cp demo & tutorial 1

8/3/2019 CP Demo & Tutorial 1

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CP Demo & Tutorial 1

Anemia, Thalassemia & Leukemia


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Examination of a blood film

A normal mature lymphocyte is seen onthe left compared to a segmented PMNon the right.

An RBC is seen to be about 2/3 the

size of a normal lymphocyte.

A monocyte is slightly larger than alymphocyte and has a folded nucleus.Monocytes can migrate out of the

bloodstream and become tissuemacrophages under the influence ofcytokines.

Platelets are small smudgy bluebetween the RBC's.


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Examination of a blood film

Eosinophil with a bilobed nucleus andnumerous reddish granules in thecytoplasm. Just underneath it is a smalllymphocyte. Eosinophils can increasewith allergic reactions and with parasiticinfestations.

Basophil has a lobed nucleus andnumerous coarse, dark blue granules inthe cytoplasm. They are infrequent in a

normal PBF, and their significance isuncertain.

A band neutrophil is seen on the left, anda large, activated lymphocyte on the right.


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Proerythroblast 12-20um, large nucleus, fine chr

strands, nucleioli +, intensebasophilic cytoplasm

Basophyilic erythroblast 10-16um, still large nucleus, thick

chr strands, coarse appearance, nonucleoli, intense basophiliccytoplasm

Polychromatic EB 8-14um, smaller nucleus, dense

clumped chromatin (cartwheel

appearance), lighter cytoplasm withHb synthesis

Orthochromatic EB 8-10um, small nucleus, coarse

pyknotic chr pattern, pale pink cytowith polychromatic hue, nucleusbegins to extrude

Reticulocyte

7-8um, no nuclues, basophilic hue,thin reticulin strands

Mature rbc Biconcave disc, central pallor, 7um,

eosinophilic


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Proerythroblast

Basophyilic erythroblast


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Orthochromatic EB

Polychromatic EB


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Reticulocyte


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Normal Blood Film

RBCs have a zone of central pallor about 1/3 the size of the RBC. minimal variation in size (anisocytosis) and shape (poikilocytosis).

WBC: band and segmented form of PMN

Platelets are seen.


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Hypochromic Microcytic Anemia

RBCs are smaller than normal and have an increased zone of central pallor(hypochromic) and smaller in size (microcytic).

There is also increased anisocytosis (variation in size) and poikilocytosis(variation in shape).


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Iron Deficiency Anemia (HMA)

The most common cause for HMA. The most common nutritional deficiency is lackof dietary iron. Thus, iron deficiency anemia is common. Persons most at risk arechildren and women in reproductive years (from menstrual blood loss and frompregnancy).


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Megaloblastic Anemia: B12 & Folic Acid

deficiency

Multisegmented neutrophils in MBA


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b Thalassemia major: HMA with evidences

of hemolysis

More pronounced target cells, hypochromia, anisopoikilocytosis,

schistocytes, teardrop cells, nucleated red cells and polychromasia

due to the presences of reticulocytes


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Erythropoiesis and Myelopoiesis


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Myeloid Cells

Myeloblast (MB) 15-20um, 80% nucleus,

2-5 nucleoli, finechromatin strands,scanty cytoplasm, very

basophilic andagranular

Promyelocytes (PMC) 15-20um, coarse chr

strand, primaryazurophil granules


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Myeloid Cells

Myelocyte (MC) 25um, thick chromatin

strands, no nucleoli,

decreased N;C ration,

primary and secondarygranules

Metamyelocytes (MTMC) 10-18um, thick chr, slight

indented nuclei (broad

bean shape), many fine

granules


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Myeloid Cells

Band form 10-15um, U-shape

nucleus, coarse andclumped chromatin,pink cytoplasm,specific granules

Mature neutrophil Smaller cells, 2-5

lobes, moresecondary granules


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ALL

The WBC's seen here are lymphocytes, but they are blasts--very immaturecells with larger nuclei that contain nucleoli. Such lymphocytes are indicativeof acute lymphocytic leukemia (ALL). ALL is more common in children thanadults. Many cases of ALL in children respond well to treatment, and manyare curable.


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AML

Here are very large, immature myeloblasts with many nucleoli. A distincitvefeature of these blasts is a linear red "Auer rod" composed of crystallized granules.These findings are typical for acute myelogenous leukemia (AML) that is mostprevalent in young adults.


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Auer rods

Auer rods are elongated, bluish-red rods composed of fused lysosomalgranules, seen in the cytoplasm of myeloblasts, promyelocytes andmonoblasts and in patients with acute myelogenous leukemia.


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Differentiation of ALL from AML

ALL (Lymphoblast)

Blast size : small

Cytoplasm: scanty

Chromatin: dense

Nucleoli : indistinct

Auer-rods: absent

Peroxidase: positive

Immunopheotype: B/T

AML (Myeloblast)

large

moderate

fine, Lacy

prominent

May be present

Negative

Myeloid marker


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CML

There are numerous granulocytic forms seen here, including immaturemyeloid cells and MTMC, MC and band forms


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CML

Basophil in CML


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CLL

LymphocytosisSmear cell

CML

Neutrophilia with full spectrumof granulocytic series

Eosinophilia, basophilia


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Study Questions 1. What are the sites of blood production in an 1. Infant 2. adult?

2. Outline how disorders of blood are broadly classified with examples?

3. What is anemia? How are anemias classified? Give examples.

4. briefly discuss common lab tests done for anemia?

5. Explain Iron deficiency and Megaloblastic anemia?

Briefly discuss their laboratory test results?

6. What is the common form of anemia seen in SEAsia?

What are the common causes?

7. What do you understand by the term "hemolytic anemia"?

8. Compare with a diagram difference between RBC in

Iron deficiency anemia & in megaloblastic anemia?


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Study Questions

1. What is Eosinophilia? What are the common causes of Eosinophilia? 2. What is Pancytopenia? What are the common causes? 3. What is aplastic anemia? What are the laboratory findings? 4. List some common causes of Lymphocytosis & Lymphopenia? 5. What is Leukemia? Briefly discuss its major classification? 6. What is Lymphoma? Mention the two major types. 7. What are the major clinical features of leukemia? 8. Mention the salient features of Acute lymphoblastic leukemia? 9. Mention the salient features of Chronic Myeloid leukemia? 10. Briefly explain why patients with Leukemia are susceptible for frequent

infections? 11. Acute Leukemia patients frequently suffer from bone pain. Briefly explain

why?


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Case study

PBF of a 24-year-old lady withheavy menstrual cycle.

Describe the salient features in theblood film.

State the possible diagnosis

PBF of a 45-year-old chronic

alcoholic with impaired LFT.Describe the salient features inthe blood film.



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Case study

PBF of a 14-year-old boy with anemia, jaundice and splenomegaly, whoneeds regular blood transfusion.

Describe the salient features in the blood film.

State the diagnosis


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Case study

A 15-year-old boy from Sudan, presented with fever.

He was pale and jaundice. Temperature 39.5.C.

Mention the salient features in the red cell series



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Case study

PBF of a 42-yr-old man with anemia andgum bleeding . Hb 11.2 g/dL,hematocrit 32.9%, MCV 89um3,

PC 95,000/mm3 , WBC 16,200 /mm3

85%blast cells as seen in the picture.

PBF of a 4-yr-old child, listless andirritable. Hb 10.2 g/dL, hematocrit30.5%, MCV 96um3, PC 45,000/mm3

, WBC 13,900 /mm3


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Case study A 45-year-old man with

complaints of abdominal

fullness and lethargy. His blood film report is as:

Haemoglobin 12.2 g/dL

WBC 67.9 x 109/L

Platelets 257 x 109/L

What are the characteristicfeatures seen on the PBF?

What is the molecular basis forthe development of this

disease?What are the other clinicalfeatures of the disease?

What is the natural course ofthis disease?


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Case study A 22-year-old young man

presented with severalfirm, rubbery enlargedlymph nodes In the rightand left cervical region.The nodes were discretenot matted together.There were no

discharging sinuses seen.He was febrile, 38.5.C

Describe the microscopicfeatures of the biospy fromthe glands and give thediagnosis

cp demo & tutorial 1

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