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

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56Normal Cells of the Blood and Hematopoietic OrgansQualitative and Quantitative Assessment of the Remaining Cells. Lymphocytecounts may be slightly raised in reactive processes, but a significantincrease suggests a disease of the lymphatic system. The exact classificationof these disease follows the criteria of lymphocyte morphology(Fig. 16). If elevated lymphocyte counts are found only in one preparationor within a circumscribed area, physiological lymph follicles in the bonemarrow are likely to be the source. In a borderline case, the histology andanalysis of lymphocyte surface markers yield more definitive data.Plasma cell counts are also slightly elevated in reactive processes andvery elevated in plasmacytoma. Reactive increase of lymphocytes andplasma cells with concomitant low counts in the other series is often anindication of panmyelopathy (aplastic anemia).Raised eosinophil and monocyte counts in bone marrow have the samediagnostic significance as in blood (p. 44).Megakaryocyte counts are reduced under the effects of all toxic stimulion bone marrow. Counts increase after bleeding, in essential thrombocytopenia(Werlhof syndrome), and in myeloproliferative diseases (chronicmyeloid leukemia, polycythemia, and essential thrombocythemia).Iron Staining of Erythropoietic Cells. Perls’ Prussian blue (also known asPerls’ acid ferrocyanide reaction) shows the presence of ferritin in 20–40%of all normoblasts, in the form of one to four small granules. The ironcontainingcells are called sideroblasts. Greater numbers of ferritingranules in normoblasts indicate a disorder of iron utilization (sideroachresia,especially in myelodysplasia), particularly when the granulesform a ring around the nucleus (ring sideroblasts). Perls’ Prussian blue reactionalso stains the diffuse iron precipitates in macrophages (Fig. 19 b).Under exogenous iron deficiency conditions the proportion of sideroblastsand iron-storing macrophages is reduced. However, if the shift iniron utilization is due to infectious and/or toxic conditions, the iron contentin normoblasts is reduced while the macrophages are loaded withiron to the point of saturation. In hemolytic conditions, the iron content ofnormoblasts is normal; it is elevated only in essential or symptomatic refractoryanemia (including megaloblastic anemia).
Not just the individual cell, but its relative proportion is relevantin bone marrow diagnosticsabcdFig. 19 Normal bone marrow findings. a Normal bone marrow: megakaryocyte(1), erythroblasts (2), and myelocyte (3). b Iron staining in the bone marrow cytology:iron-storing macrophage. c Normal bone marrow with slight preponderanceof granulocytopoiesis, e.g., promyelocyte (1), myelocyte (2), metamyelocyte (3),and band granulocyte (4). d Normal bone marrow with slight preponderance oferythropoiesis, e.g., basophilic erythroblast (1), polychromatic erythroblasts (2),and orthochromatic erythroblast (3). Compare (differential diagnosis) with theplasma cell (4) with its eccentric nucleus.57
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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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4Physiology and Pathophysiology of
Page 16 and 17: 6Physiology 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
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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
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Left shift as far as myeloblasts, p
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Bone marrow analysis is not obligat
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In the course of chronic myeloid le
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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
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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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
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Small inclusions are usually a sign
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PlasmodiumfalciparumPlasmodiumvivax
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Conspicuous erythrocyte inclusions
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Bone marrow analysis contributes to
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Thrombocytes: increases, reductions
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Thrombocytes: increases, reductions
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Variant forms of thrombocyte and me
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Thrombocyte proliferation with larg
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Cytology of Organ Biopsiesand Exuda
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Lymph Node Cytology175Anamnesis- su
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Reactive lymph node hyperplasia and
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Lymph Node Cytology179Contact witha
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Epithelioid cells dominate the lymp
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In cases of non-Hodgkin lymphoma an
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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
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Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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