Ordinary Red Platelets - Fringe Blood Smear - PowerPoint PPT Presentation

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Ordinary Red Platelets - Fringe Blood Smear PowerPoint Presentation
Ordinary Red Platelets - Fringe Blood Smear

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Ordinary Red Platelets - Fringe Blood Smear

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  1. Normal Red Blood Cells - Peripheral Blood Smear

  2. 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

  3. 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).

  4. Hypochromic Microcytic Anemia (iron deficiency)

  5. 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).

  6. Koilonychia - Iron Deficiency

  7. Macroovalocytes and Hypersegmented Neutrophil

  8. 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

  9. Bone marrow -- Megaloblastic anemia -- nuclear/cytoplasmic asynchrony,

  10. Markedly hypocellular BM - Aplastic Anemia

  11. Breast cancer replacing BM

  12. Spherocytes Lab: moderate anemia, spherocytes, reticulocytes BM - erythroid hyperplasia Coomb’s test - negative

  13. Hemoglobin Precipitates -- Heinz bodies G6PD Deficiency

  14. Bite Cell -- G6PD Deficiency Clinical? X linked, African American Males, only symptomatic during oxidative stress (meds, fava beans)

  15. Sickle Cells -- Clinical stuff: microvascular occulusions lead to tissue infarcts and pain, autosplenectomy (so no splenomegaly), increased Salmonella osteomyelitis, some aplastic crises (Parvovirus)

  16. 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.

  17. Mechanical trauma -- schistocytes

  18. Malaria in RBCs -- most common hemolytic anemia Cyclical hemolysis produces fever and chills, splenomegaly

  19. Activated neutrophil - Dohle body

  20. Leukemoid reaction (toxic granulation)

  21. Reactive Lymphocyte - Infectious Mononucleosis

  22. 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.

  23. Bone Marrow, Acute Leukemia Age distributions? ALL -- kids (4 yrs peak incidence) AML -- Adults

  24. Bone marrow acute leukemia Symptoms? Fatigue (Anemia), Bleeding (thrombocytopenia), Bone pain, infections, masses, CNS symptoms

  25. Lympoblasts -- ALL Diagnostic criteria? 30+% lymphoblasts in BM, Tdt+, MPO-

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

  27. Myeloblasts -- myeloperoxidase positive

  28. Acute Promyelocytic Leukemia (FAB - M3) Hypergranular promyelocytes, more Auer rods, DIC from tissue thromboplastin, tx w/retinoic acid

  29. Monoblasts -- Acute Myelogenous Leukemia (M5), nonspecific esterase

  30. Non-specific esterase + monoblasts (left) negative control (right)

  31. Chronic Myeloid Leukemia Features? WBC>50,000 with 80% immature, Philadelphia chromosome

  32. Chronic Myeloid Leukemia bone marrow Clinical Course? Slow progressive and then blast phase (80%)

  33. Essential Thrombocythemia - Bone marrow with greatly increased numbers of megakaryocytes

  34. Myeloid metaplasia with myelofibrosis - Bone marrow fibrosis

  35. Reactive lymphadenitis - Follicular hyperplasia

  36. Reactive lymphadenitis - Sinus histiocytosis

  37. Necrotizing lymphadenitis - high power

  38. Cat Scratch Disease - Bartonella henselae bacteria

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

  40. Follicular lymphoma - lots of follicles, B cells, common in Europe and America, adults 40+yoa

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

  42. Mycosis fungoides - Sezary Syndrome, T cell lymphoma Early skin lesions (left); Skin plaques (right)

  43. Mycosis Fungoides - Sezary cells in blood (right); Pautrier abcess in skin (left)

  44. Mycosis fungoides - Sezary cells

  45. Burkitt’s Lymphoma -- starry sky pattern due to macros Endemic type in Tropical Africa

  46. Burkitt’s Lymphoma -- B cells, EBV associated, myc translocated t(8;14)

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

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

  49. Reed-Sternberg cell -- owl eyes -- Hodgkin’s Disease