Burkitt’s Lymphoma, bone marrow touch prep + Wright’s stain

Extremely distinct, fairly uniform cells with super dark blue cytoplasm full of lipid vacuoles. It has an association with Epstein Barr virus, which is also the causative agent of infectious mono, hairy leukoplakia, and a whole host of other problems. What a tricky virus.

Trypanosoma sp in peripheral blood.

Trypanosomiasis which is spread by tsetse flies in a rather interesting way! After the fly bites someone, it defecates near the bite site and that is where this protozoan parasite can be found. The bite is painful and people smear said parasite into the wound when scratching it. The trypanosomes then spread to the nervous system, causing lethargy, tremors and confusion, and eventually coma and death. 

Acute Erythroblastic Leukemia, peripheral smear.

AEL is incredibly hard to miss when it comes up on a smear. Like all AMLs, it is a malignant expansion of precursor cells—in this case, red blood cell precursors. When doing a cell differential, the nucleated red cells are hugely elevated (by which I mean you can easily have more nucleated red cells than all the white blood cells combined where there should be very few if any in a normal smear).

Let me tell you about my most interesting bone marrow collection.

Here, the way they are done is a pathologist does the collection and the technologist assists them by setting up his tray, injecting the syringes full of aspirate into the correct tubes before they clot (some pathologists like to throw them at you; that is gross), and making smears, etc. 

The patient was a sternal collection. It was also rock solid there and the pathologist had to climb on top of her and was all but drilling the needle into her chest. Even when it is soft, this is a horrible thing to witness when you are a patient and that is partially why we normally collect from the posterior. We also couldn’t get a trephine out at the end because the marrow itself was so soft, so we ended up tapping two more holes.

The first EDTA also partially clotted and we needed another aspirate which was so hard to pull, it clotted before they could even unload the syringe and we decided to make do with what we could because it would only get harder from there.

In the meanwhile, the patient had a reaction to the anesthesia and vomited.

Once in a while we get thrown a curve ball and get specimens from people who don’t need any clinical direction anymore.

Today, I received a vitreous fluid specimen from a 15 year old boy who was killed in a bike accident—a huge bummer in and of itself. They wanted to know if alcohol was involved.

Basically, eyeball fluid is a good specimen for post mortem ethanols because the levels are pretty stable and bacteria don’t have an easy time mucking things up in there (as they tend to in a lot of specimen types).