UNIVERSITY OF WASHINGTON DEPARTMENT OF LABORATORY MEDICINE PeripheralBloodTUTOR _ senctencinan sous A PROGRAM THAT TEACHES THE INTERPRETATION OF PERIPHERAL BLOOD SMEARS Brent L Wood, MD, PhO jariet Curtis, BS, MT(ASCP} Charlotte Murray, MFA joyce A. Behrens, MS, MT(ASCP) Leonard Pagliaro, PhD adam Orkand, BA viike Astion, MO, PhOPeripheral Blood CM oem Remee i tert kel cellular elements (red blood cells, white blood cells, and platelets) and plasma (water, electrolytes, and Ce) @ A variety of disease states cause alterations in one or more components CSUR CMC melee CMa cm err Rae eM CWA SerpURDIe Orem mC UMM Rem () et ceHematopoiesis Active Marrow @ The term hematopoiesis is used to refer to the production and maturation of peripheral blood Cr Ce ee ean ele arise from precursor cells in the bone marrow. ®@ Active marrow in children is found throughout the skeletal system; however, active marrow in adults is primarily located in the central skeleton and long bones.Organization of PeripheralBlood-Tutor™ rey a Ss ‘Smear Preparation Pe’ eee) Snare Pee) ‘Smear Evaluation eS cy CUO’ See creo) Dans ETI Tocris (a ead easy Sea mr CE) eS isease Associations Oa Coe ace rey ee een’ ey GiB SY er Cd jisease Association Ty Te ence ens lil) Se Cees zc}Peripheral Blood Smear Preparation ® Peripheral blood smears can be made PR CUM An muir Crea eon push-wedge, automated wedge, automated centrifugal. ® The push-wedge method is the most common method, @ Begin by placing a drop of peripheral eter Mme Reema cme tay push-wedge method SSPush-Wedge Smear Method @ Position a second clean glass slide (ecco Rae ae Mele Cane) PTB RRs elem corer (stationary slide). @ Working quickly, back the spreader slide into the drop of blood until the blood spreads along the edge of the ue melo ta One me RUC even motion towards the opposite end Show Push-Wedge Method RUE sealPeripheral Blood Smear Quality at @ A properly made peripheral blood smear covers two-thirds of the slide and is slightly narrower than the glass slide. Boece " Comer en Cc tel) between the thick end and the feathered end. @ The smear should not have any ridges, Plu CCLRC MULL (com eySmear Evaluation CN aco eed Blood cell morphology is best evaluated in the area of the smear where the red blood cells are evenly and singly distributed, but not overlapping.Thick Area High Magnification Red blood cells overlap one another; white blood cells are shrunken and Cu ae lateeCorrect Area Low Magnification High Magnification le Panel Red blood cells do not overlap and are round with central pallor (unstained area in center); white blood cell features are clearly seen.Thin Area Low Magnification High Magnification Hie Panel RM ttere me LCM ere RUM Oma Ge lola Ce aCe lee A center); white blood cells are distorted and may be smudged (ruptured).Tri t-y- Tm aL ela] The good area of the smear should be examined in a systematic, non-overlapping pattern at both low (10 - 25x objective) and high (40 - 100x objective, usually oil immersion) magnification.The smear and stain quality should be evaluated by scanning the entire slide. The distribution of cell types should be assessed (i.e. clumping of cells, COCO ECC em eee Rey aC White blood cell number may be Cer Meee ie CM ALCL Comoe Rare or abnormal cells may be detected EUR Cmca CU MU) Teter od@ The morphology of individual red blood CCM CMe) (erere mel |My CVA CC ee em Ca tC ill reported as normal, decreased, or itd Ce SCM mem MCT a Te be performed.Smear Evaluation - Differential CE ese CMM ee meee) cell types may be determined by performing a white blood cell differential count. Ua er cee RC blood cells are counted, classified, and reported as percentages of the total white blood cells counted. Nucleated red blood cells, if present, should be counted separately and reported as the number per 100 white blood cells.Erythrocyte Maturation Sequence » >= vey = * Erythrocyte maturation occurs on a continuum that has been divided into six stages for morphologic identification. Red blood cells decrease in size and increase in hemoglobin content as they To The red blood cell nucleus decreases in size until it is extruded during TEU et BUM Ror mee aCe M Ce aC ae Malte [SL0Cy Cem Cele telPronormoblast LOTea CU aude clearing Lorene Cs elo Be CLR ORL I Slur A) BCC aa) Ls fiMeLco ltr} SURO oem aac CU) Pear me clas)Basophilic Normoblast LOeC os Lori CURR Ace Cue LM rales - large, round to oval Pee meCr eee) SMe CM uC Va tm icy (3 LC ast rere eiuyPolychromatophilic Normoblast TS Perec) Va oe @ 10-15 microns in diameter LM rales Pacers) Berea ery Baia cies eta LEC - light blue to grayOrthochromic Normoblast ee LOeC os Lee PAR as LM rales PET Mea Bee MCC) Bal Ca eile LC - pink to gray Pare CiuyPolychromatophilic Red Cell ene C Cy Va oe Leeann ECs LM rales Bris Ls Cu - light blue to pinkErythrocyte LOeC os Peete LRU Cees sae tM Terr esd LCC mmr ere A Me eo Bari Pe Ce Pag@ Erythrocytes contain hemoglobin which stains pink on Wright's stained smears. @ The degree of central pallor in seria Cee him Ute hemoglobin content. CM eM ie em Ca erythrocyte hemoglobin content is using automated instrument indices.Hees rare loot al nr eae Normochromic RBC - Normochromic Morphology’ CROW ene Peau TE UuCe har Cece Comment: Normochromic red blood cells are seen in healthy patients.Hees rare loot al nr eae Normochrom Hypochromic Semen [irene ey=r CROC ene Pag ee ec nh emcee Comment: Hypochromic red blood cells may be seen in iron deficiency anemia.RBC - Variation in Size Camm Rc CSM Cm Cele el dr cera roca ut Va Ser dL) Ci irae UCM Cleat anemia, and burn patients. EstySree hs ostB a oullnteeae Normocytic emma [ie trearleyst Deis eeu SN Bree Cree Eu Naess Comment: Normocytic red blood cells are seen in healthy patients.Sree hs ostB a oullnteeae Norm Microcytic feeeerece ites FRC os Tetras Pr iia Comment: Microcytes may be seen in iron deficiency anemia and thalassemiaSree hs ostB a oullnteeae Norm: Macroeytic feeieeeeat [irene ey=r SROs CU are Be aac) Comment: Macrocytes are commonly seen in anemia due to Vitamin B12 or folate deficiency. [IN-Ptt 4® The term poikilocytosis is used to GCE CRUE RCM sr Re shape. CMa MCN elm ge TOR Ce COR ee ECU severe iron deficiency anemia, and bum PECsfees sae ence Eiereelhy Ne as See ete) eric leg Pee Ue eta eran Lome ncaa eae haters TC aCeSchistocytes le Cells ieee [ileal ea erro en oe Ee) cu Areca Pucca) Comment: Schistocytes (keratocytes) may be seen in disseminated intravascular eerie err ranean ceEBS Nedlands Morphology: Peto Cre D Ler ey Comment: Teardrop cells (dacrocytes} generally result from marrow replacement by fibrosis aC ulaWo cliptocytes | sickle cells Meee ileal eye ea ET a ee) Latter Realy Pee Co Oe Rieke ir lcmm eae ace ReuC aed roosie Cells RBC - Burr Cells eae ae) PEO n Ly Lr UA Lag Reece meta? Pens eae Ta Cou COE ere Ran eeu Rear CeSee [retreat sea th une Perel aies Peds Cree] Comment: Sickle cells (drepanocytes) are seen in sickle cell anemia.FBS Ssdaiitenlit 5 i eStaEtoytOe Morphology: red Perce ar eects rer rnd feta re ona oe a ancesFei S Ns tiaindepliies 2 I siciie cols Meet nen Morphology: Ear rol pallor and dense Ren) eer ERC Pee Lene eee atukae ecu eu lea meeele Cells Rec eae ae) Pen Ly Oe Ae Ug eae’ Peeinet Pei eG Pee Cee Re Cun ne tie unuiee ar eceeel cas errs® Inclusions in erythrocytes stain red to Cr aOR RC Me CESS em ® Erythrocyte inclusions can be nuclear remnants, iron particles, RNA, or intracellular parasites. ®@ Erythrocyte inclusions vary in ETC eRe eo UCSe ESS in Me ites owell-. Malarial eee a Cem et Rer is Por eal PeC ee aa aed cece” PO een Cie enone acuhills pling Pappenheimer bi Malatial RBC - Heinz bodies Morphology: remy Pr eer erecnetel Rei) eee CU eee te Ree a Cet ae eve RE at) using supravital staining in patients with G6PD or unstable hemoglobins.SEES iste Howell~jolly bodies Pappenheimer b Malarial ti stem ae [iferelarel eee Lt POR Oars Erol are Miata ergy Pe meliatad Lele ey Pm ue ue uu cute neetit Pee usc ceSe ESS in Me ites owell dies benheimer bi Malarial parasites Malarial parasites ReGen ea are seen ieee Meu Comment: Malaria is a parasitic disease caused by any of four different species of eerSe ESS in Me ites owell-v appenheimer bodies: Malarial eee runiued ere reac tage Ceaeuciy clusters Pee en eee eeu eee eae ur nae aR Cun a eee Sm ie rs eC EUR eis canaGranulocyte Maturation Sequence @ Granulocyte maturation occurs on a continuum that has been divided into six stages for morphologic identification. ® Cytoplasmic granules develop during granulocyte maturation and are important for granulocyte function. ® Granulocytes are divided into three distinct lineages based on the staining characteristics of their granules - neutrophilic, eosinophilic, and basophilic.Granulocyte Lineages @ Eosinophilic granules have a basic pH and stain red with the acidic dye, eosin. Crome eum tae) en Cath URS CUBR La) PUTS ats mau an eo @ Neutrophilic granules have a neutral pH and stain poorly basophil with eosin and methylene ts onaMyeloblast Pela rests LGA oe @ Size: 15 - 20 microns in diameter be ol RIP aimee lar Sere ea) Baile sol etd LSC Ccun - scant, blue - granules absentPromyelocyte Aer Laas ®@ Size: 12 - 24 microns in diameter be eel oe PIP Meee mene h C|| ORS (mC eT MRE) PP (te ees LO CCin - sparse, blue ‘aacleelae: BCC LM et RLU me Ue a} = granules may overlie nucleusMyelocyte Pega gece a it Laas ® Size: 10 - 18 microns in diameter be eel oe PIP Meee mene h C|| SCA CEU) Paateil-tol etd LO CCin - light blue to pink SU im UG Ov Cmte cd granule = perinuclear clearingMetamyelocyte fileopes eee ery le Wes LGA oe Lr oe een Ce be ol - indented or kidney-shaped Ber ean er CU) Baaeil-tol i lest-g LSC Ccun - light pink - fine, pink-purple granulesBand etl Laas ®@ Size: 10 - 15 microns in diameter be eel oe SU RRO CUR Te 10) ACCT Race cliy Paateil-tol etd LO CCin Baltelna aiaLs SU im UG Ov Cmte cd oa coayNeutrophil Hie LGA oe @ Size: 10 - 15 microns in diameter be ol SPAM TOMO OR A UU ne) - very coarse chromatin Baaeil-tol i lest-g LSC Ccun Berle tg - fine, pink-purple granules TestEosinophil CTs granule LGA oe @ Size: 10 - 15 microns in diameter be ol -2to 3 lobes - very coarse chromatin Baaeil-tol i lest-g LSC Ccun Siecle - numerous red-orange granulesBasophil Piet LGA oe @ Size: 10-15 microns in diameter @ Nucleus: -2 to 3 lobes Ses rCr eae) Baia re tg LB ECuin - dark blue-black granules Be eu cme ema (a (0d Eee SRE RCD eee)Granulocyte Variations ® Variations in granulocytes appearance may be caused by maturation defects, IEC CME MICs CE ime Hee CM mms ac emg metabolic disorders. © Bacterial infections can cause ‘toxic’ changes to neutrophils. ennaranulocyte tions Hyposegmentation rseqmentat Meet fiery Pewee ra eg segmented nuclear rr PnP oT eat eee koe eer NO ese as ceranulo tions rsegmentat ATOR Cee Le eee clad Morphology: om cee ke Ws Perens rr eee de ULC CCUn a Rese ecue cat aSe ele Rom ee ede Hypersegmentation Mremre cae Morphology: fer ae aac Bee Comment: Hypersegmented neutrophils are seen in patients with anemia due to Vitamin B12 [I-PR al Ce Ca Backranulocyte tions rsegmentat RETRACT Morphology: mr Ree a Meco rr eum eat eee Cn aR ena ec Rca larAuer rods A= oe mers Morphology: eomrrry ieee Gens Crs Comment: Auer rods may be seen in myeloblasts from patients with acute myelogenous eres| Déhle bodies Seana eee etree yeaa OCC AI nar Susy ce aa Orr ea fe uae TW ee are as a are ree ee re ACen ar etoLymphocyte Maturation Sequence Active Marrow Se isu CRUCe umm nC mma Te) sites - the bone marrow and thymus. @ The majority of mature lymphocytes reside in the lymph nodes, spleen, and other OEE COl Ceo om ® Mature lymphocytes migrate to extravascular sites via the peripheral bloodstream.Lymphoblast I rrr Laas ®@ Size: 10 - 20 microns in diameter be eel oe = round Barman LAL) PP (te ees LO CCin - scant, blue See arog iol rel byProlymphocyte ital lety eaeea Laas ®@ Size: 10 - 20 microns in diameter be eel oe = round PPTs emer eT MRC) - single prominent nucleolus LO CCin Beers eee em Ly See arogLymphocyte rare LGA oe @ Size: 7-15 microns in diameter @ Nucleus: - round Ses rCr eae) Baia re tg LB ECuin PRU CUCL Sale nae Ges - few granules may be presentLymphocyte Variations ® The majority of lymphocytes are located te CC Om ECM oI) Tt CCM eC CuC ate ae | ym ® When activated by contact with antigens, lymphocytes undergo morphological changes. @ The specific morphological change is related to the specific lymphocyte's Lite (ayeu inl Reactive arge granular | eee asa ee aatleyst Poa RU) Es Ra onic eC Lae oer ere) ere Re Pec oc Dunk d keer cukiiEl iceseu inl Large granular | reoraae sr) etary Poa Lt Es Pe oil Percent Pen Peat Pu er ee ata hue ince ais Cordoneu inl | Cleaved Plasma cells tere aie ee aatleyst Poon) re a ec) Comment: Lymphocytes with a cleaved nucleus are associated with pertussis (whooping ere asPlasma cells Plasma cells [irene Vea yam Cece oulacas Prouuta tc Orta Comment: Plasma cells are rarely seen in the peripheral blood except in cases of severe inflammation or end stage multiple myeloma.Monocyte Maturation Sequence ® The bone marrow is the primary site of CeCe CRUEL Lele ®@ The majority of monocytes reside in tissue and are called macrophages. A ees Com Can Ree mC RUT ee ecln eres reaMonoblast oe La oa @ Size: 12 - 18 microns in diameter @ Nucleus: - round Baer mM gC LAL) Braco ecg LB CCuin Se ORU Ce CEUs Bean See CU oem)Promonocyte Cee Lao ®@ Size: 15 - 20 microns in diameter be eel SaceleCeRel mite (aca) - slightly coarse chromatin - nucleoli may be present LECH SU eR CR UCU ec VaCm eer taa = few granules may be presentMonocyte pene Key features : ®@ Size: 12 - 24 microns in diameter el to - indented or folded Bae manent) Baie erg LBs CCun - abundant, gray-blue SEU Smee ecto Pra - few granules may be presentPlatelet Maturation Sequence ® Bone marrow is the primary site of ca cm ere Uda ® Platelets (thrombocytes) arise from a large precursor cell called a megakaryocyte. Acre mee aol megakaryocyte cytoplasm. BreesMegakaryoblast Pe Da Ce Le eR Ren e Ce el to - round or oval Bee eT MEUM RCL) Bree ess LBs CCun - scant, blue See erlang ee - budding protrusions at peripheryMegakaryocyte Laas Loe eee CRS Ce be eel oe = multi-lobed (polyploid) SCA CEU) Paateil-tol etd LO CCin - light blue to pink - purple granules Ceo)Platelets py Laois @ Round or oval @ Size: 1.5 to 4 microns in diameter ®@ Nucleus: - absent LBs CCun - pale blue cytoplasm Be TU mee ae ty eresPlatelet Variations ® Platelets normally vary slightly in shape, size, and staining characteristics. ® Normal and abnormal platelets usually vary significantly in morphology. ® Morphologically abnormal platelets are CSTE Marcela ric Ri Ue or C ce normal and abnormal plateletsLarge forms Platelets -Large forms I earslateleys emg SECC ica) Aue errr ers Pee Ca Bony eeu nee eee oct Ra Ceca tC EOC heleLarge forms Hypogranular Grenier ica [fresnel eyer Perera gee ee) Poeun cee Cee oie are id platelet syndrome and myelodysplastic syndromes.Artifacts freee er Cm Ca em date tay stained peripheral blood smears. @ Improper blood collection, poor smear preparation, or poor staining can cause Pes merce om We ce ciate Ue nlc) from normal and abnormal morphology. ‘stain precipitateStain precipitate Morphology: dark Sear een Peay aoc Sree Pee ead eee aera kar uren unit gic anos 10 seconds and rinsing with distilled water.P Platelet satellitism Morphology: four Pao on ah Deka ena) ete ee ue OCT Cee eee al a Cue wl oly Eee Rn eet satellit Weer iiferearleyeN ae Cie ery Phere) reat Pec ea eee he ne waa here) Sa eek acWater artifact Plateletaggregates Giese ricerca) iiferelareleyen ed nocd Pei eee ee mare ee ek ie ecg Crea ee cer)t sat Crenated Red Blood Cells Morphology: red Pec regularly spaced eau init eee Ret Lee a Le eure ect Beret| Platelet superimposition | eee aussi) Morphology: a platelet overlying a TL ena) Pre eatd PNR ie) Leela) Acris fee eae Cu et ar ae Cua elt Relayt sat Brrcenis Morphology: a CN eeu ecu ce) Pee ny eer Berea Comment: Smudge cells (basket cells) arise from the disruption of fragile cells during smear Pcie ere cen aes en eee r Degenerated nucleus Rie reece nrc Morphology: dark Pr enros Pe se eure SCM Peer ad Comment: The number of white blood cells (usually neutrophils) with degenerated nuclei eee usreve teey @ Anemia is a decrease in the number of circulating red blood cells. ® Alterations in red blood cell morphology may suggest the cause of the anemia. LCR eer eR CMe CL oom and occasionally bone marrow examination are also useful in determining the cause of anemias. eer Ccne nannyIron deficienc ee niecae ures Morphology: ee ee ua) De ea Pee eee ecesce nce Comment: Iron deficiency is the most frequent cause of anemia worldwide and is common in females of child-bearing age.eT) frereaey Ne rer uid Bea] eae UE URN nae en eal ee RCC eyeS Senne Thalassemia Bees roe target cells, and nucleated red tere Reta y Comment: Thalassemias are genetic diseases resulting in decreased globin production, and [I-FYag Bee ae ace oe eRe Ere ie casBirecseeee urls Crear Pe eae een Penny SERN fee uae On Steen Vee eee Pt Ae eC en ale a aeVitamin B12//Folate deficiency, | Renee CC Morphology: oval eee Ee age POR Cnes De uence) ey gid Carey Ecc Comment: Folate or vitamin B12 deficiency anemia (e.g. pernicious anemia) is usually found [I-PYag in patients with poor nutrition or receiving chemotherapy.Red Blood Cell Membrane Abnormalities CM mm Mert me UCT EU abnormalities have a genetic basis. A UPC CU mC ANC TS EMule meee mea | te eee ® Structural protein abnormalities result in variations in red blood cell shape. BouncerUae tN pu alee as On eR Hereditary spherocytosis Pattie [ileal eyer Seon) Pe Ue ie rush ea A cea tak ec eck Serra cu ee caUae tN pu alee as On eR Hereditary elliptocytosis Patties as Morphology: elliptocytes Comment: Hereditary elliptocytosis is generally asymptomaticUae tN pu alee as On eR Hereditary pyropoikilocytosis attired eee [fresnel eyer extreme Penn ur PERO! Comment: Hereditary pyropoikilocytosis is an extremely rare condition resulting in severe ecu® Red blood cell globin abnormalities are usually due to inherited genetic Peel io Le mC CLU my abnormalities of the protein portion (globin) of the hemoglobin molecule. LPC oe er aggregation of hemoglobin molecules TU UCC eae ceo aayVee veal dine evap Sickle cell anemia emoglobin C Unstable hel SORE UCLule§ Morphology: Arcos POCO ees ec feta ee Eee trot ee eae eo ae at Ree ee LS CRT ee CC a ol COR Ce aCeVee veal dine evap Sickle cell anemia Hemoglobin C Pee ek [irene eY=r err on Pou hol CAT Pec ke eee cue rune a ee eect) PCIe cece ameter acoDeets Pedra eegege reg Nt |e Bickle emoglobin C Unstable hemoglobins ell anemia ees eneu ei Otten etree Pen cries eer ad err} eae ed Cun ae ye ae eu eu L te ee tte et ce BTU eee Rene ame Ata el@ Abnormalities of red blood cell morphology may result from the action of external (extrinsic) forces on the red blood cell. LM eC Reece Ce Or chemical, or biological in nature. @ The specific type of morphological abnormality that occurs is dependent upon the cause; however, poikilocytosis omen ea conUI ee taptes eae CO Me Mechanical | d e Heat | Para d agglutin ns_| (Wee Morphology: pra eeragcd Comment: Erythrocytes may become fragmented by shearing during transit through artificial“ PY reg ee te cu Se RoUI ee taptes eae CO Me Antibody - mediated | Heat | Pees ear ee [irene eY=r ee rode ret Peek cy ee uae CT eee ame Rr ence ae utara Oe Cet eel ee Ce OR ReUI ee taptes eae CO Me Do Morphology’ anisocytosis, Peo ees Meee anaes cc Ren ocd Comment: Exposure of red blood cells to elevated temperatures (burns) may result in red BCC en teen uae eeUI ee taptes eae CO Me Heat | Parasites ey Morphology’ eee Cet eg Pelee ced eae OC eet Ree Cun CMa aeUI ee taptes eae CO Me | Cold agglutinins | eters [ileal ea erro Pec om) Comment: Agglutination of red blood cells at temperatures below 32°C is generally due to the presence of autoantibodies, often as a sequelae of infection (eg. IMycoplasmali or EBV).Infections aes ® During infection, white blood cells often ier MME ela MU late (lee morphological changes. Lelia ater eC eMC Nm alterations in one or more white blood cell lineage. ®@ The type of morphologic change varies according to the specific infectious agent. Lael eia cacyBacterial infection Morphology: one Peas Meee ar Perera) fee are ee er) eee ee Rel atte oe tne tM Cet Le Co CelWBC - Infections eee ie tealeyet reactive (atypical) ero) fe uae ts Rua eRe Roe et aa ea eS OU eee ied eee Se eda - Infections Pertussis ee ee aatleyst Pon RU) CT ay Pe het het ean cecube tei eseeccic) Pore| Borrelia | Eyaced Morphology: Pres Ayr eae ar eC eae ae ae uc ny Pee ealWhite Blood Cell Anomalies @ White blood cell anomalies often have genetic causes. Leelee uel ear CUCU oa white blood cells define each anomaly. @ White blood cell anomalies are not always symptomatic. eresBey Alder-Reilly | May-Hegalin | K | P eresoe urea [iinet large, dark, ues eared sed cen nr ee ae Ceo Ne ENO eer otra arn eal Ce eu CC rea ELLEBey May-Hegglin K | P rear Morphology’ femmes) eres) teeny eel T tiny bodies, giant Bony enue Oe aCe etic ean huiar cela cea Eu csWBC - Anomalies May-Hegglin | Chediak-Higashi | Ps errant ar cat [ieee Py see Ee cu Paes TE) Comment: Chédiak-Higashi syndrome is a rare autosomal recessive trait which results in re eee ae Bere ga CB ta ColAnomalies ‘T[lmeronecel| [ornestee ure int Pomerat eu ks ieee nara) eeu ae COCs aCe en UC aE ae ee a Piet ey hac ea neo eCeL eloWBC - Anomalies Beers | Storage disease | Morphology: Pre rs| Peo) eae ee Oe Cae et ee tae eae atc ee metabolites within cells. Vacuolated lymphocytes may be seen in mucopolysaccharidoses.Myelodysplasia CCN Ee eC one MR UT failure of the bone marrow to produce adequate numbers of peripheral blood rt Cur cl arco Pea acquired genetic damage and eaten aire aC oe ea Comme CULM STC MEU mecca ran tate lines may be seen in myelodysplastic syndromes.Myelc nye Myelodysplastic syndrome Myelodysplasia Morphology’ cura Booey Deere Derren pseudo orcesre tei LETC Pe aru ute o ee euc Cue cuictMyeloproliferative Disorders @ Myeloproliferative disorders are due toa Ee mma ETS CnC cen @ The stem cells may mature along one or more cell lineages (i.e. myeloid, erythroid, megakaryocytic). Circe rete Me predominant lineage along which maturation occurs. ® Myeloproliferative disorders are chronic TO RUA ee eee Uy acute myeloid leukemia over an extended period of time.themia Vera Primary Tht vewacureor rere ey Ne anisocytosis, a ee eee) cee Perky increased neutrophils, Cee aU platelets Comment: Polycythemia verais characterized by a marked increase in erythrocyte mass and|l-Ptt 4 an increased tendency for thrombosis of arteries and veins.en ees iets Ye iocere) tod PEC eee sac PECretscecs Perrier) Pee eaE ete uae hae cu coe PC SC eee ec ae ee Cea me eeChroni¢ Myelogenous Leukemia genic Myeloid Metaplasi Morphology: ioe) ered Pena Ey BEC e sur) myeloid eins Comment: Chronic myelogenous leukemia is characterized by a large increase in Peace eee a a RC CeChronic Mi g ukemia. Primary Th Osis ice cee ae eer rerarley Ne immature erythroid A kos eee ey Pee ul COC nee urea mare eee Rue et and myeloid cells in the peripheral blood, marrow fibrosis, and splenomegaly.Acute Leukemias @ Acute leukemias result from a clonal proliferation in the bone marrow of immature cells having little or no TCU ee (tC) B @ The presence of 30% blasts in peripheral blood and/or bone marrow is the generally accepted criterion for the diagnosis of acute leukemia. @ Classification is based upon the predominant lineage along which PiU mee em (ACM Ce) (¢ PaMorphology: coy Comment: Acute lymphoblastic leukemia is a proliferation of blasts having lymphoid Sree ce Cn uuAcute Myeloid Leukemia Enc ner uit Osco Re Laila) BUmire} Pee nC a ee ee euisee ta baci) Sree a ac aeonsLymphoproliferative Disorders Rhee Cece eae eke (Rae) aclonal proliferation of abnormal lymphocytes. @ Lymphocyte proliferation may occur at CURR SARC mL mT bone marrow, lymph nade, spleen, or Ee Cie aur am CMMs eel mem tere) ECles PU aes oe MCU ett tem) a specific disorder. Baie neaChronic lymphocytic leukemia Pie ae ee eies rR uC Uy roa) Pere att) CTU Pn Ren ee cs) ro Comment: Chronic lymphocytic leukemia is the most common form of leukemia and is more One ae CePerce ery eeu eye oa Ru) Ta Seley Ba nity ener) Pregl Pret arinacls) etait ee ae aan ae eae Reese kala splenomegaly and pancytopenia.Lymphoproliferative Disorders Chronic lymphocytic leukemia Prolymphocytic leukemia Large granular lymphocytosis Se euiesaceuirs - eeu eye CT acy ee Cen aa ate rca Br) Back | markedly increased lymphocytes and massive splenomegaly. lienie oers era ra four or more red Perec ear cues stack of coins) Comment: Multiple myeloma is a clonal proliferation of plasma cells, usually in the bone are ae re ee cca aePeripheralizatioi Petr ue saree ee Morphology: large Teun Lo) Pee ee ee uur nea aa eee RN ec uu MA ue ce hePeripheralization of lymphoma Poe ee eukdacaee lt ie area ees Lo) Comment: Lymphoma is a clonal proliferation of lymphocytes occuring in tissue, but CSE ou eau a a CUR cg