BLOOD SMEAR. The red blood cells here are normal, happy RBC's.
They have a zone of central pallor about 1/3 the size of the RBC.
The RBC's demonstrate minimal variation in size (anisocytosis) and
shape (poikilocytosis). A few small fuzzy blue platelets are seen.
In the center of the field are aband neutrophil on the left and a
segmented neutrophil on the right.
Slide 4
IDENTIFY THE CELLS ON THE PBS.
Slide 5
LYMPHOCYTE. A normal mature lymphocyte is seen on the left
compared to a segmented PMN on the right. An RBC is seen to be
about 2/3 the size of a normal lymphocyte.
Slide 6
IDENTIFY THE CELL?
Slide 7
MONOCYTE. Here is a monocyte. It is slightly larger than a
lymphocyte and has a folded nucleus. Monocytes can migrate out of
the bloodstream and become tissue macrophages under the influence
of cytokines. Note the many small smudgy blue platelets between the
RBC's.
Slide 8
IDENTIFY THE CELL?
Slide 9
EOSINOPHIL. In the center of the field is an eosinophil with a
bilobed nucleus and numerous reddish granules in the cytoplasm.
Just underneath it is a small lymphocyte. Eosinophils can increase
with allergic reactions and with parasitic infestations.
Slide 10
IDENTIFY THE CELL.
Slide 11
BASOPHILS. There is a basophil in the center of the field which
has a lobed nucleus (like PMN's) and numerous coarse, dark blue
granules in the cytoplasm. They are infrequent in a normal
peripheral blood smear, and their significance is uncertain. A band
neutrophil is seen on the left, and a large, activated lymphocyte
on the right.
Slide 12
IDENTIFY THE CELLS.
Slide 13
PMN. The RBC's in the background appear normal. The important
finding here is the presence of many PMN's. An elevated WBC count
with mainly neutrophils suggests inflammation or infection. A very
high WBC count (>50,000) that is not a leukemia is known as a
"leukemoid reaction". This reaction can be distinguished from
malignant WBC's by the presence of large amounts of leukocyte
alkaline phosphatase (LAP) in the normal neutrophils.
Slide 14
WHAT IS THE PATHOLOGY HERE?
Slide 15
ROLEUX FORMATION. The RBC's here have stacked together in long
chains. This is known as "rouleaux formation" and it happens with
increased serum proteins, particularly fibrinogen and globulins.
Conditions which cause rouleaux formation include infections,
multiple myeloma, inflammatory and connective tissue disorders, and
cancers.
Slide 16
WHAT IS THE PATHOLOGY HERE?
Slide 17
IRON DEFFICIENCY ANEMIA. The RBC's here are smaller than normal
and have an increased zone of central pallor. This is indicative of
a hypochromic (less hemoglobin in each RBC) microcytic (smaller
size of each RBC) anemia. There is also increased anisocytosis
(variation in size) and poikilocytosis (variation in shape).
Slide 18
WHAT IS THE PATHOLOGY HERE?
Slide 19
IRON DEFF ANEMIA. Here is data from a CBC in a person with iron
deficiency anemia. Note the low hemoglobin (HGB). Microcytosis is
indicated by the low MCV (mean corpuscular volume). Hypochromia
correlates here with the low MCH (mean corpuscular
hemoglobin).
Slide 20
What is the pathology here?
Slide 21
Bite cells & Heinz bodies. Heinz bodies are formed via the
oxidation of iron from ferrous to ferric form leads to denatured
hemoglobin precipitation and damage to RBC membrane. When this
damaged RBC makes their way into the spleen & the splenic
macrophages try to engulf them which are then seen as bite cells on
a peripheral blood smear.
Slide 22
WHAT IS THE PATHOLOGY HERE?
Slide 23
MEGALOBLASTIC ANEMIA (B12 DEFF) Here is a hypersegmented
neutrophil that is present with megaloblastic anemias. There are 8
lobes instead of the usual 3 or 4. Such anemias can be due to
folate or to B12 deficiency. The size of the RBC's is also
increased (macrocytosis, which is hard to appreciate in a blood
smear).
Slide 24
WHAT IS THE PATHOLOGY HERE?
Slide 25
MEGALOBLASTIC ANEMIA. The CBC here shows a markedly increased
MCV, typical for megaloblastic anemia. The MCV can be mildly
increased in persons recovering from blood loss or hemolytic
anemia, because the newly released RBC's, the reticulocytes, are
increased in size over normal RBC's, which decrease in size
slightly with aging.
Slide 26
IDENTIFY THE CELLS?
Slide 27
SHISTOCYTES. There are numerous fragmented RBC's seen here.
Some of the irregular shapes appear as "helmet" cells. Such
fragmented RBC's are known as "schistocytes" and they are
indicative of a microangiopathic hemolytic anemia (MAHA) or other
cause for intravascular hemolysis. This finding is typical for
disseminated intravascular coagulopathy (DIC).
Slide 28
WHAT IS GOING ON HERE?
Slide 29
SPHEROCYTES. The size of many of these RBC's is quite small,
with lack of the central zone of pallor. These RBC's are
spherocytes. In hereditary spherocytosis, there is a lack of
spectrin, a key RBC cytoskeletal membrane protein. This produces
membrane instability that forces the cell to the smallest volume--a
sphere. In the laboratory, this is shown by increased osmotic
fragility. The spherocytes do not survive as long as normal
RBC's.
Slide 30
WHAT IS THE PATHOLOGY HERE?
Slide 31
BASOPHILLIC STIPLING. The nucleated RBC in the center contains
basophilic stippling of the cytoplasm. This suggests a toxic injury
to the bone marrow, such as with lead poisoning.
Slide 32
WHAT IS THE PATHOLOGY HERE?
Slide 33
ATYPICAL LYMPHOCYTES. The WBC's seen here are "atypical"
lymphocytes. They are atypical because they are larger (more
cytoplasm) and have nucleoli in their nuclei. The cytoplasm tends
to be indented by surrounding RBC's. Such atypical lymphocytes are
often associated with infectious mononucleosis.
Slide 34
WHAT IS THE PATHOLOGY HERE?
Slide 35
PELGER-HUET ANOMALY. If most of the neutrophils appear bilobed,
this is indicative of an uncommon condition known as Pelger-Huet
anomaly, an inherited condition. This is the heterozygous form. The
homozygous form is fatal. Just be aware of this condition when you
get back a manual differential count with mostly bands, but the WBC
count is normal or the patient shows no signs of infection or
inflammation.
Slide 36
WHAT IS THE PATHOLOGY HERE?
Slide 37
SICKLE CELL ANEMIA. Example of sickled erythrocytes in a
patient with Hgb SS who presented with severe abdominal pain in
sickle crisis. The sickled cells are prone to stick together,
plugging smaller vessels and leading to decreased blood flow with
ischemia.
Slide 38
IDENTIFY THE CELLS HERE?
Slide 39
TARGET CELLS. This patient has hemoglobin SC disease, with
hemoglobin S and hemoglobin C both present. With SC disease, the
RBC's may sickle, but not as commonly as with Hemoglobin SS
disease. The hemoglobin C leads to the formation of "target"
cells--RBC's that have a central reddish dot.
Slide 40
WHAT IS THE PATHOLOGY HERE?
Slide 41
ALL (ACUTE LYMPHOBLASTIC LEUKAMIA) The WBC's seen here are
lymphocytes, but they are blasts--very immature cells with larger
nuclei that contain nucleoli. Such lymphocytes are indicative of
acute lymphocytic leukemia (ALL). ALL is more common in children
than adults. Many cases of ALL in children respond well to
treatment, and many are curable.
Slide 42
WHAT IS THE PATHOLOGY HERE?
Slide 43
CHRONIC LYMPHOBLASTIC LEUKAMIA(CLL) These mature lymphocytes
are increased markedly in number. They are indicative of chronic
lymphocytic leukemia, a disease most often seen in older adults.
This disease responds poorly to treatment, but it is indolent.
Slide 44
SMUDGE CELLS IN CLL.
Slide 45
WHAT IS THE PATHOLOGY HERE?
Slide 46
Auer rods in AML 46
Slide 47
AML Here are very large, immature myeloblasts with many
nucleoli. A distincitve feature of these blasts is a linear red
"Auer rod" composed of crystallized granules. These findings are
typical for acute myelogenous leukemia (AML) that is most prevalent
in young adults.
Slide 48
WHAT IS THE PATHOLOGY HERE?
Slide 49
CML. This condition is one of the myeloproliferative states and
is known as chronic myelogenous leukemia (CML) that is most
prevalent in middle-aged adults. A useful test to help distinguish
this disease is the leukocyte alkaline phosphatase (LAP) score,
which should be low with CML and high with a leukemoid
reaction.
Slide 50
What is the pathology here?
Slide 51
HAIRY CELL LEUKEMIA Hairy cell leukemia is an uncommon
hematological malignancy characterized by an accumulation of
abnormal B lymphocytes. Hairy cells are abnormal white blood cells
with hair- like projections of cytoplasm; they can be seen by
examining a blood smear or bone marrow biopsy specimen. The blood
film examination is done by staining the blood cells with Wright's
stain and looking at them under a microscope. Hairy cells are
visible in this test in about 85% of cases.
Slide 52
IDENTIFY THE CELL HERE?
Slide 53
Reed-Sternberg cells. Note the large cells with large, pale
nuclei containing large purple nucleoli at the arrowheads. These
are Reed-Sternberg cells that are indicative of Hodgkin's disease.
There are four main subtypes of classic Hodgkin lymphoma with CD15+
Reed-Sternberg cells and variants: lymphocyte rich, nodular
sclerosis, mixed cellularity, and lymphocyte depletion.
