Mononuklearai

Norma
Not found

Synonyms: lymphomonocytes, atypical mononuclears, viral lymphocytes, reactive lymphocytes, Pfeiffer cells, Virocytes, Variable lymphocytes, Reactive lymphocytes.
Blood EDTA
Violet cap, blood smear

These cells appear in infectious mononucleosis, cytomegalovirus infections, and other viral diseases. Identifying them requires a certain level of expertise from a laboratory physician. During the disease, various forms of these cells may be present, sometimes they can be mistaken for blasts. In mononucleosis, the leukocyte formula shifts to the left, sometimes there is monocytosis, lymphocytosis, several plasma cells, leukocytosis up to 20×10⁹/l or leukopenia. In the literature, these cells have many synonyms and various names. Some “viral lymphocytes” may not meet such strict criteria for diagnosis (basophilia, perinuclear clear zone, azurophilic granules, wide cytoplasmic structure). These are signs of lymphocytes’ “viral irritation.” The highest degree of lymphocyte irritation is seen in mononuclears. To avoid confusion with blasts, bone marrow aspiration is not useful. It is necessary when suspecting blasts (leukemia, MDS). If there is mononucleosis, the same cells can be found in bone marrow as in peripheral blood. If identification in the blood was difficult, bone marrow examination will not provide additional information. Conversely, bone marrow examination can be misleading. In the case of mononucleosis, there may be even greater cell polymorphism in the bone marrow with a higher percentage of young cells. Sometimes, with mononucleosis, there may be hemolysis, reticulocytosis, normoblastosis. Clinically, mononucleosis is characterized by fever, exudative tonsillitis, lymphadenopathy. Other symptoms: splenomegaly, hepatomegaly, oral mucosal petechiae. A complete blood count may initially show relative or absolute lymphocytosis and 10–30% of atypical lymphocytes, mononuclears, immunoblasts, plasma cells (it can be said that all these cells are “irritated lymphocytes”). When diagnosing, the search for EBV (Epstein-Barr virus) is started. About 5% of mononucleosis cases have negative heterophilic antibody tests. In this case, an EBV (Epstein-Barr virus) serological test is necessary because almost all mononucleosis cases with a negative heterophilic antibody reaction are positive for EBV. If the EBV serology is negative, CMV serology is checked. In the case of negative CMV serology, it is advisable to look for other viral pathogens.

Source | Handbook of Basic Laboratory Tests | Doctor of Medical Sciences Gintaras Zaleskis