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

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58Normal Cells of the Blood and Hematopoietic OrgansBone Marrow: Medullary Stroma Cells➤ Fibroblastic reticular cells form a firm but elastic matrix in which theblood-forming cells reside, and are therefore rarely found in the bonemarrow aspirate or cytological smear. When present, they are mostlikely to appear as dense cell groups with long fiber-forming cytoplasmicprocesses and small nuclei. Iron staining shows them up as agroup of reticular cells which, like macrophages, have the potential tostore iron. If they become the prominent cell population in the bonemarrow, an aplastic or toxic medullary disorder must be considered.➤ Reticular histiocytes (not yet active in phagocytosis) are identical tophagocytic macrophages and are the main storage cells for tissueboundiron. Because of their small nuclei and easy-flowing cytoplasm,they are noticeable after panoptic staining only when they contain obviousentities such as lipids or pigments.➤ Osteoblasts are large cells with wide, eccentric nuclei. They differ fromplasma cells in that the cytoplasm has no perinuclear lighter space (cellcenter) and stains a cloudy grayish-blue. As they are normally rare inbone marrow, increased presence of osteoblasts in the marrow may indicatemetastasizing tumor cells (from another location).➤ Osteoclasts are multinucleated syncytia with wide layers of grayishbluestained cytoplasm, which often displays delicate azurophilicgranulation. They are normally extremely rare in aspirates, and whenthey are found it is usually under the same conditions as osteoblasts.They are distinguished from megakaryocytes by their round and regularnuclei and by their lack of thrombocyte buds.From the above, it will be seen that bone marrow findings can be assessedon the basis of a knowledge of the cells elements described above(p. 32 ff.), taking account of the eight categories given on p. 52 f. It alsoshows that a diagnosis from bone marrow aspirates can safely be madeonly in conjunction with clinical findings, blood chemistry, and the qualitativeand quantitative blood values. For this reason, a table of diagnosticsteps taking account of these categories is provided at the beginning ofeach of the following chapters.
Cells from the bone marrow stroma never occur in the bloodstreamabcFig. 20 Bone marrow stroma. a Spindle-shaped fibroblasts form the structuralframework of the bone marrow (shown here: aplastic hematopoiesis after therapyfor multiple myeloma). b A macrophage has phagocytosed residual nuclearmaterial (here after chemotherapy for acute leukemia). c Bone marrow osteoblastsare rarely found in the cytological assessment. The features that distinguishosteoblasts from plasma cells are their more loosely structured nuclei and thecloudy, “busy” basophilic cytoplasm. d Osteoclasts are multinucleated giant cellswith wide, spreading cytoplasm.59d
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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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Page 18 and 19: 8Physiology 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
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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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