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Reactive lymphs versus monocytes


evilwarning

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Hello y'all. I was wondering if anyone had some tips for differentiating reactive lymphs from monocytes because sometimes it's really hard to tell the difference!! I just got a job at a hospital and honestly I have been off the bench for over a year. The analyzer we have will flag for atypical lymphs. I swear that when I look under the scope, all I see are normal lymphs and monocytes. After my training is complete, I'm going to be training a lot of new staff members and students that come through the lab and I want to make sure I'm at the top of my game.

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Not sure what type of analyzer you are using, but I think their tech specialist would point out that analyzer flags, especially for CBCs, do not mean that that particular morphology MUST be present.  So while a flag may indicate that a slide review is necessary, it does not mean that you will find what the flag indicates.  

On our Coulter LH780, an atypical lymph flag occurs mostly when something looking like an immature or reactive lymph MAY be present.  They may actually turn out to be small monos or blasts or even big platelets.  

On the scope, for a mono the chromatin is reasonably clumped, with apparent light parachromitin, and the cytoplasm is vaugely granular with a bluish tinge.  Reactive lymphs can vary quite a bit---check an atlas.  What we call atypical lymphs here would be something with nuclear clefting (lymphoma?) or large-nucleolused (pro-lymph?) or immature (delicate chromatin/blast like).

So I would call your manufacturer and get as much info from them about how your analyzer flags stuff.  Then you may want to write up some notes on what the various flags mean and what to do about them for your associates, and add it to the back of your Lab's CBC procedure.  You need to establish and document your own protocols and have a reference available for everyone who runs that analyzer.

Scott

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  • 2 months later...

My students really find the simulated diffs on this website to be extremely helpful.  A subscription costs $35, and you can choose regular diffs or advanced diffs.  The website is 

https://www.labce.com/ and you want the "WBC Differential Simulator".  As to distinguishing reactive lymphs from monos:  there are lots of ways to describe the differences, but in the end, it just takes seeing lots and lots of cells.  Eventually your mind will make neural networks and you will just recognize the cells.  To me it's like the experience of signing up for a class with people you don't know.  At first, you have to make an effort to remember names and recognize faces.  You might get two classmates confused.  You might have to memorize distinctive characteristics:  glasses, hair color, etc.  Eventually, though, you just recognize them--even if they change hair color, or wear contacts one day.  Your mind is designed to learn to recognize things by their appearance, so relax and give your mind as much experience with seeing these cells as you can possibly manage to give it.    Keep looking at cells even if you are sick of it.  You will eventually learn.  Also, everyone learns at a different pace, so be patient with yourself and stick to it.  Lab CE will help--I'm sure of it!

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