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

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86 Abnormalities of the White Cell SeriesRelative Lymphocytosis Associated withGranulocytopenia (Neutropenia) and AgranulocytosisNeutropenia is defined by a decrease in the number of neutrophilicgranulocytes with segmented nuclei to less than 1500/µl (1.5 10 9 /l). Aneutrophil count of less than 500/µl (0.5 10 9 /l) constitutes agranulocytosis.Absolute granulocytopenias with benign cause develop into relativelymphocytoses.In the most common clinical picture, drug-induced acute agranulocytosis,the bone marrow is either poor in cells or lacks granulopoietic precursorcells (aplastic state), or shows a “maturation block” at the myeloblast–promyelocytestage. The differential diagnosis of pure agranulocytosisversus aplasias of several cell lines is outlined on page 146.Classification of Neutropenias and Agranulocytoses1. Drug-induced:a) Dose-independent—acute agranulocytosis. Caused by hypersensitivityreactions: for example to pyrazolone, antirheumatic drugs(anti-inflammatory agents), antibiotics, or thyrostatic drugs.b) Relatively dose-dependent—subacute agranulocytosis (observed forcarbamazepine [Tegretol], e.g. antidepressants, and cytostaticdrugs).c) Dose-dependent—cytostatic drugs, immunosuppressants.2. Infection-induced:a) E.g., EBV, hepatitis, typhus, brucellosis.3. Autoimmune neutropenia:a) With antibody determination of T-cell or NK-cell autoimmune responseb) In cases of systemic lupus erythematosus (SLE), Pneumocystis cariniipneumonia (PCP), Felty syndromec) In cases of selective hypoplasia of the granulocytopoiesis (“purewhite cell aplasia”)4. Congenital and familial neutropenias:Various pediatric forms; sometimes not expressed until adulthood,e.g. cyclical neutropenia5. Secondary neutropenia in bone marrow disease:Myelodysplastic syndromes (MDS), e.g., acute leukemia, plasmacytoma,pernicious anemia
Bone marrow diagnosis is indicated in cases of unexplained agranulocytosisabFig. 29 The bone marrow in agranulocytosis. a In the early phase of agranulocytosisthe bone marrow shows only red cell precursor cells (e.g., 1), plasma cells(2), and lymphocytes (3); in this sample a myeloblast—a sign of regeneration—isalready present (4). b Bone marrow in agranulocytosis during the promyelocyticphase, showing almost exclusively promyelocytes (e.g., 1); increased eosinophilicgranulocytes (2) are also present.87
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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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Normal Cells of the Blood andHemato
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Normally erythropoiesis takes place
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34Normal Cells of the Blood and Hem
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: Atypias and differential diagnoses
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
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
Page 143 and 144: Small, hemoglobin-poor erythrocytes
Page 145 and 146: 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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