Body Fluid Differential Tutorial
Continuing Education Credits
If you have forgotten the art of differentiating choroid plexus cells from ependymal cells or viral lymphocytes from fluid monocytes, you are in luck! This course provides a thorough morphologic identification of over 40 cell types and disease states to recharge your memory. The course features over 100 crystal clear, perfectly stained body fluid images to illustrate both basic and advanced cellular morphology - perfect for a comprehensive, detailed review which can help refresh any technologist, both in or out of the hematology laboratory. The course is P.A.C.E. approved for 2 full credit hours to help reach your continuing education credit requirements. Enjoy learning and/or reviewing the key identification characteristics of body fluid cells in a user-friendly and fun format. Enroll today!
Objectives
- Compare and contrast the morphology of cells found in normal cerebrospinal fluid (CSF), normal pleural fluid, normal peritoneal fluid, and normal synovial fluid.
- Identify the morphology of cells found in bronchoalveolar lavage (BAL).
- Distinguish abnormal/reactive/infected cell morphology in fluids.
- Recognize malignant cell morphology in body fluids.
- Discuss appropriate scenarios for hematology/pathology review.
Course Outline
- Cytocentrifugation Morphology
- Cytocentrifugation of Body Fluid Samples
- Cytocentrifugation of Body Fluid Samples, continued
- Cell Types Common To Most Types of Body Fluids
- Neutrophils
- Neutrophils
- Neutrophils, continued
- Eosinophils vs. Neutrophils
- True or False? Nucleated blood cells will always have the same appearance on a cytocentrifuged smear as they do on a peripheral blood smear.
- Lymphocytes, Atypical Lymphocytes, Plasma Cells
- Normal Lymphocytes
- Lymphocytes
- Lymphocytes vs. Monocytes
- Lymphocytes vs. Monocytes, continued
- Atypical Lymphocytes vs. Monocytes
- Lymphocytes and Atypical Lymphocytes
- Lymphocytes and Atypical Lymphocytes, continued
- Atypical Lymphocytes
- Viral Lymphocytes
- Lymphocytes and Plasma Cells in Body Fluids
- The image on the right is a representative field from a cytospin preparation of a CSF from a patient with a viral infection. Identify the cell indicated by the arrow.
- Monocytes and Macrophages
- Monocytes
- Monocytes vs Lymphocytes
- Monocytes and Macrophages
- Monocytes and Macrophages, continued
- Macrophages
- Phagocytosis
- Hemosiderin
- Histiocytes
- True or False? Macrophages are the phagocytes that originate from lymphocytes.
- Match each cell type listed in the drop-down box to the letter that corresponds to its identification in the image on the right.
- Cells Found in Cerebrospinal Fluid
- Cerebrospinal Fluid: Non-Blood Cells
- Ependymal Cells
- Ependymal Clumps
- Choroid Plexus Cells
- Cerebrospinal Fluid: Bone Marrow Contamination
- Bone Marrow Contamination in CSF
- Bone Marrow Contamination in CSF, continued
- What is the identification of this cellular clump found in CSF? Note the presence of many similar-appearing nuclei without distinct lines of demarcation between cells.
- Cells Found in Pleural and Peritoneal Fluids
- Mesothelial Cells
- Mesothelial Cells
- Mesothelial Cells, continued
- Reactive Mesothelial Cells
- Cells Found in Synovial Fluids
- Synovial Lining Cells
- Synovial Lining Cells, continued
- Cells Found in Bronchoalveolar Lavages
- Bronchial Lining Cells
- Bronchial Lining Cells
- Bronchial Lining Cells, continued
- Match the following cell types to the body fluids in which they may be seen when the fluid is observed on a cytocentrifuged preparation.
- Infectious Organisms in Body Fluids
- Infectious Organisms in Body Fluids
- Bacteria
- Intracellular and Extracellular Bacteria
- Intracellular Bacteria
- Peritoneal Lavage Trauma
- Trauma STAT
- Septic Arthritis
- Fungi
- Yeast
- Candida albicans - Germ Tube Formation
- Hyphae
- Toxoplasma
- Central Nervous System (CNS) Toxoplasmosis
- Central Nervous System (CNS) Toxoplasmosis, continued
- The elements indicated by the arrows were observed on a Wright-stained smear of a synovial fluid. What is the likely identification of the elements, and what would you do to confirm the finding?
- Malignant Fluids with Leukemia and Lymphoma.
- Leukemic Fluids
- Lymphoid Leukemia/Lymphomas
- Acute Lymphoblastic Leukemia (ALL): L1 Morphology
- Central Nervous System (CNS) Relapse: L2 Acute Lymphoblastic Leukemia (ALL)
- Burkitt Lymphoma
- Non-Hodgkin Lymphoma
- Anaplastic Large Cell Lymphoma (ALCL)
- Myeloid Leukemias
- Acute Myeloid Leukemia (AML)
- Acute Myeloid Leukemia (AML), continued
- Acute Monoblastic Leukemia (AMoL)
- True or False? Prominent vacuolation involving the cytoplasm of abnormal lymphoblast-like cells seen in a body fluid preparation is a distinctive feature of Burkitt Lymphoma.
- Malignant Fluids with Metastatic Tumor
- Metastatic Tumors in Fluid Cytospins
- Adenocarcinoma in Peritoneal Fluid
- Alveolar Rhabdomyosarcoma (ARMS) in Pleural Fluid
- Atypical Teratoid/Rhabdoid Tumors (ATRT) in Cerebrospinal Fluid
- Metastatic Melanoma in the Cerebrospinal Fluid (CSF)
- Primitive Neuroectodermal Tumor (PNET) in Cerebrospinal Fluid
- Medulloblastoma in Cerebrospinal Fluid
- Neuroblastoma in Pleural Fluid
- Neuroblastoma Tumor Clump vs. Mesothelial Cells in Pleural Fluid
- Retinoblastoma in Cerebrospinal Fluid
- Match the morphologic characteristics with the listed cell type.
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: This course is intended for laboratory professionals who have experience with peripheral blood morphology and basic experience with body fluid differential analysis. This tutorial will provide a review of normal and abnormal body fluid morphology utilizing Wright-Giemsa stained cytospin preparations from cerebrospinal fluid (CSF), pleural, peritoneal, and synovial fluids, as well as bronchial alveolar lavage (BAL) samples.
Author Information: Marybeth Helfrich, MLS(ASCP) is currently a Laboratory Technologist Specialist for the Hematology/Oncology Laboratory at Children's Hospital of Philadelphia. She received her Bachelor of Science in Medical Technology from Temple University in Philadelphia and has nearly 40 years of experience in both adult and pediatric hematology and oncology settings. She has been a presenter for ASCLS-PA, ASCP (local and national), and the Texas Teleconference network. She is responsible for hematology morphology instruction and training for medical technologists and fellows. She is also a regular developer of morphology tutorials for in-house continuing education activities.
Reviewer Information: Valerie F. Jalicke, MS, MLS(ASCP)CMPBTCM received her Bachelor of Science and Master of Science in Bioscience Technologies from Thomas Jefferson University in Philadelphia, PA. She currently serves as Program Director and Clinical Assistant Professor in the Medical Laboratory Science program at Thomas Jefferson University. She has over 30 years of experience as a medical laboratory scientist with a heavy focus on hematology, clinical chemistry, and urinalysis and body fluids.