MLSP 5214 Final practical notes/study

myelocyte notes

confused w/ monocytes

- myelocyte = pink cytoplasm

- monocyte = blue cytoplasm

usually in BM, presence in PB = left shift

- assoc w infection (bacterial), sepsis, CML

You think you saw an immature micromegakaryocyte?

- SIZE! in comp to other cells

- HAVE to see abnormal plt morphologies

- blebs + perinuclear blue granules

You think you saw immunoblast?

- radial basophilia

-- streaks of basophilia

- remember:

immunoblast --> plasma cell

NO stretched chromatin

increased in lympho-prolif

- viral illness like infectious mono, hepatitis

Immature basophilia notes

can see nucleus most of the time

- can't in a mature basophil

Target cells associated with

in hypo/micro = beta thalassemia (hgbinopathies), IDA

in macro = liver disease

sideroblastic anemia

RBC fragments + normo/normo =

Hemolytic anemia, DIC, other microangiopathic (TTP), HUS

Spherocytes associated with

RBC spheres containing more than normal amounts of hgb

seen in:

- AIHA

-- Ab-mediated hemolysis

- DIC

- hereditary spherocytosis (defect in spectrin)

- some infections (lecithinase bacteria like C. perfringens)

-- lecithin is apart of RBC membrane

treatment: splenectomy

Helmet cell associated with

blister rupture of membrane

- G6PD deficiency

- pulmonary embolism

Teardrops associated with

squeezing of RBCs, crowded BM or spleen

- splenomegaly

- MDS

- Severe anemia

- Fibrosis

Echinocytes associated with

aka burr cells. grooves in perimeter, osmotic imbalance

- usually drying artifact

- kidney and liver disorders

-- HUS (Shiga toxin from E. coli)

- dehydration

- HUS (Shiga toxin from E. coli)

- severe burns, gastric ulcers

Acanthocytes associated with

spikes. liver disease, lipid defects, loss of membrane changes (micro, no pallor)

- cirrhosis, hepatitis, alcoholism

Bite cells associated with

heinz body (hgb remnants) removed by spleen

- thalassemia

- G6PD def

Elliptocyte associated with

- hereditary elliptocytosis

- thalassemia

- IDA (early)

ovalocytes associated with

- macrocytic anemia

- hypersegmented neus

- B12 or folic acid deficiency

- malabsorption, intrinsic factor def, dietary def

Gaucher disease

glucocerebrosidase def. = ↑ glucocerebroside

- crumpled tissue paper look

- hepatosplenomegaly

May-Hegglin Anomaly

- neutrophils have blue-staining inclusions that resemble Dohle bodies

- thrombocytopenia

- giant abnormal platelets

Alder-Reilly Anomaly

a mucopolysaccharidosis

- every leukocyte seen exhibits dense, basophilic coarse granulation

Chediak-Higashi syndrome

- defect in microtubule polymerization

- infection prone

- Giant granules in neutrophils

- oculocutaneous albinism

Niemann-Pick disease

Sphingomyelinase deficiency = increase sphingomyelin

RBC nuclei contain sphingomyelin

Mucopolysaccharidoses present as

inclusions with halo in lymphocytes

neurological disability

Smudge cells associated with

chronic lymphocytic leukemia (CLL)

- only in PB

- any cell thats partially ruptured

An increase in eosinophils or hybrid eos-baso cells in BM vs PB

BM = inv(16)

PB = CML

Pseudo Chediak-Higashi granules

seen in any leukemia

- usually wherever Auer rods are (AML)

Acute promyelocytic leukemia (APL)

promyelocytes with intracytoplasmic Auer rods

- clefted nucleus (hourglass-shape)

- can be hypogranular

Hairy Cell Leukemia

Neoplastic proliferation of mature B cells in BM

- cells have filaments, making them look hairy

- affects spleen, BM tap usually dry

- monocytopenia

- CD19, 20, 25!, 103!

Sezary syndrome

leukemic phase of cutaneous T-cell lymphoma (mycosis fungoides)

looks like clover leaves

- itchy RASH

- CD4 (T helper)

- CD3, 7, 2!

Acute Lymphocytic Leukemia (ALL)

immature lymphocytes predominate

- kids, sudden onset

smaller lymphos, can get into spinal fluid easier

lymphoblasts = malignant

Pelger-Huet anomaly vs. pseudo Pelger-Huet

inherited, bi-lobed neutrophils in PB

- benign condition with no clinical manifestations

Pseudo Pelger Huet = only some neutrophils have bilobed nuclei

- a toxic change

- assoc w toxic granulation, degranulation, left shift, MDS, etc.

Epstein Syndrome

splenomegaly, thrombocytopenia, prolonged bleeding time, giant platelets with abnormal structure

Diseases associated with abnormally large platelets

Epstein syndrome

Bernard-Soulier

Bernard-Soulier syndrome

genetic GPIB deficiency; platelet ADHESION impaired

- thrombocytopenia with enlarged platelets (enlarged bc more immature)

Dimorphic blood picture

two pop of size and color

- sideroblastic anemia: hypo/micro and normo

- treated IDA: transfused RBC and pt RBCs

Howell-Jolly bodies

nucleus remnants

- post-splenectomy (or nonfunctional spleen), usually seen with nRBCs

- splenomegaly

Basophilic stippling associated with

Lead Poisoning

Thalassemias

Anemia of Chronic Disease

coarse stippling = pappenheimer, sideroblastic anemia

Hypochromasia

low hgb conc

- low MCHC

IDA, megaloblastic anemia, thalassemias

Polychromasia

immature RBCs, bluish-purple

few = normal

increase = excess demand OR recovery from deficiency

Rouleaux associated with

multiple myeloma (plasma cells)

Agglutination associated with

cold agglutinins disease

mast cells

found in the CT of the dermis

respond to injury, infection, or allergy by producing and releasing substances

- including heparin and histamine

seen in sideroblastic anemia in tissues

Immune Thrombocytopenic Purpura (ITP)

Autoimmune platelet destruction

- thrombocytopenia

platelet satellitism, edta platelet clumping

Pseudothrombocytopenia

Primary Myelofibrosis (PMF)

NRBCs and early granulocyte progenitors = leukoerythroblastosis + basophilia

Teardrop-shaped RBC's (dacryocytes)

cells damaged during the birthing process in the fibrotic marrow

Heinz body vs. Howell-Jolly body

Heinz - G6PD deficiency

Howell-Jolly - asplenia

Ehrlichiosis

Obligate intracellular pathogens of host phagocytes

bruising and petechiae

-Cytoplasmic inclusions

- leuko and thrombocytopenia

Ehrlichia chaffeensis causes human monocytic ehrlichiosis (HME)

Cabot ring associated with

miotic spindles

- megaloblastic anemia

- thalassemia

- post-splenectomy

sickle cell due to

polymerizations due to amino acid substitution

Stomatocytes associated with

usually artifact

- alcoholism

- ion pump defects

- malignancies

Sudan Black B (SBB)

only pos rxn is significant

- strongly pos = auer rod = AML not ALL

Periodic acid-Schiff (PAS)

malignant erythroid precursor = strongly pos

Fagg*t cell

cells that contain many auer rods

- freq found in PML, t(15:17)