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

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112Abnormalities of the White Cell SeriesReactive Left ShiftA relative left shift in the granulocyte series means less mature forms inexcess of 5% band neutrophils; the preceding, less differentiated cell formsare included and all transitional forms are taken into account. This leftshift almost always indicates an increase in new cell production in this cellseries. In most cases, it is associated with a raised total leukocyte count.However, since total leukocyte counts are subject to various interferingfactors that can also alter the cell distribution, left shift without leukocytosiscan occur, and has no further diagnostic value. At best, if no other explanationsoffer, a left shift without leukemia can prompt investigation forsplenomegaly, which would have prevented elevation of the leukocytecount by increased sequestration of leukocytes as in hypersplenism.In evaluating the magnitude of a left shift, the basic principle is that themore immature the cell forms, the more rarely they appear; and that thereis a continuum starting from segmented granulocytes and sometimesreaching as far as myeloblasts. Accordingly, a moderate left shift of mediummagnitude may include myelocytes and a severe left shift may go asfar as a few promyelocytes and (very rarely) myeloblasts, all depending onhow fulminant the triggering process is and how responsive the individual.The term “pathological left shift” (for a left shift that includespromyelocytes and myeloblasts) is inappropriate, because such observationscan reflect a very active physiological reaction, perhaps following a“leukemoid reaction” with pronounced left shift and leukocytosis.Causes of Reactive Left ShiftLeft shift occurs regularly in the following situations:➤ Bacterial infections (including miliary tuberculosis),➤ Nonbacterial inflammation (e.g., colitis, pancreatitis, phlebitis, andconnective tissue diseases)➤ Cell breakdown (e.g., burns, liver failure, hemolysis)Left shift sometimes occurs in the following situations:➤ Infection with fungi, mycoplasm, viruses, or parasites➤ Myocardial or pulmonary infarction➤ Metabolic changes (e.g., pregnancy, acidosis, hyperthyroidism)➤ Phases of compensation and recuperation (hemorrhages, hemolysis,or after medical or radiological immunosuppression).
Predominance of the granulocytic lineage with copious granulationand sporadic immature cells: usually a reactive left shiftabdceFig. 38 Left shift. a and b Typical blood smear after bacterial infection: toxic granulationin a segmented granulocyte (1), monocyte with gray–blue cytoplasm(2), metamyelocyte (3), and myelocyte (4). c Blood analysis in sepsis: promyelocyte(1) and orthochromatic erythroblast (2). Thrombocytopenia. d and e Reactiveleft shift as far as promyelocytes (1). Particularly striking are the reddish granulesin a band neutrophilic granulocyte (2).113
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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 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 and 118: In unexplained anemia and/or leukoc
Page 119 and 120: The classification of myelodysplasi
Page 121: Prevalence of Polynuclear (Segmente
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
Page 169 and 170: PlasmodiumfalciparumPlasmodiumvivax
Page 171 and 172: 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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