h. L.E. Cells.

(1) Persons having lupus erythematosus, one of the “collagen” diseases, have an abnormal; plasma protein that causes swelling and breakdown of certain blood cell nuclei in vitro. This degenerated nuclear material attracts phagocytic cells, particularly

segmented neutrophils, which engulf this nuclear mass. The resulting phagocyte and inclusion material is termed an "L.E." cell. (2) The nucleus of an L.E. cell is adjacent to the peripheral outline of the inclusion material. The inclusion is smooth and silky or light purple and has no visible chromatin network.

Figure 4-7d. Variations in leukocytes: L.E. Cells. i. Rosettes. Rosette formation is the intermediate stage in the formation of an L.E. cell. A rosette formation consists of neutrophilic leukocytes surrounding free masses of lysed nuclear material. j. Tart cells. A tart cell, which may be confused with the L.E. cell, contains lysed nuclear material within its cytoplasm. It differs from an L.E. cell because the inclusion retains characteristic nuclear structure. This inclusion is not smooth and has a darker staining periphery. The significance of tart cells is not known but their presence in an L.E. preparation does not signify a positive test for systemic lupus erythematosus.
19. a. b. c. d. When is the most appropriate time to draw blood for thick and thin blood film preparation for the diagnosis of malaria? when the fever peaks after the fever peaks every 2 hours immediately on request

ANSWER (d): The majority of patients we see in the US with malaria have never been exposed to the organism before; therefore they have no antibody and when they present they do NOT have a synchronized fever cycle. These immunologically nave patients may present with nonspecific symptoms that can mimic many other diseases. The rule of thumb is to draw immediately; do not wait for some "magic" periodic cycle that may never appear. Patients with a very low parasitemia withP. falciparum can become quite ill before they have any type of fever cycle or gametocytes. With any patient where malaria is suspect or the patient has a FUO (fever of unknown origin), blood should be drawn and both thick and thin blood films prepared and examined immediately. This request is always considered a STAT request. Blood can be collected at any time, but the best way is midway between episodes of fever and chills, when the greatest number of malaria parasites are present. It may be necessary to collect several specimens at intervals of 4-6 hours. Draw blood from the patient's vein according to the following steps:

The blood sample should be stored like this.... and tested within x time.

When to collect the blood sample As soon as possible if malaria is suspected. However, it may be necessary to collect blood on several occasions to detect the parasite During peaks of fever Before the patient receives antimalarial drugs.