Normal Red Blood Cells - Peripheral Blood Smear
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Normal Red Blood Cells - Peripheral Blood Smear. Peripheral Blood Cells. A. Erythrocytes; B. Large Granular Lymphocyte; C. Neutrophil; D. Eosinophil; E. Neutrophil; F. Monocyte; G. Platelets; H. Lymphocyte; I. Band Neutrophil; J. Basophil.

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PowerPoint Slideshow about 'Hematology' - daniel_millan


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Peripheral Blood Cells

A. Erythrocytes; B. Large Granular Lymphocyte; C. Neutrophil; D. Eosinophil;

E. Neutrophil; F. Monocyte; G. Platelets; H. Lymphocyte; I. Band Neutrophil; J. Basophil


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The red blood cells here are normal, happy RBC's. They have a zone of central pallor about 1/3 the size of the RBC. The RBC's demonstrate minimal variation in size (anisocytosis) and shape (poikilocytosis).



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The RBC's here are smaller than normal and have an increased zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).


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Koilonychia - Iron Deficiency zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).


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Macroovalocytes and Hypersegmented Neutrophil zone of central pallor. This is indicative of a hypochromic (less hemoglobin in each RBC) microcytic (smaller size of each RBC) anemia. There is also increased anisocytosis (variation in size) and poikilocytosis (variation in shape).


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Here is a hypersegmented neutrophil that is present with megaloblastic anemias. There are 8 lobes instead of the usual 3 or 4. Such anemias can be due to folate or to B12 deficiency. The size of the RBC's is also increased





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Spherocytes asynchrony,

Lab: moderate anemia, spherocytes, reticulocytes

BM - erythroid hyperplasia

Coomb’s test - negative


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Hemoglobin Precipitates asynchrony, -- Heinz bodies G6PD Deficiency


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Bite Cell -- G6PD Deficiency asynchrony,

Clinical?

X linked, African American Males, only symptomatic during oxidative stress (meds, fava beans)


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Sickle Cells -- Clinical stuff: asynchrony,

microvascular occulusions lead to tissue infarcts and pain, autosplenectomy (so no splenomegaly), increased Salmonella osteomyelitis, some aplastic crises (Parvovirus)


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Sickle cell anemia in sickle cell crisis. The abnormal hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.


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Mechanical trauma -- schistocytes hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.


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Malaria in RBCs -- most common hemolytic anemia hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.

Cyclical hemolysis produces fever and chills, splenomegaly


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Activated neutrophil - Dohle body hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.


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Leukemoid reaction (toxic granulation) hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.


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Reactive Lymphocyte - Infectious Mononucleosis hemoglobin SS is crystalizes when oxygen tension is low, and the RBC's change shape to long, thin sickles that sludge in capillaries, further decreasing blood flow and oxygen tension. Persons with sickle cell trait (Hemoglobin AS) are much less likely to have this happen.


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Normal bone marrow. Note the presence of megakaryocytes, erythroid islands, and granulocytic precursors. This marrow is taken from the posterior iliac crest in a middle aged person, so it is about 50% cellular, with steatocytes mixed with the marrow elements.


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Bone Marrow, Acute Leukemia Age distributions? erythroid islands, and granulocytic precursors. This marrow is taken from the posterior iliac crest in a middle aged person, so it is about 50% cellular, with steatocytes mixed with the marrow elements.

ALL -- kids (4 yrs peak incidence)

AML -- Adults


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Bone marrow acute leukemia Symptoms? erythroid islands, and granulocytic precursors. This marrow is taken from the posterior iliac crest in a middle aged person, so it is about 50% cellular, with steatocytes mixed with the marrow elements.

Fatigue (Anemia), Bleeding (thrombocytopenia), Bone pain, infections, masses, CNS symptoms


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Lympoblasts -- ALL erythroid islands, and granulocytic precursors. This marrow is taken from the posterior iliac crest in a middle aged person, so it is about 50% cellular, with steatocytes mixed with the marrow elements.

Diagnostic criteria?

30+% lymphoblasts in BM, Tdt+, MPO-


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AML -- myeloblasts with Auer Rod, worse prognosis than ALL, allogenic Bone Marrow Transplant curative


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Myeloblasts -- myeloperoxidase positive allogenic Bone Marrow Transplant curative


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Acute Promyelocytic Leukemia (FAB - M3) allogenic Bone Marrow Transplant curative

Hypergranular promyelocytes, more Auer rods, DIC from tissue thromboplastin, tx w/retinoic acid



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Non-specific esterase + monoblasts (left) esterase

negative control (right)


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Chronic Myeloid Leukemia Features? esterase

WBC>50,000 with 80% immature, Philadelphia chromosome


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Chronic Myeloid Leukemia bone marrow esterase

Clinical Course?

Slow progressive and then blast phase (80%)


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Essential Thrombocythemia - Bone marrow with greatly esterase

increased numbers of megakaryocytes






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Cat Scratch Disease - esteraseBartonella henselae bacteria


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Reactive lymphocytes - Infectious Mononucleosis -- Tcells proliferate, but B cells are infected



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Follicular lymphoma, usually diagnosed at a high stage, when bone marrow is involved, angular cells = cleaved cells


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Mycosis fungoides - Sezary Syndrome, T cell lymphoma bone marrow is involved, angular cells = cleaved cells

Early skin lesions (left); Skin plaques (right)


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Mycosis Fungoides - bone marrow is involved, angular cells = cleaved cells

Sezary cells in blood (right);

Pautrier abcess in skin (left)


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Mycosis fungoides - Sezary cells bone marrow is involved, angular cells = cleaved cells


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Burkitt’s Lymphoma -- starry sky pattern due to macros bone marrow is involved, angular cells = cleaved cells

Endemic type in Tropical Africa



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Hodgkins’ Disease -- cervical and mediastinal lymphadenopathy, spreads sequentially along lymph node chain, adolescents and older adults


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Hodgkin’s disease -- Nodular Sclerosis type, most common subtype, dense band s of collagen/fibrosis, few Reed-Sternberg cells, young adult females


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Reed-Sternberg cell -- owl eyes -- Hodgkin’s Disease subtype, dense band s of collagen/fibrosis, few Reed-Sternberg cells, young adult females


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Chronic Lymphocytic Leukemia - little cytoplasm subtype, dense band s of collagen/fibrosis, few Reed-Sternberg cells, young adult females


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These mature lymphocytes are increased markedly in number. They are indicative of chronic lymphocytic leukemia, a disease most often seen in older adults. This disease responds poorly to treatment, but it is indolent.


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CLL smudge cell They are indicative of chronic lymphocytic leukemia, a disease most often seen in older adults. This disease responds poorly to treatment, but it is indolent.


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CLL bone marrow They are indicative of chronic lymphocytic leukemia, a disease most often seen in older adults. This disease responds poorly to treatment, but it is indolent.


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Hairy cell leukemia -- single light chain expressed, (CD19 or CD20), TRAP positive, splenomegaly, pancytopenia, usually older males


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Electronmicrographs of a Hairy Cell or CD20), TRAP positive, splenomegaly, pancytopenia, usually older males

transmission EM (left); scanning EM (right)


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Multiple Myeloma or CD20), TRAP positive, splenomegaly, pancytopenia, usually older males

Stained gel

image

Albumin

Tracing of

serum protein

electrophoresis -

abnormal

M spike

2

1


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Multiple Myeloma -- Rouleaux or CD20), TRAP positive, splenomegaly, pancytopenia, usually older males



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Plasma cell myeloma, large cytoplasm, IL-6 mediated effects,

Symptoms?

Bone pain, pathologic fractures, hypercalcemia, anemia, amyloidosis



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Plasmacytoma -- solid tumor of plasma cells, osseous usually vertebral, soft tissue usually upper respiratory tract


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