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

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6Physiology and Pathophysiology of Blood Cellsendothelium of the body cavities; epithelioid cells; foreign body macrophages(including Langhans’ giant cells); and many other cells.Lymphocytes are divided into two major basic groups according tofunction.Thymus-dependent T-lymphocytes, which make up about 70% oflymphocytes, provide local defense against antigens from organic and inorganicforeign bodies in the form of delayed-type hypersensitivity, as classicallyexemplified by the tuberculin reaction. T-lymphocytes are dividedinto helper cells and suppressor cells. The small group of NK (naturalkiller) cells, which have a direct cytotoxic function, is closely related to theT-cell group.The other group is the bone-marrow-dependent B-lymphocytes or B-cells, which make up about 20% of lymphocytes. Through their developmentinto immunoglobulin-secreting plasma cells, B-lymphocytes are responsiblefor the entire humoral side of defense against viruses, bacteria,and allergens.Table 1Cells in a normal peripheral blood smear and their physiological rolesCell type Function Count(% of leukocytes)Neutrophilic bandgranulocytes (bandneutrophil)Neutrophilic segmentedgranulocyte (segmentedneutrophil)Lymphocytes(B- and T-lymphocytes,morphologically indistinguishable)MonocytesEosinophilic granulocytesBasophilic granulocytesPrecursors of segmented cellsthat provide antibacterialimmune responsePhagocytosis of bacteria;migrate into tissue for this purposeB-lymphocytes (20% of ⎫lymphocytes) mature and ⎪form plasma cells antibody⎪⎪production.⎬T-lymphocytes (70%): cyto-⎪toxic defense against viruses, ⎪foreign antigens, and tumors. ⎭Phagocytosis of bacteria, protozoa,fungi, foreign bodies.Transformation in target tissueImmune defense against parasites,immune regulationRegulation of the response tolocal inflammatory processes0–4%50–70%20–50%2–8%1–4%0–1%
Introduction to the Physiology and Pathophysiology7Erythrocytes are the oxygen carriers for all oxygen-dependent metabolicreactions in the organism. They are the only blood cells without nuclei,since this allows them to bind and exchange the greatest number ofO 2 molecules. Their physiological biconcave disk shape with a thick rimprovides optimal plasticity.Thrombocytes form the aggregates that, along with humoral coagulationfactors, close up vascular lesions. During the aggregation process, inaddition to the mechanical function, thrombocytic granules also releasefactors that promote coagulation.Thrombocytes develop from polyploid megakaryocytes in the bonemarrow. They are the enucleated, fragmented cytoplasmic portions ofthese progenitor cells.Principles of Regulation and Dysregulation in theBlood Cell Series and their Diagnostic ImplicationsQuantitative and qualitative equilibrium between all blood cells is maintainedunder normal conditions through regulation by humoral factors,which ensure a balance between cell production (mostly in the bone marrow)and cell degradation (mostly in the spleen, liver, bone marrow, andthe diffuse reticular tissue).Compensatory increases in cell production are induced by cell loss or increasedcell demand. This compensatory process can lead to qualitativechanges in the composition of the blood, e.g., the occurrence of nucleatedred cell precursors compensating for blood loss or increased oxygen requirement,or following deficiency of certain metabolites (in the restitutionphase, e.g., during iron or vitamin supplementation). Similarly,during acute immune reactions, which lead to an increased demand forcells, immature leukocyte forms may appear (“left shift”).Increased cell counts in one series can lead to suppression of cell productionin another series. The classic example is the suppression of erythrocyteproduction (the pathomechanical details of which are incompletelyunderstood) during infectious/toxic reactions, which affect the white cells(“infectious anemia”).Metabolite deficiency as a pathogenic stimulus affects the erythrocyte seriesfirst and most frequently. Although other cell series are also affected,this series, with its high turnover, is the one most vulnerable to metabolitedeficiencies. Iron deficiency, for example, rapidly leads to reducedhemoglobin in the erythrocytes, while vitamin B 12 and/or folic acid deficiencywill result in complex disturbances in cell formation. Eventually,these disturbances will start to show effects in the other cell series as well.
Page 3 and 4: iiiColor Atlas of HematologyPractic
Page 5 and 6: vPrefaceOur Current EditionAlthough
Page 7 and 8: viiContentsPhysiology and Pathophys
Page 9 and 10: ContentsixAcute Lymphoblastic Leuke
Page 12 and 13: 2Physiology and Pathophysiology of
Page 39 and 40: Normal Cells of the Blood andHemato
Page 41: Normally erythropoiesis takes place
Page 44 and 45: 34Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
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56Normal Cells of the Blood and Hem
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58Normal Cells of the Blood and Hem
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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
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Cytoplasmic processes the main feat
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Plasmacytoma cannot be diagnosed wi
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Atypias and differential diagnoses
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Bone marrow diagnosis is indicated
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Conspicuously large numbers of mono
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Fundamental characteristic of acute
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The diagnosis of acute leukemia is
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Acute leukemias may also derive fro
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New WHO classification: AML with dy
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The cells in acute lymphocytic leuk
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In unexplained anemia and/or leukoc
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The classification of myelodysplasi
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Prevalence of Polynuclear (Segmente
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Predominance of the granulocytic li
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Prevalence of Polynuclear (Segmente
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Left shift as far as myeloblasts, p
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Bone marrow analysis is not obligat
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In the course of chronic myeloid le
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Enlarged spleen and presence of imm
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Eosinophilia and basophilia are usu
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Erythrocyte and ThrombocyteAbnormal
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Hypochromic Anemias129Insufficient
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Hypochromic Anemias131BSGIron Ferri
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Small, hemoglobin-poor erythrocytes
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Hypochromic erythrocytes of very va
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Hypochromic Anemias137Hypochromic S
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Hypochromic anemia without iron def
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Consistently elevated “young” e
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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Unexplained decrease in cell counts
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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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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