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

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46Normal Cells of the Blood and Hematopoietic OrgansMonocytesMonocytes are produced in the bone marrow; their line of developmentbranches off at a very early stage from that of the granulocytic series (seeflow chart p. 3), but does not contain any distinct, specific precursors thatcan be securely identified with diagnostic significance in everyday morphologicalstudies. Owing to their great motility and adhesiveness, maturemonocytes are morphologically probably the most diversified of allcells. Measuring anywhere between 20 and 40 µm in size, their constantcharacteristic is an ovoid nucleus, usually irregular in outline, with invaginationsand often pseudopodia-like cytoplasmic processes. The fine,“busy” structure of their nuclear chromatin allows them to be distinguishedfrom myelocytes, whose chromatin has a patchy, streaky structure,and also from lymphocytes, which have dense, homogeneous nuclei.The basophilic cytoplasmic layer varies in width, stains a grayish color,and contains a scattered population of very fine reddish granules that areat the very limit of the eye’s resolution. These characteristics vary greatlywith the size of the monocyte, which in turn is dependent on the thicknessof the smear. Where the smear is thin, especially at the feathered end,monocytes are abundant, relatively large and loosely structured, and theircytoplasm stains light gray–blue (“dove gray”). In thick, dense parts of thesmear, some monocytes look more like lymphocytes: only a certain nuclearindentation and the “thundercloud” gray–blue staining of the cytoplasmmay still mark them out.Diagnostic Implications. In line with their function (see p. 5) as phagocyticdefense cells, an elevation of the monocyte population above 7% andabove 850/µl indicates an immune defense reaction; only when a sharprise in monocyte counts is accompanied by a drop in absolute counts inthe other cell series is monocytic leukemia suggested (p. 101). Phagocytosisof erythrocytes and white blood cells (hemophagocytosis) may occurin some virus infections and autoimmune diseases.➤ Monocytosis in cases of infection: always present at the end of acute infections;chronic especially in– Endocarditis lenta, listeriosis, brucellosis, tuberculosis➤ Monocytosis in cases of a non-infectious response, e.g.,– Collagenosis, Crohn disease, ulcerative colitis➤ Monocytoses in/as neoplasia, e.g.,– Paraneoplastic in cases of disseminating tumors, bronchial carcinoma,breast carcinoma, Hodgkin disease, myelodysplasias (especiallyCMML, pp. 107 f) and acute monocytic leukemia (p. 101)
Monocytes show the greatest morphological variation amongblood cellsabcdefghFig. 15 Monocytes. a–c Range of appearances of typical monocytes with lobed,nucleus, gray–blue stained cytoplasm and fine granulation. d Phagocytic monocytewith plasma vacuoles. e Monocyte (1) to the right of a lymphocyte with azurophilicgranules (2). f Monocyte (1) with nucleus resembling that of a band neutrophil,but its cytoplasm stains typically gray–blue. Lymphocyte (2). g A monocytethat has phagocytosed two erythrocytes and harbors them in its wide cytoplasm(arrows) (sample taken after bone marrow transplantation). h Esterasestaining, a typical marker enzyme for cells of the monocyte lineage.47
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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 44 and 45: 34Normal 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 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
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In the course of chronic myeloid le
Page 133 and 134:
Enlarged spleen and presence of imm
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Eosinophilia and basophilia are usu
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Erythrocyte and ThrombocyteAbnormal
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Hypochromic Anemias129Insufficient
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Hypochromic Anemias131BSGIron Ferri
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Small, hemoglobin-poor erythrocytes
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Hypochromic erythrocytes of very va
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Hypochromic Anemias137Hypochromic S
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Hypochromic anemia without iron def
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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
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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Conspicuous large erythrocytes sugg
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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
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Tumor cells can be identified in pl
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Viral, bacterial, and malignant men
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191IndexAActinomycosis 179Addison d
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Index193Disseminated intravascularc
Page 205 and 206:
Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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