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

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96 Abnormalities of the White Cell SeriesAcute Myeloblastic Leukemia (Type M 0 through M 2 in the FAB Classification).Morphologically, the cell populations that dominate the CBC andbone marrow analyses (Fig. 31) more or less resemble myeloblasts in thecourse of normal granulopoiesis. Differences may be found to varyingdegrees in the form of coarser chromatin structure, more prominently definednucleoli, and relatively narrow cytoplasm. Compared with lymphocytes(micromyeloblasts), the analyzed cells may be up to threefold larger.In a good smear, the transformed cells can be distinguished from lymphaticcells by their usually reticular chromatin structure and its irregularorganization. Occasionally, the cytoplasm contains crystalloid azurophilicneedle-shaped primary granules (Auer bodies). Auer bodies (rods) areconglomerates of azurophilic granules. A few cells may begin to displaypromyelocytic granulation. Cytochemistry shows that from stage M 1 onward,more than 3% of the blasts are peroxidase-positive.Characteristics of Acute LeukemiasAge of onset: Any age.Clinical findings: Fatigue, fever, and signs of hemorrhage in laterstages.Lymph node and mediastinal tumors are typical only in ALL.Generalized involvement of all organs (sometimes including themeninges) is always present.CBC and laboratory: Hb , thrombocytes , leukocytes usuallystrongly elevated (~ 80%) but sometimes decreased or normal.In the differential blood analysis, blasts predominate (morphologiesvary).Beware: Extensive urate accumulation!Further diagnostics: Bone marrow, cytochemistry, immunocytochemistry,cytogenetics, and molecular genetics.Differential diagnosis: Transformed myeloproliferative syndrome(e.g., CML) or myelodysplastic syndrome.Leukemic non-Hodgkin lymphomas (incl. CLL).Aplastic anemias.Tumors in the bone marrow (carcinomas, but also rhabdomyosarcoma).Course, therapy: Usually rapid progression with infectious complicationsand bleeding.Immediate efficient chemotherapy in a hematology facility; bonemarrow transplant may be considered, with curative intent.
Fundamental characteristic of acute leukemia: variable blastsdrive out other cell seriesabcdFig. 31 Acute leukemia, M 0–M 2. a Undifferentiated blast with dense, fine chromatin,nucleolus (arrow), and narrow basophilic cytoplasm without granules. Thiscell type is typical of early myeloid leukemia (M 0–M 1); the final classification ismade using cell surface marker analysis (see Table 14). b The peroxidase reaction,characteristic of cells in the myeloid series, shows positive ( 3%) only for stageM 1 leukemia and higher. The image shows a weakly positive blast (1), strongly positiveeosinophil (2), and positive myelocyte (3). c and d Variants of M 2 leukemia.Some of the cells already contain granules (1) and crystal-like Auer bodies (2).97
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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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Advancing nuclear contraction and s
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Note the granulations, inclusions,
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Page 56 and 57: 46Normal 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 and 100: Conspicuously large numbers of mono
Page 105: Predominance of Mononuclear Round t
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
Page 151 and 152: Consistently elevated “young” e
Page 153 and 154: Distribution pattern and shape of e
Page 155 and 156: 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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