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Issue 14 - SMILE, what's new & blood cell abnormalities...

Evening team! Welcome to the 14th instalment of our weekly dose! Better late than never! Phew, that w
Issue 14 - SMILE, what's new & blood cell abnormalities...
By Pulsenotes • Issue #14 • View online
Evening team!
Welcome to the 14th instalment of our weekly dose!
Better late than never! Phew, that was a busy week. It may be a day late, but as always the newsletter is full of medical goodness!
In this week’s newsletter, I’ll be thanking SMILE, Ben will let you know what’s new @pulsenotes and, of course, some more medical nuggets of wisdom from Norton.
Enjoy our ‘weekly dose’? - Remember to tell your friends about us!

SMILES all round
Goodbye (for now) to the SMILE team, innovators and leaders in providing medical students with high quality education during lockdown.
Hopefully everyone caught their final lecture of the term - the team signing off with John and Paul wearing little more than a SMILE.
SMILE (Sustaining Medical Education in a Lockdown Environment), created by our good friend from medical school, John Pascoe, was one of the first to recognise the short-fall in educational opportunities for healthcare students during the COVID-19 lockdown.
As well as providing daily (and often multiple) lectures for months - an impressive organisational feat - they have used their platform to promote a number of charities close to their hearts.
We would like to thank John, Paul and Muntasha - as well as the rest of their team for the past few months. Hopefully we will continue our collaborations when SMILE returns.
Ending with a SMILE - great work!
Ending with a SMILE - great work!
What's new this week?
LIVE webinars - what we’ve got coming up…
Our summer series of FREE LIVE WEBINARS continues with two lectures from the two Ben’s!
This week, Ben will be taking you through the principles of plastic surgery whilst Norton will be covering pure exam gold with a lecture on infective endocarditis.
  1. Tuesday 4th August 10:00 am BST - Pulsenotes LIVE: Principles of Plastic Surgery.
  2. Friday 7th August 11:00 am BST - Pulsenotes LIVE: Infective endocarditis.
Remember - recordings of all these LIVE events will be available for members that aren’t able to make it!
More new stuff…
We’ve just uploaded recordings of the following LIVE events for you to watch at your leisure! As ever, they are split into chapters, with speed controls to speed up or slow down as you wish!
  • Malaria
  • Bowel obstruction
Only one new topic this week but any ortho-keeno’s should check out our brand-new notes on Tibial plateau fractures.
Norton's Corner
Blood cell abnormalities
Our blood can tell us a lot about what’s happening in the body. Whether it’s a Howell-Jolly body or presence of Auer rods, subtle appearances of our blood cells under the microscope can help us clinch the diagnosis.
There are certain red blood cell and white blood cell abnormalities that may point towards a diagnosis. These may include alterations in shape (poikilocytosis), size (anisocytosis), or presence of different cellular features. It’s important you can recognise some of these abnormalities, particularly for exams. So let’s look at the classics.
Red blood cell abnormalities
  • Howell-Jolly bodies: basophilic nuclear remnants (i.e. DNA) in circulating red cells. Suggestive of hyposplenism.
  • Pencil cell: long, thin cells that look like pencils. Typical in iron-deficiency anaemia. NB - can be seen in other conditions too!
  • Schistocyte: red blood cell fragments. Suggests mechanical damage in the circulation (e.g. from a metallic heart valve) or thrombotic microangiopathy.
  • Elliptocytes: oval shaped cells, often elongated. Seen in hereditary elliptocytosis. Inherited mutation that affects the cytoskeletal structure of red cells.
  • Spherocytes: small, compact red cells that lack central pallor due to loss of part of the membrane. Seen in haemolysis, or rarely, hereditary spherocytosis.
  • Rouleaux formation: refers to ‘stacked’ or 'clumped’ red cells that suggests an inflammatory process with acute phase proteins that increase cell adhesion.
  • Heinz bodies: denatured haemoglobin within red cells, which is classically seen in G6PD deficiency.
White blood cell abnormalities
  • Auer rods: needle-like bodies seen in the cytoplasm of myeloblasts. Sometimes seen in acute myeloid leukaemia.
  • Smudge/smear cells: remnants of cells lacking an identifiable cytoplasmic membrane or nuclear structure. Sometimes seen in chronic lymphocytic leukaemia.
  • Toxic granulation: increased staining and density cytoplasmic granules in neutrophils. Suggests an acute inflammatory response.
  • Hairy cells: hair-like projections of the cytoplasm of white cells. Many be see in a rare leukaemia of B lymphocytes termed 'hairy cell leukaemia’.
  • Reactive lymphocytes: large lymphocytes that have reacted to an immune-stimulus with dark-blue cytoplasms and irregular nucleus. Typically seen in viral infections.
Remember, you don’t have to be an expert in blood cell morphology, just try to remember these high yield ones for exams. It makes haematology SBAs so much simpler!
Benjamin Norton (@medicalreg)
Final words
Remember to get in contact with any questions, suggestions, or topics that you wish to be covered!
Thanks for reading, remember to tell your friends, and see you next week!
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