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

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158Erythrocyte and Thrombocyte AbnormalitiesHematological Diagnosis of MalariaVarious parasites may be found in the blood stream, e.g., trypanosomesand filariae. Among the parasitic diseases, probably only malaria is ofpractical diagnostic relevance in the northern hemisphere, while at thesame time malarial involvement of erythrocytes may confuse the interpretationof erythrocyte morphology. For these reasons, a knowledge ofthe principal different morphological forms of malarial plasmodia isadvisable.Recurrent fever and influenza-like symptoms after a stay in tropical regionssuggest malaria. The diagnosis may be confirmed from normalblood smears or thick smears; in the latter the erythrocytes have beenhemolyzed and the pathogens exposed. Depending on the stage in the lifecycle of the plasmodia, a variety of morphologically completely differentforms may be found in the erythrocytes, sometimes even next to eachother. The different types of pathogens show subtle specific differencesthat, once the referring physician suspects malaria, are best left to thespecialist in tropical medicine, who will determine which of the followingis the causative organism: Plasmodium vivax (tertian malaria), Plasmodiumfalciparum (falciparum or malignant tertian malaria) and Plasmodiummalariae (quartan malaria) (Table 27, Fig. 56). Most cases ofmalaria are caused by P. vivax (42%) and P. falciparum (43%).The key morphological characteristics in all forms of malaria can besummarized as the following basic forms: The first developmental stage ofthe pathogen, generally found in quite large erythrocytes, appears as smallring-shaped bodies with a central vacuole, called trophozoites (or thesignet-ring stage) (Fig. 57). The point-like center is usually most noticeable,as it is reminiscent of a Howell–Jolly body, and only a very carefulsearch for the delicate ring form will supply the diagnosis. Occasionally,there are several signet-ring entities in one erythrocyte. All invaded cellsmay show reddish stippling, known as malarial stippling or Schüffner’sdots. The pathogens keep dividing, progressively filling the vacuoles, andthen develop into schizonts (Fig. 56), which soon fill the entire erythrocytewith an average of 10–15 nuclei. Some schizonts have brown-black pigmentinclusions. Finally the schizonts disintegrate, the erythrocyte ruptures,and the host runs a fever. The separate parts (merozoites) then start anew invasion of erythrocytes.In parallel with asexual reproduction, merozoites develop into gamonts,which always remain mononuclear and can completely fill theerythrocyte with their stippled cell bodies. The large, dark blue-stainedforms (macrogametes) are female cells (Fig. 57 d), the smaller, light bluestainedforms (microgametes) are male cells. Macrogametes usually predominate.They continue their development in the stomach of the infectedAnopheles mosquito.
PlasmodiumfalciparumPlasmodiumvivaxPlasmodiumovalePlasmodiummalariaeMaturemicrogametocyteMaturemacrogametocyteMatureschizontIntermediatetrophozoiteYoungtrophozoiteFig. 56 Differential diagnosis of malaria plasmodia in a blood smear (from Kayser,F., et al., Medizinische Mikrobiologie (Medical Microbiology), Thieme, Stuttgart,1993).159
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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
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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 and 166: In older patients, myelodysplastic
Page 167: Small inclusions are usually a sign
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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