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

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34Normal Cells of the Blood and Hematopoietic OrgansImmature White Cell Precursors: Myeloblasts andPromyelocytesMyeloblasts are the least mature cells in the granulocyte lineage. Mononuclear,round-to-ovoid cells, they may be distinguished from proerythroblastsby the finer, “grainy” reticular structure of their nuclei and thefaintly basophilic cytoplasm. On first impression, they may look like largeor even small lymphocytes (micromyeloblasts), but the delicate structureof their nuclei always gives them away as myeloblasts. In some areas, condensedchromatin may start to look like nucleoli. Sporadically, the cytoplasmcontains azurophilic granules.Promyelocytes are the product of myeloblast division, and usually growlarger than their progenitor cells. During maturation, their nuclei show anincreasingly coarse chromatin structure. The nucleus is eccentric; thelighter zone over its bay-like indentation corresponds to the Golgi apparatus.The wide layer of basophilic cytoplasm contains copious largeazurophilic granules containing peroxidases, hydrolases, and otherenzymes. These granulations also exist scattered all around the nucleus, asmay be seen by focusing on different planes of the preparation using themicrometer adjustment on the microscope.Diagnostic Implications. Ordinarily, both cell types are encountered onlyin the bone marrow, where they are the most actively dividing cells andmain progenitors of granulocytes. In times of increased granulocyte production,promyelocytes and (in rare cases) myeloblasts may be releasedinto the blood stream (pathological left shift, see p. 112). Under strong regenerationpressure from the erythrocyte series, too—e.g., during thecompensation phase following various anemias—immature white cellprecursors, like the red cell precursors, may be swept into the peripheralblood. Bone marrow involvement by tumor metastases also increases thepermeability of the blood–bone marrow barrier for immature white cellprecursors (for an overview, see p. 112 ff.).In some acute forms of leukemia, myeloblasts (and also, rarely, promyelocytes)dominate the blood analysis (p. 97).
Round cells with “grainy” reticular chromatin structure areblasts, not lymphocytesabcdFig. 10 Granulocyte precursors. a The least mature precursor in granulopoiesisis the myeloblast, which is released into the blood stream only under pathologicalconditions. A large myeloblast is shown with a fine reticular nuclear structure anda narrow layer of slightly basophilic cytoplasm without granules. b Myeloblast andneutrophilic granulocytes with segmented nuclei (blood smear from a patientwith AML). c Myeloblast (1), which shows the start of azurophilic granulation(arrow), and a promyelocyte (2) with copious large azurophilic granules, typicallyin a perinuclear location. d Large promyelocyte (1), myelocyte (2), metamyelocyte(3), and polychromatic erythroblast (4).35
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 46 and 47: 36Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
Page 71 and 72: Abnormalities of the White Cell Ser
Page 73 and 74: Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 85 and 86: Monotonous proliferation of small l
Page 87 and 88: Atypical lymphocytes are not part o
Page 89 and 90: Deep nuclear indentation suggests f
Page 91 and 92: Cytoplasmic processes the main feat
Page 93 and 94: Plasmacytoma cannot be diagnosed wi
Page 95 and 96:
Atypias and differential diagnoses
Page 97 and 98:
Bone marrow diagnosis is indicated
Page 99 and 100:
Conspicuously large numbers of mono
Page 101 and 102:
Predominance of Mononuclear Round t
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Fundamental characteristic of acute
Page 109 and 110:
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
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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 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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