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

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168Erythrocyte and Thrombocyte AbnormalitiesThrombocytopenias Due to Reduced Cell ProductionIn this condition, blood contains few, usually small, pyknotic (“old”)thrombocytes. Only a very few megakaryocytes are found in the bonemarrow, and these have a normal appearance.CausesChronic alcoholism. There may be some overlap with increased turnoverand folic acid deficiency.Chemical and radiological noxae. Cytostatics naturally lead directly to adose-dependent reduction in megakaryocyte counts. A large therapeuticradiation burden in the area of blood-producing bone marrow has thesame result, which may persist for many months.Virus infections. Measles, mononucleosis (Epstein–Barr virus, cytomegalovirus),rubella, and influenza may (usually in children) trigger thrombocytopeniasof various types. In these cases, the virus affects the megakaryocytesdirectly. However, antibodies to thrombocytes may also arisein the course of these infections (p. 166), so that the pathomechanism ofthe parainfectious thrombocytopenias described by Werlhof in childrenmay lie in impaired production and/or increased degradation of thrombocytes.Neoplastic and aplastic bone marrow diseases. All neoplasms of the bonemarrow cell series (e.g., leukemia, lymphoma, and plasmacytoma), togetherwith their precursor forms (e.g., myelodysplasia), lead to progressivethrombocytopenia, as do panmyelophthisis and bone marrow infiltrationby metastases from solid tumors.Vitamin deficiency. Folic acid and vitamin B 12 deficiencies from variouscauses (p. 152) also affect the rapidly proliferating megakaryocytes. Inthese cases, thrombocytopenia is often present before anemia andleukocytopenia in circulating blood, while the bone marrow showscopious megakaryocytes that have been blocked from maturation.Constitutional diseases. An amegakaryocytic thrombocytopenia withoutany of the above causes is rare. It is seen in children with congenital radialaplasia; in adults it tends usually to be an early sign of leukemia,myelodysplastic syndrome, or aplastic anemia.Wiscott-Aldrich syndrome (thrombocytopenia, immune deficiency, andeczema) is an X-chromosomal recessive disease in boys and presents withthrombocytopenia with ineffective megakaryopoiesis.The May-Hegglin anomaly (dominant hereditary transmission) ischaracterized by thrombocytopenia with giant thrombocytes andgranulocyte inclusions, which resemble Döhle bodies (endoplasmatic reticulumaggregates).
Variant forms of thrombocyte and megakaryocyte morphologyin the bone marrow are diagnostic aids in thrombocytopeniaabcdefFig. 60 Morphology of thrombocytes and megakaryocytes. a Bone marrow inthrombocytopenia due to increased turnover (e.g., immunothrombocytopenia).Mononuclear “young” megakaryocytes clearly budding a thrombocyte (irregular,cloudy cytoplasm structure). b In thrombocytopenia against a background ofmyelodysplasia, the bone marrow shows various megakaryocyte anomalies: here,too small a nucleus surrounded by too wide cytoplasm. c–f In myelodysplasia(c and d) and acute myeloid leukemia (e and f), bizarre anomalous thrombocyteshapes (arrows) may occasionally be found.169
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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
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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
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 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: Thrombocytes: increases, reductions
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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