Can I offer just one quick thing that in your description of a neutrophil nuclei, you say the average is 3.5 lobes, which kind of range, but in reality, it's 325 lobes is what neutrophils have. Two lobes are almost always abnormal. Yeah, that might be more palatable to the reader than 3.5. Yeah. Fair enough. Yeah. At least three and up to five. I think that's clear, right? Two is abnormal. At least three and up to five or something. Okay. Is there anything known about whether this lamin deficiency has any functional effect? You're talking about in the heritable peltruhuit? I mean, do they work normally no matter what? It's not a no matter what. There are rare patients with peltruhuit anomaly who do have clinical problems. Most do not, however. So it seems clinically benign in the majority. But are those clinical problems from the neutrophils or clinical problems from lamin receptors somewhere else? I think it's lamin receptors somewhere else. I'm not an expert in inherited peltruhuit anomaly. Oh, yes you are. You're out of question. You know more about it than the rest of us. All right. Excellent. I think everybody's going to get this right even if they don't know anything about it, right? Because the only answer makes any sense in 2021. All right. And this is an educational question. This would never appear on your bullets. Correct. Correct. And Greg, I guess to that end, is there any sort of clinical correlate? Can you sort of bring it? Is there some way to tie in to sort of the clinical significance of knowing this? Well, I do think there are two things of clinical significance, which is it's an abnormality and it's got to make you think about why is this happening. And I think we should probably all know that some viral illnesses, including COVID-19, can do this. I mean, do you want, do you want to say something which is true and not especially helpful and write something like whether this is in fact pathogenic and COVID-19 is unknown? I mean, or even, I mean, and this is, right. You don't know it's not pathogenic. You just don't know whether it is. And the other thing that I find interesting is that the magnitude of these cells is correlated with severity of illness, which is just a little bit interesting. Well, I had a case of AIP. I wish I'd looked at the blood smear because only at post-mortem did it turn out to be COVID. You know, I think a lot of this has to do with neutrophils excluding some of their nuclei as nets. And so I think that they become hyponucleated because of that. I think they pick up parts of their nuclei. So there may be some path, it's probably linked to severity because it's linked to the amount of neutrophil net activity you have. I mean, and maybe even in the question stem, thinking of a way that this would like come to the ICU physician's attention, like you get called from the pathology lab on a blood smear abnormality or something like that. But like, why, you know, I don't know. I guess there was a comment made about making sure all the questions are, you know, relevant to the ICU from one of our, I guess, CIC customers. Are you telling me that you don't routinely look at your patients' blood smears? I mean, of course I always do, but. There needs to be, by the way, a review paper of the peripheral blood smear for the intensivist. And if any of you would like to collaborate on said paper, please message me. A textbook, Greg. My father is a hematologist and he would agree with you, Greg. So Greg, I would try to make the, I agree with Jackie. I would try to tie this in somehow. Will do. As flimsy as that tie-in may be, I'd try. I can put in something like you're called by the pathology lab because an abnormality was detected on the peripheral blood smear. Right. But in the discussion, I would try to make this at least conceivably relevant clinically. Okay. And adding in Javier's point about nets might be a way to do that. Yes, exactly.

neutrophil nuclei

lamin deficiency

pelger-huet anomaly

viral illnesses

peripheral blood smears