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

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152Erythrocyte and Thrombocyte AbnormalitiesHyperchromic AnemiasIn patients with clear signs of anemia, e.g., a “sickly pallor,” atrophic lingualmucosa, and sometimes also neurological signs of bathyanesthesia(loss of deep sensibility), even just a cursory examination of the bloodsmear may indicate the diagnosis. Marked poikilocytosis and anisocytosisare seen, and the large size of the erythrocytes is particularly conspicuousin comparison with the lymphocytes, whose diameter they exceed (megalocytes).These are the hallmarks of macrocytic, and, with respect to bonemarrow cells, usually also megaloblastic anemia, with a mean cell diametergreater than 8 µm and a cell volume (MCV) usually greater than100 µm 3 . Mean cell Hb content (MCH) is more than 36 pg (1.99 fmol) andthus indicates hyperchromic anemia.Only when there is severe pre-existing concomitant iron deficiency is acombination of macrocytic cells and hypochromic MCH possible (“dimorphicanemia”).Table 26Most common causes of hyperchromic anemiasVitamin-B 12 deficiencyNutritional deficits, e. g.– Goat milk– Vegetarian diet– AlcoholismImpaired absorption– Genuine pernicious anemia– Status after gastrectomy– Ileum resection– Crohn disease– Celiac disease, sprue (psilosis)– Intestinal diverticulosis– Insufficiency of the exocrine pancreas– Fish tapewormFolic acid deficiencyNutritional deficits– Chronic abuse of alcoholImpaired absorption– E.g., sprue (psilosis)Increased requirement– Pregnancy– Hemolytic anemiaInterference/antagonism– Phenylhydantoin– Cytostatic antimetabolic drugs– Trimethoprim (antibacterialcombination drug)– Oral contrazeptives– Antidepressants– AlcoholAlthough other rare causes exist (Table 26), almost all patients with hyperchromicanemia suffer from vitamin B 12 and/or folic acid deficiency.Since a deficiency of these essential metabolic building blocks suppressesDNA synthesis not only in erythropoiesis, but in the other cell series aswell, over time more or less severe pancytopenia will develop.
Conspicuous large erythrocytes suggest hyperchromic macrocyticanemia, usually megaloblastic in the bone marrowabcdFig. 53 Hyperchromic anemia. a Marked anisocytosis. In addition to normalsizederythrocytes (1), macrocytes (2) and large ovoid megalocytes are seen (3).Hypersegmented granulocyte (4). b In hyperchromic anemia, red cell precursorsmay be released into the peripheral blood: here, a polychromatic erythroblast. cand d Bone marrow in megaloblastic anemia: slight (1) or marked (2) looseningup of the nuclear structure, in some cases with binuclearity (3). Giant forms ofband granulocytes and metamyelocytes (4) are often present.153
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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
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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
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 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: Thrombocytopenia with leukocytosis
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
Page 193 and 194: In cases of non-Hodgkin lymphoma an
Page 195 and 196: Accessible cysts (e.g., branchial c
Page 197 and 198: Tumor cells can be identified in pl
Page 199 and 200: Viral, bacterial, and malignant men
Page 201 and 202: 191IndexAActinomycosis 179Addison d
Page 203 and 204: Index193Disseminated intravascularc
Page 205 and 206: Index195blast crisis 120-121bone ma
Page 207 and 208: Index197in hemolytic anemia 140orth
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