased and reached now 16% of all papers published in CCLM . It also became evident that blood coagulation and fibrinolysis, erythrocytes, platelets and instrument and method evaluation constituted the ‘hottest’ topics with regard to number of publications. Some traditional, characteristic CCLM categories like reference intervals, standardization and harmonization, were more stable and probably will remain so in the future. With the advent of important newer topics, like new coagulation assays and drugs and cell population data generated by hematology analyzers, laboratory hematology is anticipated to remain a significant discipline in CCLM publications.
... This is a recently described finding in HCL when using analyzers based on physical properties technology. 2 Furthermore, the suspicion based in a single patient that analyzers using fluorescent staining and laser scatter technology (Sysmex, Kobe, Japan) do not also properly classify HCL must be confirmed. 3 In this report we describe our experience with cell count and flags provided by the XN-module in a continuous series of HCL patients. ...
... Our results confirm the similar findings described in a previous study concerning the performance of XNseries that included a single HCL patient with abnormal appearance of the monocyte´s area in WPC scattergram. 3 However, we also found differences regarding the findings highlighted by Seghezzi et al. 3 in the WDF scattergram between one sample from a HCL patient vs other sample from a splenic marginal zone lymphoma (SMZL) patient, both cases with the same low count of villous cells (3%). The authors describe the WDF scattergram of the first case with an abnormal monocyte cluster clearly lower than the usual position and the second one with an abnormal lymphocyte double cluster. ...
Hairy cell leukemia (HCL) is a relatively rare chronic B-cell malignancy that involves the bone marrow, spleen and peripheral blood. Monocytopenia could represent a clue for the suspicion of HCL with complete blood counts (CBCs) and careful assessment of the cell morphology being the first steps in the identification of hairy cells. The purpose of our study is to describe our experience with cell count and flag performance provided by the XN-module in a continuous series of six HCL patients diagnosed in the last two years. The final diagnosis was made by immunophenotypic and genetic analysis. Five out of six patients presented relative monocytosis on automated differential count. Nevertheless, the relative monocyte count was overestimated by the analyzer regarding to the manual count in all cases. The smear revision showed that most cells classified as monocytes were primarily hairy cells which afterwards were confirmed by the immunophenotype. All patients showed potentially pathologic WDF scatergrams or flags and were selected for microscopic smear review. In five of the six patients the WDF channel displayed the “Blasts/Abn Lympho?” flag and triggered the reflex reanalysis using the WPC channel. All samples presented lack or abnormal position of the monocytes cluster in the WPC scattergram. As a conclusion the monocytopenia should be taken with caution for the initial screening of hairy cell leukemia. Instead, an abnormal appearance of WDF scattergram and the lack or an ectopic position of the monocyte cluster in WPC scattergram should be considered to initiate the review of the peripheral blood smear.
... Relationships can be established between WBCs found in red blood cells in both men and women and weight, uric acid, cholesterol, heart rate, creatinine, ethnicity, sex, height, blood pressure, and blood sugar. Abnormalities in the distribution of cells on the scattergram are important indicators in determining many other diseases, such as leukaemia [1][2][3]. ...
The acute respiratory syndrome COVID-19 disease, which is caused by SARS-CoV-2, has infected many people over a short time and caused the death of more than 2 million people. The gold standard in detecting COVID-19 is to apply the reverse transcription polymerase chain reaction (RT-PCR) test. This test has low sensitivity and produces false results of approximately 15%-20%. Computer tomography (CT) images were checked as a result of suspicious RT-PCR tests. If the virus is not infected in the lung, the virus is not observed on CT lung images. To overcome this problem, we propose a 25-depth convolutional neural network (CNN) model that uses scattergram images, which we call Scat-NET. Scattergram images are frequently used to reveal the numbers of neutrophils, eosinophils, basophils, lymphocytes and monocytes, which are measurements used in evaluating disease symptoms, and the relationships between them. To the best of our knowledge, using the CNN together with scattergram images in the detection of COVID-19 is the first study on this subject. Scattergram images obtained from 335 patients in total were classified using the Scat-NET architecture. The overall accuracy was 92.4%. The most striking finding in the results obtained was that COVID-19 patients with negative RT-PCR tests but positive CT test results were positive. As a result, we emphasize that the Scat-NET model will be an alternative to CT scans and could be applied as a secondary test for patients with negative RT-PCR tests.
Disease Overview
Hairy cell leukemia (HCL) and HCL‐like disorders, including HCL variant (HCL‐V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogenous group of mature lymphoid B‐cell disorders characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment.
Diagnosis
Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11c, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral bone marrow infiltration and the presence of BRAFV600E somatic mutation.
Risk Stratification
Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood, and the immunoglobulin heavy chain variable region gene mutational status. VH4‐34 positive HCL cases are associated with a poor prognosis, as well as HCL with TP53 mutations and HCL‐V.
Treatment
Patients should be treated only if HCL is symptomatic. Chemotherapy with risk‐adapted therapy purine analogs (PNAs) are indicated in first‐line HCL patients. The use of chemo‐immunotherapy combining cladribine (CDA) and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus R, MEK inhibitors (MEKi), recombinant immunoconjugates targeting CD22, Bruton tyrosine kinase inhibitors (BTKi), and Bcl‐2 inhibitors (Bcl‐2i). However, the optimal sequence of the different treatments remains to be determined.
