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118Abnormalities of the White Cell SeriesBone Marrow Analysis in CML. In many clinical situations, the findingsfrom the CBC, the BCR-ABL transformation and the enlarged spleen unequivocallypoint to a diagnosis of CML. Analysis of the bone marrowshould be performed because it provides a series of insights into the diseaseprocesses.Normally, the cell density is considerably elevated and granulopoieticcells predominate in the CBC. Cells in this series mature properly, apartfrom a slight left shift in the chronic phase of CML. CML differs from reactiveleukocytoses because there are no signs of stress, such as toxic granulationor dissociation in the nuclear maturation process.Mature neutrophils may occasionally show pseudo-Pelger forms (p. 43)and the eosinophilic and, especially, basophilic granulocyte counts areoften elevated. The proportion of cells from the red blood cell seriesdecreases. Histiocytes may store glucocerebrosides, as in Gaucher syndrome(pseudo-Gaucher cells), or lipids in the form of sea-blue precipitates(sea-blue histiocytes after Romanowsky staining).Megakaryocytes are usually increased and are often present as micromegakaryocytes,with one or two nuclei which are only slightly larger thanthose of promyelocytes. Their cytoplasm typically shows clouds ofgranules, as in the maturation of thrombocytes.
Bone marrow analysis is not obligatory in chronic myeloid leukemia,but helps to distinguish between the various chronic myeloproliferativedisordersabcFig. 40 Bone marrow cytology in CML. a Bone marrow cytology in the chronicphase: increased cell density due to increased, left-shifted granulopoiesis, e.g.,promyelocyte nest (1) and megakaryopoiesis (2). Eosinophils are increased (arrows),erythropoiesis reduced. b Often micromegakaryocytes are found in thebone marrow cytology. c Pseudo-Gaucher cells in the bone marrow in CML.119
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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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Abnormalities of the White Cell Ser
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Predominance of Mononuclear Round t
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Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 81 and 82: Predominance of Mononuclear Round t
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 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: Left shift as far as myeloblasts, p
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
Page 173 and 174: Bone marrow analysis contributes to
Page 175 and 176: Thrombocytes: increases, reductions
Page 177 and 178: 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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