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

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108Abnormalities of the White Cell SeriesTable 17ContinuedForm of myelodysplasia Blood analysis Bone marrowCMML = chronic myelomonocyticleukemiaRAEB in transformation(RAEB t)*Blasts 5%, monocytes 1000/µl,pseudo-Pelger syndromeSimilar to RAEB but 5% blastsHypercellular, blasts 20%, elevated promonocytesBlasts 20–30% (somecells contain Auerbodies)* In the WHO classification, the category RAEB t would belong to the category of acute myeloidleukemia.The new WHO classification of myelodysplastic syndromes defines thedifferences in cell morphology even more precisely than the FAB classification(Table 18).For the criteria of dysplasia, see page 106.The “5q- syndrome” is highlighted as a specific type of myelodysplasiain the WHO classification; in the FAB classification it would be a subtype ofRA and RAS. A macrocytic anemia, the 5q- syndrome manifests with normalor increased thrombocyte counts while the bone marrow containsmegakaryocytes with hyposegmented round nuclei (Fig. 37 b).Naturally, bone marrow analysis is of particular importance in the myelodysplasias.Table 18WHO classification of myelodysplastic syndromesDisease* Dysplasia** Blasts inperipheralbloodBlasts in thebone marrowRing sideroblastsin thebone marrowCytogenetics5q- syndrome Usually only E 5% 5% 15% 5q onlyRA Usually only DysE 1% 5% 15% VariableRARS Usually only DysE None 5% 15% VariableRCMD 2–3 lines Rarely 5% 15% VariableRCMD-RS 2–3 lines Rarely 5% 15% VariableRAEB-1 1–3 lines 5% 5–9% 15% VariableRAEB-2 1–3 lines 5–19% 10–19% 15% VariableCMML-1 1–3 lines 5% 10% 15% VariableCMML-2 1–3 lines 5–19% 10–19% 15% VariableMDS-U 1 cell lineage None 5% 15% Variable* RA = refractory anemia; RARS = refractory anemia with ring sideroblasts; RCMD = refractorycytopenia with more than one dysplastic cell line; RCMD-RC = refractory cytopenia with morethan one dysplastic lineage and ring sideroblasts; RAEB = refractory anemia with elevated blastcount; CMML = chronic myelomonocytic leukemia, persistent monocytosis (more than1 10 9 /l) in peripheral blood; MDS-U = MDS, unclassifiable. ** Dysplasia in granulopoiesis= Dys G, in erythropoiesis = DysE, in megakaryopoiesis = DysM, multilineage dysplasia= two cell lines affected; trilineage dysplasia (TLD) = all three lineage show dysplasia.
The classification of myelodysplasias requires bone marrow analysisabcdFig. 37 Bone marrow analysis in myelodysplasia. a Dysmegakaryopoiesis inmyelodysplastic syndrome (MDS). Relatively small disk-forming megakaryocytes(1) and multiple singular nuclei (2) are often seen. b Mononuclear megakaryocytes(frequent in 5q-syndrome). c Dyserythropoiesis. Particularly striking is thecoarse nuclear structure with very light gaps in the chromatin (arrow 1). Some aremegaloblast-like but coarser (arrow 2). d Iron staining of the bone marrow (Prussianblue) in myelodysplasia of the RARS type: dense iron granules forming a partialring around the nuclei (ring sideroblasts).109
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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 68 and 69: 58Normal 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 and 114: New WHO classification: AML with dy
Page 115 and 116: The cells in acute lymphocytic leuk
Page 117: In unexplained anemia and/or leukoc
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
Page 165 and 166: In older patients, myelodysplastic
Page 167 and 168: 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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