Leukemia and Lymphoma Lecture Notes

Leukemia and Lymphoma

Cell Types

• Atypical Lymphocytes: Important in diagnosing leukemia and lymphoma.

Key Features for Identifying Abnormal White Blood Cells (WBCs)

1. Size of Nucleus

• Abnormal WBCs exhibit differing sizes in their nuclei as compared to normal cells.

2. Nuclear Cytoplasm (N:C) Ratio

• Normal N:C Ratio: Indicates health of the cell.
• Abnormal N:C Ratio: Can either be decreased or increased based on the cell type.
  • Small decrease observed in atypical cells.
  • Large increase indicates abnormality.

3. Color

• Cytoplasm Color:
  • Normal: Pinkish-Purple.
  • Abnormal: Bluish tint in atypical lymphocytes.

4. Presence of Granules

• Azurophilic Granules:
  • Presence indicates abnormality, except in blasts (immature cells).
• Specific Granules:
  • Their presence tends to be absent in atypical cells except in monocytes.

5. Presence of Nucleoli

• Nucleoli in Abnormal Cells: Indicates active maturation process in the cell.
• Nucleoli in Normal Cells: Indicates regular size as per healthy cellular structure.

How to Perform a Differential Count

1. Counting Adult WBCs: Count 100 WBCs in total and identify them as either mature or immature.
2. Counting RBC Morphology: Analyze RBC morphology and inclusions in 10 different fields at the feather edge of the slide.
3. Platelets Count:
   • Count the platelets across all 10 fields.
   • Platelet Estimate Formula:
     • $ext{Average of 10 fields count} imes 20,000$.

RBC Inclusions

Types of Inclusions

• Normal: All inclusions must be identified within normal cells (both WBCs and RBCs).
• Abnormal: All inclusions observed are considered abnormal.
• RBC inclusions include:
  • a) Howell-Jolly bodies
  • b) Pappenheimer bodies
  • c) Basophilic stippling
  • d) Cabot rings
  • e) Malarial parasites
  • f) Nucleated RBCs (NRBC)
  • g) Heinz bodies

WBC Inclusions

• Found solely in neutrophils (band or segmented):
  • Toxic granulation (indicative of bacterial infection).
  • Döhle bodies (associated with infections).
  • Toxic vacuoles.
  • If toxic granulation is present alone (without other inclusions), classify as old cell.
• Chronic Infection Indicator:
  • If viral infection is present alongside toxic granulation, classify as a chronic bacterial infection.

Abnormal Cells and Stages of Development

Myeloblast Series

• Types of Myeloblasts:
  • Myeloblast
  • Promyelocyte
  • Myelocyte
  • Metamyelocyte
  • Band cell
  • Segmented neutrophil

Granular Abnormal Promyelocyte

• Characteristics:
  • Exhibits basophilic cytoplasm.
  • Shows fine azurophilic granulation.
  • Absence of significance of azurophilic granulation can exist.

Additional Notes

Society and Institutions

• Refers to professional bodies like the American Society of Hematology and institutions involved in hematology education.
• Inclusion of resources, such as Kyoto University and the Wadsworth Center, implies the academic underpinnings in hematological research and education.