Los tiempos de la “nueva normalidad” están constituyendo una época, cuando menos, nada normal. Algunas de sus características, por todos conocidas y comentadas, son la incertidumbre, la rigidez, la crítica, y por qué no decirlo, la contradicción. Contradicción en las normas, en los protocolos, en la información… En las normas que cambian y se contraponen a lo largo del tiempo, en los protocolos que chocan con una realidad en la que su desarrollo no siempre es posible, en la información muchas veces poco clara y, de sentencias y declaraciones de escasa base científica y pobres evidencias.

Figure 1. Laboratory report proposal for automated urinary biochemistry.

 

Difficulty in clinical laboratory reports interpretation frequently lies in the elevated number of parameters (clinical tests and calculated values) that are displayed. Reports for automated urinary biochemistry are a good example of this situation.

In order to make easier interpretations, in our lab we decided to divide urinary laboratory reports into three physiological parts based on the renal location where filtration, reabsorption or secretion from each analyte are mainly performed, achieving a complete functional evaluation.

Figure 1. Binucleated lymphocytes in peripherical blood smear (May-Grünwald-Giemsa) in a polyclonal b-cell lymphocytosis patient.

An image of an extension of peripheral blood smear, stained with May-Grünwald-Giemsa, is presented (figure 1). It is observed binucleated lymphocytes. These entities are constant and they are almost a exclusive feature of persistent polyclonal B lymphocytosis (LBPP). Morphologically, the lymphocytes are medium-large in size with a moderately condensed, bilobed nucleus, with a broad and slightly basophilic cytoplasm, as seen in the image. In addition, it is also common to observe the presence of lymphocytes with a central incisure nucleus, more or less deep that represents the different evolutionary stages prior to the binucleated lymphocyte (figure 2).

Figure 1. Sulphadiazine crystals with wheat sheaf-shaped with eccentric binding morphology corresponding to the first urine sample sent to the laboratory (a) and the second urine sample (two days later) (b). Pictures at 20 and 40 increases.

 

A 49-year-old male HIV positive patient came to hospital for sudden impairment of his writing capacity of new onset without other associated symptoms. A cerebral nuclear magnetic resonance was performed, showing a space occupying lesion in the right temporoparietal space with cortical involvement, ring enhancement and associated perilesional edema. He began oral corticosteroid treatment and became asymptomatic.

Figure 2. Cannibalism and cell in mitosis. In the figure, a cell mitosis can be seen in the upper central part, accompanied in the lower right part of the figure by multiple cells in which cannibalism can be observed. (Pleural fluid smear. Quick panoptic stain. 600x).

An image of a pleural fluid smear stained with quick panoptic is presented. The figure shows abundant atypical cells and cell cannibalism phenomenon that suggest a neoplastic origin (figure_1). The situation described was observed in many fields of pleural fluid smear, along with abundant atypical nest cells with mitosis phenomena (figure 2).