ELECTRON MICROSCOPE REPORT TEMPLATES

Andy Nguyen, M.D. / UT-Medical School at Houston, Pathology/ Last Revision on: 7/14/2015

PLATELET EM

Microscopic:

The whole blood is centrifuged to obtain a platelet pellet for electron microscopy. Adequate numbers of platelets are available for evaluation. Ultra-structural photomicrographs show platelets with normal size. The platelets show adequate presence of both alpha and dense granules. A few of the platelets contain cytoplasmic glycogen, and several show pseudopod formation. The open canalicular system is normally formed. The contractile tubules, mitochondria also show normal morphology.

Diagnosis:

Platelets, electron microscopy:

- Normal platelet ultra-structure, see Comment.

- No evidence of platelet storage pool disease is seen.

CPT:88348 x1                       

Comment:

Review of patient’s laboratory results (MHH-EMR) shows normal platelet aggregation study, PT, PTT, and von Willebrand panel (samples collected on 10/8/2010)

+++++

WBC EM:

Diagnosis:

Leukocytes, electron microscopy:

- Normal ultra structure.

- No evidence of cytoplasmic inclusions seen in MYH9-related disorders.

Comment:

Peripheral blood smear review (Memorial Hermann Laboratory, accession number xxxx, on xx/xx/2010) shows marked thrombocytopenia (plt 9k), small platelets, normal morphology of neutrophils with no evidence of Dohle-like bodies in cytoplasm.

EM
The whole blood sample is centrifuged to obtain a leukocyte pellet for electron microscopy. Adequate numbers of polymorphonuclear cells are available for evaluation. They show normal ultrastructure. No cytoplasmic patches typically associated with MYH9-related disorders are seen (patches consisting of small glycogen granules with fine electron-dense fibrils).

CPT 88348x1

+++++

WBC EM:

DIAGNOSIS:

Lymphocytes, electron microscopy:

- Normal ultra structure.

- No evidence of deposits seen in neuronal ceroid lipopofuscinosis.

Microscopic Description:

The whole blood sample is centrifuged to obtain a leukocyte pellet for electron microscopy. Adequate number of lymphocytes are available for evaluation. They show normal ultrastructure. No deposits typically associated with neuronal ceroid lipopofuscinosis are seen (granular osmophilic deposits, electron-dense deposits with fingerprint profiles, or deposits with curvilinear profiles).

+++++

Platelet EM

Diagnosis:

Platelets, electron microscopy:

- Storage pool disease with alpha granule deficiency, see Comment.

Comment:

Review of medical records shows that patient is a 25 y/o female with easy bruising, which she has acquired over the last several months. She did not have such symptom until several months ago. Review of patient’s laboratory results (MHH-EMR) shows normal von Willebrand panel. Platelet aggregation study shows adequate aggregation with arachidonic acid, collagen, and ristocetin, decreased aggregation with ADP, and epinephrine. Loss of secondary aggregation is seen with ADP and epinephrine. These findings are consistent with platelet dysfunction. Differential diagnosis includes medication effect and platelet storage pool disease. The current EM study is consistent with platelet storage pool disease (alpha granule deficiency subtype).

Microscopic:

The whole blood is centrifuged to obtain a platelet pellet for electron microscopy. Adequate numbers of platelets are available for evaluation. Ultra-structural photomicrographs show many platelets with large size, many vacuoles, some containing granular debris. Alpha granules are decreased in number. Mitochondria and dense bodies are present in normal number. A few of the platelets contain cytoplasmic glycogen, and several show pseudopod formation. The contractile tubules show normal morphology. A subpopulation of platelets has normal size and normal number of alpha and dense granules.

CPT:88348 x1