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

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156Erythrocyte and Thrombocyte AbnormalitiesErythrocyte InclusionsErythrocytes normally show fairly homogeneous hemoglobinization afterpanoptic staining; only after supravital staining (p. 155) will the remainsof their ribosomes show as substantia granulofilamentosa in the reticulocytes.Under certain conditions during the preparation of erythrocytes,aggregates of ribosomal material may be seen as basophilic stippling, alsovisible after Giemsa staining (Fig. 55 a). This is normal in fetal and infantblood; in adults a small degree of basophilic stippling has nonspecific diagnosticvalue, like anisocytosis indicating only a nonspecific reactiveprocess. Not until a large proportion of basophilic stippled erythrocytes isseen concomitantly with anemia does this phenomenon have diagnosticsignificance: thalassemia, lead poisoning, and sideroblastic anemia are allpossibilities. Errant chromosomes from the mitotic spindle are sometimesfound in normoblasts as small spheres with a diameter of about 1 µm,which have remained in the erythrocyte after expulsion of the nucleus andlie about as unevenly distributed Howell–Jolly bodies in the cytoplasm(Fig. 55 b, c). Normally, these cells are quickly sequestered by the spleen.Always after splenectomy, rarely also in hemolytic conditions and megaloblasticanemia, they are observed in erythrocytes at a rate of 1‰.These Howell-Jolly bodies are visible after normal panoptic staining.Supravital staining (see reticulocyte count, p. 11) may produce a fewglobular precipitates at the cell membrane, known as Heinz bodies. Theyare a rare phenomenon and may indicate the presence of unstablehemoglobins in rare familial or severe toxic hemolytic conditions (p. 144).An ellipsoid, eosinophil-violet stained, delicately structured ring inerythrocytes is called a Cabot ring (Fig. 55 d). It probably consists not, as itsform might suggest, of remnants of the nuclear membrane, but of fibersfrom the mitotic spindle. Because these ring structures are sporadicallyseen in all severe anemias, no specific conclusions can be drawn from theirpresence, but in the absence of any other rationale for severe anemia theyare compatible with the suspicion of an incipient idiopathic erythropoieticdisorder (e.g., panmyelopathy or smoldering leukosis orleukemia).
Small inclusions are usually a sign of nonspecific anomalies orartifactsbacdefgFig. 55 Erythrocyte inclusions. a Polychromatic erythrocyte with fine, dense basophilicstippling. b Erythrocyte with Howell–Jolly bodies (arrow) in addition to alymphocyte (after splenectomy). c Erythrocyte with two Howell–Jolly bodies (arrow)alongside an orthochromatic erythroblast with basophilic stippling (thalassemia,in this case with functional asplenia). d Erythrocyte with a delicate Cabotring (arrow) (here in a case of osteomyelosclerosis). e Thrombocyte layered ontoan erythrocyte (arrow). f and g Fixation and staining artifacts.157
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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
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Acute leukemias may also derive fro
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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 and 162: Thrombocytopenia with leukocytosis
Page 163 and 164: Conspicuous large erythrocytes sugg
Page 165: In older patients, myelodysplastic
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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