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

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62Abnormalities of the White Cell SeriesA very old-fashioned, intuitive way of classifying CBCs is to divide theminto those in which round to oval (mononuclear) cells predominate andthose in which segmented (polynuclear) cells predominate. However, thisold method does allow the relevant differential diagnosis to be inferredfrom a cursory screening of a slide.Differential Diagnostic NotesDifferential diagnosis when round to oval cells predominate➤ Reactive lymphocytoses and monocytoses, pp. 67 f., 89➤ Lymphatic system diseases (lymphomas, lymphocytic leukemia),p. 70➤ Acute leukemias, including episodes of chronic myeloid leukemia(CML), p. 96 ff.➤ Low counts of cells with segmented nuclei (agranulocytosis–aplastic anemia–myelodysplasia), pp. 86, 106, 148Differential diagnosis when segmented cells predominate➤ Reactive processes, p. 112 ff.➤ Chronic myeloid leukemia, p. 114 ff.➤ Osteomyelosclerosis, p. 122➤ Polycythemia vera, p. 162 ff.
Predominance of Mononuclear Round to Oval Cells63Predominance of Mononuclear Roundto Oval Cells (Table 5)The cell counts (per microliter) show a wide range of values and dependon a variety of conditions even in normal blood. Any disease may thereforeresult in higher (leukocytosis) or lower cell counts (leukopenia). Theassessment of cell counts requires the knowledge of normal values andtheir ranges (spreads) (Table 2, p. 12). The most important diagnostic indicatortherefore is not the cell count but the cell type. In a first assessment,mononuclear (round to oval) and polynuclear (segmented) cells arecompared. This is the first step in the differential diagnosis of the multifacetedspectrum of blood cells.Absolute or relative predominance of mononuclear cells points to a definedset of diagnostic probabilities. The differential diagnostic notes oppositecan help with a first orientation.Consequently, the most important step is to distinguish between lymphaticcells and myeloid blasts. The nuclear morphology makes it possibleto distinguish between the two cell types. In lymphatic cells the nucleususually displays dense coarse chromatin with slate-like architecture andlighter zones between very dense ones. In contrast, the immature cells inmyeloid leukemias contain nuclei with a more delicate reticular, sometimessand-like chromatin structure with a finer, more irregular pattern.
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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 22 and 23: 12Physiology 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: Abnormalities of the White Cell Ser
Page 75 and 76: 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
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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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