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Normal Red Blood Cells - Peripheral Blood Smear - PowerPoint PPT Presentation


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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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slide2

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

slide3

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).

slide5

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).

slide8

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

slide12

Spherocytes

Lab: moderate anemia, spherocytes, reticulocytes

BM - erythroid hyperplasia

Coomb’s test - negative

slide14

Bite Cell -- G6PD Deficiency

Clinical?

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

slide15

Sickle Cells -- Clinical stuff:

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

slide16

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.

slide18

Malaria in RBCs -- most common hemolytic anemia

Cyclical hemolysis produces fever and chills, splenomegaly

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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.

slide23

Bone Marrow, Acute Leukemia Age distributions?

ALL -- kids (4 yrs peak incidence)

AML -- Adults

slide24

Bone marrow acute leukemia Symptoms?

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

slide25

Lympoblasts -- ALL

Diagnostic criteria?

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

slide26

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

slide28

Acute Promyelocytic Leukemia (FAB - M3)

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

slide31

Chronic Myeloid Leukemia Features?

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

slide32

Chronic Myeloid Leukemia bone marrow

Clinical Course?

Slow progressive and then blast phase (80%)

slide33

Essential Thrombocythemia - Bone marrow with greatly

increased numbers of megakaryocytes

slide39

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

slide41

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

slide42

Mycosis fungoides - Sezary Syndrome, T cell lymphoma

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

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Mycosis Fungoides -

Sezary cells in blood (right);

Pautrier abcess in skin (left)

slide48

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

slide49

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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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.

slide55

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

slide56

Electronmicrographs of a Hairy Cell

transmission EM (left); scanning EM (right)

slide57

Multiple Myeloma

Stained gel

image

Albumin

Tracing of

serum protein

electrophoresis -

abnormal

M spike

2

1

slide60

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

Symptoms?

Bone pain, pathologic fractures, hypercalcemia, anemia, amyloidosis

slide62

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