Color Atlas of Hematology - Practical Microscopic and Clinical ...

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90Abnormalities of the White Cell SeriesAcute LeukemiasAcute leukemias are described in this place for morphological reasons, becausethey involve a predominance of mononuclear cells (p. 63). Although—orperhaps because—the term “leukemia” is relatively imprecise,an overview seems required (Table 13).The cellular phenomenon common to the different forms of leukemia isthe rapidly progressive reduction in numbers of mature granulocytes,thrombocytes, and erythrocytes. Simultaneously, the leukocyte countusually increases due to the occurrence of atypical round cells.Table 13Overview of all forms of leukemiaType of leukemiaClassification/clinical findingsAcute leukemias (ALAML, ALL)– Myeloid M 0-7 (incl. monocytic, erythroid,megakaryoblastic leukemias)Always acute disease, often withfever and tendency to hemorrhage– Lymphocytic There may be lymphoma and thymusinfiltratesChronic myeloid leukemia (CML)– Persistent leukemic diseases of themyeloproliferative system (p. 114)Chronic lymphocytic leukemia (CLL)and other leukemic lymphomas– B-CLL (90%), T-CLL (p.74 f.)– Prolymphocytic leukemia (p.77)– Hairy cell leukemia (p.80)Chronic disease, usually withsplenomegaly– Chronic lymphocytic leukemia,(rarely) prolymphocyticleukemia and hairy cell leukemiaare primary leukemic lymphomaswith a chronic course.All other non-Hodgkin lymphomascan develop secondaryleukemic diseaseChronic myelomonocytic leukemia(CMML)– Leukemic form of myelodysplasia(p.106) is classified betweenmyelodysplasia and myeloproliferativediseasesSubacute disease with transitionsinto acute forms of myeloidleukemia (secondary AML followingMDS)
Predominance of Mononuclear Round to Oval Cells91Note that in about one-fourth of all leukemias total leukocyte counts arenormal, or even reduced, and the atypical round cells affect only the relative(differential) blood analysis (“aleukemic leukemia”).In all forms of leukemia, the more fluffy layered areas of a smear show thatthe nuclear chromatin structure is not dense and coarse, as in a normallymphocyte nucleus (p. 49), but more delicately structured and irregular,often “sand-like”. A careful blood cell analysis should be carried out—perhapswith the assistance of a specialist laboratory—before bone marrowanalysis is performed.In most cases, the high leukocyte count facilitates the diagnosis ofleukemia. Apart from the leukemia-specific blast cells, a variable numberof segmented neutrophilic granulocytes may also remain, depending onthe disease progression at the time of diagnosis. This gap in the cell seriesbetween blasts and mature cells is called “leukemic hiatus.” It is found inALL but not in reactive responses or chronic myeloid leukemia, whichshow a continuous left shift. Morphological or differential diagnosis ofacute leukemia is followed by the diagnostic work-up that continues withcytochemical tests. Immunological identification of leukemia cells is alwaysindicated (Table 14).Diagnostic work-up when acute leukemia is suspected:CBC, cytochemistry, bone marrow. Collection of material to identify cellsurface markers, cytogenetics, molecular genetics.Morphological and Cytochemical Cell IdentificationAfter a first-line diagnosis of acute leukemia has been arrived at on thebasis of the cell morphology (see above), the diagnosis must be refined bycytochemical testing of blood cells or bone marrow (on fresh smears).Table 14 shows a leukemia classification based on both morphological andcytochemical criteria. The table shows that a peroxidase test allowsleukemias to be classified as peroxidase-positive (myeloid or monocytic)or peroxidase-negative (lymphoblastic). The next step is the immunologicalclassification based on cell markers.In routine clinical hematology, the FAB classification (Table 14) will bewith us for a few more years.
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Normal Cells of the Blood andHemato
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Normally erythropoiesis takes place
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34Normal Cells of the Blood and Hem
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36Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
Page 54 and 55: 44Normal Cells of the Blood and Hem
Page 71 and 72: Abnormalities of the White Cell Ser
Page 73 and 74: Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 85 and 86: Monotonous proliferation of small l
Page 87 and 88: Atypical lymphocytes are not part o
Page 89 and 90: Deep nuclear indentation suggests f
Page 91 and 92: Cytoplasmic processes the main feat
Page 93 and 94: Plasmacytoma cannot be diagnosed wi
Page 95 and 96: Atypias and differential diagnoses
Page 97 and 98: Bone marrow diagnosis is indicated
Page 99: Conspicuously large numbers of mono
Page 107 and 108: Fundamental characteristic of acute
Page 109 and 110: The diagnosis of acute leukemia is
Page 111 and 112: Acute leukemias may also derive fro
Page 113 and 114: New WHO classification: AML with dy
Page 115 and 116: The cells in acute lymphocytic leuk
Page 117 and 118: In unexplained anemia and/or leukoc
Page 119 and 120: The classification of myelodysplasi
Page 121 and 122: Prevalence of Polynuclear (Segmente
Page 123 and 124: Predominance of the granulocytic li
Page 125 and 126: Prevalence of Polynuclear (Segmente
Page 127 and 128: Left shift as far as myeloblasts, p
Page 129 and 130: Bone marrow analysis is not obligat
Page 131 and 132: In the course of chronic myeloid le
Page 133 and 134: Enlarged spleen and presence of imm
Page 135 and 136: Eosinophilia and basophilia are usu
Page 137 and 138: Erythrocyte and ThrombocyteAbnormal
Page 139 and 140: Hypochromic Anemias129Insufficient
Page 141 and 142: Hypochromic Anemias131BSGIron Ferri
Page 143 and 144: Small, hemoglobin-poor erythrocytes
Page 145 and 146: Hypochromic erythrocytes of very va
Page 147 and 148: Hypochromic Anemias137Hypochromic S
Page 149 and 150: Hypochromic anemia without iron def
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Consistently elevated “young” e
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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Unexplained decrease in cell counts
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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Conspicuous large erythrocytes sugg
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In older patients, myelodysplastic
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Small inclusions are usually a sign
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PlasmodiumfalciparumPlasmodiumvivax
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Conspicuous erythrocyte inclusions
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Bone marrow analysis contributes to
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Thrombocytes: increases, reductions
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Thrombocytes: increases, reductions
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Variant forms of thrombocyte and me
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Thrombocyte proliferation with larg
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Cytology of Organ Biopsiesand Exuda
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Lymph Node Cytology175Anamnesis- su
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Reactive lymph node hyperplasia and
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Lymph Node Cytology179Contact witha
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Epithelioid cells dominate the lymp
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In cases of non-Hodgkin lymphoma an
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Accessible cysts (e.g., branchial c
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Tumor cells can be identified in pl
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Viral, bacterial, and malignant men
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191IndexAActinomycosis 179Addison d
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Index193Disseminated intravascularc
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Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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