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

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132Erythrocyte and Thrombocyte AbnormalitiesTable 23Normal ranges for physiological iron and its transport proteinsOld unitsSI unitsSerum ironNewborns 150–200µg/dl 27–36µmol/lAdultsFemale 60–140µg/dl 11–25µmol/lMale 80–150µg/dl 14–27µmol/lTIBC 300–350µg/dl 54–63µmol/lTransferrin 250–450µg/dl 2.5–4.5 g/lSerum ferritinTIBC = Total iron binding capacity.30–300µg/l(15–160µg/l premenopausal)This usually renders determination of transferrin and total iron bindingcapacity (TIBC) unnecessary. If samples are being sent away to a laboratory,it is preferable to send serum produced by low-speed centrifugation,since the erythrocytes in whole blood can become mechanically damagedduring shipment and may then release iron. Table 23 shows the variationof serum iron values according to gender and age.It is important to note that acute blood loss causes normochromic anemia.Only chronic bleeding or earlier serious acute blood loss leads to irondeficiency manifested as hypochromic anemia.Iron Deficiency and Blood Cell Analysis Focusing on the erythrocyte morphologyis the quickest and most efficient way to investigate hypochromicanemia when the serum iron has dropped below normal values. In hypochromicanemia with iron and hemoglobin deficiency (whether due to insufficientiron intake or an increased physiological iron requirement),erythrocyte size and shape does not usually vary much (see Fig. 45). Only inadvanced anemias (from approx. 11 g/dl, equivalent to 6.27 mmol/l Hb)are relatively small erythrocytes (microcytes) with reduced MCV andMCH and grayish stained basophilic erythrocytes (polychromatic erythrocytes)seen, indicating inadequate hemoglobin content. Cells with theappearance of relatively large polychromatic erythrocytes are reticulocytes.The details of their morphology can be seen after supravital staining(p. 141). A few target cells (p. 139) will be seen in conditions of severe irondeficiency.In severe hemoglobin deficiency ( 8 g/dl, equivalent to 4.96 mmol/l)the residual hemoglobin is found mostly at the peripheral edge of theerythrocyte, giving the appearance of a ring-shaped erythrocyte.
Small, hemoglobin-poor erythrocytes indicate iron deficiencyabcdFig. 45 Iron deficiency anemia. a and b Erythrocyte morphology in iron deficiencyanemia: ring-shaped erythrocytes (1), microcytes (2) faintly visible target cells(3), and a lymphocyte (4) for size comparison. Normal-sized erythrocytes (5) aftertransfusion. c Bone marrow cytology in iron deficiency anemia shows only increasedhematopoiesis and left shift to basophilic erythroblasts (1). d Absence ofiron deposits after iron staining (Prussian blue reaction). Megakaryocyte (1).133
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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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During lymphatic reactive states, v
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Extreme transformation of lymphocyt
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Monotonous proliferation of small l
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Atypical lymphocytes are not part o
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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 101 and 102: Predominance of Mononuclear Round t
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 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: Hypochromic Anemias131BSGIron Ferri
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
Page 179 and 180: Variant forms of thrombocyte and me
Page 181 and 182: Thrombocyte proliferation with larg
Page 183 and 184: Cytology of Organ Biopsiesand Exuda
Page 185 and 186: Lymph Node Cytology175Anamnesis- su
Page 187 and 188: Reactive lymph node hyperplasia and
Page 189 and 190: Lymph Node Cytology179Contact witha
Page 191 and 192: 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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