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

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104Abnormalities of the White Cell SeriesAcute Lymphoblastic Leukemia (ALL)ALL are the leukemias in which the cells do not morphologically resemblemyeloblasts, promyelocytes, or monocytes, nor do they show the correspondingcytochemical pattern. Common attributes are a usually slightlysmaller cell nucleus and denser chromatin structure, the grainy consistencyof which can be made out only with optimal smear technique (i.e.,very light). The classification as ALL is based on the (often remote) similaritiesof the cells to lymphocytes or lymphoblasts from lymph nodes, andon their immunological cell marker behavior. Insufficiently close morphologicalanalysis can also result in possible confusion with chronic lymphocyticleukemia (CLL), but cell surface marker analysis (see below) will correctthis mistake. Advanced diagnostics start with peroxidase and esterasetests on fresh smears, performed in a hematology laboratory, togetherwith (as a minimum) immunological marker studies carried out on freshheparinized blood samples in a specialist laboratory. The detailed differentiationprovided by this cell surface marker analysis has prognostic implicationsand some therapeutic relevance especially for the distinction tobilineage leukemia and AML (Table 16).Table 16 Immunological classification of acute bilineage leukemias (adapted from Bene MCet al. (1995) European Group for the Immunological Characterization of Leukemias (EGIL) 9:1783–1786)Score B-lymphoid T-lymphoid Myeloid2 CytCD79a* CD3(m/cyt) MP0Cyt IgManti-TCR1 CD19 CD2 CD117CD20 CD5 CD13CD10 CD8 CD33CD10CD650.5 TdT TdT CD14CD24 CD7 CD15CD1aCD64* CD79a may also be expressed in some cases of precursor T-lymphoblastic leukemia/lymphoma.
The cells in acute lymphocytic leukemia vary, and the subtypescan be reliably identified only by immunological methodsabcdFig. 35 Acute lymphocytic leukemias. a Screening view: blasts (1) and lymphocytes(2) in ALL. Further classification of the blasts requires immunological methods(common ALL). b Same case as a . The blasts show a dense, irregular nuclearstructure and narrow cytoplasm (cf. mononucleosis, p. 69). Lymphocyte (2). c ALLblasts with indentations must be distinguished from small-cell non-Hodgkinlymphoma (e.g., mantle cell lymphoma, p. 77) by cell surface marker analysis.d Bone marrow: large, vacuolated blasts, typical of B-cell ALL. The image showsresidual dysplastic erythropoietic cells (arrow).105
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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 64 and 65: 54Normal 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 and 110: The diagnosis of acute leukemia is
Page 111 and 112: Acute leukemias may also derive fro
Page 113: New WHO classification: AML with dy
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
Page 161 and 162: Thrombocytopenia with leukocytosis
Page 163 and 164: 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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