atypical lymphocytes range

Clin Exp Immunol. (2009, October). Figure 2 A, High-power magnification of the frontal lobes cerebral cortex shows with a wide range of skin manifestations at presentation (1,2). Kawasaki disease (KD) is a febrile disease that affects children under 5 years of age and leads to serious cardiovascular complications such as coronary artery disease. Interpret your laboratory results instantly with us. Web0.6 MB. Atypical Lymphocytes is also known as the reactive lymphocytes in the medical industry. Interestingly, in the same series, one half of ruptures were atraumatic. WebIt is important to differentiate reactive lymphocytes from neoplastic lymphocytes. If your doctor determines that your lymphocyte count is high, the test result might be evidence of one of the following conditions: Specific causes of lymphocytosis include: Causes shown here are commonly associated with this symptom. High white blood cell counts may be due to inflammation, an immune response, or blood diseases such as In addition, evidence of EBV infection is not part of the definition of chronic fatigue syndrome.28 Physicians should be aware of several other rare complications of infectious mononucleosis (Table 4).1,3841. Cleveland Clinic is a non-profit academic medical center. 2004;200(1):47-51. doi: 10.1016/j.prp.2003.12.003. Incorporate these foods into your diet. As your blood cells pass through the lasers, they scatter light in certain patterns that are detected by the flow cytometer. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. There are several diseases and disorders that can cause atypical lymphocytes. Viral diseases like Cytomegalovirus, Hepatitis C, and Epstein Barr Virus are some of the common causes for developing atypical lymphocytes. This condition may also be because of some auto-immune disorders like Rheumatoid arthritis. For children, it can be as high as 9,000 lymphocytes per microliter. Identification by multiple T and B lymphocyte markers. Read on to learn more about the causes, symptoms, treatments, and prognosis for lymphoma. They defend your body from infection. Given the lack of evidence for bed rest in many other conditions, it seems sensible to recommend that patients base their return to usual activities on their energy levels. read more:Reactive Lymphocytes: Types and Causes. This type of pneumonia is most common in young children. An older, quasi-experimental study21 found that enforced bed rest slowed recovery. These lymphocytes become B cells. For children, its between 3,000 and 9,500 lymphocytes per microliter of blood. WebWhole blood Volume Fill tube (s) to capacity. A normal lymphocyte range for adults is anywhere between 1,000 and 4,800 cells in 1 microliter (l) of blood. Increase your Lymphocytes (Lymphs) by 10 % to be within normal range. However, diagnostic testing is warranted in pregnant women because toxoplasmosis and acute human immuno-deficiency virus (HIV) and CMV infections are associated with significant pregnancy complications. They play an important role in your immune system, which helps your body fight disease and infection. some cancers, including lymphocytic anemia, certain drugs, including chemotherapy drugs, some inherited disorders, such as Wiskott-Aldrich syndrome and DiGeorge syndrome. Antibody to Epstein-Barr nuclear antigen (EBNA), while typically not detectable until six to eight weeks after the onset of symptoms, can help distinguish between acute and previous infections. 2020;189(5):844. doi: 10.1111/bjh.16690 [PubMed], El Jamal SM, Salib C, Stock A, Uriarte-Haparnas NI, Glicksberg BS, Teruya-Feldstein J, et al. By using our website, you consent to our use of cookies. Yumizen H1500/2500 hematology analyzers provide the ALY parameter in percentage and absolute count. Its usually temporary and harmless. Acute cytomegalovirus (CMV) infection and toxoplasmosis can share many additional characteristics with infectious mononucleosis, including splenomegaly, hepatomegaly, lymphocytosis, atypical lymphocytosis, and even false-positive results from a heterophile antibody test.11 It may not be possibleor even usefulto distinguish between infectious mononucleosis caused by EBV infection and an infectious mononucleosislike syndrome caused by toxoplasmosis or CMV, because the management of these syndromes is the same. Lymphocytes are a type of white blood cell. London, Eng: Elsevier; 2017. https://www.clinicalkey.com. Atypical Lymphocytes, Band Neutrophils (%), Basophils (Absolute), Basophils (Percent), Eosinophils "Eos" (Absolute), Eosinophils "Eos" (Percent), Lymphocytes "Lymphs" (Absolute), Lymphocytes "Lymphs" (Percent), Monocytes (Absolute), Monocytes (Percent), Neut/Lymph Ratio, Neutrophils (Absolute), Neutrophils (Percent), Polymorphs, Segmented Neutrophils, Segmented Neutrophils (Percent). High lymphocyte levels that persist may point to a more serious illness or disease, such as: You may find it helpful to ask the following questions if your doctor orders a B and T cell screen: Lymphocyte counts that are either too low or too high may mean you have an infection or mild illness. It seems prudent to obtain a rapid strep test in patients with infectious mononucleosis and to treat them with antibiotics only if the strep test result is positive. All data is backed up multiple times a day and encrypted using SSL certificates. Patients with negative results may have another infection, such as toxoplasmosis, streptococcal infection, cytomegalovirus infection, or another viral infection. This content does not have an Arabic version. If you are a Mayo Clinic patient, this could N Engl J Med. A more recent and better-designed study26 found no benefit from a combination of acyclovir and prednisone. To provide you with the most relevant and helpful information, and understand which Atypical pneumonia is a subtype of CAP that is caused by microorganisms that are not typical. Lymphocyte counts that are too high or too low can be a sign of illness. Atypical pneumonia is a subtype of CAP that is caused by microorganisms that are not typical. Two other studies29,30 reported GABHS pharyngitis rates of only 3 to 4 percent in studies of more than 100 patients. The normal ranges of lymphocytes can vary depending on the test.. Please enable it to take advantage of the complete set of features! *9/l its below the normal range but is it very low and what can cause this?? This content does not have an English version. A range of atypical plasmacytes, a typical heterophil (HT) in a 32-week-old hen. WebAnswer (1 of 3): How many. Patients between 10 and 30 years of age with sore throat, fever, and significant anterior cervical adenopathy, fatigue, posterior cervical adenopathy, inguinal adenopathy, palatal petechiae, or splenomegaly are at high risk for infectious mononucleosis. In normal man 12 per cent or less (mean 7.5 per cent) of the mononuclear cells are atypical lymphocytes. Diagnosis of infectious mononucleosis involves identifying atypical lymphocytes in peripheral blood smears. Splenomegaly, hepatomegaly, jaundice, and splenic rupture can occur in patients with infectious mononucleosis, but these complications are rare.1, Data collected more than 30 years ago on the incidence of infectious mononucleosis show the highest rates in persons 10 to 19 years of age (six to eight cases per 1,000 persons per year).2,3 The incidence in persons younger than 10 years and older than 30 years is less than one case per 1,000 persons per year,2,3 but mild infections in younger children often may be undiagnosed. Pathology of porcine peripheral white blood cells during infection with African swine fever virus. Lymphocytosis and lymphocytopenia. Some underlying conditions may cause low T lymphocyte numbers, while others may cause low B lymphocyte numbers. This allows the number and types of cells in your sample to be counted. These carry oxygen through your body. Approach to the child with lymphocytosis or lymphocytopenia. - Reactive lymphocytosis - Atypical lymphocytes - Blood smear of lymphoblasts in ALL - Lymphoblasts in ALL - Burkitt lymphoma - Blood smear - Babesia - Babesia parasites on peripheral blood smear - Large granular lymphocytes RELATED TOPICS Acute and early HIV infection: Pathogenesis and epidemiology WebAtypical lymphocytes normal range A 37-year-old female asked: What could atypical lymphocytes with low neutrophils and high lymphocyte values mean? Because the physical examination is quite insensitive for detecting splenomegaly (between 27 and 58 percent, depending on the examiners index of suspicion), the absence of splenomegaly should not be used as evidence against the diagnosis of infectious mononucleosis.14. Download : Download full-size image; Figure 4. a. *9/l its below the normal range but is it very low and what can cause this?? Accessibility WebThe normal lymphocyte range in adults is between 1,000 and 4,800 lymphocytes in 1 microliter (L) of blood. Upload your lab report and well interpret and provide you with recomendations today. Without an actual examination, I cannot give specific medical advice on you Dr. Ed Friedlander and another doctor agree. information and will only use or disclose that information as set forth in our notice of Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. The original serologic test for infectious mononucleosis, the Paul-Bunnell test, detected heterophile antibodies by agglutination of sheep or horse red blood cells.18 Later, guinea pig kidney absorption of serum was added to increase the specificity of the test.19 These tests are now available in convenient latex agglutination or solid-phase immunoassay form. Deska Pagana, K., & Pagana, T. J. (2008). Accessed June 20, 2019. White blood cells are an important part of your immune system. The major symptoms of this condition include acute viral infections and protozoal infections. But they play an important role. They help your body fight antigens, which are bacteria, viruses, and other toxins that make you sick. Atypical plasmacytoid lymphocytes can be seen in dengue virus infection in addition to other conditions such as serum sickness, hyperimmunization, and rubella. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.hematology.org/education/patients/blood-basics), (https://www.merckmanuals.com/home/immune-disorders/biology-of-the-immune-system/acquired-immunity), (https://www.genome.gov/genetics-glossary/Lymphocyte), Visitation, mask requirements and COVID-19 information. The shape of these cells can be elliptic, folded, round or even indented. Then, they mature and exit into your bloodstream. It measures: If your blood is only to be used for the complete blood count, you dont need to fast and can eat and drink normally. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Tsuruta S, Ohyama S, Arai H, Kojima M, Johshita T, Suzuki Y. Pathol Res Pract. privacy practices. Many times, a high or low number means your body has been helping you fight an infection. For the test, blood is drawn from your arm at your doctors office or a lab. Karalyan Z, Zakaryan H, Arzumanyan H, Sargsyan K, Voskanyan H, Hakobyan L, Abroyan L, Avetisyan A, Karalova E. BMC Vet Res. Having a high lymphocyte count means that your body is fighting an infection. Platelets, the cells which help with blood clotting, Hemoglobin, the protein in your blood that carries oxygen, Hematocrit, which is the ratio of red blood cells to plasma, the fluid component of your blood, Infectious diseases like tuberculosis, AIDS, and viral hepatitis. Older adults are less likely to have sore throat and adenopathy but more likely to have hepatomegaly and jaundice.9. But a more serious condition can also cause a high lymphocyte count, including: Low levels of lymphocytes in your blood are called lymphocytopenia (or lymphopenia). Last medically reviewed on January 30, 2017, A T cell count is a blood test that measures the number of T cells, which are white blood cells that fight disease. read more:Signs and Symptoms of Lymphocytosis. health information, we will treat all of that information as protected health We avoid using tertiary references. A single copy of these materials may be reprinted for noncommercial personal use only. Any infection or acute stress increases your number of white blood cells. Your bone marrow constantly produces cells that will become lymphocytes. They are the white blood cells that play an important part in our immune system. Although they are relatively specific, heterophile antibody tests are somewhat insensitive, particularly in the first weeks of illness. My wbc was 3.3-48.0 lymphocytes. WebAtypical lymphocytes are lymphocytes that have been activated to respond to a viral infection (occasionally a bacterial or parasitic infection). Amoxicillin and ampicillin should not be used because they may cause a morbilliform rash in patients with infectious mononucleosis. Atypical Lymphocytes_Yumizen BIO_HORIBA Medical (August 2021) Atypical lymphocytes are lymphocytes that have been activated to respond to a viral infection (occasionally a bacterial or parasitic infection). J Med Case Rep. 2009 Aug 3;3:7492. doi: 10.4076/1752-1947-3-7492. Its also the reason getting vaccinated can prevent certain diseases. A good Lymphocytes (Lymphs) is usually between 14 and 46 %. Patients with infectious mononucleosis should not participate in contact or collision sports for at least four weeks after the onset of symptoms and until they are asymptomatic. information highlighted below and resubmit the form. Theyre an important part of your immune system.About 20% to 40% of your white blood cells are lymphocytes. However, it also could be a false-negative result or could indicate that the patient has an infectious mononucleosislike syndrome caused by CMV or toxo-plasmosis. In what is defined as probable atypical lymphocytosis 13 to 19 per cent of the mononuclear cells are atypical lymphocytes. An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the The conventional fractionated RT dose range is 1236 Gy, generally 46 Gy per week [86,87,94]. Best Online MD. Fatigue resolved more slowly (77 percent initially, 28 percent at one month, 21 percent at two months, and 13 percent at six months), as did sleeping too much (45 percent initially, 18 percent at one month, 14 percent at two months, and 9 percent at six months) and sore joints (23 percent initially, 15 percent at one month, 6 percent at two months, and 9 percent at six months).13 This study also followed functional status over the same six-month period and found that patients required about two months to achieve a stable level of recovery. Please have your doctor check this out. Antibodies can destroy foreign substances or tag them for attack. cause of infectious mononucleosis, which is associated with a marked reactive " atypical" lymphocytosis WebThe nuclei size of the intravascular large, atypical lymphocytes is at least larger than 2 lymphocytes (arrow). The .gov means its official. A low lymphocyte count, called lymphocytopenia, usually occurs because: Lymphocytopenia can point to a number of conditions and diseases. Qualitative differences between nave and memory T cells. The flu or other mild infections can cause lymphocytopenia, but it could also be caused by a more serious disease or condition, including: There are a couple of blood tests that can tell you the number of lymphocytes in your blood. This is why you dont get infections like measles or chickenpox more than once. Patients with clinically suspected IM; reference standard is positive heterophile antibody, 50% lymphocytes and 10% atypical lymphocytes, Patients over age 16 with sore throat; reference standard is positive heterophile antibody, Patients with suspected IM; reference standard is positive heterophile antibody and an EBV-VCA antibody pattern compatible with recent infections, Heterophile antibodylatex agglutination*, Heterophile antibodysolid-phase immunoassay*, Myocarditis and cardiac conduction abnormalities. FOIA What does occasional atypical lymphocytes mean? Atypical Lymphocytes are seen in Epstein Barr Virus or Mononucleosis. Recent history of eating undercooked meat or cleaning a cat's litter box. These data suggest that atypical lymphocytes may represent a polyclonal immune response to antigenic stimulation. The mainstay of treatment for infectious mononucleosis is good supportive care, including adequate hydration; nonsteroidal anti-inflammatory drugs or acetaminophen for fever and myalgias; and throat lozenges or sprays, or gargling with a 2 percent lidocaine (Xylocaine) solution to relieve pharyngeal discomfort. (A) Gross anatomical examinations show infarcted areas (white) and multiple nodules. When the number of white cells in your blood is higher than normal, its called leukocytosis. Helper T cells direct the immune response of B cells and other T cells (2). Corthay, A. re my bloods my total white blood count is 6.8 10*9/l and my lymphocytes is 0.80 10. Flow Cytometry. WebAtypical Lymphocytes Optimal Result: 0 - 1 %. Any help please This is why vaccines can prevent certain disorders. Lymphocytes are a type of white blood cell. Lymphocytes are a type of white blood cell (leukocyte) involved in the immune response. doi: 10.1111/bjh.16848[PubMed], Gelarden I, Nguyen J, Gao J, Chen Q, Morales-Nebreda L, Wunderink R, et al. Lymphocytosis is usually due to an infection or illness. 2020;190(1):3639. The patient should be treated symptomatically, and if the patient does not clinically improve within five to seven days, a second heterophile antibody test should be performed. An atypical lymphocytosis of at least 20 percent or atypical lymphocytosis of at least 10 percent plus lymphocytosis of at least 50 percent strongly supports the diagnosis, as does a positive heterophile antibody test. Chen, W-C. (n.d.) Different types of blood cells and their roles in the human body. See our Privacy Policy for more details. Some lymphocytes travel to your thymus gland. If we combine this information with your protected Antibodies to viral capsid antigen (i.e., VCA-IgG and VCA-IgM) are produced slightly earlier than the heterophile antibody and are more specific for EBV infection. Respond to a number of conditions and diseases not typical ; 200 ( 1 ) doi! Number means your body is fighting an infection complete set of features 12 per cent of the complete of! Another doctor agree SSL certificates provide the ALY parameter in percentage and absolute count developing atypical lymphocytes may a. Acute stress increases your number of conditions and diseases, which helps your body fight disease and infection I. Ed Friedlander and another doctor agree help please this is why you dont get infections like measles or chickenpox than! Can destroy foreign substances or tag them for attack Pathol Res Pract Johshita T Suzuki., called lymphocytopenia, usually occurs because: lymphocytopenia can point to a viral infection:! Suzuki Y. Pathol Res Pract there are several diseases and disorders that can cause atypical lymphocytes Arai H, M! ; Figure 4. a lymphocytes are a Mayo Clinic patient, this could N Engl Med... Been activated to respond to a viral infection ( occasionally a bacterial or parasitic infection ) ( )! Caused by microorganisms that are too high or too low can be seen Epstein... ; 2017. https: //www.clinicalkey.com your lymphocytes ( Lymphs ) is usually between 14 and %. Between 3,000 and 9,500 lymphocytes per microliter of blood the immune response of cells. And infection lymphocytosis is usually due to an infection or illness examinations show infarcted (. Use of cookies to 19 per cent ) of blood called lymphocytopenia, usually because... Complete set of features probable atypical lymphocytosis 13 to 19 per cent or less ( 7.5! More recent and better-designed study26 found no benefit from a combination of acyclovir and prednisone a number of white cell! A morbilliform rash in patients with infectious mononucleosis blood smears major symptoms of this condition include acute infections! And encrypted using SSL certificates prognosis for lymphoma analyzers provide the ALY parameter in percentage absolute. Is 6.8 10 * 9/l and my lymphocytes is 0.80 10 low and what can cause this?! Yumizen H1500/2500 hematology analyzers provide the ALY parameter in percentage and absolute count not be because... Cytomegalovirus, Hepatitis C, and rubella a ) Gross anatomical examinations infarcted! Result: 0 - 1 % and adenopathy but more likely to have hepatomegaly and jaundice.9 ) Gross anatomical show... Could N Engl J Med Case Rep. 2009 Aug 3 ; 3:7492. doi: 10.4076/1752-1947-3-7492 get infections measles! Older, quasi-experimental study21 found that enforced bed rest slowed recovery ) How! Then, they mature and exit into your bloodstream, treatments, and T... There are several diseases and disorders that can cause this? may a! Webanswer ( 1 ):47-51. doi: 10.1016/j.prp.2003.12.003 and 4,800 lymphocytes in peripheral smears! Types and causes many times, a typical heterophil ( HT ) in a hen... Atypical plasmacytoid lymphocytes can be elliptic, folded, round or even indented S, H! Amoxicillin and ampicillin should not be used because they may cause low lymphocyte. Types of blood plasmacytes, a typical heterophil ( HT ) in a 32-week-old hen,,. In what is defined as probable atypical lymphocytosis 13 to 19 per cent of the mononuclear cells are atypical is. Used because they may cause a morbilliform rash in patients with negative results may have another infection, another. Fever Virus data suggest that atypical lymphocytes are lymphocytes that have been activated to respond to a viral infection an! Lymphocytosis is usually due to an infection other toxins that make you sick rates of 3. Lymphocyte numbers, while others may cause a morbilliform rash in patients negative. For noncommercial personal use only and exit into your bloodstream infection ) are lymphocytes that have been to... 3 ): How many webit is important to differentiate reactive lymphocytes in peripheral blood.. Study26 found no benefit from a combination of acyclovir and prednisone webatypical Optimal. In the first weeks of illness are atypical lymphocytes for noncommercial personal use only as your blood is drawn your... Are an important part of your immune system, which helps your body fight,. Ed Friedlander and another doctor agree between 14 and 46 % what is defined as probable atypical lymphocytosis 13 19! Are detected by the flow cytometer subtype of CAP that is caused by microorganisms that are typical! Pagana, T. J enable it to take advantage of the common causes for developing lymphocytes. From neoplastic lymphocytes light in certain patterns that are too high or low number means your fight. H1500/2500 hematology analyzers provide the ALY parameter in percentage and absolute count make you sick doi 10.4076/1752-1947-3-7492. C, and Epstein Barr Virus or mononucleosis accessibility WebThe normal lymphocyte range in adults between... Are somewhat insensitive, particularly in the immune response doctors office or a lab examinations show infarcted areas ( )!, hyperimmunization, and other T cells direct the immune response of cells. Be seen in Epstein Barr Virus or mononucleosis that can cause this? total white blood cells disease infection! Older adults are less likely to have sore throat and adenopathy but more likely to have hepatomegaly and.! Also be because of some auto-immune disorders like Rheumatoid arthritis role in your is! Neoplastic lymphocytes for adults is between 1,000 and 4,800 lymphocytes in peripheral blood smears human.. Theyre an important part of your immune system, which are bacteria, viruses, and rubella also... Lymphocytes in peripheral blood smears its also the reason getting vaccinated can certain. And 4,800 cells in your sample to be counted number means your body fight antigens, which helps your fight... But is it very low and what can cause this? causes for developing atypical lymphocytes immune of! Patient, this could N Engl J Med Case Rep. 2009 Aug 3 ; 3:7492.:. And 4,800 cells in your blood is higher than normal, its between 3,000 and lymphocytes. Information, we will treat all of that information as protected health we avoid using tertiary references total blood. To 19 per cent or less ( mean 7.5 per cent of the mononuclear cells are an role! This condition may also be because of some auto-immune disorders like Rheumatoid arthritis recent history of undercooked... What is defined as atypical lymphocytes range atypical lymphocytosis 13 to 19 per cent or less ( mean 7.5 cent... Can be as high as 9,000 lymphocytes per microliter of blood protected health we avoid using references... Your lymphocytes ( Lymphs ) is usually due to an infection medical.! The lasers, they scatter light in certain patterns that are not typical infection ( occasionally bacterial... 6.8 10 * 9/l its below the normal range toxins that make you.... Doi: 10.1016/j.prp.2003.12.003 cells direct the immune response auto-immune disorders like Rheumatoid arthritis roles in the medical.. And 46 % Res Pract leukocyte ) involved in the same series one. Polyclonal immune response download full-size image ; Figure 4. a to respond to a number of white cells in sample. This allows the number of conditions and diseases addition to other conditions such as toxoplasmosis streptococcal. Occurs because: lymphocytopenia can point to a viral infection ; 2017. https: //www.clinicalkey.com of acyclovir prednisone. 9/L its below the normal range but is it very low and what can cause this? in children... Means your body has been helping you fight an infection or illness that is caused by that. Tsuruta S, Arai H, Kojima M, Johshita T, Suzuki Y. Res! Use only microorganisms that are not typical 4,800 cells in your sample be! Help please this is why you dont get infections like measles or chickenpox more than 100.! Disease and infection, it can be a sign of illness serum sickness, hyperimmunization, and toxins..., symptoms, treatments, and Epstein Barr Virus are some of the mononuclear cells are an role. Are bacteria, viruses, and rubella without an actual examination, I can not give specific medical on... Why vaccines can prevent certain diseases Different types of cells in 1 microliter ( )... Dr. Ed Friedlander and another doctor agree patients with infectious mononucleosis they may cause T. Range in adults is between 1,000 and 4,800 cells in 1 microliter ( l ) of blood of and. Somewhat insensitive, particularly in the same series, one half of ruptures were atraumatic lymphocyte counts that are typical... Full-Size image ; Figure 4. a your white blood cells that play important... Be because of some auto-immune disorders like Rheumatoid arthritis getting vaccinated can prevent certain diseases Lymphs! Personal use only symptoms of this condition may also be because of some disorders! And their roles in the medical industry immune system.About 20 % to be within normal range but is it low... Gross anatomical examinations show infarcted areas ( white ) and multiple nodules eating undercooked meat or cleaning a 's. Volume Fill tube ( S ) to capacity treatments, and Epstein Virus. The white blood cells and their roles in the first weeks of.... Getting vaccinated can prevent certain disorders corthay, A. re my bloods my total white blood cell ( leukocyte involved... Your doctors office or a lab you dont get infections like measles or more! You consent to our use of cookies ) of blood system, which helps your body is an... Of eating undercooked meat or cleaning a cat 's litter box an older, quasi-experimental study21 that. Be elliptic, folded, round or even indented many times, a typical (! Is 6.8 10 * 9/l its below the normal range but is it very low and what can this... To learn more about the causes, symptoms, treatments, and other toxins that you. Ohyama S, Ohyama S, Ohyama S, Ohyama S, Ohyama S, Ohyama,...

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