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100Abnormalities of the White Cell SeriesAcute Monocytic Leukemia (FAB Classification Types M 5 a+b). Two morphologicallydistinct forms of acute monocytic leukemias exist, monoblasticand monocytic. In the monoblastic variant M 5a , blasts predominate in theblood and bone marrow. The blast nuclei show a delicate chromatin structurewith several nucleoli. Often, only the faintly grayish-blue stained cytoplasmhints at their derivation.In monocytic leukemia (type M 5b ), the bone marrow contains promonocytes,which are similar to the blasts in monocytic leukemia, but their nucleiare polymorphic and show ridges and lobes. Some promonocytesshow faintly stained azurophilic granules. The peripheral blood containsmonocytoid cells in different stages of maturation which cannot be distinguishedwith certainty from normal monocytes. Both types are characterizedby strong positive esterase reactions in over 80% of the blasts,whereas the peroxidase reactivity is usually negative, or positive in only afew cells.Acute Erythroleukemia (FAB Classification Type M 6 )Erythroleukemia is a malignant disorder of both cell series. It is suspectedwhen mature granulocytes are virtually absent, but blasts (myeloblasts)are present in addition to nucleated erythrocyte precursors, usuallyerythroblasts (for morphology, see p. 33). The bone marrow is completelyoverwhelmed by myeloblasts and erythroblasts (more than 50% of cells inthe process of erythropoiesis). Bone marrow cytology and cytochemistryconfirm the diagnosis. Sporadically, some cases show granulopenia,erythroblasts, and severely dedifferentiated blasts, which correspond toimmature red cell precursors (proerythroblasts and macroblasts).The differential diagnosis in cases of cytopenia with red blood cell precursorsfound in the CBC must include bone marrow carcinosis, in whichthe bone marrow–blood barrier is destroyed and immature red cells (andsometimes white cells) appear in the bloodstream. Bone marrow cytologyand/or bone marrow histology clarifies the diagnosis. Hemolysis with hypersplenismcan also show this constellation of signs.Fig. 33 Acute leukemia M 5 and M 6. a In monoblastic leukemia M 5 a, blasts with a fine nuclear structure and wide cytoplasm dominate the CBC. b Seemingly maturemonocytes in monocytic leukemia M 5 b. c Homogeneous infiltration of thebone marrow by monoblasts (M 5 a). Only residual granulopoiesis (arrow). d Sameas c but after esterase staining. The stage M 5 a blasts show a clear positive reaction(red stain). There is a nonspecific-esterase (NSE)-negative promyelocyte.
Acute leukemias may also derive from monoblasts or erythroblastsabcdefFig. 33 e Same as c Only the myelocyte in the center stains peroxidase-positive(brown tint); the monoblasts are peroxidase-negative. f In acute erythrocytic leukemia(M 6) erythroblasts and myeloblasts are usually found in the blood. Thisimage of bone marrow cytology in M 6 shows increased, dysplastic erythropoiesis(e.g., 1) in addition to myeloblasts (2).101
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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 60 and 61: 50Normal 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 107 and 108: Fundamental characteristic of acute
Page 109: The diagnosis of acute leukemia is
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
Page 157 and 158: Unexplained decrease in cell counts
Page 159 and 160: 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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